Gem P. Daus, MAHRSA’s Office of Health Equity

Social Determinants of Health – Rural Considerations

FORHP Network Planning Grantees Meeting 2/27/2019

www.hrsa.gov/about/organization/bureaus/ohe/

Health Resources and Services Administration (HRSA)Mission

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To improve health and achieve health equity through access to quality services, a skilled health workforce and

innovative programs

Health Resources and Services Administration (HRSA)Overview

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• Supports more than 90 programs that provide health care to people who are geographically isolated, economically or medically challenged

• HRSA does this through grants and cooperative agreements to more than 3,000 awardees, including community and faith-based organizations, colleges and universities, hospitals, state, local, and tribal governments, and private entities

• Every year, HRSA programs serve tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access quality health care

HRSA’s Office of Health EquityOverview

HRSA’s Office of Health Equity (OHE) works to reduce health inequities so that communities and individuals can achieve their highest level of health for all people.

This is accomplished through the development of strategic partnerships, internally and externally, with an emphasis on the integration of equity concepts into policy and programming across all HRSA bureaus and offices to positively impact the people we serve.

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Achieving Health Equity:Key Concepts

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Health Disparities / Inequalities / Inequities• Differences in health between groups (e.g., socioeconomic,

demographic, geographic)• Considered to be unfair, unjust, avoidable, or unnecessary• Can be reduced or remedied through policy action

Health Equity

• The absence of disparities or avoidable differences among socioeconomic and demographic groups or geographic areas in health status and health outcomes such as disease, disability, or mortality

Social Determinants of Health

• Conditions in the environments in which people are born, live, learn, work, and play that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Achieving Health Equity:Social Determinants of Health

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“Social determinants of health is an abstract term, but for millions of Americans, it is a very tangible, frightening challenge: How can someone manage diabetes if they are constantly worrying about how they’re going to afford their meals each week? How can a mother with an asthmatic son really improve his health if it’s their living environment that’s driving his condition? This can feel like a frustrating, almost fruitless position for a healthcare provider, who understands what is driving the health conditions they’re trying to treat, who wants to help, but can’t simply write a prescription for healthy meals, a new home, or clean air.”

Secretary Alex M. Azar, IIHatch Foundation for Civility and SolutionsNovember 14, 2018Washington, D.C.

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• These are conditions that affect the “health functioning, quality-of-life outcomes… risks,” and exposures one may experience in their social environment1 such as:• Race/Ethnicity

• Socioeconomic Status/Social Class

• Gender

• Sexual Orientation

• Age

• Disability

• Religion

• Educational Attainment

• Housing Conditions

• Geographic area (i.e. rural, urban, suburban)

• Access to transportation

• Public investment in public health infrastructure

1. Health Resources and Services Administration, Office of Health Equity. Health Equity Report 2017. Rockville, Maryland: U.S. Department of Health and Human Services; 2018.

2. Source: Tarlov, A.R., Public Policy Frameworks for Improving Population Health. Annals of the New York Academy of Sciences, 1999. 896(SOCIOECONOMIC STATUS AND HEALTH IN INDUSTRIAL NATIONS: SOCIAL, PSYCHOLOGICAL, AND BIOLOGICAL PATHWAYS): p. 281-293.

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Achieving Health Equity:Social Determinants of Health

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According to the National Advisory Committee on Rural Health and Human Services, the unique characteristics of rural communities influence the ways that social determinants manifest.

• Wealth, income, poverty: low perceptions of mobility means people feel they lack control over their lives, which induces toxic stress and leads people to engage in risky behaviors.

• Education and labor markets: students who leave to attend 4-year colleges often do not return. For those who stay, the local job market is dominated by low-wage service jobs.

• Transportation: rural residents don’t have as much access to public transportation as urban residents, and drive farther to get social and health services and basic goods.

Source: National Advisory Committee on Rural Health and Human Services, Policy Brief, January 2017.

Rural ConsiderationsSocial Determinants of Health

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The Importance of Eliminating Health Disparities

Achieving Health Equity is a Matter of Social Justice

• As the Universal Declaration of Human Rights states, every human being has the right to adequate standard of living for health, education, work, and leisure regardless of race, religion, gender, or sexual orientation1

Addressing Social Determinants of Health May Reduce Healthcare Costs2

1. UN General Assembly. “Universal Declaration of Human Rights.” United Nations, 217 (III) A, 1948, Paris, art. 2, 24, 25, & 26,

http://www.un.org/en/universal-declaration-human-rights/index.html

2. Brooks, Tricia and Whitener, Kelly. Leveraging Medicaid to Address Social Determinants and Improve Child and Population

Health. Georgetown Health Policy Institute: Center for Children and Families. February 2018.

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Summary

• Achieving health equity means eliminating health disparities that disadvantage vulnerable and underserved populations

• Social determinants of health greatly impact the health conditions of individuals and a population more than medical care or genetics

• Social determinants manifest in ways that are unique rural communities

• HRSA’s grant programs provide attempt to address the gaps in healthcare access and quality in order to achieve health equity

Connect with HRSA

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Gem P. Daus, MAPublic Health AnalystOffice of Health Equity301-443-2462gdaus@hrsa.gov

Link to OHE and Health Equity Report: https://www.hrsa.gov/about/organization/bureaus/ohe/