Thursday, November 3, 2011

Addressing the Social Determinants of Health Disparities

As those of us who work in public health know, improving health outcomes has a lot to do with improving the environment in which people live, work, and learn. Addressing the social determinants of health, such as education and income, is critical in order to create healthier communities.

At the New York REACH US Health Disparities Summit a few weeks ago, Dr. Robert Fullilove gave a keynote address on the social determinants of health disparities, exhorting the audience to look at a variety of factors when working within communities to improve health. Dr. Fullilove, the Associate Dean for Community and Minority Affairs and a Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health at Columbia University, has an extensive background working on minority health issues, especially in urban environments. He spoke about rebuilding communities as a way to improve health and referenced the breakdown of family cohesion in crime-blighted neighborhoods as an impediment to public health.

Though Dr. Fullilove touched upon many social determinants of health, one of his major points was the need to engage formerly incarcerated people, especially men, in the public health field. He examined the health needs of the so-called “million dollar blocks”, single city blocks with residents whom the state spends over a million dollars per year to incarcerate. Dr. Fullilove spoke about efforts to engage these men as partners in improving the health of their community upon their reentry into society. He also addressed the plight of at-risk populations, positing that risky behavior is not always a personal decision, but a factor of the environment. He called on the audience to realize that it was necessary to rebuild communities and the social fabric in order to improve health outcomes. As Dr. Fullilove said, “We don’t need a mass movement, we’re looking for people and for communities.”

The push for a community-based solution to eliminate health disparities remains a central component of Bronx Health REACH’s mission. As a number of Bronx Health REACH’s projects have shown, building support within a community to improve health outcomes does lead to positive results. Our work in churches and schools to promote healthy eating and increased physical activity has led to behavior change, as well as changes in the environment. To take one example, Bronx Health REACH’s Culinary Initiative, which aims to introduce healthy options in church meals, has led to less fat and salt being used by church culinary committees in preparing meals. Our efforts to engage all facets of the community also resonate with Dr. Fullilove’s call to action. In the fight to achieve health equity, it’s necessary to reach out to new partners and work with them to improve health outcomes.

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