what are the social determinants of health

Environmental health is targeted towards preventing disease and creating health-supportive environments. It includes the aspects of human health that are determined by physical, chemical, biological and social factors in the environment.

Environmental health

Environmental health also works to assess and control these factors. The Department of Health and Human Services has an important role in protecting the health of Victorians from the potential health effects of environmental hazards.

The department does this by:raising awareness of environmental hazards in the communityproviding technical guidance and adviceinforming state and national policy. Local government employs environmental health officers to work directly with communities on environmental health issues. The department works closely with local government to support the environmental health profession. The Environment Protection Authority is now the Victorian Government contact point for people who have health concerns that are related to pollution and waste.

Information on relevant government websites is in the process of being updated to reflect these changed areas of responsibility. Environmental health professionals A quick reference page for environmental health professionals that includes all the information environmental health officers need for their day-to-day work. Per- and poly-fluoroalkyl substances (PFAS)Per- and poly-fluoroalkyl substances, also known as “PFAS”, are a group of chemicals that have been used since the 1950s in fire-fighting foams.

Pesticide use and pest control Commercial pest control operators (PCOs) are licensed and regulated by the department. Climate and weather The Victorian Government has a role to play in protecting the community from the effects of climate change and weather events.

Environmental health in the community Community-wide environmental health hazards include mercury in fish, contaminated land and noise. Disease clusters can also be of concern. Environmental health at home There are several potential environmental health hazards in the home, including mercury, indoor air pollution, asbestos and carbon monoxide.

Resolved environmental health incidents Archive of health advice issued for environmental health incidents that have occured in Victoria. Find a health service Victorian health services Emergency Department Use my location Contact details Environmental Health Program Ph: 1300 761 874 Fax: 1300 768 874environmental.healthunit@dhhs.vic.gov.au50 Lonsdale Street, Melbourne, 3000 Victoria, Australia

And for some, even when the best choices known are made, their health outcomes are limited by these other factors. Economic and social drivers such as income, education and social connectedness have a direct bearing on health.

Chapter 4: The Chief Public Health Officer's report on the state of public health in Canada 2008 â What makes and keeps us healthy

Chapter 4: The Chief Public Health Officer's report on the state of public health in Canada 2008 – What makes and keeps us healthy Previous Table of Contents Next Chapter 4 - Social and Economic Influences What makes – and keeps – us healthy Income Employment and working conditions Food security Environment and housing Early childhood development Education and literacy Social support and connectedness Health behaviours Access to health care Summary Social and Economic Factors that Influence Our Health and Contribute to Health Inequalities What makes – and keeps – us healthy If good health is not shared equally by Canadians, then understanding the many factors – or determinants – that contribute to health and differences in health status is essential to identifying and implementing solutions to this challenge.

Health inequalities are differences in health status experienced by various individuals or groups in society. These can be the result of genetic and biological factors, choices made or by chance, but often they are because of unequal access to key factors that influence health like income, education, employment and social supports. 2Age, sex and heredity are key factors that determine health. The choices we make also matter, but these choices are influenced by environments, experiences, cultures and other factors (the determinants of health).

145, 167 These socio-economic determinants strongly interact to influence health and, in general, an improvement in any of these can produce an improvement in both health behaviours and outcomes among individuals and/or groups. Those with very low incomes, for example, often lack resources and access to nutritious food, adequate housing, safe walking paths and working conditions, which can impact negatively on their health. 7 As well, they may face financial and life stress, which – over time – can have health consequences such as high blood pressure, or immune and circulatory complications.

145 On the other hand, those who have adequate income and employment are likely to experience health outcomes that are less dependent on material needs but are nonetheless affected by the demands they face at home and at work and the degree to which they have control and decision-making influence in those settings. Generally, the degree to which people feel they have control over their circumstances is related to how healthy they are.

Increased exposure to stress, as well as a lack of resources, skills, social support and connection to the community can contribute to less healthy coping skills and poorer health behaviours such as smoking, over-consumption of alcohol and less healthy eating habits.

7, 122The structure of society also influences health through the distribution of public goods and resources. In fact, the extent to which these are equally shared across the population has been shown to influence the health of the population.2 Social support, social networking and connection to culture can protect against the health affects of living in disadvantaged circumstances.

As well, having a good start in life can help set the trajectory for a healthier life. Research now shows that many challenges for adults (e.g. mental health issues, obesity, heart disease, criminality, low literacy) have roots in early childhood.

Providing children with environments that are stimulating, supportive and include positive parental involvement – particularly during the first six years of life – can influence health (e.g.

by mitigating poor health outcomes in later life). 212The following socio-economic determinants of health will be discussed in further detail in this chapter. The order of this discussion reflects the importance of the broader economic and social context for health behaviours, access to health care and ultimately the health of the population. The determinants include:income;employment and working conditions;food security;environment and housing;early childhood development;education and literacy;social support and connectedness;health behaviours; andaccess to health care.

Table 4.1 shows both measured statistics and self-reported indicators of key socio-economic factors that influence the health of the overall population. These statistics are collected from sources such as the census, filed income and tax records, scientific monitors (e.g.

air quality instruments), and police/enforcement records for criminal and/or violent offences. The self-reported indicators in this table rely on information provided by individuals on health behaviours (e.g. daily smoking, sexual practices), access to health care (e.g. visiting a physician), food security and having a sense of community.

What follows is a description of these key factors, how they affect different groups of Canadians and how they vary across the population.

Also included in this chapter are interventions that show how these factors can be impacted through specific policies and programs. They have been developed and delivered by different sectors of Canadian society − including the public health sector − that have been working together, as well as independently, applying growing knowledge and experience of what affects health and quality of life to reduce inequalities.

For some interventions, evidence exists regarding their demonstrated value. Others have been identified as ‘promising’ but have not been fully studied or evaluated to prove their effectiveness. An effort has been made to highlight activities across a range of age groups, populations and environments across Canada.

Table 4.1 Factors influencing our health Value Description Year Income Persons living in low income (after-tax)10.8percent of the population based on 1992 low-income cut-off levels2005Employment and working conditions Unemployment rate6.3percent of the population aged 15+ years2006Food security People reporting food insecurity *9.2percent of the population aged 12+ years2004Environment and housing Ground-level ozone exposure38.1parts per billion (population weighted)2005Fine particulate matter (PM2.5) exposure9.5micrograms per cubic metre (population weighted)2005Unable to access acceptable housing13.7percent of the population2001Education and literacy High school graduates79.7percent of the population aged 25+ years2006Some postsecondary education60.1percent of the population aged 25+ years2006Postsecondary education54.2percent of the population aged 25+ years2006Social support and connectedness Very or somewhat strong sense of62.3percent of the population aged 12+ years2005community belonging *Violent crimes committed951per 100,000 population2006Health behaviours Daily smoking *18.6percent of the population aged 15+ years2006Engaged in leisure time physical activity *52.2percent of the population aged 12+ years2005Fruit and vegetable consumption 5+ times a day *41.2percent of the population aged 12+ years2005Heavy drinking (5+ drinks on one occasion21.8percent of the population aged 12+ years200512+ times in a year) *Any illicit drug use *12.6percent of the population aged 12+ years2002Teen pregnancy30.5pregnancies per 1,000 female population aged 15 to 19 years2004Access to health care Regular family physician *86.4percent of the population aged 12+ years2005Contact with dental professional *63.7percent of the population aged 12+ years2005* Denotes self-reported data Note: Some data may not be comparable.

More detailed information can be found in Appendix D: Definitions and Data Sources for Indicators. Sources: Public Health Agency of Canada using data from Health Canada, Statistics Canada, Canada Mortgage and Housing Canada and Environment Canada. Previous Table of Contents Next Report a problem or mistake on this page Share this page Date modified: 2008-06-06

Health promotion and disease prevention programs often address social determinants of health, which influence modifiable risk behaviors. Social determinants of health are the economic, social, cultural, and political conditions in which people are born, grow, and live that affect health status.

Defining Health Promotion and Disease Prevention

Rural Health Community Health Gateway Evidence-Based Toolkits Rural Health Promotion and Disease Prevention Toolkit Defining Health Promotion and Disease Prevention Health promotion and disease prevention programs focus on keeping people healthy.

Health promotion engages and empowers individuals and communities to engage in healthy behaviors, and make changes that reduce the risk of developing chronic diseases and other morbidities. Defined by the World Health Organization, health promotion is:“The process of enabling people to increase control over, and to improve, their health.

It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.”Disease prevention focuses on prevention strategies to reduce the risk of developing chronic diseases and other morbidities.

Modifiable risk behaviors include, for example, tobacco use, poor eating habits, and lack of physical activity, which contribute to the development of chronic disease.

Typical activities for health promotion and disease prevention programs include: Communication: Raising awareness about healthy behaviors for the general public. Examples of communication strategies include public service announcements, health fairs, mass media campaigns, and newsletters. Education: Empowering behavior change and actions through increased knowledge. Examples of health education strategies include courses, trainings, and support groups.

Policy: Regulating or mandating activities by organizations or public agencies that encourage healthy decision-making. Environment: Changing structures or environments to make healthy decisions more readily available to large populations.

Health promotion and disease prevention program models are provided in Module 2 . Resources to Learn More Chronic Disease Prevention and Health Promotion Website Provides information, statistics, tools, and resources related to health promotion and disease prevention program planning. Organization (s): Centers for Disease Control and Prevention Disease Prevention and Health Promotion Website The website includes examples of health promotion and disease prevention programs in rural areas.

Organization (s): Robert Wood Johnson Foundation Milestones in Health Promotion: Statement from Global Conferences Document This publication provides information on the global definition of health promotion and various actions that can help support and improve health outcomes. Organization (s): World Health Organization Date: 2009National Prevention Strategy: America's Plan for Better Health and Wellness Website This website provides information on the National Prevention Strategy – a comprehensive plan with evidence-based recommendations for building healthy and safe environments, expanding access to quality care, empowering people to make healthier choices, and eliminating health disparities.

Organization (s): Centers for Disease Control and Prevention The Power of Prevention: Chronic Disease...the Public Health Challenge of the 21st Century Document A publication covering chronic diseases, their causes, and their costs.

Recommends strategies and actions for improving well-being, reducing health disparities, promoting policy, translation of research, and workforce development. Organization (s): Centers for Disease Control and Prevention Date: 2009Previous Page: 1: Health Promotion and Disease Prevention Next Page: Barriers Was the information on this page useful? Yes No Submit

The outcome of social exclusion is that affected individuals or communities are prevented from participating fully in the economic, social, and political life of the society in which they live.

Social exclusion

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Please help improve it or discuss these issues on the talk page. ( Learn how and when to remove these template messages)This article needs additional citations for verification. (August 2011)This article is written like a personal reflection or opinion essay that states a Wikipedia editor's personal feelings about a topic. (July 2016)This article possibly contains original research. (November 2016

)Social exclusion, or social marginalization, is the social disadvantage and relegation to the fringe of society. It is a term used widely in Europe and was first used in France. [1] It is used across disciplines including education, sociology, psychology, politics and economics.

Social exclusion is the process in which individuals or people are systematically blocked from (or denied full access to) various rights, opportunities and resources that are normally available to members of a different group, and which are fundamental to social integration and observance of human rights within that particular group [2] (e.g., housing, employment, healthcare, civic engagement, democratic participation, and due process).

Alienation or disenfranchisement resulting from social exclusion can be connected to a person's social class, race, skin color, religious affiliation, ethnic origin, educational status, childhood relationships, [3] living standards, or appearance. Such exclusionary forms of discrimination may also apply to people with a disability, minorities, LGBTQ+ people, drug users, [4] institutional care leavers, [5] the elderly and the young.

Anyone who appears to deviate in any way from perceived norms of a population may thereby become subject to coarse or subtle forms of social exclusion.

Health behaviors (such as tobacco use and diet) account for 30 percent, while the physical environment accounts for 10 percent. According to the model, fully 40 percent of population health relates to social and economic factors such as education, employment, income, safety, and social support.

Quality Matters Archive

"Publications Newsletters Quality Matters Archive February/March 2012 Improving Population Heal... Quality Matters Archive Quality Matters reported on emerging models and trends in health care delivery reform and interviews with leaders in the field.

Please read its successor, Transforming Care. February/March 2012 Issue Next Article Subscribe to this Newsletter Add to My Library Print Improving Population Health Through Communitywide Partnerships Summary: Community health partnerships that bring clinicians together with civic groups, social service providers, and educational leaders among many others are proving to be an effective means of improving population health. Among their benefits, the partnerships help communities prioritize health needs and streamline resources to address them.

By Martha Hostetter and Sarah Klein Many quality improvement techniques—including the promotion of evidence-based treatments and well-coordinated care—can improve health outcomes, but their influence is often limited by factors beyond clinicians' control, such as patients' education, employment, and social support.

1 To address the social and economic factors that affect health, quality improvement initiatives must reach beyond the traditional boundaries of the health care system.

One promising approach is the use of community-based partnerships that bring a wide range of stakeholders—health care providers, educators, business leaders, social service providers, community organizations, and clergy—together to promote healthy behavior, improve access to primary and preventive care, and reduce health disparities. Models of Community Engagement In northeast Wisconsin for example, the Theda Care health system, comprised of five hospitals and 22 physician clinics, launched a Community Health Action Team (CHAT) that the local education system, government, businesses, clergy, and nonprofit organizations, as well as clinicians, in identifying community health issues.

The 25-member group then takes part in ""plunge"" events designed to hear from affected residents as well as caregivers on the frontlines.

One CHAT program, the Shawano County Rural Health Initiative, arose from the team’s realization that many local farming families were uninsured or had inadequate coverage, and often skipped check-ups or treatment for chronic conditions.

Many of these families also faced economic hardships and felt disconnected from their communities. Over the past eight years, rural health coordinators have visited more than 325 farms—40 percent of all of the farms in Shawano County—to provide health information, perform screenings, and connect residents to needed health and social services.

2 The coordinators are all registered nurses who receive training to do this work; two are paid by the Rural Health Initiative and one works for the region's public health department. Their outreach to farming families has resulted in the identification of more than 225 people in need of acute care, including residents at risk for suicide and those with untreated melanoma, severe hypertension, and diabetes.

The coordinators have also made 568 referrals for health concerns and nearly twice that many for non-health services such as financial counseling or other social services.

According to Rhonda Strebel, M. B. A., executive director of the initiative, this approach has been effective because it takes health—or what she describes as ""kitchen wellness""— to people's homes and because she and other coordinators have rural backgrounds that help them understand farmers' needs.

""The plunges get at the foundational layer of what creates health,"" says Paula Morgen, Theda Care's manager of community involvement. ""Afterward, everybody on the team has learned the same things at same time, and they feel ownership of the issue.""

In addition to the Rural Health Initiative, plunge events have led to efforts to improve transportation services for seniors, expand adult literacy education, and raise awareness of poverty.

Most of the funds for the CHAT programs come from Theda Care, which provides money from a percentage of its profits each year. In Ohio, clinicians at Cincinnati Children's Hospital Medical Center are encouraged to look beyond the traditional ways of treating medical conditions to consider the upstream factors—such as poverty and nutrition—that affect children's health.

In one example, pediatricians used funding from the National Institutes for Health to pinpoint where children with asthma live. The process known as “geocoding” helped highlight the importance of factors such as housing—not just drug treatments—in children's health.

It also made it clear that the hospital needed community partners. One such partnership with the Legal Aid Society of Greater Cincinnati revealed that 16 children with asthma lived in housing owned by the same developer, who had allowed the apartments to become squalid.

Legal Aid helped the tenants form an association to demand repairs. The hospital is now expanding this approach to other conditions. ""Our Population Health team is now geocoding all emergency department visits and admissions for childhood injury by age group and mechanism,"" says Robert Kahn, M. D., M. P. H., associate professor of pediatrics at the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center.

""We can then go back to the community to share this information with the police and fire departments, EMS, as well as the town council and mayor to brainstorm about ways to improve child safety.""

3 In Windsor, Vt., Mt. Ascutney Hospital and Health Center has had nearly two decades' of experience in a community-based approach to improve senior housing, prevent substance abuse, and connect residents to social services. Its efforts were recognized with the 2011 Foster G. Mc Gaw Prize for Excellence in Community Service, awarded by the American Hospital Association and the Baxter Allegiance Foundation.

Mt. Ascutney has made it a priority to track the outcomes of this work, though this is difficult given the fact that changes in community health may not become apparent for years.

Nonetheless, it has been able to show measureable improvement from its decade-long partnership with local schools to educate high school kids about the risks of substance abuse and tobacco use—an issue identified in a community needs assessment.

Over 2001 to 2011, Windsor youth reported greater-than-average decreases in alcohol, tobacco, and marijuana use, compared with the state average: a 13 percentage-point reduction in alcohol consumption among Windsor eighth graders, compared with a 10 percentage-point reduction statewide; a 16 percentage-point reduction in smoking, compared with a 10 percentage-point reduction statewide; and an 11 percentage-point reduction in marijuana use, compared with a 2 percentage-point reduction statewide.

In South Carolina, the Healthy Columbia initiative, which focuses on the region in the zip code 29203, relies on the principles of community organizing to increase access to care and reduce rates of chronic disease, emergency department utilization, and hospitalization.

The program relies primarily on volunteers to implement screening programs for blood pressure and diabetes, provide peer-to-peer health coaching, and build community gardens where vegetables are in short supply. The program’s 200 volunteers—drawn from local churches, civic organizations, local fraternities and sororities, and health care organizations—have been trained in community organizing and are expected to recruit more volunteers, says Laura Long, M. D., M. P. H., a founding member of the group and vice president of clinical quality and health management for Blue Cross Blue Shield of South Carolina.

4 In some locations, community groups receive guidance from the Institute for Healthcare Improvement's Triple Aim initiative, which is designed to help them identify unmet health needs (see Q&A ).

In Pueblo, Colo., the IHI program helped identify the importance of increasing access to primary care, improving chronic disease management, and developing more regional health promotion programs, says Donald Moore, M. H. A., CEO of Pueblo Community Health Center. “What really resonated with the community was engaging patients in their responsibility for health and use of health care. We are framing the whole discussion of chronic disease management and ER usage in that patient responsibility framework.

Without activating patients to do more for their own health, clinics, hospitals and health care providers, alone, won't be successful with our Triple Aim effort.” Moore says. Even the Best Can Do Better Even communities with good health outcomes are working to do better. In both 2010 and 2011, Collier County was ranked the healthiest in Florida out of 67 counties on County Health Rankings.org, a benchmarking site created by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

""We were a bit surprised the first year we were anointed healthiest county,"" says Allen Weiss, M. D., president and CEO of the NCH Healthcare System, based in Naples.

""We got together to talk about it—we had 100 different agencies in the room, representatives from public health, the YMCA, schools, fire department, and others. Rather than working at what we are already good at—low mortality rates, low door-to-balloon time, infant birth weight—we said, let's look at what we don't do well, and form mini taskforces to come back with an executable plan—one idea of something we can do to try to address it.""

Among other efforts, the group is focusing on lowering childhood obesity rates, targeting their efforts to one zip code where three public elementary schools have obesity rates topping 25 percent.

Todd Vedder, M. D., NCH's chair of pediatrics, is leading efforts to engage parents, increase kids' caloric burn during play periods, increase kids' opportunities to take part in fitness activities and choose healthy foods, and increase the number of mothers who exclusively breastfeed their babies at two, four, and six months.

Sustaining the Work For community health improvement efforts to succeed, many say, it is important to keep momentum going on collaborative efforts, especially when team members come and go, and no one person feels ownership of the work.

Morgen of Theda Care recalls that its initial effort to improve health beyond its clinics—aimed at getting women screened for breast cancer—fizzled out because it relied on a flawed approach. ""We started with the medical model: we picked health experts, and then reached out to hair salons to enlist stylists in educating women,"" she says.

""It had an impact, but it wasn't sustainable because it relied solely on us to keep it going."" After going through a ""Creating Healthy Communities"" fellowship program from the American Hospital Association, Morgen helped to develop the CHAT model of community engagement, in which Theda Care acts more as a facilitator than a leader of projects.

5 ""Our doctors and nurses absolutely should have a seat at the table, but they shouldn't be the only ones driving solutions,"" she says.

The NCH health system began with what Weiss describes as ""small, doable"" projects but then gave legs to these efforts by lending its community partners the infrastructure and staff resources to raise funds and spin off an independent nonprofit, the Safe and Health Children's Coalition of Collier County, that focuses on reducing SIDS, childhood obesity, and drowning (the number-one cause of death among preschool children in Florida). ""Not only does [the hospital] need to be the guiding force, you have to be willing to take on risk and responsibility,"" says Mt.

Ascutney's Donovan. ""We have served as fiscal agent for the majority of grants that come into community; we are financial incubator for many programs."" Sorting out what to do with the savings and developing equitable ways of reinvesting it to sustain the programs may be more complicated. “Is the negotiation with the hospital where the cost savings and utilization changes are occurring or is it with the insurers who are paying less than they otherwise might have?

How do you structure those relationships? None of us in the field know exactly how to do that,” Milstein says.

Still, there’s cause for optimism. New payment models, which focus on prevention and wellness, rather than acute care, and on bundled or per capita payments for populations, are likely to lead to a redefinition of institutional roles in health care. ""The era of inpatient growth is over,"" says Weiss. ""Hospitals have to get into the prevention business: everyone benefits when we work towards keeping people healthy.""

John O'Brien, president and CEO of UMass Memorial Health Care, Inc., and chair of the Foster G. Mc Gaw Prize Committee, says that efforts to improve community health may not have immediate returns, but in the dawning era of capitated payments such programs are likely to pay off: ""This is a business issue—this isn't altruism.

Community benefit is good business. ""Resources for Community Health Improvement Health Improvement Health care providers' efforts to reach beyond their walls to improve community health are prompted in part by new federal regulations that encourage local coordination and fostered by the availability of benchmarking tools and technical assistance programs.

These include: Simulation/Planning: The Fannie E. Rippel Foundation's Re Think Health program has made available a regional health planning tool that enables stakeholders to use the techniques of simulation modeling and game-based learning to forecast the costs and benefits of various interventions (such as improving preventive health, reducing crime, and enhancing care for chronic mental illness) and to make decisions about how and where to invest resources.

The model might indicate that “if you are really trying to deliver value to the insurers, you might need reduce costs still further than you could accomplish just with readmissions alone or just with outpatient stuff and the ER,” says Bobby Milstein, Ph. D., M. P. H., director of the Rippel Foundation’s Re Think Health Dynamics program. “A lot of this is about setting realistic expectations and then not getting comfortable with the mediocre improvement,” he says.

Federal funds: There has been significant funding from the federal government to increase wellness through community-based programs that aim to reduce health care costs by preventing disease in the first place. For example, the Centers for Disease Control and Prevention is supporting 149 ACHIEVE communities in their efforts to reduce tobacco use and exposure, promote physical activity and healthy eating, and improve access to preventive health services.

Measurement: The forthcoming Scorecard on U. S. Local Health System Performance, 2012, from The Commonwealth Fund’s Commission on a High Performance Health System compares 306 hospital referral regions on several indicators of health care access, quality, health outcomes, and utilization/costs.

This information can help partners identify community assets and target areas where they lag behind regional, state, and national benchmarks. In addition, the Centers for Medicare and Medicaid Services recently made its extensive Medicare claims database —including information on individual providers—available to certain types of community groups for the purposes of performance benchmarking and reporting efforts, as part of a provision of the Affordable Care Act.

Why Not The Best.org, The Commonwealth Fund's benchmarking and quality improvement site, enables explorations of regional performance on several measures of health care quality, outcomes, and population health.

Finally, communities developing regional health information exchanges will have significant advantages in using health care data to study and improve population health.

Improvement Initiatives: As part of its Aligning Forces for Quality work, the Robert Wood Johnson Foundation has provided funding and technical assistance to 16 geographic regions that have brought stakeholders together to reduce fragmentation, improve quality of care, and measure and publicly report performance, among other goals. Community Health Assessments: The Affordable Care Act requires nonprofit hospitals to perform community needs assessments by gathering input from individuals across the community, including those with public heath expertise, and describing how the hospital plans to implement programs to address the identified needs.

The Association for Community Health Improvement offers a Community Health Assessment Toolkit to help hospitals understand and improve the health of residents in their communities.1 According to a widely cited model from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, population health is determined by several different factors—with access to and the quality of clinical care accounting for just 20 percent.

Health behaviors (such as tobacco use and diet) account for 30 percent, while the physical environment accounts for 10 percent. According to the model, fully 40 percent of population health relates to social and economic factors such as education, employment, income, safety, and social support.

Also see J. M. Mc Ginnis, P. Williams-Russo, and J. R. Knickman, ""The Case for More Active Policy Attention to Health Promotion,"" Health Affairs, March 2002 21 (2):78–93.

2 While the initiative cannot pay for the services to which patients are referred, they work with health care providers to facilitate affordable access. The goal of the program is to provide access to preventive and timely care and to help people avoid costly conditions.

Generally, the CHAT teams fund no more than half of the start-up costs of projects. 3 For more information about how to create medical-legal partnerships, see http://www.ihi.org/knowledge/Pages/Audioand Video/WIHIRemoving Barriersto Care Medical Legal Partnerships.aspx.

4 For more information, see http://www.ihi.org/knowledge/Pages/Audioand Video/WIHIOrganizingfor Health South Carolina.aspx. 5 This fellowship program evolved into the Association for Community Health Improvement, http://www.communityhlth.org/, which offers education, tools, and other resources for hospitals to measure and improve community health.

Next Article Subscribe to this Newsletter Add to My Library Print* Required. ***I thought you would be interested in this item from www.commonwealthfund.org. Privacy & Terms SENDGet Updates That Matter Sign up to receive e-alerts and newsletters on the health policy topics you care about most. Full Issue Table of Contents Improving Population Health Through Communitywide Partnerships Q&A: Tackling the Triple Aim in a Region News Briefs Publications of Note Editorial Advisory Board "

Closing the gap in a generation: Health equity through action on the social determinants of health (PDF) - Final report of the Commission on Social Determinants of Health. Geneva, 2008, World Health Organization.

Table of Contents: Introduction: Why viral suppression is important What are Social Determinants of Health Why address Social Determinants of Health How to address Social Determinants of Health Who should address Social Determinants of Health How to identify what Social Determinants of Health impact your community Raising awareness using social media for Social Determinants of Health Funding strategies Evaluation Webinars Notice to Readers This document provides an overview of Social Determinants of Health (SDH) and approaches for reducing HIV-related disparities and their collective impact on vulnerable populations.

Strategies in this toolkit can be used to increase awareness and direct prevention initiatives. These examples are provided for illustrative purposes and do not constitute endorsement. Links to organizations found in this document are provided solely as a service to the reader. These links do not constitute an endorsement of these organizations or their programs, and none should be inferred.

The Texas HIV Syndicate is not responsible for the content of the individual organization sites listed in this document.

Document created February 2016The Social Determinants of Health: Approaches to the HIV Epidemic Toolkit was prepared by The Texas HIV Syndicate: Public Awareness Priority Group with Stan Baker, Arianni Becerra, Nike Blue, Alex Byrd, Jackie Bzostek, Jeanett Deas-Calhoun, Ana Colin-Hernandez, Tom Cassady, Charlene Doria-Ortiz, Herman Finley, Nell Gaither, Helen Turner-Goldenberg, Gregg Gunter, Lionel Hillard, Ashley Innes, Marsha Jones, Markelse, Jordan, Robyn Koch, Sara Mendez, Shawna Stewart, Steven Vargas, and John Waller in association with the Texas Department of State Health Services.

PDF version of this toolkit (PDF : 818 k B)1. Introduction Purpose and Intended Target Audience of the Toolkit The purpose of the Texas HIV Syndicate is to reduce HIV infections in Texas by identifying strategies to enhance and expand work already being done across the spectrum of HIV prevention and treatment. Texas HIV Syndicate priority groups develop resources to advance the identified strategies across the state.

The Social Determinants of Health: Approaches to the HIV Epidemic Toolkit (Toolkit) is a unique resource. Rather than solely addressing communities themselves, it was developed at a state level for individuals and organizations working with and through communities.

The Toolkit is an information source which will be available to interested parties across the state. Social Determinants of Health (SDH) are defined in the toolkit and information is given on raising awareness (through social media) about the role SDH play in the spread of HIV and HIV-related disparities. The Toolkit consolidates multiple sources of information into one easily accessible electronic location.

Toolkit Use While many organizations across the State of Texas have begun to address SDH in their own communities, this Toolkit is an informative guide of available resources to supplement and complement existing efforts. The Toolkit is not prescriptive. It outlines processes that can be referenced, as needed, for use to meet individual program needs.2.

What are Social Determinants of Health Healthy People.gov states that SDH are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Resources that enhance quality of life can have a significant influence on population health outcomes.” (Healthy People.gov, 2015)Healthy People.gov also notes that “our health is influenced in part by social determinants such as access to social and economic opportunities; resources and support available in our homes, neighborhoods, and communities; quality of our schooling; safety of our workplaces; cleanliness of our water, food, and air; and the nature of our social interactions and relationships.” (Healthy People 2020, 2015)The website provides the following examples of SDH: Availability of resources to meet daily needs (e.g., safe housing & local food markets)Access to educational, economic, and job opportunities Access to health care services Quality of education and job training Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination, racism, & distrust of government)Exposure to crime, violence, and social disorder (e.g., presence of trash & lack of cooperation in a community)Socioeconomic conditions (e.g., concentrated poverty & accompanying stressful conditions)Residential segregation Language and literacy Access to mass media and emerging technologies (e.g., cell phones, Internet,& social media)Culture (Healthy People 2020, 2015)Additional SDH Resources Healthy People 2020Centers for Disease Control and Prevention: Frequently Asked Questions World Health Organization Centers for Disease Control and Prevention National Partnership for Action to End Health Disparities U. S. Department of Health and Human Services Office of Minority Health The Robert Wood Johnson Foundation National Association of County and City Health Officials - Contains: Trainings, web based courses, & healthy equity tools Equity, social determinants and public health programmes (PDF) - Editors Erik Blas and Anand Sivasankara Kurup.

WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.

Data Set Directory of Social Determinants of Health at the Local Level (PDF) - Hillemeier, M., Lynch, J., Harper, S., Casper, M., Data Set Directory of Social Determinants of Health at the Local Level. Atlanta: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health (PDF) - Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health.

Atlanta: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.3.

Why Address Social Determinants of Health Addressing social factors is critical in the quest to eliminate health disparities and understand the relationship between underlying conditions and individual choice. In order to improve health, we need to focus on addressing the characteristics of communities. The following links provide information & justification regarding the need to address SDH.

Improving the Health of All Americans by Focusing On Communities This two page document by Robert Wood Johnson Foundation Commission to Build a Healthier America explains that in order to improve health we need to focus on improving the characteristics of communities.

Social Determinants of Health Solid Facts (PDF)This report by WHO contains the following SDH topics: The social gradient Stress Early life Social exclusion Work unemployment Social support Addiction Food Transport Addressing Social Determinants of Health (PDF)The 2008 Consultation Meeting Report from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) provides examples of opportunities and recommendations of future directions regarding SDH in the areas of public health policy, data systems, agency partnerships, capacity building, prevention research, and evaluation.

( Prevention, 2009)Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States (PDF)This is an NCHHSTP White Paper on Social Determinants of Health, 2010. Social Determinants of Health (PDF)This is an article by Community Health Improvement Partners (CHIP).

CHIP draws from the materials published by Phil Rabinowitz and his colleagues at the University of Kansas Community Tool Box (CTB) and provides a brief overview of the what, why, who, when and how of addressing the social determinants of health (CBT, 2010).4.

How to Address Social Determinants of Health A New Way to Talk about Social Determinants of Health This article from the Robert Wood Johnson Foundation (RWJF) provides guidance on how to develop messaging around SDH.

It includes best practices in language, word choice, use of support data, and us of pictures to tell your stories. (2010 Robert Wood Johnson Foundation, 2015) RWJF shares the following methods for talking about Social Determinants of Health. “These proxy statements can replace the SDH descriptor and help people understand the concept more clearly.

Six Ways to Talk About Social Determinants of Health Health starts, long before illness, in our homes, schools and jobs. All Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education or ethnic background. Your neighborhood or job shouldn’t be hazardous to your health. Your opportunity for health starts long before you need medical care.

Health begins where we live, learn, work, and play. The opportunity for health begins in our families, neighborhoods, schools, and jobs.” (2010 Robert Wood Johnson Foundation, 2015)From Theory to Action: Applying Social Determinants of Health to Public Health Practice This article written by Hazel Dean, Kim Williams, and Kevin Fenton seeks to illustrate how public health professionals can address SDH using a variety of public health activities that promote health equity among the populations most disproportionately impacted by infectious and chronic diseases.5.

Who Should Address Social Determinants of Health Everyone involved in health-related program development must consider health issues in the context of SDH.

Those affected by specific health issues, as well as those addressing those issues, should know as much as possible about its context and history, as well as who in their community might be able to address SDH.“The University of Kansas Community Tool Box advocates for participatory approaches to planning and, in this case, for a participatory approach to analysis and intervention as well.

The presence of representatives of groups affected by the issue will ensure that everyone knows its full context and history.” (KU Work Group for Community Health and Development, 2015 Chapter 17, Section 5: Addressing Social Determinants of Health and Development) Those who should be involved include: Those directly affected by, or at risk for, a particular health condition or community development issue.

Policy makers, legislators, officials, or others who can influence the issue. Human services staff, administrators, and others (such as police officers, teachers, and coalition members) who are responsible for dealing with the various issues.

Local figures, including advocates, clergy, and others, in the community to whom people turn for support. Members of groups that may be asked to change, sacrifice, or take action in order to address the issue.

Employers, landlords and other property owners, health and human service workers, police, and teachers might all fall into this category. (KU Work Group for Community Health and Development, 2015 Chapter 17, Section 5: Addressing Social Determinants of Health and Development)Community Tool Box This website contains a section discussing social determinants of health from the perspective of what, why, who, when and how.

Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health (PDF)This workbook by the Center for Disease Control and Prevention is for public health practitioners and partners interested in addressing SDH and provides a fundamental perspective on who should address SDH.

Section 1 of the workbook titled “Creating Your Partnership to Address Social Determinants of Health” makes the following key point:“It is essential to build partnerships to address social determinants of health because no one group, be it health care providers, public health practitioners, or community members, can accomplish the many tasks required for changing social, economic, and environmental conditions that impact health.” (Brennan Ramirez LK, 2015)Additional Resources Closing the gap in a generation: Health equity through action on the social determinants of health (PDF) - 2008 WHO Commission on Social Determinants of Health: Final report/Executive summary ACTION: SDH - Website houses SDH information and provides a platform for SDH discussion.

Tackling social determinants of health through community based initiatives ( PDF format) - Article by M. Assai, S. Siddiqi, and S. Watts, provided by the British Medical Journal.

BMJ, vol. 333, 21 October, 2006.6. How to Identify Which Social Determinants of Health Impact Your Community Community assessments can and should be more than just gathering and analyzing data. They can also be a basis for creating change. A community-based needs assessment can help provide a snapshot of families in the service area and their economic wellbeing, educational status, health and welfare. Recognizing and identifying community strengths and weaknesses can influence strategic planning and decision-making. Identifying Community Assets and Resources This approach puts a focus on community assets and strengths.

Community assets and strengths can be used to meet community needs. (KU Work Group for Community Health and Development, 2015 Chapter 3, Section 8: Identifying Community Assets and Resources)Developing a Plan for Assessing Local Needs and Resources This website describes why you should assess needs and resources and why you should develop an assessment plan.

Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis A SWOT analysis can offer helpful perspectives at any stage of an effort.

It can be used to: Explore possibilities for new efforts or solutions to problems. Assist in the decision making process of determining the best path for your initiative, by identifying opportunities and threats to success. Determine where change is possible. When at a juncture or turning point, an inventory of your strengths and weaknesses can reveal priorities and possibilities.

Adjust and refine plans mid-course. A new opportunity might open wider avenues, while a new threat could close a path that once existed. (KU Work Group for Community Health and Development., 2015 Chapter 3, Section 14: SWOT Analysis: Strengths, Weaknesses, Opportunities, and Threats)Additional SDH Resources Addressing Social Determinants of Health - Practical Playbook website contains tips, strategies, and other resources.

Mind Tools Website - Overview of SWOTCommunity Tool Box - descriptions, tools, & examples of SWOTCommunity needs assessments (PDF)Community assessment tools (PDF)Health Impact Assessment (HIA) generic screening tool Health Impact Assessment (HIA) (PDF)Why and how to collect information - This section talks about hard data: where to get it, how to use it, and its limitations.2-1-1 Texas: Finding Help in Texas - Resources by zip code Housing, Shelter, Food Assistance, etc.2015 HIV Handbook - A Guide for HIV and AIDS services in North Texas7.

Raising Awareness using Social Media for Social Determinants of Health Message Design Strategies to Raise Public Awareness of Social Determinants of Health and Population Health Disparities This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery.

(Niederdeppe, 2008)Implementing a Social Marketing Effort Some of the information included in this tool kit: What is social marketing Who can do social marketing Why is social marketing important Stages of a successful social marketing effort Conducting a social marketing campaign Collecting information about the problem Understanding the issue Conducting focus groups, interviews, public forums and listening sessions (KU Work Group for Community Health and Development., 2015 Toolkits Section 13: Implementing a Social Marketing Effort)How To: Start an Awareness Campaign about Your Cause This website contains tips on how to start an awareness campaign.

Types of Campaigns Service - An example of a service approach could be an organizer convincing neighborhood religious institutions to put cots in their basements for the homeless Education - An example of an educational approach could be researching causes of homelessness and educating the community on this social issue. Self-Help - An example of helping others to help themselves could be to hold workshops for homeless people that enabled them to gain new knowledge, skills, and employment.

Advocacy - An example of an advocacy approach could be lobbying for more homeless shelters and food programs. When advocating for change those affected may not necessarily be involved with the effort. Direct Action - An example of involving groups of people to take action for change could be organizing a rally protesting against the criminalization of homelessness and the dehumanizing policies toward those living without homes.

Types of Social Media Campaigns ( source)Photo campaigns Blog Entries Design campaigns Video campaigns Mixed media Additional Social Media Resources Online Fundraising Tools Policy Tool for Social Media - Social media policy outlines guidelines for communicating online.

This tool provides a policy that can be customized for your organization. HIV Prevention Goes Social Part II Social Media Strategy, Policy, & Monitoring Workbook (PDF)HIV Prevention Goes Social Using Social Media to Create, Connect, and Come Together (PDF)The National Minority AIDS Council - HIV Goes Social and other resources8.

Funding Strategies10 Ways to Start a Fund for Social Good Online - This website Mashable.com provides a list and description of online tools to help bring awareness to and raise funds for a campaign. Top 10 Crowdfunding Sites - Crowd funding is the process of collecting funds for a wide variety of purposes through a collective approach by numerous participants.

This website provides a list of sites and important information to know. The following websites announce available grant opportunities Janssen Therapeutics Grants & Contributions Viiv Healthcare Grants Bristol Myers Squibb Grants9. Evaluating Social Media Health Communicator’s Social Media Toolkit (PDF) - This toolkit by CDC’s Electronic Media Branch includes a Social Media Evaluation Worksheet starting on page 50, in addition to links to other helpful resources.

A Tip-a-Day by and for Evaluators - This website by the American Evaluation Association offers a blog that includes daily posts of all things related to evaluation. Nonprofit Social Media Decision Guide - Idealware provides a free download to their Nonprofit Social Media Decision Guide.

The guide walks through a five-step process for: Understanding Social Media Defining Your Goals and Audience Evaluating Specific Tools Choosing Tools to Meet Your Goals Creating Your Social Media Strategy Additional Evaluation Resources Evaluating your Social Media Program Resources for Evaluating Social Media Using Hoot Suite to Monitor Evaluation Trends and Conversations on Social Media10.

Webinars Social Determinants of Health: Reforming the Health System to Work Smarter, Not Harder, to eliminate Health Disparities - This webinar by the National Conference of State Legislators (NCSL) is part of their health disparity project.

Social Determinants of Mental Health - This webpage provides a video which explores the social determinants of mental health such as, poverty, violence, racism, abandoned housing, safety, green space, and clean air and water. Social Determinants of Health Program Planning in Public Health: What’s the evidence? - This webinar is hosted by Health Evidence.

Health Evidence is an online database containing effective public health interventions and other resources. Enhancing Your HIV Prevention Work with a Social Determinants of Health Approach - Webinar by the UCLA Center for HIV Identification, Prevention, and Treatment (CHIPTS) on the role of SDH in HIV.

Health Disparities and Social Determinants of Health - Webinar by Physicians for a National Health Program (PNHP)Understanding Social Determinants of Health from the Ground Up: Taking Neighborhood Health to Heart - Webinar by Public Health Practice grounded on community based participatory research. Social Determinants of Health - Ted Talk by Clair Pomeroy raises the issue of socioeconomics in relation to the provision of health care and treatment.

Clair speaks from her viewpoint and experience as a fourteen year old surviving on the streets and various foster centers.

A New Way to Talk About the Social Determinants of Health The webinar is based on A New Way to Talk About the Social Determinants of Health article by RWJF which contains the following elements: A Foreword by Jane Lowe: Why We Need a Better Way to Talk About the Social Determinants of Health Peeling the Onion: How We Found a Better Way to Talk About the Social Determinants of Health Choosing Words: Best Practices in the Language and Framing of Social Determinants of Health Finding One Fact to Fight Fiction: The Use of Data and Information to Support—Not Make—Your Case Thinking in Pictures: The Deep Metaphors That Drive How Politicians See Health Disparities (by Elizabeth Carger)Changing Our Frame of Mind: The Role of the Mind, Brain and Emotion in Developing Messages (by Drew Westen, Ph. D.)This Webinar on ways to create effective and persuasive messages is hosted by RWJF. (Robert Wood Johnson Foundation, Carger E, and Westen D, 2015)

About social determinants of health The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. Key concepts

About social determinants of health

Employment conditions Measures to clarify how different types of jobs and the threat of unemployment affect workers’ health.

WHO /D. Rodriguez Social exclusion The relational processes that lead to the exclusion of particular groups of people from engaging fully in community and social life. WHO /D. Rodriguez Public health programmes and social determinants Factors in the design and implementation of programs that increase access to health care for socially and economically disadvantaged groups.

WHO /M. Dakin Women and gender equity Mechanisms, processes and actions that can be taken to reduce gender-based inequities in health by examining different areas. Early child development Well established evidence illustrates that opportunities provided to young children are crucial in shaping lifelong health and development status.

WHO /A. Kari Globalization How globalization’s dynamics and processes affect health outcomes: trade liberalization, integration of production of goods. WHO/S. Volkov Health systems Innovative approaches that effectively incorporate action on social determinants of health. WHO /R. B. Sorensen Measurement and evidence The development of methodologies and tools for measuring the causes, pathways and health outcomes of policy interventions. WHO /A. Kari Urbanization Broad policy interventions related to healthy urbanization, including close examination of slum upgrading.

This raises concerns of worsening rural health disparities in the future. For additional information about the causes of health disparities in rural areas, see RHIhub's topic guide: Social Determinants of Health for Rural People.

Rural Health Disparities

"Rural Health Topics & States Topics Rural Health Disparities Rural Americans are a population group that experiences significant health disparities. Health disparities are differences in health status when compared to the general population, often characterized by indicators such as higher incidence of disease and disability, increased mortality rates, lower life expectancies, and higher rates of pain and suffering. Rural risk factors for health disparities include geographic isolation, lower socio-economic status, higher rates of health risk behaviors, and limited job opportunities. Higher rates of chronic illness and poor overall health are found in rural communities when compared to urban populations.

Several studies have shown that rural residents are older, poorer, and have fewer physicians to care for them. This inequality is intensified as rural residents are less likely to have employer-provided healthcare coverage, and if they are poor, often are not covered by Medicaid.

Federal and state agencies and membership organizations are working to reduce these disparities and improve the health and overall well-being of rural America.

Some provide funding, information, and technical assistance to be used at the state, regional, and local level, while others inform state and federal legislators to help them understand the issues affecting population health and healthcare in rural America. For an in-depth look at rural health disparities, the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report Rural Health Series examines rural mortality and preventable deaths, health-related behaviors, chronic disease, and related topics.

Additional insights and data are available in the Rural Health Reform Policy Research Center's 2014 Update of the Rural-Urban Chartbook and Exploring Rural and Urban Mortality Differences . Frequently Asked Questions How do rural mortality rates compare to urban? How does rural life expectancy compare to urban?

What regions of the country experience high levels of rural health disparities? What is the difference between health disparities and health inequities? What are the causes of rural health disparities? Where can I find supporting documents and statistics on rural health disparities?

What agencies and organizations are working to seek solutions to these disparities? Where can I find programs that illustrate best practices to meet the challenges of providing health services in areas characterized by disparities?

What are the health disparities that affect rural minority populations? How do rural mortality rates compare to urban?

Rural Mortality Rates Compared to Urban Rates per 100,000 Population Nonmetro counties Metro counties Measure With a city ≥ 10,000 population Without a city ≥ 10,000 population Large central Large fringe Small Infant mortality 6.8 7.0 6.8 5.7 6.7Chronic obstructive pulmonary disease (COPD), death rate among persons 20 years of age or older 79.9 81.9 56.2 60.6 70.9Death rates for ischemic heart disease among persons 20 years of age and older 197.2 206.5 192.9 174.9 173.8Death rates for all unintentional injuries 58.9 52.7 32.1 33.1 40.8Death rates for all motor vehicle traffic-related injuries 23.3 19.5 7.9 9.3 12.1Suicide 18.2 20.0 12.8 13.7 16.1Source: Rural Health Reform Policy Research Center.

The 2014 Update of the Rural-Urban Chartbook. (2008–2011 data. )Another way to examine rural-urban mortality differences is by examining excess deaths. Across U. S. counties, the proportion of deaths that occur before age 80 varies; the lowest rate is used as a benchmark.

Excess deaths are deaths in each county that might not have been expected if the county matched the lowest U. S. county rate (the benchmark rate).

Recent CDC National Vital Statistics System data for the 5 leading causes of death in the U. S. continues to demonstrate higher rates of excess deaths for populations in nonmetropolitan areas than in metropolitan areas by identifying the percentages of potentially excess deaths.

Percentage of Excess (or Potentially Preventable) Deaths for Leading Causes of Death Cause of Death Nonmetro Counties Metro Counties Heart Disease 42.6% 27.6%Cancer 24.2% 13.5%Unintentional injury 57.5% 39.2%Chronic lower respiratory disease 54.3% 30.9%Stroke 37.8% 26.1%Source: CDC Stacks, Supplemental tables for Leading Causes of Death in Nonmetropolitan and Metropolitan Areas – United States, 1999–2014: Figures 2-5Four of the five leading causes of death in rural areas are associated with chronic disease.

RHIhub’s Chronic Disease in Rural America topic guide provides additional information and resources on the impact of chronic disease in rural areas and funding opportunities for programs to address chronic conditions.

How does rural life expectancy compare to urban? Rural Life Expectancy Compared to Urban, 2005-2009, in Years of Age Life Expectancy Nonmetro Counties Metro Counties All 76.8 78.8Male 74.1 76.2Female 79.7 81.3White 77.2 79.2Black 72.8 74.2American Indian and Alaska Native 74.8 85.8Asian and Pacific Islander 84.9 86.9Hispanic 82.2 83.1Source: Singh, G. K., Siahpush, M. 2014. Widening Rural-Urban Disparities in Life Expectancy, U. S., 1969-2009. American Journal of Preventive Medicine, 46 (2), 19-29.

Article Abstract What regions of the country experience high levels of rural health disparities? High levels of rural health disparities are found in several regions in the U. S. although not all of these regions exhibit the same high levels in all identified disparities. The South The rural South is consistently at the top of the list for high rates of mortality for nearly all leading causes of death.

Average life expectancy at birth is lower in the South than the national average by a year and in some states by 3 – 4 years. CDC has identified the nonmetropolitan areas of the South as having the highest rates of potentially excess deaths related to heart disease, cancer, chronic lower respiratory disease, and stroke. In the Southeastern region, states with largely rural populations exhibit a diabetes prevalence rate higher than 10.6% and in some areas almost double the national rate.

Other health concerns with high mortality rates include septicemia, liver disease and suicide. Appalachia Many areas of Appalachia overlap with the rural South and exhibit many of the same health disparities. A recent study identified infant mortality as 16% higher in Appalachia than in the U. S. as a whole over the period from 2009-2013, and the deficit in life expectancy has widened by 2.4 years since 1990-1992.

Research has shown mortality rates for cancer, heart disease, diabetes, chronic lower respiratory disease, unintentional injury, and stroke in Appalachia are higher than the rest of the nation. Other diseases and health concerns causing death which are prevalent in the region include septicemia, chronic liver disease, suicide, prescription drug and illegal drug overdose. Additional information can be found in Health Disparities in Appalachia and Appalachian Diseases of Despair .

The Delta Region The Delta Region, also located in the South but limited to rural geographic areas along the Mississippi River, exhibits many of the same disparities found in the South and in Appalachia.

Life expectancy for counties located in the Delta Region are some of the lowest in the country, as low as 70.93 years at birth compared to 79.08 for the U. S. as a whole. Mortality rates for cancer, suicide, diabetes, lower respiratory, stroke, and septicemia are higher than the rest of the nation.

Heart disease is of special concern as it is higher than the national average for all age groups including children. Other health issues prevalent in the Delta Region include high mortality rates due to pregnancy, childbirth, and sudden infant death syndrome.

See Exploring Rural and Urban Mortality Differences in the Delta Region for specific data. U. S. – Mexico Border While life expectancy in many counties of the border region exceeds the national rate , there continue to be persistent health issues confronting the border region including obesity, diabetes, unintentional injuries, and tuberculosis according to Healthy Border 2020.

Nearly 60% of adults residing in the border region are overweight or obese. Border areas also have some of the highest rates of diabetes in the U. S. In Texas several border counties exhibit a diabetes prevalence rate greater than 20% .

Mortality rates due to unintentional injuries from traffic fatalities and infectious disease such as tuberculosis continue to be a concern; however, in recent years these mortality rates have decreased, particularly on the U. S. side of the border.

Another important health issue in the border region is the prevalence of asthma affecting adults and children, which is often caused by poor air quality due to emissions from industry, electrical generation, unpaved roads, and vehicles on the road. American Indian/Alaska Native (AI/AN) Tribal Communities American Indian/Alaska Native populations live 4.4 years less than the U. S. population for all races.

The leading causes of death among AI/AN populations are heart disease, unintentional injuries, cancer, and diabetes. The Indian Health Service's Disparities Fact Sheet notes that AI/AN populations experience mortality for several causes at over double the rate of the U. S. population. Additional information regarding health disparities of AI/AN are further detailed in Trends in Indian Health: 2014 Edition .

For additional information, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington developed the U. S. Health Map, an interactive map providing county-level data for the U. S. on life expectancy, mortality rates, and risk factors. Health trend data by county is available for major causes of death, including several types of cancer, cardiovascular diseases, stroke, obesity, diabetes, hypertension, unintentional injury, and mental and substance use disorder.

IHME also publishes data and maps on major causes of death by county: US County Profiles – Institute for Health Metrics and Evaluation . What is the difference between health disparities and health inequities? Healthy People 2020 defines health disparities as:""a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.

Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. ""Health equity is defined by the National Partnership for Action to End Health Disparities as the:""Attainment of the highest level of health for all people.

Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. ""Lastly, health inequity is defined in CDC’s Social Determinants of Health Definitions as the:""difference or disparity in health outcomes that is systematic, avoidable, and unjust.

""What are the causes of rural health disparities? Causes of health disparities in rural America are many and vary by region. Some frequently cited factors that underlie rural disparities include healthcare access, socioeconomic status, unhealthy behaviors, and chronic conditions. Access to Healthcare Rural people experience many barriers to healthcare access which can contribute to health disparities.

The following factors create access difficulties for rural Americans: The uninsured rate is higher in the rural counties (nonmetropolitan) than in the urban (metropolitan) counties as reported by CDC's National Center for Health Statistics. Healthcare workforce shortages are prevalent with less than 8% of all physicians and surgeons choosing to practice in rural settings according to the National Center for Health Workforce Analysis .

Services available in rural areas are less likely to include specialized and highly sophisticated or high-intensity care. This exacerbates the problems with distance to care for people requiring higher levels of care. For some services, such as emergency medical services, the lower level of care available, when added to the increased time to services caused by distance, can be the difference in life or death.

Transportation to care can be a barrier due to long distances, poor road conditions, and the limited availability of public transportation options in rural areas.

For additional information about the access to healthcare in rural areas, see RHIhub’s topic guide: Healthcare Access in Rural Communities . Socioeconomic Status According to the Kaiser Commission on Medicaid and the Uninsured, rural populations have a higher rate of low to moderate income, are less likely to have employer-sponsored insurance coverage, and are more likely to have Medicaid or another form of public health insurance. Rural residents are more likely to be unemployed, have lower rates of post-secondary education, and have lower median household incomes than urban residents. Research has shown that these and other social determinants of health have a significant effect on health status.

Health Behaviors Whether populations adopt positive health behaviors impacts rates of disparities in health status and mortality. A 2017 Morbidity and Mortality Weekly Report article examined the prevalence of 5 key health-related behaviors by urban-rural status. Urban residents were more likely to report 4 or 5 of the behaviors. Prevalence of Health-Related Behaviors Among Adults, 2013Behavior Large metro center Large fringe metro Medium metro Small metro Micro-politan Non-core Current nonsmoking 83.9% 82.3% 80.5% 77.5% 76.5% 74.9%Non- or moderate drinking 61.1% 59.9% 63.3% 64.3% 67.3% 68.6%Maintaining normal body weight 36.5% 35.3% 33.3% 32.9% 30.6% 28.9%Meeting aerobic activity recommendations 51.4% 51.4% 51.1% 50.7% 49.2% 46.7%Sufficient sleep 62.4% 61.7% 62.4% 62.1% 61.1% 61.5%Reported 4 or 5 of these health-related behaviors 31.7% 30.2% 30.5% 29.5% 28.8% 27.0%Source: Health-Related Behaviors by Urban-Rural County Classification — United States, 2013, CDC Morbidity and Mortality Weekly Report The 2014 Update of the Rural-Urban Chartbook reports a striking difference in the rates of adolescent smoking among urban-rural classifications, with youth in rural noncore counties being more than twice as likely to smoke as their peers in large central metropolitan counties (11% vs. 5%).

This raises concerns of worsening rural health disparities in the future. For additional information about the causes of health disparities in rural areas, see RHIhub's topic guide: Social Determinants of Health for Rural People.

Where can I find supporting documents and statistics on rural health disparities? Several publications identify and describe the rural/urban disparities. Exploring Rural and Urban Mortality Differences Provides data tables and online tools displaying mortality rates for the 10 leading causes of death by rurality, age, region, and sex.

The 2014 Update of the Rural-Urban Chartbook Highlights current trends and disparities across different levels of metro- and nonmetropolitan counties. Includes population characteristics, health-related behaviors and risk factors, mortality rates, and healthcare access and use. Individual data tables are available in an Excel file. National Healthcare Disparities Report Produced annually by the Agency for Healthcare Research and Quality (AHRQ), provides a comprehensive national overview of disparities in healthcare among racial, ethnic, and socioeconomic groups in the general U. S. population and rural areas.

Tracks the success of activities to reduce disparities. Health Disparities: A Rural-Urban Chartbook Presents data on health disparities experienced by people living in rural America.

Some disparities identified are poorer health status, higher prevalence of obesity, lesser options for activity and higher mortality rates. Health, United States, 2016: With Chartbook on Long-term Trends in Health Presents an annual overview of national trends in health statistics.

Covers health status and determinants, healthcare utilization, access and expenditures. For data on rural areas see index under "" Metropolitan/nonmetropolitan data .

""Rural Healthy People 2020 Texas A&M’s Health Science Center School of Rural Public Health’s Southwest Rural Health Research Center published Rural Healthy People 2020 to provide a resource that documents the successes, challenges, and relevant information for planning. Rural Health Research Gateway: Health Disparities and Health Equity Topic Provides publications and projects on the topic of rural health disparities developed by rural health research centers that are funded by the Federal Office of Rural Health Policy (FORHP).

For additional information on rural/urban disparities see What sources cover health behaviors and health status for rural areas or by county? on RHIhub's Finding Statistics and Data Related to Rural Health topic guide. What agencies and organizations are working to seek solutions to these disparities?

Federal Office of Rural Health Policy (FORHP) FORHP, part of the Health Resources and Services Administration under the U. S. Department of Health and Human Services, promotes better healthcare service in rural America.

FORHP focuses on matters affecting rural hospitals and healthcare, coordinating activities within the department that relate to rural healthcare, maintaining a national information clearinghouse, and providing rural-specific grant programs to address many of the disparities affecting rural health. Several Rural Health Research Centers are funded by FORHP to help policymakers understand the problems rural communities face in regards to health disparities and in assuring access to healthcare.

Their research findings inform a wide audience of national, state, and local decision-makers concerned with rural health. Agency for Healthcare Research and Quality (AHRQ) Sponsors and conducts research that provides evidence-based information on healthcare outcomes; quality; and cost, use, and access. AHRQ publishes an annual National Healthcare Disparities Report that summarizes healthcare quality and access in the United States among priority populations including people with disabilities, rural populations and racial, ethnic, and socioeconomic groups.

National Institute on Minority Health and Health Disparities Leads scientific research to improve minority health and eliminate health disparities through research, training of a diverse workforce, research capacity and infrastructure development, public education and information dissemination programs. National Rural Health Association (NRHA) Promotes leadership, ideas, information, communication, education, research, advocacy, and methods to improve rural health and reduce health disparities.

The organization is composed of individual and organizational members who share a common interest in rural health. Robert Wood Johnson Foundation (RWJF) Supports research and programs devoted to health and healthcare.

Engages policymakers, business leaders, and community groups to establish a national agenda for improving population health, well-being, health equity, and to achieve better health, and track progress. For additional information on rural health research see the Conducting Rural Health Research, Assessments and Evaluation topic guide.

Where can I find programs that illustrate best practices to meet the challenges of providing health services in areas characterized by disparities? The Rural Health Information Hub's Rural Health Models and Innovations features examples of programs and interventions that have shown to be successful in providing health services in rural areas experiencing health disparities. Some examples of successful programs include: Hidalgo Medical Services – Family Support Program – Community based chronic disease intervention program to help individuals with diabetes or who are at risk for diabetes.

Community health workers (CHWs) provide education and support to diabetic and pre-diabetic patients. Kentucky Homeplace – Another community health worker (CHW) initiative focused on reducing health disparities in the rural areas of Kentucky with an emphasis on coordinating care and health coaching. Many health services are provided at no cost to the patient. The Robert Wood Johnson Foundation awards an annual Culture of Health Prize to communities that are working to improve health, well-being and health equity.

A browsable database allows you to explore prize winners' stories by community type including rural and tribal as well as by topic. What are the health disparities that affect rural minority populations? Rural minority populations often experience health disparities related to their health status, rates of chronic disease, life expectancy, and rates of unintentional injury.

Racial/Ethnic Health Disparities Among Rural Adults – United States, 2012 – 2015 shows health disparities for adult rural minority populations as compared to other racial or ethnic groups, including: Adult rural American Indians/Alaskan Natives, non-Hispanic blacks, and Hispanics self-reported higher rates of fair or poor health Rural non-Hispanic blacks and American Indian/Alaskan Native adults were more likely to report having multiple chronic health conditions than non-Hispanic whites Adult rural non-Hispanic blacks were most at risk for obesity and severe obesity American Indian/Alaskan Native rural adults reported the most limitations in their activities due to physical, mental, and emotional problems In the article All-Cause and Cause-Specific Mortality Among US Youth: Socioeconomic and Rural-Urban Disparities and International Patterns, the authors found that rural American Indian and Alaska Native (AI/AN) youth have a higher mortality rate than their urban counterparts.

Additionally, the rate of substance abuse admissions was higher for rural AI/AN than for those residing in urban areas according to a SAMHSA report .

Rural minorities face a myriad of issues that can affect their health ranging from chronic poverty, to a lack of stable medical care for migrant workers, and to language barriers experienced by newcomers to this country.

According to the HHS Action Plan to Reduce Racial and Ethnic Health Disparities the two major factors contributing to their disproportionate health problems are inadequate access to care and substandard quality of care.

Several federal government agencies within the Department of Health & Human Services work to eliminate the health disparities experienced by minority populations: HHS Office of Minority Health Dedicated to improving the health status of racial and ethnic minorities, eliminating health disparities, and achieving health equity in the United States National Partnership for Action (NPA) Works to mobilize and connect individuals and organizations across the country to create a nation free of health disparities, with quality health outcomes for all people Federal Office of Rural Health Policy (FORHP) Has had a longstanding concern with the diverse health needs of rural minority populations and provides information, expertise and grant opportunities to address the inequities found in rural minority health populations CDC's Office of Minority Health & Health Equity (OMHHE) Aims to accelerate CDC’s health impact in the U.

S population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities. Also, each state has a state office of minority health or health equity office designated to reduce health disparities within their state that provides state-level health information and resources targeted toward minority populations. Last Reviewed: 11/14/2017 "

According to the World Health Organization, the main determinants of health include the social and economic environment, the physical environment, and the person's individual characteristics and behaviors.

Health

"From Wikipedia, the free encyclopedianavigation search This article is about the human condition. For other uses, see Health (disambiguation). ""Healthy Living"" redirects here. For the publishing imprint, see Book Publishing Company. Health is the ability of a biological system to acquire, convert, allocate, distribute, and utilize the energy with maximum efficiency.

The World Health Organization (WHO) defined human health in a broader sense in its 1948 constitution as ""a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.""

[1] [2] This definition has been subject to controversy, in particular as lacking operational value, the ambiguity in developing cohesive health strategies, and because of the problem created by use of the word ""complete"", which makes it practically impossible to achieve. [3] [4] [5] Other definitions have been proposed, among which a recent definition that correlates health and personal satisfaction. [6] [7]An alternative approach focuses on avoiding definitions, which demand precise descriptions of the term.

Instead, following a three-year global conversation, convened by Alex Jadad [8] [9], ""health"" has been conceptualized as the ability to adapt and self manage when individuals communities face physical, mental or social challenges [10]. Contents [ hide ]1 History2 Determinants2.1 Potential issues3 Mental health4 Maintaining4.1 Diet4.2 Exercise4.3 Sleep4.4 Role of science4.5 Role of public health4.6 Self-care strategies5 Occupational6 See also7 References8 External links History [ edit]The definition of health has evolved over time.

In keeping with the biomedical perspective, early definitions of health focused on the theme of the body's ability to function; health was seen as a state of normal function that could be disrupted from time to time by disease.

An example of such a definition of health is: ""a state characterized by anatomic, physiologic, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological, and social stress "". [11] Then, in 1948, in a radical departure from previous definitions, the World Health Organization (WHO) proposed a definition that aimed higher: linking health to well-being, in terms of ""physical, mental, and social well-being, and not merely the absence of disease and infirmity"".

[12] Although this definition was welcomed by some as being innovative, it was also criticized as being vague, excessively broad, and was not construed as measurable.

For a long time, it was set aside as an impractical ideal and most discussions of health returned to the practicality of the biomedical model. [13]Just as there was a shift from viewing disease as a state to thinking of it as a process, the same shift happened in definitions of health. Again, the WHO played a leading role when it fostered the development of the health promotion movement in the 1980s. This brought in a new conception of health, not as a state, but in dynamic terms of resiliency, in other words, as ""a resource for living"".

1984 WHO revised the definition of health defined it as ""the extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities"". [14] Thus, health referred to the ability to maintain homeostasis and recover from insults. Mental, intellectual, emotional, and social health referred to a person's ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living.

[13]Since the late 1970s, the federal Healthy People Initiative has been a visible component of the United States’ approach to improving population health.

[15] In each decade, a new version of Healthy People is issued, [16] featuring updated goals and identifying topic areas and quantifiable objectives for health improvement during the succeeding ten years, with assessment at that point of progress or lack thereof. Progress has been limited to many objectives, leading to concerns about the effectiveness of Healthy People in shaping outcomes in the context of a decentralized and uncoordinated US health system. Healthy People 2020 gives more prominence to health promotion and preventive approaches and adds a substantive focus on the importance of addressing social determinants of health.

A new expanded digital interface facilitates use and dissemination rather than bulky printed books as produced in the past. The impact of these changes to Healthy People will be determined in the coming years. [17]Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by health care providers.

Applications with regard to animal health are covered by the veterinary sciences. The term ""healthy"" is also widely used in the context of many types of non-living organizations and their impacts for the benefit of humans, such as in the sense of healthy communities, healthy cities or healthy environments.

In addition to health care interventions and a person's surroundings, a number of other factors are known to influence the health status of individuals, including their background, lifestyle, and economic, social conditions, and spirituality; these are referred to as ""determinants of health.""

Studies have shown that high levels of stress can affect human health. [18]In the first decade of the 21th century, the conceptualization of health as an ability opened the door for self-assessments to become the main indicators to judge the performance of efforts aimed at improving human health [19]. It also created the opportunity for every person to feel healthy, even in the presence of multiple chronic diseases, or a terminal condition, and for the re-examination of determinants of health, away from the traditional approach that focuses on the reduction of the prevalence of diseases [20].

Determinants [ edit]See also: Social determinants of health and Risk factor Generally, the context in which an individual lives is of great importance for both his health status and quality of their life [21]. It is increasingly recognized that health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the individual and society.

According to the World Health Organization, the main determinants of health include the social and economic environment, the physical environment, and the person's individual characteristics and behaviors.

[22]More specifically, key factors that have been found to influence whether people are healthy or unhealthy include the following: [22] [23] [24]Income and social status Social support networks Education and literacy Employment/working conditions Social environments Physical environments Personal health practices and coping skills Healthy child development Biology and genetics Health care services Gender Culture Donald Henderson as part of the CDC's smallpox eradication team in 1966.

An increasing number of studies and reports from different organizations and contexts examine the linkages between health and different factors, including lifestyles, environments, health care organization, and health policy, one specific health policy brought into many countries in recent years was the introduction of the sugar tax.

Beverage taxes came into light with increasing concerns about obesity, particularly among youth. Sugar-sweetened beverages have become a target of anti-obesity initiatives with increasing evidence of their link to obesity.

[25] – such as the 1974 Lalonde report from Canada; [24] the Alameda County Study in California; [26] and the series of World Health Reports of the World Health Organization, which focuses on global health issues including access to health care and improving public health outcomes, especially in developing countries.

[27]The concept of the "" health field, "" as distinct from medical care, emerged from the Lalonde report from Canada.

The report identified three interdependent fields as key determinants of an individual's health. These are: [24]Lifestyle: the aggregation of personal decisions (i.e., over which the individual has control) that can be said to contribute to, or cause, illness or death;Environmental: all matters related to health external to the human body and over which the individual has little or no control;Biomedical: all aspects of health, physical and mental, developed within the human body as influenced by genetic make-up. The maintenance and promotion of health is achieved through different combination of physical, mental, and social well-being, together sometimes referred to as the ""health triangle.""

[28] [29] The WHO's 1986 Ottawa Charter for Health Promotion further stated that health is not just a state, but also ""a resource for everyday life, not the objective of living.

Health is a positive concept emphasizing social and personal resources, as well as physical capacities."" [30]Focusing more on lifestyle issues and their relationships with functional health, data from the Alameda County Study suggested that people can improve their health via exercise, enough sleep, maintaining a healthy body weight, limiting alcohol use, and avoiding smoking.

[31] Health and illness can co-exist, as even people with multiple chronic diseases or terminal illnesses can consider themselves healthy. [32]The environment is often cited as an important factor influencing the health status of individuals. This includes characteristics of the natural environment, the built environment, and the social environment. Factors such as clean water and air, adequate housing, and safe communities and roads all have been found to contribute to good health, especially to the health of infants and children.

[22] [33] Some studies have shown that a lack of neighborhood recreational spaces including natural environment leads to lower levels of personal satisfaction and higher levels of obesity, linked to lower overall health and well being.

[34] This suggests that the positive health benefits of natural space in urban neighborhoods should be taken into account in public policy and land use. Genetics, or inherited traits from parents, also play a role in determining the health status of individuals and populations.

This can encompass both the predisposition to certain diseases and health conditions, as well as the habits and behaviors individuals develop through the lifestyle of their families. For example, genetics may play a role in the manner in which people cope with stress, either mental, emotional or physical. For example, obesity is a significant problem in the United States that contributes to bad mental health and causes stress in the lives of great numbers of people [35].

(One difficulty is the issue raised by the debate over the relative strengths of genetics and other factors; interactions between genetics and environment may be of particular importance. )Potential issues [ edit]This section has an unclear citation style. The references used may be made clearer with a different or consistent style of citation and footnoting.

(March 2014) ( Learn how and when to remove this template message)A number of types of health issues are common around the globe. Disease is one of the most common. According to Global Issues.org, approximately 36 million people die each year from non-communicable (not contagious) disease including cardiovascular disease, cancer, diabetes and chronic lung disease (Shah, 2014).

Among communicable diseases, both viral and bacterial, AIDS / HIV, tuberculosis, and malaria are the most common, causing millions of deaths every year (Shah, 2014). Another health issue that causes death or contributes to other health problems is malnutrition, especially among children.

One of the groups malnutrition affects most is young children. Approximately 7.5 million children under the age of 5 die from malnutrition, usually brought on by not having the money to find or make food (Shah, 2014).

Bodily injuries are also a common health issue worldwide. These injuries, including broken bones, fractures, and burns can reduce a person's quality of life or can cause fatalities including infections that resulted from the injury or the severity injury in general (Moffett, 2013). [36]Lifestyle choices are contributing factors to poor health in many cases. These include smoking cigarettes, and can also include a poor diet, whether it is overeating or an overly constrictive diet.

Inactivity can also contribute to health issues and also a lack of sleep, excessive alcohol consumption, and neglect of oral hygiene (Moffett2013). There are also genetic disorders that are inherited by the person and can vary in how much they affect the person and when they surface (Moffett, 2013). Though the majority of these health issues are preventable, a major contributor to global ill health is the fact that approximately 1 billion people lack access to health care systems (Shah, 2014). Arguably, the most common and harmful health issue is that a great many people do not have access to quality remedies.

[37] [38]Mental health [ edit]Main article: Mental health The World Health Organization describes mental health as ""a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community"".

[39] Mental Health is not just the absence of mental illness. [40]Mental illness is described as 'the spectrum of cognitive, emotional, and behavioral conditions that interfere with social and emotional well-being and the lives and productivity of people. Having a mental illness can seriously impair, temporarily or permanently, the mental functioning of a person. Other terms include: 'mental health problem', 'illness', 'disorder', 'dysfunction'. [41]Roughly a quarter of all adults 18 and over in the US are considered diagnosable with mental illness.

Mental illnesses are the leading cause of disability in the US and Canada. Examples include, schizophrenia, ADHD, major depressive disorder, bipolar disorder, anxiety disorder, post-traumatic stress disorder and autism. [42]Many teens suffer from mental health issues in response to the pressures of society and social problems they encounter. Some of the key mental health issues seen in teens are: depression, eating disorders, and drug abuse. There are many ways to prevent these health issues from occurring such as communicating well with a teen suffering from mental health issues.

Mental health can be treated and be attentive to teens' behavior. [43]Many factors contribute to mental health problems, including: Biological factors, such as genes or brain chemistry Life experiences, such as trauma or abuse Family history of mental health problems Maintaining [ edit]Achieving and maintaining health is an ongoing process, shaped by both the evolution of health care knowledge and practices as well as personal strategies and organized interventions for staying healthy.

Diet [ edit]Main articles: Healthy diet and Human nutrition Percentage of overweight or obese population in 2010, Data source: OECD's i Library, http://stats.oecd.org [44]Percentage of obese population in 2010, Data source: OECD's i Library, http://stats.oecd.org [45]An important way to maintain your personal health is to have a healthy diet. A healthy diet includes a variety of plant-based and animal-based foods that provide nutrients to your body.

Such nutrients give you energy and keep your body running. Nutrients help build and strengthen bones, muscles, and tendons and also regulate body processes (i.e. blood pressure ). The food guide pyramid is a pyramid-shaped guide of healthy foods divided into sections. Each section shows the recommended intake for each food group (i.e. Protein, Fat, Carbohydrates, and Sugars).

Making healthy food choices is important because it can lower your risk of heart disease, developing some types of cancer, and it will contribute to maintaining a healthy weight. [46]The Mediterranean diet is commonly associated with health-promoting effects due to the fact that it contains some bioactive compounds like phenolic compounds, isoprenoids and alkaloids. [47]Exercise [ edit]Main article: Physical exercise Physical exercise enhances or maintains physical fitness and overall health and wellness.

It strengthens muscles and improves the cardiovascular system. According to the National Institute of Health (NIH) there are four types of exercise; Endurance, Strength, Flexibility, and Balance. Endurance exercises are those that will elevate your heart rate including; walking, jogging, running, hiking etc. [48]Sleep [ edit]Main articles: Sleep and Sleep deprivation Sleep is an essential component to maintaining health.

In children, sleep is also vital for growth and development. Ongoing sleep deprivation has been linked to an increased risk for some chronic health problems. In addition, sleep deprivation has been shown to correlate with both increased susceptibility to illness and slower recovery times from illness.

[49] In one study, people with chronic insufficient sleep, set as six hours of sleep a night or less, were found to be four times more likely to catch a cold compared to those who reported sleeping for seven hours or more a night. [50] Due to the role of sleep in regulating metabolism, insufficient sleep may also play a role in weight gain or, conversely, in impeding weight loss.

[51] Additionally, in 2007, the International Agency for Research on Cancer, which is the cancer research agency for the World Health Organization, declared that ""shiftwork that involves circadian disruption is probably carcinogenic to humans,"" speaking to the dangers of long-term nighttime work due to its intrusion on sleep.

[52] In 2015, the National Sleep Foundation released updated recommendations for sleep duration requirements based on age and concluded that ""Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.""

[53]Age and condition Sleep Needs Newborns (0–3 months) 14 to 17 hours Infants (4–11 months) 12 to 15 hours Toddlers (1–2 years) 11 to 14 hours Preschoolers (3–5 years) 10 to 13 hours School-age children (6–13 years) 9 to 11 hours Teenagers (14–17 years) 8 to 10 hours Adults (18–64 years) 7 to 9 hours Older Adults (65 years and over) 7 to 8 hours Role of science [ edit]Main articles: Health science and Health care The Dutch Public Health Service provides medical care for the natives of the Dutch East Indies, May 1946Health science is the branch of science focused on health.

There are two main approaches to health science: the study and research of the body and health-related issues to understand how humans (and animals) function, and the application of that knowledge to improve health and to prevent and cure diseases and other physical and mental impairments.

The science builds on many sub-fields, including biology, biochemistry, physics, epidemiology, pharmacology, medical sociology. Applied health sciences endeavor to better understand and improve human health through applications in areas such as health education, biomedical engineering, biotechnology and public health. Organized interventions to improve health based on the principles and procedures developed through the health sciences are provided by practitioners trained in medicine, nursing, nutrition, pharmacy, social work, psychology, occupational therapy, physical therapy and other health care professions. Clinical practitioners focus mainly on the health of individuals, while public health practitioners consider the overall health of communities and populations. Workplace wellness programs are increasingly adopted by companies for their value in improving the health and well-being of their employees, as are school health services in order to improve the health and well-being of children.

Role of public health [ edit]Main article: Public health See also: Global health Postage stamp, New Zealand, 1933.

Public health has been promoted – and depicted – in a wide variety of ways. Public health has been described as ""the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals."" [54] It is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents (for instance, in the case of a pandemic ).

Public health has many sub-fields, but typically includes the interdisciplinary categories of epidemiology, biostatistics and health services. Environmental health, community health, behavioral health, and occupational health are also important areas of public health.

The focus of public health interventions is to prevent and manage diseases, injuries and other health conditions through surveillance of cases and the promotion of healthy behavior, communities, and (in aspects relevant to human health) environments. Its aim is to prevent health problems from happening or re-occurring by implementing educational programs, developing policies, administering services and conducting research. [55] In many cases, treating a disease or controlling a pathogen can be vital to preventing it in others, such as during an outbreak.

Vaccination programs and distribution of condoms to prevent the spread of communicable diseases are examples of common preventive public health measures, as are educational campaigns to promote vaccination and the use of condoms (including overcoming resistance to such). Public health also takes various actions to limit the health disparities between different areas of the country and, in some cases, the continent or world. One issue is the access of individuals and communities to health care in terms of financial, geographical or socio-cultural constraints to accessing and using services.

[56] Applications of the public health system include the areas of maternal and child health, health services administration, emergency response, and prevention and control of infectious and chronic diseases. The great positive impact of public health programs is widely acknowledged. Due in part to the policies and actions developed through public health, the 20th century registered a decrease in the mortality rates for infants and children and a continual increase in life expectancy in most parts of the world.

For example, it is estimated that life expectancy has increased for Americans by thirty years since 1900, [57] and worldwide by six years since 1990.

[58]Self-care strategies [ edit]Main article: Self care See also: Chronic care management, Social relation, and Stress management A lady washing her hands c. 1655Personal health depends partially on the active, passive, and assisted cues people observe and adopt about their own health. These include personal actions for preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. They also include personal hygiene practices to prevent infection and illness, such as bathing and washing hands with soap; brushing and flossing teeth; storing, preparing and handling food safely; and many others.

The information gleaned from personal observations of daily living – such as about sleep patterns, exercise behavior, nutritional intake and environmental features – may be used to inform personal decisions and actions ( e.g., ""I feel tired in the morning so I am going to try sleeping on a different pillow""), as well as clinical decisions and treatment plans ( e.g., a patient who notices his or her shoes are tighter than usual may be having exacerbation of left-sided heart failure, and may require diuretic medication to reduce fluid overload).

[59]Personal health also depends partially on the social structure of a person's life. The maintenance of strong social relationships, volunteering, and other social activities have been linked to positive mental health and also increased longevity.

One American study among seniors over age 70, found that frequent volunteering was associated with reduced risk of dying compared with older persons who did not volunteer, regardless of physical health status. [60] Another study from Singapore reported that volunteering retirees had significantly better cognitive performance scores, fewer depressive symptoms, and better mental well-being and life satisfaction than non-volunteering retirees.

[61]Prolonged psychological stress may negatively impact health, and has been cited as a factor in cognitive impairment with aging, depressive illness, and expression of disease. [62] Stress management is the application of methods to either reduce stress or increase tolerance to stress. Relaxation techniques are physical methods used to relieve stress. Psychological methods include cognitive therapy, meditation, and positive thinking, which work by reducing response to stress. Improving relevant skills, such as problem solving and time management skills, reduces uncertainty and builds confidence, which also reduces the reaction to stress-causing situations where those skills are applicable. Occupational [ edit]Main article: Occupational safety and health In addition to safety risks, many jobs also present risks of disease, illness and other long-term health problems.

Among the most common occupational diseases are various forms of pneumoconiosis, including silicosis and coal worker's pneumoconiosis (black lung disease). Asthma is another respiratory illness that many workers are vulnerable to. Workers may also be vulnerable to skin diseases, including eczema, dermatitis, urticaria, sunburn, and skin cancer.

[63] [64] Other occupational diseases of concern include carpal tunnel syndrome and lead poisoning.

As the number of service sector jobs has risen in developed countries, more and more jobs have become sedentary, presenting a different array of health problems than those associated with manufacturing and the primary sector. Contemporary problems, such as the growing rate of obesity and issues relating to stress and overwork in many countries, have further complicated the interaction between work and health.

Many governments view occupational health as a social challenge and have formed public organizations to ensure the health and safety of workers. Examples of these include the British Health and Safety Executive and in the United States, the National Institute for Occupational Safety and Health, which conducts research on occupational health and safety, and the Occupational Safety and Health Administration, which handles regulation and policy relating to worker safety and health.

[65] [66] [67]See also [ edit]Book: Health Men's health Women's health Youth health Population health Public health Disease burden Health care Health system Medicine Human enhancement One Health Healing Wellness [ disambiguation needed]References [ edit]^ World Health Organization.

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But much of the responsibility of the social inequity that leads to different health outcomes lies elsewhere. Health is affected by policies in other sectors, such as education, taxation, transport, and agriculture too.

How social class affects health

How social class affects health March 10, 2014 3.53pm EDTAuthor Sharon Friel Professor of Health Equity, Australian National University Disclosure statement Sharon Friel receives funding from the Australian Research Council.

Partners Australian National University provides funding as a member of The Conversation AU. View all partners Republish this article Republish our articles for free, online or in print, under Creative Commons license. Your socioeconomic status affects your access to quality and affordable education and health care. Andrew Warran/Flickr, CC BY-NC-NDEmail Twitter Facebook Linked In Print The Conversation is running a series, Class in Australia, to identify, illuminate and debate its many manifestations.

Here, Sharon Friel considers the points where class and health interact. The unequal distribution of power, money and resources also creates health inequities.

Nowhere is this clearer to witness in Australia than in the fact that the richest 20% of the population can expect to live an average of six years longer than the poorest 20%. Australians who are socially disadvantaged by income, employment status, education and place of residence, and Indigenous Australians, also have a higher risk of chronic diseases, such as diabetes, heart disease and cancers, and depression.

Things don’t have to be this way. Differences in health outcomes at the population level are not explained by genetic variation or because of some mythical deviant behaviour particular to people in lower social class groups. Indeed, the existence of systematic social differences in health outcomes show there’s something in our society creating an unequal distribution of opportunity to be healthy.

These health differences are both avoidable and unfair. Embracing complexity People need the basic material requisites for a decent life, they need to have control over their lives, and they need a voice in decision-making processes and implementation of policy and programs that affect them.

Economic and social policies generate and distribute political power, income, goods and services. And who you are will affect your access to quality and affordable education and health care, sufficient nutritious food, good work and leisure conditions, among other things.

Together these factors constitute what determines your health and social health inequities. A first glance, the “social determinants of health” approach suggests that health inequities are produced (and prevented) by policies and actions within the health sector. The possible $6 co-payment for a visit to the doctor touted by the health minister, for instance, would undoubtedly affect lower income groups more than others.

Education, for example, equips people with the resources needed throughout life to achieve a secure income, provide for family, and cope with disease. Children from economically disadvantaged backgrounds are more likely to do poorly in school and drop out early.

They usually grow up to be adults with lower incomes and are less empowered to provide good health care, nutrition, and stimulation to their own children. This is how disadvantage is transmitted through generations. Decent work, including wages that reflect the real cost of living, is also important for health.

Work can provide financial security, social status, personal development, social relations and self-esteem, and protection from physical and psychosocial hazards. In Australia, the wages of a worker in the bottom 10% of income earners has risen by 15% since 1975, while wages of people in the top 10% have risen by 59% in the same period.

In 2009, the top 20 CEOs in Australia earned more than 100 times the average wage. What’s more, the number of factors affecting health may actually be growing. Because we live in a rapidly globalising world, we now need to consider the effects of trade on lives and health as well.

We need to ensure trade policy doesn’t undermine governments’ capacity to regulate in favour of health;And that deregulation of working conditions doesn’t widen the gap between good and poor quality jobs, which can be worse for health than no job at all. Australian data show adverse job conditions (high job demands and complexity, low job control, job insecurity and unfair pay) are worse for mental health than being unemployed.

Creating change One way of looking at this is that it’s all too complex and difficult to do anything about. Another is to recognise the numerous entry points and opportunities to improve health and quality of life.

For people not convinced by the argument that health inequities are unethical, the fact that they’re also incredibly inefficient should stimulate action to reduce them. Preventing health inequities would result in savings of $2.3 billion in hospital expenditure; and 5.3 million fewer Pharmaceutical Benefit Scheme scripts would be filled each year, resulting in annual savings of $184.5 million.

Clearly, reducing health inequities is not something that can be achieved overnight. It requires a long-term view, and sustained political will. The intersectoral nature of the determinants of health inequities demands a holistic response. It requires ministers from all policy domains to each consider the impact of their decisions on the social well-being and health of all Australians.

But the current political climate doesn’t bode well for health inequities in this country. The apparent focus on productivity at any cost, and the control of public discourse by a powerful business elite suggests we have a long way to go before we can create economic and social conditions that support all people to achieve their potential.

See the other articles in the series Class in Australia here. Social determinants of health Class in Australia Tweet Share Get newsletter You might also like Dental report card fail: half of adults and one-third of kids don’t brush twice a day People with disability have a lot to offer employers Explainer: How we all benefit from the public health system Expansion of cashless welfare card shows shock tactics speak louder than evidence