Putting Communities in Context for Better Health Philanthropy
posted on: April 15, 2011
Did you know that geography, poverty, literacy rates and other social factors have greater cumulative influence on someone’s health outcome in the U.S. than do disease, injury or mortality? And yet, many health grantmakers fail to take into account these social determinants and base their domestic health grantmaking using a medical lens alone.
Dr. Anthony Iton of The California Endowment has challenged his colleagues to look into the eyes of the children to assess the health of a community. The kind of pattern recognition that a skilled clinician uses to assess and begin to diagnose a person’s psychological and physical condition by looking at them has been imitated in recent years through research that diagnoses the health status of communities. Such research has resulted in an understanding of the role of place in the health outcomes of Americans.“Systemic, avoidable, unfair and unjust” are Dr. Iton’s words for the inequities that result from “socio-ecological” factors, including including discrimination, institutional power and neighborhood conditions. These social determinants of health play a larger part in health outcomes than do risk behaviors, disease or injury, or mortality, which comprise the usual measures of the “medical model” that has dominated the country’s public health and medical care. The medical model fails to see people in context.
Context helps us understand the root causes of health outcomes. For instance, social “stressors” have biochemical effects. The body releases cortisol in response to stress. Higher levels of cortisol are correlated with lower life expectancy. Take away the negative stressors in people’s communities – poor housing, the inability to read, discrimination, powerlessness, violence and poverty – and you improve health outcomes.
While traditional medical care is critical and must be reformed, it can no longer be our sole focus. Dr. David Satcher, former U.S. surgeon general, notes that between 1991 and 2000, advances in medical technology averted 177,000 deaths, but he also notes that the elimination of disparities between African Americans and whites could have averted 886,000 deaths. He contends, “If we can achieve health equity and create healthy communities, we can do more to improve the overall health of the nation than is likely from advances in medicine.”
8. Martha Halko, Michele Benko, and The Land Use Committee, 2009 Cuyahoga County Health and Land Use Summit Report, http://www.ccbh.net/ccbh/opencms/CCBH/pdf/communityhealth/2009SummitReport.pdf.
9. Bay Area Regional Health Inequities Initiative (2008), http://www.barhii.org/press/download/barhii_report08.pdf.
10. Anthony Iton, presentation at Consumer Health Foundation Annual Meeting, May 20, 2010.
12. David Williams, Manuela V. Costa, A. O. Odunlami and S. A. Mohammed, “Moving Upstream: How Interventions that Address Social Determinants of Health Can Improve Health and Reduce Disparities,” Journal of Public Health Management and Practice, 14 (6) S8 – S17 (2008).
13. Bay Area Regional Health Inequities Initiative, Op.Cit., p. 8.