Measures of Social Determinants of Health Linked with Chronic Conditions
Submission Date: July 2015
Entry Type: Case Study
State/Territory Submitted on the Behalf of: Hawaii
States/Territories Involved: Hawaii
Funding Source: CDC
CDC Funding:Yes
CDC Funding (Specified):DP09-9010301PPHF11, Other CDC Funding
Domain Addressed:Epidemiology and Surveillance
Public Health Issue:The link between social determinants of health (SDH) and health outcomes is widely recognized in the public health literature, according to the Centers for disease Control and Prevention (CDC). These are the non-medical and non-behavioral forerunners of health and illness: the social, political, economic and cultural conditions in which people are born, grow, live, work and age, that impact their health. Ideally, measures of social determinants of health are best studied using longitudinal cohort studies. Barriers to conducting longitudinal studies make cross-sectional health surveys a good choice if they already measure some components of the social determinants of health, health equity, and health disparities.
Project Objectives:To pilot test the social context module as part of the Hawaii Behavioral Risk Factor Surveillance System survey and combined results with those from the Hawaii Health Survey, U.S. Census occupational and industry classifications and the MacArthur Scale of Subjective Social Status.
Program Action:In order to provide better population-based measures of the SDH and health equity, the Hawaii State Department of Health (DOH) piloted a set of questions on social context developed by the CDC. The Social Context module measures people’s perceptions of their economic vulnerabilities and contains work-associated questions. The Hawaii DOH assessment related respondent’s health conditions to answers to questions from the Social Context Module – for example their food security worries or concerns they may have about paying for housing.
Link to the BRFSS Social Context Module is available at: http://www.cdc.gov/brfss/questionnaires/pdf-ques/2012_BRFSS.pdf
Link to the MacArthur Scale of Subjective Social Status is available at: http://www.macses.ucsf.edu/research/psychosocial/subjective.php
Preliminary use of both the BRFSS Social Context Module and the MacArthur Scale of Subjective Social Status in the State of Hawaii produced results that illustrate how socio-economic status vulnerabilities are related to physical health, mental well-being, and behavioral health risk factors. These results show the utility of adding social context and additional socio-economic status indicators to health surveys to enhance our knowledge of the role of the social determinants on health.
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In order to provide better population-based measures of the SDH and health equity, the Hawaii State Department of Health (DOH) piloted a set of questions on social context developed by the CDC. The Social Context module measures people’s perceptions of their economic vulnerabilities and contains work-associated questions. The Hawaii DOH assessment related respondent’s health conditions to answers to questions from the Social Context Module – for example their food security worries or concerns they may have about paying for housing.
Link to the BRFSS Social Context Module is available at: http://www.cdc.gov/brfss/questionnaires/pdf-ques/2012_BRFSS.pdf
Link to the MacArthur Scale of Subjective Social Status is available at: http://www.macses.ucsf.edu/research/psychosocial/subjective.php
Preliminary use of both the BRFSS Social Context Module and the MacArthur Scale of Subjective Social Status in the State of Hawaii produced results that illustrate how socio-economic status vulnerabilities are related to physical health, mental well-being, and behavioral health risk factors. These results show the utility of adding social context and additional socio-economic status indicators to health surveys to enhance our knowledge of the role of the social determinants on health.
Data/Other Information Collected:The Hawaii Health Survey (HHS) and the Hawaii Behavioral Risk Factor Surveillance System (BRFSS) are annual telephone surveys of Hawaii’s population. The social context module questions were asked from April to December, 2010 with a 50% response rate (~4,300 respondents). The HHS in 2010 & 2011 has a sample size of 10,654. Both data sets, BRFSS and HHS, were weighted and the BRFSS data were age-adjusted. The HHS mental health summary score (from the SF-12v2™ Health Survey2) was used to compare associations with social determinants. Lower scores equate with poorer mental health.
Impact/Accomplishments:The prevalence of health conditions, risk behaviors and health care access as related to Hawaii respondent’s specific worries and living accommodations are indicated in the tables below. Boldface type indicates a statistically significant difference. Adults who worried about having enough money to buy nutritious food or about paying their rent or mortgage had a higher prevalence of health conditions such as diabetes or obesity and/or poorer mental health than those who weren’t worried about these things. Adults who rent or have other arrangements for housing compared to those who own a home have a higher prevalence of certain health conditions, poorer mental health scores, a higher prevalence of risk factors and are less likely to have access to health care than those who owned their home.
Mental well-being was also significantly associated with occupation – for example, poorer mental health scores were associated with lower occupational level. Poorer mental health summary scores were significantly associated with worrying about food, worrying about rent, and owning versus renting a home. Respondents were also asked where they rank themselves on the socio-economic ladders for their own community and in the U.S. using the MacArthur Social “Ladder.” Over 30% of Hawaii adults responding ranked themselves in the middle of the ladder on both the community and the United States SES Ladder. Results show that poorer mental health (lower mean mental health score) was associated with adults who ranked themselves near the lower part of both ladders.
While all of Hawaii’s CDC-funded chronic disease program work plans contain embedded language about addressing health disparities along with specific programmatic activities to address health disparities, these new findings will further inform future chronic disease program activities.
Program Areas:Social Determinants of Health
State Contact Information:
HI
Ann Pobutsky, PhD
University of Hawaii at Manoa, Center on the Family Data Center
808-956-2238
pobutsky@hawaii.edu