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The Effect of Social Determinants  Of Health (SDoH) On Health Outcomes

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Title:
The Effect of Social Determinants Of Health (SDoH) On Health Outcomes
Series Title:
PUAD 5003 Research and Analytic Methods
Creator:
Smyrnios, Panos

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Course Material ( sobekcm )

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Abstract:
The social determinants of health (SDoH) are the physical and social conditions in which people live, learn, work, and play, and they are the aspects that often have the greatest impact on American’s health outcomes1. Examples of SDoH include but are in no way limited to education, availability of resources to meet daily needs, social support, public safety, transportation, language/literacy, culture, and race/ethnicity. SDoH often help explain why vulnerable populations are vulnerable to health disparities. Because of this, addressing SDoH has increasingly become a focus for policymakers, public health officials, foundations, and non-profits around the nation. Mississippi is ranked as the least healthy state in the nation and has some of the most glaring disparities in SDoH2. Because of this, I examined Mississippi to see which SDoH characteristics are most strongly linked to overall health outcomes
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Collected for Auraria Institutional Repository by the Self-Submittal tool. Submitted by Panos Smyrnios.
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Unpublished

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Auraria Institutional Repository
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Auraria Library
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I N T R O DUC T I O N The social determinants of health ( SDoH ) are the physical and social conditions in which people live, learn, work, and play, and they are the aspects that often have the greatest impact on 1 . Examples of SDoH include but are in no way limited to education, availability of resources to meet daily needs, social support, public safety, transportation, language/literacy, culture, and race/ethnicity. SDoH often help explain why vulnerable populations are vulnerable to health disparities. Because of this, addressing SDoH has increasingly become a focus for policymakers, public health officials, foundations, and non profits around the nation. Mississippi is ranked as the least healthy state in the nation and has some of the most glaring disparities in SDoH 2 . Because of this, I examined Mississippi to see which SDoH characteristics are most strongly linked to overall health outcomes. PROBLEM Because there are so many SDoH characteristics, it is vital for administrators and stakeholders working on public health initiatives to understand which factors in particular are correlated to worse health outcomes. The following 8 characteristics arise most frequently in literature as having the highest impact 1 : Low income : Without sufficient income, people cannot afford insurance, food, rent, utilities, transportation, and other variables that impact daily living and, inherently, health. Not having a high school education : Education is closely tied to income, importance placed on health, and opportunities to live a healthy life 3 . Having a disability: Disabilities significantly utilize pubic services and everyday amenities 1 . Single parent households with children under 18: Single parents with underage children have face greater barriers, such as time, costs, and stress. Minority race/ethnicity: There is substantial evidence that racial and ethnic minorities receive lower quality of care and face greater barriers in education, employment, and safety that Whites 4 . M E T H O DS Data: To evaluate the correlation between the SDoH factors (independent variable) and health outcomes (dependent variable), I utilized the following data at the county level for the state of Mississippi. There are 82 counties: Analytical Technique : I conducted a multi variate linear regression using Excel that assessed the correlation between the SDoH factors by county h ealth o utcome r ank (dependent variable). A confidence interval of p<0.05 was used to determine statistical significance. Because income underlies nearly all other SDoH factors, it showed significant levels co linearity with nearly all of the other factors. Because of this, I removed per capita income from the multi variate linear regression model, and conducted a simple linear regression with just per capita income (independent variable) and health outcome rank (dependent variable). RESULTS The SDoH factors that had statistically significant Not having a high school education (% No HS) : Where the higher the % of the population without high school degrees, the worse the county ranked in health outcomes (see Figure 1). Disability prevalence (% Disabled): Where the higher the % of the population with disabilities, the worse the county ranked in health outcomes (see Figure 1). Race/Ethnicity (Race/Ethnicity): Where the higher the % of the population was made up of minority race and ethnicities, the worse the county ranked in health outcomes (see Figure 1). Income (Income) : Where the lower the per capita income was, the worse the county ranked in health outcomes (see Figure 2). Figure 1. Multivariate linear regression model for all SDoH variables but Income. Figure 2. Linear regression model for Income. RECCOMENDATIONS FOR MISSISSIPPI PUBLIC ADMINISTRATORS AND PUBLIC HEALTH STAKEHOLDERS State and national public administrators and public health stakeholders that are involved in addressing the health disparities in Mississippi should consider the following recommendations stemming from this research: 1. Increase grant and government program funding that supports those with low education, low income, disabilities, and minority race/ethnicity status. The support can take many forms, including offering free prevention services (e.g. cancer screenings) and offering culturally relevant public health navigation and coordination for state and federal programs to historically underserved communities. 2. Increase the involvement of the most impacted communities in public health strategic planning, project implementation, and policymaking efforts for government, foundation, and non profit funded initiatives. 3. Use of Health Impact Assessments to review needed, proposed, and existing social policies for their likely impact on health 1 . 4. Integrate health equity and anti racist principles in all public health efforts. The first step to this is increasing equity, diversity, and inclusion education and training for the government and non government public health workforce 4 . REFERENCES 1. HealthyPeaople.gov. ( n.d. ). Social Determinants of Health. https ://www.healthypeople.gov/2020/topics objectives/topic/social determinants of health3. 2. America's Health Rankings analysis of 2. Health Rankings.( n.d. ) AmericasHealthRankings.org 3. Hahn, R. A., & Truman, B. I. (2015). Education Improves Public Health and Promotes Health Equity. International journal of health services : planning, administration, evaluation, 45(4), 657 678. https:// doi.org/10.1177/0020731415585986 4. Egede L. E. (2006). Race, ethnicity, culture, and disparities in health care. Journal of general internal medicine, 21(6), 667 669. https://doi.org/10.1111/j.1525 1497.2006.0512.x THE EFFECT OF SOCIAL DETERMINANTS OF HEALTH ( SDOH ) ON HEALTH OUTCOMES IN THE STATE OF MISSISSIPPI By Panos Smyrnios, PUAD 5003 Research and Analytic Methods, Professor: Serena Kim CONCLUSION The results showed that some but not all of the SDoH factors contributed to worse health outcomes for Mississippi counties and were statistically significant. Understanding which SDoH factors contribute to health outcomes is vital for policy makers, public health officials, and other stakeholders in conducting public health work in Mississippi. It is no surprise that income underlies and is highly tied to all of the other SDoH characteristics, as this is commonly expressed in literature 1 . Overall, this analysis adds to literature and public health studies examining the effects of SDoH on health outcomes, especially within the state of Mississippi. PROBLEM CONT. Not Owning a Vehicle: Not owning a vehicle everyday necessities, interact with their community, and receive healthcare 1 . Insurance Coverage: Being uninsured creates a significant barrier in receiving both preventative and emergency healthcare. Independent Variables (source: ACS 2014 2018, 5 year estimates) Dependent Variable (source: Robert Wood County Health Rankings) Per capita income (Income) % (25+) persons w/o a high school diploma (% No HS) % population w/ disability (% Disabled) % single parent households w/ children <18 (% SP Households) % population that is minority, i.e. all persons but non hispanic white (race/ethnicity) % households w/o vehicle (% no vehicle) % population that is uninsured (insurance) rankings by health outcome rating , with 1 (best) to 82 (worst). Health outcomes ratings are composed of: Length of Life , measuring premature death and life expectancy. Quality of Life , with measures of low birthweight and those who rated their physical or mental health as poor.