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Social Determinants of Health      and Health Equity   Virginia Rural Health Action Conference            Charlottesville,...
County Life Expectancies by RaceMurray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. PLoS MedicineVol. ...
Male life           Female life             General                                                         Female–male di...
WHO Conceptual ModelFrom: A Conceptual Model for Taking Action on the Social Determinants of Health.Geneva: World Health O...
Beyond the Clinical Setting
Role of Personal Health BehaviorsCause                                       Estimated deathsTobacco                      ...
The importance of behavioral and social factors   Policies to promote child                                    Policies to...
“Downstream” determinants• Access to healthy foods   •   Tobacco and alcohol• Physical activity         •   Healthy housin...
“Health in All” Policies•   Transportation•   Land use•   Built environment•   Taxes                     Health and•   Hou...
“Upstream determinants”• Inadequate education• Unemployment• Declining income and net worth
Am J Public Health. 2004;94:2078-81
Figure 1. Potential Lives Saved by Improvements in Age-Adjusted Mortality Rates in the                                    ...
Figure 2. Difference in Age-Adjusted Mortality Rates of Whites and African Americans in 1991-                             ...
Am J Public Health. 2007;97:679–683
250,000      Deaths (per year) potentially      averted in the United States                                      200,000 ...
www.humanneeds.vcu.edu
Poverty in South Delta, Mississippi
Life Expectancy in South Delta,          Mississippi
Am J Public Health. 2010;100:750-5
Proportion of Deaths in Virginia Associated With           Reduced Household Income                  30                  2...
Page County, Virginia
www.countyhealthcalculator.org
Annual Costs (Health Care And Program Spending), Three Layered Intervention Scenarios,                                    ...
Contact Information• Steven H. Woolf, MD, MPH  Center on Human Needs  Department of Family Medicine  Virginia Commonwealth...
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  1. 1. Social Determinants of Health and Health Equity Virginia Rural Health Action Conference Charlottesville, Virginia October 8, 2012 Steven H. Woolf, MD, MPH VCU Center on Human Needs Department of Family Medicine Virginia Commonwealth University
  2. 2. County Life Expectancies by RaceMurray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. PLoS MedicineVol. 3, No. 9, e260 doi:10.1371/journal.pmed.0030260
  3. 3. Male life Female life General Female–male difference America expectancy expectancy description in life expectancy at birth at birth 1 Asians 82.8 87.7 4.9 White low-income 2 rural 76.2 81.8 5.6 Northland 3 Middle America 75.2 80.2 5.0 White poor 4 Appalachia/ 71.8 77.8 6.1 Mississippi Valley Western Native 5 Americans 69.4 75.9 6.6 Black middle 6 America 69.6 75.9 6.4 Black poor rural 7 South 67.7 74.6 6.9 Black high-risk 8 urban 66.7 74.9 8.2Murray CJ, Kulkarni S, Ezzati M. Eight Americas: new perspectives on U.S. healthdisparities.Am J Prev Med 2005;29(5 Suppl 1):4-10.
  4. 4. WHO Conceptual ModelFrom: A Conceptual Model for Taking Action on the Social Determinants of Health.Geneva: World Health Organization, 2010
  5. 5. Beyond the Clinical Setting
  6. 6. Role of Personal Health BehaviorsCause Estimated deathsTobacco 400,000Diet/activity patterns 300,000Alcohol 100,000Microbial agents 90,000Toxic agents 60,000Firearms 35,000Sexual behavior 30,000Motor vehicles 25,000Illicit use of drugs 20,000Source: McGinnis and Foege. JAMA 1993;270:2207-12.
  7. 7. The importance of behavioral and social factors Policies to promote child Policies to promote economic and youth development development and reduce poverty and education, infancy through college Policies to promote healthier homes, neighborhoods, Economic & Social schools and Opportunities and Resources workplaces Living & Working Conditions in Homes and Communities Medical Personal Care Behavior HEALTH Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org
  8. 8. “Downstream” determinants• Access to healthy foods • Tobacco and alcohol• Physical activity • Healthy housing • Safe neighborhoods • Clean air and water • Safe working conditions
  9. 9. “Health in All” Policies• Transportation• Land use• Built environment• Taxes Health and• Housing illness• Agriculture• Environmental justice• Etc.
  10. 10. “Upstream determinants”• Inadequate education• Unemployment• Declining income and net worth
  11. 11. Am J Public Health. 2004;94:2078-81
  12. 12. Figure 1. Potential Lives Saved by Improvements in Age-Adjusted Mortality Rates in the United States, 1991-2000 Age-Adjusted Mortality 1,700,000 1,700 Rate (per 100,000) 1,500,000 1,400 1,300,000 1,100 1,100,000 800 Potentially Averted Deaths 900,000 500 in the United States 700,000 200 500,000 -100 300,000 -400 176,633 100,000 -700 -100,000 -1,000 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 US deaths potentially averted each year by secular improvements in age-adjusted mortality rates Cumulative deaths potentially averted after 1990 US age-adjusted mortality rate Legend: Age-adjusted death rates taken from: Table 35. Death rates for all causes, according to sex, race, Hispanic origin, and age: United States, selected years 1950-2001, accessed at ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus03/Table035.xls. Potentially avertable deaths calculated as described in text and Table 1.From: Woolf SH, Johnson RE. Am J Public Health 2004;94:2078-81
  13. 13. Figure 2. Difference in Age-Adjusted Mortality Rates of Whites and African Americans in 1991- 2000 and Potential Lives Saved if the Rates Had Been Comparable Age-Adjusted Mortality 1,700,000 1,700 Rate (per 100,000) 1,500,000 1,400 1,300,000 1,100 1,100,000 800 886,202 900,000 500 Resolving Disparities Avertable Deaths by 700,000 200 500,000 -100 300,000 -400 100,000 -700 -100,000 -1,000 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 African American deaths potentially averted each year by correcting disparity in age-adjusted mortality rates Cumulative deaths potentially averted after 1990 African American male age-adjusted mortality rate White male age-adjusted mortality rate African American female age-adjusted mortality rate White female age-adjusted mortality rate Legend: Age-adjusted death rates taken from: Table 35. Death rates for all causes, according to sex, race, Hispanic origin, and age: United States, selected years 1950-2001, accessed at ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus03/Table035.xls. Potentially avertable deaths calculated as described in text and Table 2.From: Woolf SH, Johnson RE. Am J Public Health 2004;94:2078-81
  14. 14. Am J Public Health. 2007;97:679–683
  15. 15. 250,000 Deaths (per year) potentially averted in the United States 200,000 150,000 100,000 50,000 0 -50,000 1996 1997 1998 1999 2000 Year 2001 2002 Deaths potentially averted by medical advances (see footnotes) Deaths potentially averted by eliminating education-associated excess mortality (see footnotes)Am J Public Health. 2007;97:679–683
  16. 16. www.humanneeds.vcu.edu
  17. 17. Poverty in South Delta, Mississippi
  18. 18. Life Expectancy in South Delta, Mississippi
  19. 19. Am J Public Health. 2010;100:750-5
  20. 20. Proportion of Deaths in Virginia Associated With Reduced Household Income 30 25 20 Proportion of deaths that 15 would be averted (%) 10 5 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006Am J Public Health. 2010;100:750-5
  21. 21. Page County, Virginia
  22. 22. www.countyhealthcalculator.org
  23. 23. Annual Costs (Health Care And Program Spending), Three Layered Intervention Scenarios, Year 0 To Year 25. Milstein B et al. Health Aff 2011;30:823-832©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
  24. 24. Contact Information• Steven H. Woolf, MD, MPH Center on Human Needs Department of Family Medicine Virginia Commonwealth University 804-828-9625• swoolf@vcu.edu

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