Social Determinants of Health


Treating Type 2 Diabetes With A Dose Of History

San Francisco poet Erica McMath has seen the devastating effects of type-2 diabetes first hand (Jeremy Raff/KQED)

Erica Sheppard McMath has seen the devastating effects of Type 2 diabetes first hand (Jeremy Raff/KQED)

The diabetes epidemic is not abstract to Erica Sheppard McMath. As a girl, she watched her uncle deteriorate each time she saw him at family events. His eyes yellowed before he went blind. Then, his foot was amputated. Finally, he died from diabetes-related complications.

“It’s like seeing someone literally fall apart limb by limb because of what they’re putting in their mouth,” said McMath.

Growing up, diabetes was everywhere. In just a few years, one aunt was blind at 32, another was on dialysis, and a 9-year-old cousin started insulin treatment.
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People with Low Incomes Say They Suffer Poorer Health

Uzuri Pease-Greene talks with two police officers in the public housing complex in San Francisco where she lives. (Talia Herman/NPR)

Uzuri Pease-Greene talks with two police officers in the public housing complex in San Francisco where she lives. (Talia Herman/NPR)

By Patti Neighmond, NPR

When you ask people what impacts health you’ll get a lot of different answers: Access to good health care and preventative services, personal behavior, exposure to germs or pollution and stress.

But if you dig a little deeper you’ll find a clear dividing line, and it boils down to one word: money.

“My health is deteriorating, and I know what the cause of it is, but I can’t fix it.”    

People whose household income is more than $75,000 a year have very different perceptions of what affects health than those whose household income is less than $25,000. This is one key finding in a poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. One third of respondents who are low income say lack of money has a harmful effect on health.

This is the case for 29-year-old Anna Beer of Spokane, Wash. She lives with her husband in the basement of her father’s house. Beer got laid off from her job as a nanny last summer. Now she is attending college in the hope that she will get a better than minimum-wage job when she graduates. Beer’s husband earns $10 an hour working at a retail store. “This is probably the most poor we’ve been,” Beer says. Continue reading

In Impoverished Eastern Coachella Valley, Data Brings Change

By Lisa Morehouse

Known locally as Duroville, Desert Mobile Home Park, near Thermal, CA, is in the heart of Eastern Coachella Valley. (Lisa Morehouse/KQED)

Desert Mobile Home Park, near Thermal, CA, in the heart of eastern Coachella Valley. (Lisa Morehouse/KQED)

About 40 miles from the Southern California resort town of Palm Springs is an abundant agricultural region, the Eastern Coachella Valley. It’s in the middle of a desert, but because of irrigation, the land there is rich.

Most of the people who live there are not.

The economy depends on the labor of the region’s farmworkers, many of whom struggle financially. For years, this desert valley has also been known as another kind of desert:  a data desert. Though many here know the area is rife with environmental hazards and social vulnerabilities like poverty and limited English-proficiency, there hasn’t been plentiful information about environmental risks, air quality, or residents’ social capital and resources. Without data identifying problems, it’s difficult to make a case for improvements.

But a new report released Wednesday documents the overlap of environmental and social access problems in the Eastern Coachella Valley. Revealing the Invisible Coachella Valley analyzes public data tracking environmental issues (including pollution, air quality, and water quality) and overlays that information with data on residents’ social and economic resources (such as poverty rates, education levels, unemployment, and health). Continue reading

Alameda County Details How Transit Cuts Harm Health

By Rachel Dornhelm

(Getty Images)

(Getty Images)

At first glance, you might not think that cuts to public transportation might affect someone’s health. But Devilla Ervin understands the impact firsthand. The 23-year-old lives in West Oakland and a few years ago worked the graveyard shift at McDonald’s.

“I got off work at 4 a.m. and there was no bus service,” he describes. “And so I was walking in my community of West Oakland, with shootings and violence, 45 minutes to an hour to get home.”

Yet, in addition to the threat of violence, Ervin also described a sense of social isolation that he’s felt as a result of recent cuts to bus service in his area.

“It’s not good for physical and mental health,” he says. “It wasn’t good for my spiritual health too, because I couldn’t get to church. A lot of the bus cuts were around International Boulevard where my church is.”

Access to public transportation is what policy types call a “social determinant of health” or SDOH. Health is about much more than health care, than simply seeing a doctor.

Now, in a new study, the Alameda County Public Health Department documents the link Ervin has experienced between health and access to reliable public transportation. Continue reading

Best Health System in the World?

American children are less likely to live to age 5 than children in other high-income countries. (Photo: Comstock)

American children are less likely to live to age 5 than children in other high-income countries. (Photo: Comstock)

If one big thing you want out of life is to live a long time in good health, the U.S. is not doing a good job, says a major report from the National Research Council and the Institute of Medicine, entitled “Shorter Lives, Poorer Health.”

There’s no explaining it away. A panel of physicians and researchers from around the country found a health disadvantage at all ages — from birth to 75 — when compared against people in 16 other “high income” countries.

The breadth and scale of this report is something: 405 pages of analysis across diseases, ages and incomes groups.

“The rule is we’re worse on everything.”

Even well-off Americans, “those who have health insurance, college educations, higher incomes and healthy behaviors,” according to the press release, seem to be in worse health than their counterparts in the other well-off countries.

Dr. Steven Woolf, chair of the panel that wrote the report, said they were “struck by the gravity” of what they learned. “Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind.”

Pretty sobering. Continue reading

Smoking or Schools: Which is More Important to Your Health?

(Raul Lieberwirth: Flickr)

Sorry, cigarettes are still terrible for you, but can a good school system lead to better health? (Raul Lieberwirth: Flickr)

Too often, we confuse health with health care. Health care comes from a doctor or hospital. But health comes from many places we don’t normally think of as health at all — things like good schools, safe neighborhoods and access to a variety of jobs. In other words, if you live in places without those things, you have a lower likelihood of enjoying good health.

Today, a new study from researchers at Stanford’s School of Medicine confirms that health disparities across the country have more to do with social factors than the color of your skin or where you live. In fact, the researchers say that some of these social factors even outweigh — gasp — the effect of cigarette smoking. (More on that later).

The study, Geographic and Racial Variation in Premature Mortality in the US, looked at counties across the United States and the likelihood of people living to age 70. Lead author Dr. Mark Cullen says this measure is a good alternative to looking at life expectancy, because it shifts attention to events that occur earlier in life. In particular, researchers found that educational opportunities, distribution of income and a mix of jobs accounted for better health outcomes across the population of a county. These “social determinants of health” as public health professionals call them, also explain health disparities between African-Americans and caucasians. “In most parts of the country,” Cullen says, “if African-Americans had the same advantages that their white counterparts had, almost ALL of the racial disparity would go away.” Continue reading