Lessons from Social Epidemiology in

Health CareIleana Ponce-Gonzalez, MD: Senior Adviser for Scientific & Strategic

Planning, Migrant Clinicians NetworkKristen West: Vice President of Programs, Empire Health Foundation

Robbi Kay Norman: Co-Founder, Uncommon Solutions

Historic Moment:What is our call to action in our communities?How we frame the context for action matters

Charity• Is giving

• Is kind

• Is donating what is surplus for essentials

• Does good

• Is comfortable

• Requires no change

• Is easy to give

• Requires no critical analysis

• Is interested in compassion and reducing immediate suffering

Social Justice• Is sharing

• Is fair and just

• Equitably distributes resources for essentials

• Makes right

• Can be uncomfortable

• Requires change

• Is hard to achieve

• Requires complex analysis

• Is interested in ending the need for charity

For instance… charity or social justice?

For instance: equality or equity?

EQUALITY EQUITY

EQUALITY = SAMENESS

Equality is about SAMENESS, it promotes fairness and justice by giving everyone the same thing.

BUT it can only work IF everyone starts from the SAME place, in this example equality only works if

everyone is the same height.

EQUITY = FAIRNESS

Equity is about FAIRNESS, it’s about making sure people get access to the same

opportunities.

Sometimes our differences and/or history can create barriers to participation, so we must FIRST ensure EQUITY before we can enjoy

equality.

The future wayLocal decisions about how to Redistribute medical care resources with a focus on fairness and health outcomes: “Better health for everyone at

less cost”

More Than Health CareSocial Determinants of Health

Kristen West FisherVice President of ProgramsEmpire Health Foundation

Why? Health Is More Than HealthcareHealthcare providers see only the top of the iceberg…

…but what’s under the

water has a profound effect on

their patients’

health outcomes

Health Care10%

Genetics30%Behavior & Environment

60%

What factors contribute to

health outcomes?

National SpendingHealth Care vs. Social Services

We spend almost twice as much on

health care as we do on social services…

National SpendingWhat are we buying?

Higher health care spending does not

mean better health

outcomes.…yet we experience

worse health outcomes.

What does this mean for health reform in the United States?Robbi Kay NormanUncommon Solutions

Health Equity & Social Determinants: Connecting All of

Our Dots

Health reform will not be successful at improving health unless

population-based health and social determinants of health

are addressed along with quality healthcare.

TRADITIONAL HEALTH CARE

Center for Outcomes Research & Education CORE

Traditional clinical decision making excels at finding the right strategy to treat, screen for, or manage the symptoms of patients.

However, in a world of profoundly interconnected systems, outcomes are shaped by a lot more than what happens at the point of care.

CLINICAL STRATEGIESSCREENINGS & TREATMENT

OUTCOMESHEALTHCOST

QUALITY

THE NEW HEALTH CAREHEALTH SERVICES & SYSTEMS

ORGANIZATION & DELIVERY OF CARE

CLINICAL STRATEGIESSCREENINGS & TREATMENT

OUTCOMESHEALTHCOST

QUALITY

CONNECTED SYSTEMSSTRUCTURE OF CARE DELIVERY

HEALTH POLICY PAYMENT & FINANCE

Center for Outcomes Research & Education CORE

THE NEW HEALTH CAREHEALTH SERVICES & SYSTEMS

ORGANIZATION & DELIVERY OF CARE

SOCIAL DETERMINANTS OF HEALTH RESEARCHPOPULATION HEALTH DRIVERS

CLINICAL STRATEGIESSCREENINGS & TREATMENT

OUTCOMESHEALTHCOST

QUALITY

CONNECTED SYSTEMSSTRUCTURE OF CARE DELIVERY

HEALTH POLICY PAYMENT & FINANCE

PHYSICAL ENVIRONMENTBIOGRAPHIES & LIFE EVENTS

SOCIAL STRUCTURE & CULTURE BUILT ENVIRONMENT

Center for Outcomes Research & Education CORE

Health Equity & Social Determinants

“Is it unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.” Institute of Medicine

https://www.youtube.com/watch?v=_11xLlwKgWc

Example of applying “the new health care” for high impact

ILEANA PONCE-GONZALEZ, MD: SENIOR ADVISER FOR SCIENTIFIC & STRATEGIC PLANNING, MIGRANT CLINICIANS NETWORK

Social Determinant of Health in Migrant Populations

Migrant-specific data are not widely available, Migrants experience greater rates of disease

complications due :  Cultural issues: such as language, literacy,

medical knowledge, health care practices and beliefs, and dietary practice.

Poverty: with unreliable transportation, lack of insurance and prescription coverage, inability to buy services and supplies or to modify diets, and substandard housing that may lack refrigeration, privacy, or adequate bath facilities.

Housing: substandard housing -lack refrigeration, privacy, or adequate bath facilities.

Food Insecurity: lack of access of healthy food Racism that motivates policies or actions that

frighten members of particular racial/ethnic groups.

Migration: causing discontinuity of care and unfamiliar health care systems, as well as special needs related to traveling long distances.

Political considerations associated with immigration: status of the patient and family, and work environments that typically do not include benefits, supports and protections such as disability coverage or worker's compensation.

Work environments: complicate the needs associated with foot care, glucose monitoring, hydration, rest, and self-medication.

Social support: exclusion or insulation Limited literacy  Limited job security: retaliation, sick leave

Influence of Social Determinants on Type 2 Diabetes

Poverty Personal financial burden of increased

health care costs Insufficient access to the resources

necessary to manage the condition: housing, nutritious food, and health care services

Diabetes can decrease an individual’s productivity at work , employment-related problems

Limit educational attainment

Exacerbate the cycle of inequality

PovertyMaterial

deprivation Social exclusion

Disadvantages Consequences

Policies to Address the Social Determinants of

Type 2 Diabetes

Expansion of standardized data collection under recent PPACA legislation .

Type 2 diabetes interventions must incorporate horizontal and vertical polices anchored in integrated data to address the complex relationship between Type 2 diabetes and social determinants of health.

Support Migrants in your states by collaborating and supporting MCN Health Network in the state

The data could be critical to connect vulnerable populations with the necessary resources that have the potential to alter detrimental sociobiologic processes that foster complex chronic conditions, such as Type 2 diabetes.

Comprehensive data could guide the development of system policies, resource allocation, referral processes, and partnerships with community organizations and social support programs.

Ten Recommendation of Diabetes Epidemic & Action Report, Washington State 2014.

Ensure all appropriate populations have access to the Diabetes Prevention Program in Washington.

Increase access to safe and affordable active living where people work, learn, live, play, and worship across their lifespan.

Increase access to healthy foods and beverages where people work, learn, live, play, and worship.

Ensure all people with diabetes receive self-management education from a Diabetes Education Program.

Ensure people with diabetes and gum disease have access to guideline-based oral health treatment.

Enhance care coordination for people with both diabetes and mental illness.

Ensure all appropriate populations have access to Chronic Disease Self-Management Education programs in Washington.

Ensure involvement of Community Health Workers to address diabetes in populations with the greatest needs.

Increase stakeholder involvement in policymaking that pertains to diabetes.

Support programs as the Plan for a Healthier Washington’s investment in Analytics, Interoperability & Measurement.

Call to Action: Moving beyond talkWHAT ARE YOU DOING IN YOUR REGION TO FORGE AN INTERSECTION BETWEEN HEALTH CARE, POPULATION HEALTH AND SOCIAL DETERMINANTS OF HEALTH?