SDOH: The Game of Life

Education is the first step to understanding the social determinants of health and making on impact on health outcomes. Our team developed a presentation to take to professionals and key stakeholders in our community to demonstrate and provide tools to identify and subsequently address the social determinants of health.

The demographics and environment of the population we serve in the health district leads to a variety of disproportionate health outcomes. A low level of health literacy, education, cultural and linguistic barriers, lack of transportation, distance to services, access to healthy foods, poverty, lack of housing, insurance, and resources, and a variety of other factors all contribute to disproportionate health outcomes. Our data shows significant disparities in regards to childhood obesity in Hispanics, oral health problems, immunization rates, drug and alcohol use, cancer screenings rates, and heart disease, among others. One of the biggest barriers we face is understanding how the social determinants of health make an impact on the health outcomes itself and then how to take action to address it. Stakeholders seem to understand that families aren’t concerned about eating healthy foods if their primary concern is finding a safe place to live, but then what actions can we take to make an impact? Moving the community from understanding the factors that impact the health outcomes we’re concerned about to planning how to take action in those regards is a barrier to truly addressing the social determinants of health.

After the attending the in-person training with NACCHO staff and other grantees in March 2018, our team developed a work plan that included creating a presentation on what the social determinants of health are to present to area coalitions that work as part of our Community Health Improvement Plans. The presentation included a hands-on activity that gave three participants differing life circumstances to visually demonstrate the social determinants of health and the challenges that arise in each situation. Participants were given their story and then asked to shoot a basket from varying distances to represent their access to good health, in which as the life situation or social determinants were more prominent, they were placed further away from the basket. Then a short presentation followed to provide examples and definitions of the social determinants, as well as open up discussion about how that coalition could impact upstream factors for good health. The partners involved in developing, supporting, and leading this activity were the local health department, the local hospital, and the United Way. The primary implementation of these activities took place in Platte County, Nebraska, but will continue to be shared with other counties within the health district in the future. This took place in the months following the grant training in March and will continue.

The presentation was conducted during two different community coalition meetings during the grant period. Representatives from over 20 different community agencies were in attendance at the presentations and are key stakeholders in the community that can relay the information further to their workplace. A short assessment of three questions were asked of participants after the presentation. The three questions were: 1) After attending this presentation, do you feel this will help you gain a better understanding of the social determinants of health? How? 2) As you better understand the concept of social determinants of health, how do you feel this will impact the coalition? 3) How do you feel this will impact your day to day work? Responses indicated that many people enjoyed the demonstration in that it was visual and made more of an impact. Another stated, "It brings to light where we need to focus our efforts." Their knowledge and awareness will hopefully continue to spread into their everyday work and be shared with more people in the community.

The initiative was successful because we had a captive audience. This topic was relevant our audience's professional life, their business, and relative to the coalition's mission and values. It was also a topic of importance that had not previously been discussed at prior meetings, so it brought new awareness to the coalition members that are very much engaged in this type of work; they just may not have realized it. We learned that more time for follow-up discussion and focusing on how the social determinants fit into the coalition or committee's work plans would have been beneficial. We recommend using a visual activity to show the effects of the social determinants to a group rather than just telling them. That visual made a much larger impact than information could on its own. Another lesson learned that worked well for us was to utilize existing coalitions or groups to present to. Trying to get this information out would be difficult if we had to rely on people coming to a separate presentation, so to utilize those existing groups with key stakeholders from the community present opened that door and also gave us a bigger bang for our buck.