We had a rousing discussion about what determines health—and illness—at a gathering this week, and we talked about Indian health issues.
The buzz phrase today: Social Determinants of Health.
That refers to the panoply of items, issues, attributes, variables or factors that influence and affect health. By social, folks are talking about poverty and geography, rather than genetics.
According to the World Health Organization (WHO):
“The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities–the unfair and avoidable differences in health status seen within and between countries.”
When it comes to American Indian peoples we cannot separate the role of poverty from health, and Native Americans have highest poverty rate—twice the national average at 26%.
Injuries, diabetes and bronchiolitis (lung infection) comprise the diseases that have the greatest impact in our populations, and are two to three times as high among Native Americans compared with all racial and ethnic populations combined, according to the Centers for Disease Control and Prevention.
We talked about the importance of defining the problem, which forces our focus away from individuals and squarely on broad-based factors—the so-called Social Determinants of Health. Two of the three killers noted above—injuries and diabetes (type 2)—aren’t caused by genetics: they are a function of how and where we live.
Tribes are getting serious about health programs.
Many programs use an approach that has, at its core, science education. The thesis is that, if folks know the science of the problem, then they can change the problem.
For example, the Diabetes-Based Education in Tribal Schools program, sponsored by the National Institutes of Health, lists one of its goals as increasing “understanding of health, diabetes and maintaining life in balance among American Indian-Alaska Native students.”
This approach aligns with the foundation of mainstream health promotions and campaigns: provide education, awareness and understanding.
My criticism of this approach is that knowing the science doesn’t necessarily provide you with the tools for change. Sometimes effective change programs are ones that don’t require knowledge (although I will be among the first to welcome knowledge as a good thing).
Rather, effective change programs need to do two things: change the social system at a macro-level and tap into value systems that underlie behaviors at a micro-level.