The products of one’s environment play significant roles in the choices that a person makes. These products are what we call the social determinants of health. The social determinants of health consider how social and neighborhood conditions come together to impact health outcomes. These factors can fall under income & unemployment, food access, health care, parks & physical activity, community safety housing, environmental quality, education, and transportation. When these resources are disproportionately distributed amongst communities, they lead to health disparities, which are the inequalities that have arisen in health outcomes across different racial, ethnic, and socioeconomic groups.
According to the Robert Wood Johnson Foundation, health disparities are defined as differences in health or in the key determinants of health, such as education, safe housing, and discrimination, which adversely affect marginalized or excluded groups.
There is a widely held preconception that an individual’s behavior is a determinant of their health outcome. This notion places the sole responsibility and control on the individual and fails to recognize outside sources. The products of one’s environment play significant roles in the choices that a person makes. These products are what we call the social determinants of health. The social determinants of health consider how social and neighborhood conditions come together to impact health outcomes. These factors can fall under income & unemployment, food access, health care, parks & physical activity, community safety housing, environmental quality, education, and transportation. When these resources are disproportionately distributed amongst communities, they lead to health disparities, which are the inequalities that have arisen in health outcomes across different racial, ethnic, and socioeconomic groups.
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A food desert is a neighborhood or area where its residents have little or no access to healthy, fresh foods. This lack of accessibility is a major barrier to those in the community who are trying to live healthier lifestyles. According to the United States Department of Agriculture (USDA), 39.4 million Americans continue to live in communities where it is far easier for most residents to buy grape soda instead of a handful of grapes. Lower-income families have access to fewer supermarkets and other healthy food retail outlets that provide a wide selection of affordable, nutritious foods. This problem impacts residents of both urban and rural areas across the country and is compounded by disproportionately higher rates of diet-related disease and the lost commercial vitality that makes communities livable and helps local economies thrive.
Sources: The Food Trust’s Special Report: HFFI Impacts, The Grocery Gap.
Obesity means an amount of body fat that exceeds the level generally considered healthy for a particular height. Obesity is one of the biggest health concerns in communities across the country, with about 70 percent of county officials ranking it as a leading problem where they live. Factors related to obesity are also rated as communities’ priority health issues, including nutrition and physical activity at 58 percent, heart disease and hypertension at 57 percent and diabetes at 44 percent. More than 70% of American adults are obese or overweight. According to the County Health Rankings 2018 report, Hamilton County has an obesity rate of 28.9% which is slightly higher than the national rate of 28 %.
The cost of obesity: The obesity crisis costs our nation more than $150 billion in healthcare costs annually and billions of dollars more in lost productivity.
Obesity is a national security issue: Being overweight or obese is the leading cause of medical disqualifications, with nearly one-quarter of service applicants rejected for exceeding the weight or body fat standards. Obese service members and members of their family who are obese cost the military about $1 billion every year in healthcare costs and lost productivity.
Obesity is a community safety issue: With millions of obese and overweight Americans serving as first responders, firefighters, police officers, and in other essential community service and protection roles, public safety is at risk. Seventy percent of firefighters are overweight or obese, putting them at risk for cardiovascular events — the leading cause of line-of-duty deaths. Police officers have a shorter life expectancy compared with the general population, likely due to their higher-than-average obesity rates.
Obesity is a child development and academic achievement issue: Obesity prevention is an investment in our children’s ability to learn and grow. Childhood obesity is correlated with poor educational performance and increased risk for bullying and depression. If all kids have the opportunity to grow up at a healthy weight — a lifestyle that includes nutritious food and plenty of time for active play — they are more likely to reach their full potential.
Obesity is an equity issue: Obesity disproportionately affects low-income and rural communities as well as certain racial and ethnic groups, including Blacks, Latinos, and Native Americans. Societal inequities contribute to these disparities. For example, in many communities, children have few safe outdoor spaces to play or accessible routes to walk or bike to school. Their neighborhoods may often be food deserts, having small food outlets and fast-food restaurants that sell and advertise unhealthy food and beverages, but lacking those with fresh and healthy foods at affordable prices. Thus, addressing the obesity epidemic is also a fight for health equity.
Sources: The State of Obesity: Better Policies for a Healthier America Report by Robert Wood Johnson Foundation and Trust for America’s Health.
Infant Mortality is defined as the death of a baby before reaching his or her first birthday. Infant mortality is an indicator of the health of an entire community. It can be caused by many things such as premature birth, unsafe sleep environments, and smoking while pregnant. The Infant Mortality Rate (IMR) is defined as the number of infant deaths for every 1,000 live births. In America, the infant mortality rate is 5.98. Ohio has the 5th worst IMR at 7.6. Ohio has the WORST IMR among African Americans in the whole nation.
In Hamilton County, the IMR is 9.5. Hamilton County’s IMR among African Americans is almost triple that of White Americans. According to Ohio Department of Health as of 2014, the infant mortality rate for African Americans in Hamilton County is reported as 18.9 compared to a rate of 7.8 for White Americans. The margin for this disparity is wide and many of the infant deaths are preventable with education, proper care, and support of the community for new and expecting mothers.
The City of Cincinnati in 2016 implemented a Health in All policy which the National Association of County and City Health Officials (NACCHO) recommended that local governments adopt a HIAP approach to its policy-making process. The process ensures that all policies made outside of the healthcare system have a positive or neutral effect on the determinants of health, including, but not limited to, the quality of schools, socioeconomic conditions, transportation options, public safety and residential segregation.
The City of Cincinnati Healthy Living Task Force in collaboration with the Center for Closing the Health Gap are focused on improving the health of all Cincinnati residents with a focus on the most vulnerable populations. HIAP emphasizes the need to collaborate across sectors to achieve common health goals, and is an innovative approach to the processes through which policies are created and implemented.