Building Healthy &

Resilient Communities: A
Social Determinates Approach

National Press Foundation

Washington, DC

Georges C. Benjamin, MD, MACP, FACEP (E), FNAPA

Executive Director
American Public Health Association
July 16, 2017
 Objectives

1. Articulate a social determinates framework for

improving health
2. Name three social determinates that influence
individual and population health
3. Describe three ways resilient communities can
withstand threats to human health
Some Things Are Just True

If you always do what

you always did then
youll always get what
you always got
Moms Mabley
 What Is Health?

Health is a state of complete physical,

mental and social well-being and not
merely the absence of disease or infirmity

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22
June,1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100)
and entered into force on 7 April 1948. The Definition has not been amended since 1948.
Determinants of Health & Their
Contribution to Premature Death
Proportional Contribution to Premature Death
Social
circumstances
15%
Genetic Environmental
predisposition exposure
30% 5%
Health care
10%

Behavioral
patterns
Adapted from: McGinnis JM, Williams-Russo P, Knickman
40% JR. The case for more active policy attention to health promotion. Health
Aff (Millwood) 2002;21(2):78-93.
 Health Is About
Access To Health Care
Insurance is the primary
method to achieve access to
health care
Thousands die annually without
health insurance**
Superb healthcare providers
Safety net provider system
Clinics
Charity care
Emergency department
Universal coverage essential to *(Gallup poll 1/15)
resilience ** AJPH 2009
Health Is About More
Than Health Care
Place Matters!
Differences In How Long
& How Well We Live
 Your Zip Code Matters
Determines Access To
High-quality schools Toxins (from highways,
Job opportunities factories & other)
Safe, affordable & Quality primary care
healthy housing and good hospitals
Fresh produce & Affordable, reliable,
nutritious food public transit
Safe to exercise, walk Social cohesion and
or play outside social capital
Nearby Nature

11
 A Short Distances To Large
Disparities In Mortality: Washington, DC
 Health Is About Risky Behavior
Tobacco is the number one
preventable cause of death
480,000 deaths
Numerous morbidities
Starts in early adolescence
& adulthood
Everyone pays the costs
There are individual &
community based solutions
Health education
Cessation therapy
Smoke free policy & laws
Reduce access to youth Tobacco: Public Enemy Number One
Health Is About Equitable Access
To Affordable Nutritious Foods

Address food deserts

Planning
Zoning
Regulation
Fiscal incentives
Food assistance
policy
Health Is About What We Eat:
The Tale Of One Soda
17 teaspoons of sugar
250 calories
4 miles bicycling to compensate
Soda Many potential solutions
Consumer education Product & menu labeling
20 oz Reduce consumption & portion size reduction
Increase food choices where food is served
Reduce access in vending machines
Increase healthier products water, juices, etc.
Fiscal incentives
Junk food taxes
Health Is About External
& Internal Stressors
 Health Is About
Ensuring Safe Food

17
Poor Air Quality
Clean Water
AndUnsafe Water
 Health Is About
Critical Infrastructure

I 35W Minnesota Bridge Collapse, 2007

Health Is About Where
We Dump Our Trash

Separate toxins from residential locations

Identify & remediate risky waste sites
Addressing Climate Change
Health Is About How We Plan
& Build Our Communities
Health Is About Places To Play:
To Address Sedentary Lifestyles

Better performance in
school
Better mental health
Better physical fitness
 Health Is About
Transportation Systems

Shift from a model that

moves cars to a active
transportation model that
moves people with health
as a co-benefit
Health Is About Equitable Access
To Quality Housing
Homelessness Is A Social
Determinant of Health
Poor health is a cause of
homelessness
14% in homeless health
programs are kids
Homeless 3 - 6 times more
likely to be sick
3 - 4 times more likely to die
prematurely
High percent without health
insurance

29
Access To Broadband Matters

Essential for
Education
Work
Communication

Broadband deserts are a significant problem

Health Is About Poverty
And Income Inequality
AndStrong Families &
Community Networks
Must Use A Holistic Approach
To Health
Engages Hero's Beyond
The Health Sector
What If We Built Our Community Systems
To Address The Social Determinants
 Asthma: A Common
Clinical Condition
Asthma is a common environmental sensitive
condition
Minorities disproportionably impacted
Asthma attacks a significant barrier to school
attendance
Must know root cause of poor control by clinical
& social determinates
Allows one to craft broad solutions that address
both
A Unrecognized Epidemic
 Enter Public Health

Health department notified

Epidemiological investigation occurred
All occurred in kids going to the same
school
Variance in where they lived
All resulted in school absence on similar
days
No single hospital or insurer would pick
this up because of small sample size in
each ED
All Kids Ride On Same Bus
Coordinated Community Resources
Using Heros Beyond Health Care

School system
Private hospital
Public health
Transportation
Reduced ER visits
Dollars saved
Health Improved & less disparity
Less school absenteeism
Transportation safer
Bus mechanic
Create Health As A Shared Value
 About APHA

APHA is a global community of public health

professionals and the collective voice for the
health of the public. APHA is the only
organization that combines 140 years of
perspective, a broad-based constituency and the
ability to influence federal policy to advocate for
and improve the publics health.

Founded April 18, 1872

501C(3) & Nonpartisan
Over 50,000 individual & affiliate members