Sec. 1002. Findings

1,251 words·~6 min read·/bill/116/s/4819/is/section-1002

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Congress finds as follows: Social determinants of health are the greatest predictors of health outcomes. Social determinants of health, including health-related behaviors, social and economic factors, and physical environment factors account for 80 percent of health outcomes, whereas clinical care accounts for 20 percent of improved health outcomes. Yet, in 2017, public health spending represented only 2.5 percent of all health spending in the United States. There are more opportunities to improve health for everyone when we understand that health starts, first, not in a medical setting, but in our families, in our schools and workplaces, in our neighborhoods, in the air we breathe, and in the water we drink.

Healthy People 2020 identifies health and health care quality as a function of not only access to health care, but also the social determinants of health, categorized into the following: neighborhoods and the built environment; social and community context; education; and economic stability. The following examples illustrate the nexus between the unequal distribution of the social determinants of health and health disparities: The built environment influences residents’ level of physical activity.

Neighborhoods with high levels of poverty are significantly less likely to have places where children can be physically active, such as parks, green spaces, and bike paths and lanes. Neighborhoods and communities can provide opportunities for physical activity and support active lifestyles through accessible and safe parks and open spaces and through land use policy, zoning, and healthy community design. Emotional and physical health and well-being are directly impacted by perceived levels of safety, such as unlit streets at night.

Community members have expressed that safety is not only a barrier to accessing programs and services that increase quality of life but they are also not able to access physical activity in their community through the built environment. Historical and institutional racism in the United States has shaped the way in which social and economic resources and exposure to health promoting environments are distributed. Income, education, occupation, neighborhood conditions, schools, workplaces, the use of health and social services, and experiences with the criminal justice system are all highly patterned by race, with people of color experiencing more that is health harming.

Finding ways to uncouple the link between race and access to resources and healthy environments is a principal means of reducing health disparities. Additionally, the anticipation of racism itself causes higher psychological and cardiovascular stress levels that are linked to poor health outcomes. Remedying discriminatory practices at the individual and systemic levels will likely reduce health disparities caused by this unequal distribution of stress. Poor health among Native Americans has largely been driven by post-colonial oppression and historical trauma.

The expropriation of native lands and territories to the American state had severe consequences on Native American health. This resulted in the deprivation of traditional food sources—and nutrients—for Native Americans and also the destruction of traditional economies and community organization. Today, Native Americans have twice the rate of diabetes of non-Hispanic Whites. Recognition of the origins of the diabetes as having a social and community context, rather than just individual responsibility and genetic predisposition, will shape better policy to provide food security.

In the context of prisons, overcrowding has led to the deterioration of the physical and mental health of individuals after they leave prison. In particular, the mass incarceration of African-American males as a result of unequal contact with and treatment in the criminal justice system has contributed to an overburdening of certain infectious diseases within the African-American community. As a social institution, incarceration amplifies existing adverse health conditions by concentrating diseases and harmful health behaviors such as tobacco use, drug use, and violence.

Educational attainment is the strongest predictor of adult mortality. It is a basic component of socioeconomic status that shapes earning potential to access resources that promote health. People with more education are less likely to report that they are in poor health, and are also less likely to have diabetes and other chronic diseases. Individuals with lower levels of educational attainment are much more likely to report to be current smokers. In 2017, smoking prevalence was 36.8 percent among adults with a GED diploma, 23.1 percent with less than a high school diploma, and 18.7 percent with a high school diploma, while dropping significantly to 7.1 percent among adults with an undergraduate college degree and 4.1 percent with a postgraduate college degree.

Income inequality differences account for a large part of health disparities.. For example, children living in poverty experience poorer housing conditions, increased exposure to indoor allergens and toxins (such as pesticides, lead, mercury, radon, air pollution, and carcinogens), increased food insecurity, and more psychological stress. These experiences culminate in worse adult health as compared with children with higher socioeconomic status. Specifically, children living in lower socioeconomic neighborhoods have higher rates of asthma due to higher rates of psychological stress resulting from higher rates of violence.

Food insecurity is associated with obesity and racial and ethnic minorities have higher rates of food insecurity. Lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied (referred to in this section as LGBTQIA ) individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBTQIA individuals has been associated with high rates of psychiatric disorders, substance abuse, and suicide.

Experiences of violence and victimization are frequent for LGBTQIA individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBTQIA individuals. Individuals in older and cheaper housing are at higher risks to be exposed to lead, particularly in housing built prior to 1960. The threat of lead poisoning disproportionally affects vulnerable populations, with children living in poverty (5.6 percent) and Black children (5.6) experiencing the highest rates.

According to the Department of Housing and Urban Development, about 3,600,000 homes nationwide that house young children have lead hazards such as contaminated drinking water, peeling paint, contaminated dust, or toxic soil. The combined cost of medical treatment and special education for lead poisoned children averages about $5,600 per child per year, and lead poisoning costs the United States an estimated $50,000,000,000 annually. According to the report Healthy People 2020, individuals with disabilities, as a group, experience health disparities in routine public health arenas such as health behaviors, clinical preventive services, and chronic conditions.

Compared with individuals without disabilities, individuals with disabilities are— less likely to receive recommended preventive health care services, such as routine teeth cleanings and cancer screenings; at a high risk for poor health outcomes such as obesity, hypertension, falls-related injuries, and mood disorders such as depression; and more likely to engage in unhealthy behaviors that put their health at risk, such as cigarette smoking and inadequate physical activity. Laws and regulations that improve opportunities to live in safe neighborhoods with more social cohesion, attain higher education, sustain stable employment, and bridge class differences help foster the health and safety of individuals.

The global public health community has reached consensus through the Rio Political Declaration of Social Determinants of Health adopted by the World Health Organization in October 2011 that [c]ollaboration in coordinated and intersectoral policy actions has proven to be effective. Health in All Policies, an initiative of the American Public Health Association, together with intersectoral cooperation and action, is one promising approach to enhance accountability in other sectors of health, as well as the promotion of health equity and more inclusive and productive societies. .