“We have two rulebooks — one for charity and one for the rest of the economic world. It’s an apartheid and it discriminates against the nonprofit sector…” You want to make $50 million selling violent video games to kids—go for it—we’ll put you on the cover of Wired magazine. But, you want make half a million dollars trying to cure kids of malaria you’re considered a parasite yourself.”
-Dan Pallotta
A Resource to Help Communities Address Social Determinants of Health
Table of Contents
Introduction p.4
Participants p.5
Chapter One: Achieving Health Equity p.6
What is health equity? p.6
How do social determinants influence health? p.10
Learning from doing p.11
Chapter Two: Communities Working to Achieve Health Equity p.12 Background: The Social Determinants of Disparities in Health Forum p.12 Small-scale program and policy initiatives p.14
Case Study 1: Project Brotherhood p.14 Case Study 2: Poder Es Salud (Power for Health) p.16 Case Study 3: Project BRAVE: Building and Revitalizing an Anti-Violence Environment p.18
Traditional public health program and policy initiatives p.20 Case Study 4: Healthy Eating and Exercising to Reduce Diabetes p.20 Case Study 5: Taking Action: The Boston Public Health Commission’s Efforts to Undo Racism p.22 Case Study 6: The Community Action Model to Address Disparities in Health p.24
Large-scale program and policy initiatives p.26 Case Study 7: New Deal for Communities p.26 Case Study 8: From Neurons to King County Neighborhoods p.28 Case Study 9: The Delta Health Center p.30
Chapter Three: Developing a Social Determinants of Health
Inequities Initiative in Your Community p.32–89 Section 1: Creating Your Partnership to Address Social Determinants of Health p.34 Section 2: Focusing Your Partnership on Social Determinants of Health p.42 Section 3: Building Capacity to Address Social Determinants of Health p.54 Section 4: Selecting Your Approach to Create Change p.58 Section 5: Moving to Action p.76 Section 6: Assessing Your Progress p.82 Section 7: Maintaining Momentum p.88
Chapter Four: Closing Thoughts p.90
Tables
Table 1.1: Examples of Health Disparities by Racial/Ethnic Group or by Socioeconomic Status p.7 Table 1.2: Social Determinants by Populations p.8 Table 3.1: Applying Assessment Methods to Different Types of Social Determinants p.47
Figures
Figure 1.1: Pathways from Social Determinants to Health p.10 Figure 1.2: Growing Communities: Social Determinants, Behavior, and Health p.11 Figure 3.1: Phases of a Social Determinants of Health Initiative p.33
Suggested Readings and Resources p.92
References p.106
#5. Focus on getting better, rather than being good
Believing you have the ability to reach your goals is important, but so is believing you can get the ability. Many of us believe that our intelligence, our personality, and our physical aptitudes are fixed — that no matter what we do, we won’t improve. As a result, we focus on goals that are all about proving ourselves, rather than developing and acquiring new skills.
Fortunately, decades of research suggest that the belief in fixed ability is completely wrong — abilities of all kinds are profoundly malleable. Embracing the fact that you can change will allow you to make better choices, and reach your fullest potential. People whose goals are about getting better, rather than being good, take difficulty in stride, and appreciate the journey as much as the destination.
The California Endowment is investing $1 billion between 2010 and 2020 in 14 low-income communities in the California Bay area to improve health outcomes. Tony Iton, MD, JD, MPH, former director of the Alameda County Department of Public Health and now Senior Vice President, Healthy Communities at The California Endowment leads the effort. For over a decade in the Bay area, Dr. Iton, who focuses on public health practice, has studied the link between social, economic and political constraints on communities and health outcomes. His findings corroborate over 30 years of international research that show morbidity (how people feel when they are alive) and even death can be socially determined.
Using this rough explanatory model as a guide:
Dr. Iton’s teams have rigorously assessed community needs and are working with residents to—among other things—achieve more political participation in driving policy change to reduce socioeconomic inequality. It appears to be an incredibly well thought out plan. For example, Iton has hired health journalists and is training them to become experts in crafting impactful narratives around “equity, fairness and values” to promote community concerns. In addition to examining such things as healthy school programs and land use policies the initiative is working with youth leaders to develop solutions to youth violence that are more restorative and less punitive. Not exactly an agenda that come to mind when thinking about the mission of public health. It is a comprehensive program and bears watching.
Read more about this initiative and the 14 communities here .
Last Friday, the University of Chicago announced that randomized clinical trial evidence has shown an out-of-school sports counseling program, B.A.M. (Becoming A Man) reduces youth violence, increases school engagement and strengthens longer-term life chances. The program also proved cost-effective. These are amazing findings by a University of Chicago research team that included highly regarded social scientist Harold Pollack.
We support the call for an end to The War on Drugs against young men. Yet, job availability for those “displaced” when the war ends will be necessary to make the end to The War on Drugs truly successful. Social innovation and public/private leadership can include a bridge to alternative work opportunities for young men right now.
We were encouraged to find solid programs on a local and national level, both in the U.S. and abroad. In New York City, community resources are being provided by local government and nonprofits. As an example, the NeON program is a new government program that targets court-involved adolescents and young adults, while Community Service Society of New York is a nonprofit with a long history of providing outstanding research, advocacy and direct service programs. Nationally, the Open Society Foundations and Echoing Green’s inaugural Black Male Achievement Fellowship are building a pipeline of young social entrepreneurs with great ideas to help. Finally, JOBLINGE, a Germany-based nonprofit, has been profiled by The World Economic Forum as a best practice in reducing youth unemployment.
We are two social justice warriors here to join the conversation on how collective action can address pressing social problems. We brought our most inspirational quotes and an 8-track too.
