Working Up Stream: Social Determinants of Health

Alexa Horwart, M.P.PHealth Equity Organizer

ISAIAH

About me:

About you!

• Your name• Where you work• Why you chose this breakout

About ISAIAH

Purpose and Outcomes

• To understand what “social determinants of health” are

• To understand how different types of racism create health disparities

• To re-think what creates health• To grapple with what this means for you as

CHWs• To collectively think about actions

Focus:

• Small and large group discussion• Wisdom in the room• Localized contexts and examples• Respectful conversation about racism and

health• Critical thinking/asking questions, no easy

answers

Source: Minnesota Department of Health

What is a “social determinant of health”?

“Health happens where you live, work, play, worship”

What about our choices?

Who gets to be healthy?

• From your experience, how would you answer this question?

Who gets to be healthy? Continued• African American and American Indian babies die in the first year of life at

twice the rate of white babies. While infant mortality rates for all groups have declined, the disparity in rates has existed for over 20 years.

• American Indian, Hispanic/Latino, and African American youth have the highest rates of obesity.

• Intimate partner violence affects 11 to 24 percent of high school seniors, with the highest rates among American Indian, African American and Hispanic/Latino students.

• African American and Hispanic/Latino women in Minnesota are more likely to be diagnosed with later-stage breast cancer.

• Low wage workers die 8 years earlier on average than high income earners. They also have higher rates of almost all chronic disease than higher income earners.

Types of Racism

• Individual• Internalized• Institutional• Structural

Outcomes…

• The “bars of the cage”…– Criminal justice: in Minnesota African Americans are

incarcerated at a rate of 9:1 compared to whites, one of the worst

– Education: Youth of color are suspended at rates far higher than white peers in most school districts in MN

– Housing: Minnesota has the worst homeownership gap in the country• Additionally, a recent UofMN law school report found that

redlining is still happening in Minnesota

Our health disparities are clearly not due to genetics or culture.

What about class…?

• Poverty rates for children under 18 in Minnesota are nearly five times as high for African American children as for white children.

• Unemployment is highest among populations of color, American Indians, and people who live in rural Minnesota.

• African Americans and Hispanic/Latinos in Minnesota have less than half the per-capital income of the white population.

What about education?

• For all races, infant mortality decreases with education, BUT…

• White high school graduates have the same infant mortality as Black college graduates

• This is not genetic… RACE is NOT GENES. There is not genetic basis for genes.

The “Other” Social Determinants of Health

Structural and historical oppressions based on race, class,

gender

A power and wealth imbalance

Income, housing, neighborhood, education

Levels of intervention• Ambulance at bottom of cliff= medical care• Net half way down= prevention and safety net

programs, monitoring prenatal care• Fence at top= primary prevention, adequate

nutrition• Moving people from cliff= jobs, self

determination, housing• Health disparities, three levels: quality of

health care, access to health care, living conditions

Room check!!

• How are you feeling about this?

• How does this make you feel in relationship to your work and your clients?

Social Determinants of Health in our HC System…

Examples??

Changing the conversation about what creates health…

Dominant Narrative of Health

• What are the stories we tell about health? About who gets to be healthy? And how we create health?

• Where do these stories come from?• What are the consequences of these stories?

Where do we go from here?

• Stories/narrative• Direct service work• Changing the health care system:– And institutional change

• Organizing and political advocacy– Example: raising the minimum wage, paid family

leave, fair housing laws, universal health care• Organizing: self-determination• Any others?

Evaluation

• What was new/surprising/thought-provoking?• What is still circling in your mind that you are

unsure about?• What, if anything, are you going to do with

this information?

Thank you!