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?