Socioeconomic Determinants of Health

Pam Silberman, JD, DrPHNorth Carolina Institute of Medicine

Barbara Pullen Smith, MPHOffice of Minority Health and Health Disparities

Louisa WarrenNC Justice Center

Health Equity

Racial and ethnic minorities generally experience poorer health outcomes than non-minorities

A person’s income, wealth, educational achievements, workplace and community can also have profound health effects

Health equity is the attempt to achieve the best possible health outcomes for everyone, targeting those who have been marginalized in the past

2Healthy People 2020. Subcommittee on Health Equity and Health Disparities. Draft criteria. May 1, 2008

Racial and Ethnic Disparities

Racial and ethnic minorities comprised 29% of North Carolina’s population in 2007

Minorities have lower life expectancies than whites, living on average about 4.5 years less (72.1 years for minorities, 76.8 for whites)

Minorities are less likely to have insurance coverage and more likely to report access barriers

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Risk of Mortality by Race/Ethnicity

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Health Disparities

Racial and ethnic disparities in health outcomes persist, even after adjusting for other socioeconomic factors Its not just poverty or lack of insurance

coverage that creates these differences! People of color may have a distrust of the

traditional health care system because of a past history of discrimination

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Task Force Recommendations

Public and private funders that fund prevention activities should promote the use of evidence-based strategies that take into account the racial, ethnic, cultural, geographic and economic diversity of the group to be served Funders should expand support for community-based

participatory research targeting health disparities

DPH should involve trusted community members in prevention activities

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Socioeconomic Disparities

Income is positively related to health.Higher income people can generally afford

health insurance coverage, live in healthier communities, and have more opportunities to eat healthy foods and exercise

North Carolinians are more likely to have low incomes (<200% FPG) than nationally (NC: 35.1%, US: 30.6%) (2007)

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Socioeconomic Disparities

Substandard, unhealthy, overcrowded and unaffordable home environments contribute to health problems Substandard housing can create health hazards (ie,

mold, allergens, unintentional injuries) Living in overcrowded conditions makes it easier to

transmit certain infectious diseases Paying excessive housing costs leaves less for food and

health related costs Neighborhood characteristics can adversely affect health

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Socioeconomic Disparities

Educational achievement is strongly correlated to health—those with less education have more chronic health problems and shorter life expectancies Less than 3/4ths of North Carolina high school

students graduate high school Education shapes both health behaviors and health

outcomes

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Task Force Recommendations

Priority Recommendations: Increase the state Earned Income Tax Credit Increase enrollment in the Supplemental Nutrition

Assistance Program (formerly Food Stamps) Increase the high school graduation rate

Other recommendations: Increase funding to build affordable housing Expand opportunities for high quality early childhood

education and health programs

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