Social Determinants Of Health

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Our report card continues to ask questions about what makes us healthy. Research and experience tells us that our health comes from a network of issues known as Social Determinants of Health. Many would say that health care is what makes us healthy, but too often health care doesn’t come into play until after we are already sick. The social determinants frame a holistic spectrum of what impacts health: our physical environment, our behaviors, socio-economic factors, biological factors, and medical care. In Cowlitz County, the Health and Human Services Department, medical providers, schools, and others are using the social determinants of health to identify areas of need and develop upstream solutions.

Social determinants of health include access to care and quality of care, education, employment, family/social support, tobacco use, diet and exercise, and environmental quality. The chart below provides a more detailed list of determinants of our health.

Adverse Childhood Experiences (ACEs) is another area of research used by local decision makers. These are things that happened to us as children including hunger, abuse, family violence, drug and alcohol, poverty and other factors, that are predictors of health in adults who experienced those situations. A study by the Centers for Disease Control found that while the average lifespan for a child born today is 80 years, a child who has six or more adverse childhood experiences on average, will find their life cut short to 60 years.  Understanding how trauma impacts individuals over a lifetime and how different levels of exposure to trauma play out across the population, is another tool local decision makers are using to get at the root causes of poor health outcomes in our community.

With the community report card, it’s important to recognize that one change can impact many factors. For example a family which moves into a home that is affordable, safe, and healthy increases the chances of their children attending school, parents buying healthy foods, and developing social cohesion within their neighborhood. That’s why social determinants of health are a network with many factors connected to one another. The 2015 edition of the Cowlitz Community Report Card reviews Social Determinants of Health as a framework to look at the health of our community. The use of current data, an examination of what’s being done locally, and a community committed to answering calls to action, can create the change leading to a long and healthy life. The report card also recognizes that in social determinants of health issues such as age, gender, and race are also important factors to consider.

Four years ago, Pathways 2020 accepted the definition of health from the World Health Organization as “a state of complete physical, mental, and social well-being and not just the absence of sickness or frailty”. After completing eight report cards, we’ve learned that just looking at data doesn’t tell us the story of how we got to where we are – we need to ask how we can make things better. We need to look upstream. Policy, systems, and environmental change are at the heart of the report card.

A healthy community takes much more than individual responsibility for health. It is the social, physical, and environmental conditions where individuals live, work, and play that create the conditions of health for an entire community. If we want children to become more physically active, it is not just a matter of providing basketballs and expecting individual change.  School district policies can play a role in encouraging and requiring a level of meaningful physical activity. Worksites can develop workplace wellness programs that support improved employee wellness.  Expanding access to home visiting programs like Early Head Start, Nurse Family Partnership, and Parent Child Assistance Program can give new families the preventative help they need to avoid a large list of negative outcomes later in life.  The bottom line is that it will take all of us asking, “How do we get healthier together?” to make the changes we need to live in a healthier community.

The report card looks at six determinants of health: economic vitality, education, health, access to healthy foods, social cohesion, and housing. We look at these issues by providing relevant local data, exploring local responses to these topics, and providing an opportunity for positive community impact through a series of calls to action. Each of the individual sections is an honest look at the community, good news, promising news, and where needed, a look at the warts. Please use the report card to begin discussions, to develop cooperation and collaboration, to react and then to act. Health is a responsibility that the individual and the community both share. Since the last report card, the community has shown stronger qualities through the economy and education. Ass a community we can capitalize on these gains and expand into all of the social determinants of health.