I. Purpose of the Guide

I. PURPOSE OF THE GUIDE

The public health community has reached a consensus that where you live determines how long and how well you will live, with neighborhood wealth as one of the most important influences. In societies where everyone is supported to flourish socially and financially, people are healthier and so is the economy. According to the World Health Organization, “(p)olicies that recognize that what makes societies prosper and flourish can also make people healthy have more impact. Fair access to education, good work, decent housing and income all support health. Health contributes to increased productivity, a more efficient workforce, healthier ageing and less expenditure on sickness and social benefits. The health and well-being of the population are best achieved if the whole of government works together to address the social and individual determinants of health.” As part of traditional public health practice, health departments collect data and implement programs based on individual health behaviors and outcomes—including indicators related to health and risk behaviors, infection, disease, injury, birth, and death. With most of these data, there are differences in outcomes and disparities in health between population groups classically defined by race, ethnicity, gender, disability status, and age. Public health interventions typically have been designed to reach and meet the needs of specified groups with higher rates of particular conditions—such as diabetes among Hispanic/Latinos or hypertension among African Americans/Blacks. Although there is an important role for culturally appropriate programs that build awareness and self-efficacy to make healthier individual choices (for example, in nutrition and exercise), this traditional, downstream view often also propagates a misunderstanding that individual behavior (i.e., “personal responsibility”) is the principle or only cause of preventable disease. While this perspective has some merit, it ignores the influence of historically discriminatory public and economic polices that determine poverty, educational attainment, and neighborhood living conditions. These upstream social determinants promote, enable, and reinforce the unhealthy behaviors leading to preventable disease, disability, and death. Thus the use of the term ‘health inequities, defined by the World Health Organization as “the differences in health status and mortality rates across population groups that are systemic, avoidable, unfair, and unjust.” The purpose of this guide is to show local health department (LHD) epidemiologists, data analysts, and other professionals how to collect, analyze, and display a prioritized list of social determinant of health living condition (SDOH-LC) indicators and frame these data in the context of neighborhood mortality, morbidity, and social conditions. The recommendations in this guide are designed to help local health departments (LHDs) use SDOH-LC indicators to make measurable improvements in health and quality of life—particularly for neighborhoods and populations that emerge from the data as having the greatest SDOH needs. By following the recommendations outlined in this guide, we expect the reader will be able to: