“Targeting the Social Determinants of Health”

Atlanta, GAAtlanta, GAMarch 7, 2013March 7, 2013

David Satcher, M.D., PhD.

Director, The Satcher Health Leadership Institute and

The Center of Excellence on Health Disparities

Poussaint-Satcher- Cosby Professor of Mental Health

Morehouse School of Medicine

16th U.S. Surgeon General

Urban Health Disparities SummitUrban Health Disparities SummitShaping Action to Reduce DisparitiesShaping Action to Reduce Disparities

Georgia State UniversityGeorgia State University

Satcher Health Leadership Institute Satcher Health Leadership Institute MissionMission

The mission of the Satcher Health Leadership Institute (SHLI) is to develop a diverse group of exceptional health leaders, advance and support comprehensive health system strategies, and actively promote policies and practices that will reduce and ultimately eliminate disparities in health.

www.satcherhealthleadershipinstitute.orgwww.satcherhealthleadershipinstitute.org

““Today, the need for leaders is too Today, the need for leaders is too

great to leave their emergence to great to leave their emergence to chancechance.”.”

Institute of Medicine Report, 1988

LEADERSHIP LESSONS FROM THE LEADERSHIP LESSONS FROM THE SATCHER HEALTH LEADERSHIP SATCHER HEALTH LEADERSHIP

INSTITUTE INSTITUTE

• Leadership Responds to Opportunities, Challenges and CrisesLeadership Responds to Opportunities, Challenges and Crises

• Leadership is a Team SportLeadership is a Team Sport

• Leadership is Not Position DependentLeadership is Not Position Dependent

• Effective Leadership Transforms communitiesEffective Leadership Transforms communities

• Leadership Requires a Global PerspectiveLeadership Requires a Global Perspective

• Leadership is like a Relay RaceLeadership is like a Relay Race

Reports of the 16th

Surgeon GeneralReports of the 16th

Surgeon General

Best available science

HEALTHY PEOPLE 2010:HEALTHY PEOPLE 2010:OVERARCHING GOALSOVERARCHING GOALS

• Increase Years and Quality of

Healthy Life

• Eliminate Racial and ethnic Health Disparities

HEALTH DISPARITIESHEALTHY PEOPLE 2010

DEFINITION

Differences that occur in health by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.

Infant Mortality Rates By Race and Hispanic Origin, 1999

Infant deaths per 1,000 live births

5.8

14

9.3

4.85.7

0

2

4

6

8

10

12

14

White Black AI/AN A/PI Hispanic

Disparities: Infant Mortality

DISPARITIES: CARDIOVASCULAR DISPARITIES: CARDIOVASCULAR DISEASEDISEASE

AGE-ADJUSTED TOTAL PREVALENCE OF DIABETES IN AGE-ADJUSTED TOTAL PREVALENCE OF DIABETES IN PEOPLE AGED 20 YEARS OR OLDER, BY PEOPLE AGED 20 YEARS OR OLDER, BY

RACE/ETHNICITY—RACE/ETHNICITY—UNITED STATES, 2002UNITED STATES, 2002

Source: 1999-2001 National Health Interview Survey

and 1999-2000 National Health and Nutrition Examination Survey

WHAT IF WE HAD ELIMINATED WHAT IF WE HAD ELIMINATED DISPARITIES IN THE LAST CENTURY?DISPARITIES IN THE LAST CENTURY?

Fewer Black Deaths…Fewer Black Deaths…

In 2000In 2000

83,500 overall83,500 overall• 24,000 from heart disease24,000 from heart disease• 7,000 from HIV / AIDS7,000 from HIV / AIDS• 4,700 infant deaths4,700 infant deaths• 22,000 from diabetes22,000 from diabetes• 2000 fewer Black women from breast cancer2000 fewer Black women from breast cancer

More Health Insurance Coverage…More Health Insurance Coverage…• 2.5 million Blacks, including 620,000 children2.5 million Blacks, including 620,000 children

Source: D. Satcher et al, Health Affairs, March/April 2005

WHAT IF WE WERE EQUAL?WHAT IF WE WERE EQUAL?

Source: D. Satcher et al, Health Affairs, March/April 2005

Difference in Child Mortality Rate ChangesDifference in Child Mortality Rate ChangesUnder-five mortality rate by regionUnder-five mortality rate by region

Source: UNICEF 2001Source: UNICEF 2001

CSDH: Fig. 2.2CSDH: Fig. 2.2Under-5 Mortality Rate Per 1000 Live Births by Under-5 Mortality Rate Per 1000 Live Births by

Levels of Household WealthLevels of Household Wealth

Source: Gwatkin et al. (2007), using DHS data; WHO Commission Final

Report, 2008.

Source: Gwatkin et al. (2007), using DHS data; WHO Commission Final

Report, 2008.

Determinants of HealthDeterminants of Health

Source: Healthy People 2010Source: Healthy People 2010

Fig. 4.1 D. Satcher, R. Pamies, F. Dunston 2006

Community Factors Associated withRacial and Ethnic Health Disparities

Environmental toxins Alcohol or drug

additionSubstandard

education

Violence

PovertySubstandard

housing

Poor Health Outcomes

HEALTHY PEOPLE 2020:HEALTHY PEOPLE 2020:OVERARCHING GOALSOVERARCHING GOALS

• Attain high quality, longer lives free of preventable disease, disability, injury, and premature death

• Achieve health equity, eliminate disparities, and improve the health of all groups

• Create social and physical environments that promote good health for all

• Promote quality of life, healthy development, and healthy behaviors across all life stages

WHAT ARE THE SOCIAL WHAT ARE THE SOCIAL DETERMINANTS OF DETERMINANTS OF HEALTH?HEALTH?

• The conditions in which people are born, grow, live, work and age.

• They are shaped by the distribution of money, power and resources at global, national and local levels.

• Changes in the Social Determinants of Health often require policy changes.

HEALTH DISPARITIES & HEALTH DISPARITIES & THE AFFORDABLE CARE ACTTHE AFFORDABLE CARE ACT

Preventive care Coordinated care Diversity and cultural competency Health care providers for underserved

communities Ending insurance discrimination Affordable insurance coverage

NATIONAL PREVENTION NATIONAL PREVENTION STRATEGYSTRATEGY

Establish the National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness, and public health activities.

Establish a Prevention and Public Health Fund for prevention, wellness, and public health activities.

Establish a grant program to support the delivery of evidence-based and community-based prevention.

LIFESTYLE INDICATORS AND LIFESTYLE INDICATORS AND THE 16THE 16THTH SURGEON SURGEON GENERAL’S RXGENERAL’S RX

“ “In order to eliminate In order to eliminate disparities in health, we disparities in health, we need leaders who care need leaders who care

enough, know enough, will enough, know enough, will do enough and are do enough and are

persistent enough.”persistent enough.”

“Targeting the Social Determinants of Health”

Atlanta, GAAtlanta, GAMarch 7, 2013March 7, 2013

David Satcher, M.D., PhD.

Director, The Satcher Health Leadership Institute and

The Center of Excellence on Health Disparities

Poussaint-Satcher- Cosby Professor of Mental Health

Morehouse School of Medicine

16th U.S. Surgeon General

Urban Health Disparities SummitUrban Health Disparities SummitShaping Action to Reduce DisparitiesShaping Action to Reduce Disparities

Georgia State UniversityGeorgia State University