Social Determinants of Health
What are social determinants of health?
Watch Khan Academy’s “Health and Healthcare Disparities” - 4min (1)
How are health disparities changing over time and space?
How does inequality affect health?
Check out Richard Wilkinson’s TedTalk “How Economic Inequality Harms Societies”- 16min (4)
What are the current disparities in health for different social determinants (sex, income, race, and location)?
How is this relevant to Harlem Hospital and The Allen Hospital?
The average household income of residents of Central/East Harlem, Washington Heights, and the South Bronx is $44,321 compared with the national average of $67,315 (7). Between 40.3 and 60.4% of residents in these communities receive some form of government assistance, including cash assistance, TANF, SSI, or Medicaid (7).
There are many mediators of socioeconomic status as a social determinant of health. Here are some examples in Central Harlem and Washington Heights from a 2015 report:
1. Housing: The percentage of renters with maintenance defects in their home (including water leaks, cracks and holes, inadequate heat, mice or rats, and peeling paint) is 74% in Central Harlem and 75% in Washington Heights. This is compared to 57% for Manhattan overall (8).
2. Education: The percentage to graduate college is 39% in Central Harlem and 36% in Washington Heights, compared to 63% for Manhattan overall (8).
3. Employment: The unemployment rate is 13% in Central Harlem and 16% in Washington Heights, compared to 8% for Manhattan overall (8).
Incarceration:The Central Harlem incarceration rate for adults ages 16 and older is the third highest in the city and more than 3 times the Manhattan rate (8). The Washington Heights incarceration rate is 20th in the city and higher than the Manhattan rate (8).
As a result of some of these social determinants, there are significant health disparities in Central Harlem and Washington Heights compared to other neighborhoods in NYC. Here are some examples from a 2015 report:
1. Obesity: The prevalence of obesity is 28% in Central Harlem and 22% in Washington Heights, compared to 16% for Manhattan overall (8).
2. HIV: The incidence of new HIV diagnoses in Central Harlem is the 2nd highest in the city, more than 2 times the citywide rate.8 The incidence in Washington Heights is the 11th highest in the city (8).
3. Stroke: The rate of stroke hospitalizations in Central Harlem is the 4th highest in the city with 466 per 100,000 adults. The rate in Washington Heights is 329 per 100,000 adults, compared to 264 per 100,000 for Manhattan overall (8).
4. Mental Illness: The Central Harlem rate of psychiatric hospitalizations is 1038 per 100,000 compared to 755 per 100,000 for Manhattan overall.8 The rate in Washington Heights is actually lower than the citywide rate at 497 per 100,000 (8).
How is this relevant to Stamford Hospital?
In 2015, the Stamford median household income was $79,359, higher than the median income in Connecticut overall, and almost double the average income in Central Harlem and Washington Heights (9). Only 9.4% of the population lives below the poverty line, lower than the national average of 14.7% (9).
1. Housing: The median property value in Stamford is $501,200, which is greater than the state median value of $260,000 (9). Though more than 55% of residents own their home, this is lower than the statewide average (9).
2. Education: According to the American Community Survey, 47% of residents have at least a bachelor’s degree, which is higher than 38% in Connecticut overall (10).
3. Employment: The unemployment rate in Stamford is 3.7%, which is lower than the statewide rate of 4.3% (11).
1. Mortality: Between 2008 and 2012, mortality from all causes, accidents, cancer, drug use, heart disease, kidney disease, chronic lower respiratory disease, and stroke was lower in Stamford than in Connecticut overall (12).
2. Hypertension: In Stamford, 24% of residents have hypertension compared with 28% of the state of Connecticut. However, the Stamford hypertension rate varies by income. 34% of residents with an income less than $30,000 have hypertension, compared with 19% of residents with an income greater than $75,000 (12).
3. Asthma: 9% of residents have asthma compared with 13% of Connecticut residents overall. However, this rate increases to the statewide average in patients with an income less than $30,000, compared with 8% of residents with an income greater than $75,000 (12).
4. Obesity: 22% of Stamford residents are obese, compared with 26% of Connecticut overall. However, this rate increases to 33% in residents with an income less than $30,000, compared with 19% of those with an income greater than $75,000 (12).
If I am interested in this topic, where can I learn more?
The documentary traces health disparities and social determinants in multiple neighborhoods in Louisville, Kentucky.
There are seven modules and a game designed to provide training in recognizing social determinants of health and providing care for underserved populations.
This podcast outlines the history of redlining, the Fair Housing Act of 1968, and housing inequality over the last 50 years. It explains how neighborhoods remain segregated and a major social determinant of health.
1. Khan Academy. Retrieved February 20, 2017, from https://www.khanacademy.org/test-prep/mcat/social-inequality/social-class/v/health-and-healthcare-disparities-in-the-us.
2. Tavernise, S. (2016, February 12). Disparity in Life Spans of the Rich and the Poor Is Growing. Retrieved February 21, 2017, from https://www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html?_r=0
3. Frostenson, J. B. (2016, December 13). These maps show how Americans are dying younger. It's not just the opioid epidemic. Retrieved July 03, 2017, from https://www.vox.com/2016/12/13/13926618/mortality-trends-america-causes-death-by-county
4. Wilkinson, R. How economic inequality harms societies. Retrieved April 10, 2017, from https://www.ted.com/talks/richard_wilkinson
5. Office of Minority Health. Retrieved July 03, 2017, from https://www.minorityhealth.hhs.gov/omh/Content.aspx?ID=11397&lvl=1&lvlid=4
6. Neighborhood Atlas. Retrieved from https://www.neighborhoodatlas.medicine.wisc.edu/mapping
7. HARLEM HOSPITAL CENTER - nychealthandhospitals.org. Retrieved February 20, 2017, from http://www.nychealthandhospitals.org/harlem/wp-content/uploads/sites/13/2016/08/chna-harlem-2013.pdf
8. New York City Community Health Profiles. Retrieved February 21, 2017, from https://www1.nyc.gov/site/doh/data/data-publications/profiles.page#mn
9. Stamford, CT. Retrieved January 07, 2018, from https://datausa.io/profile/geo/stamford-ct/#housing
10. Stamford, Connecticut Education Data. Retrieved January 07, 2018, from http://www.towncharts.com/Connecticut/Education/Stamford-city-CT-Education-data.html
11. Office of Research, Department of Labor. Retrieved January 07, 2018, from http://www1.ctdol.state.ct.us/lmi/laus/lmi123.asp
12. 2016 Stamford Hospital Community Health Needs Assessment. Retrieved January 07, 2018, from http://www.ct.gov/dph/lib/dph/ohca/community_needs_assessment/chna/2016/2016_stamford_hospital.pdf
13. Unnatural Causes 1 - In Sickness and In Wealth in Unnatural Causes. Retrieved February 21, 2017, from https://vimeo.com/channels/873023/118749412
14. Caring with Compassion. Retrieved March 19, 2017, from https://caringwithcompassion.org/
15. House Rules. Retrieved October 01, 2017, from https://www.thisamericanlife.org/radio-archives/episode/512/house-rules