Presentation by Steven H. Woolf, MD, MPH at the 2009 Virginia Health Equity Conference. Dr. Woolf shared research on the dramatic influences of social conditions on health inequities nationally and in the Commonwealth of Virginia. He also discussed the importance of packaging the evidence in compelling formats for policymakers and the public.

1. Putting Social Determinants in Perspective for Policymakers Health Equity Conference Richmond, Virginia September 11, 2009 Steven H. Woolf, MD, MPH Departments of Family Medicine, Epidemiology and Community Health Virginia Commonwealth University

2. Economic & Social Opportunities and Resources Living & Working Conditions in Homes and Communities Personal Behavior Medical Care HEALTH Finding solutions: Understanding the importance of social factors Policies to promote healthier homes, neighborhoods, schools and workplaces Policies to promote child and youth development and education, infancy through college Policies to promote economic development and reduce poverty Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org

7. Copyright ©2007 by Project HOPE, all rights reserved. Chapin White, Health Care Spending Growth: How Different Is The United States From The Rest Of The OECD?, Health Affairs, Vol 26, Issue 1, 154-161

12. “ Health is more than health care.”

16. Determinants of Population Health Social determinants of health Primary prevention Secondary prevention Tertiary prevention

17. Societal Preference

20. June 11, 1963

22. HealthUS, National Center for Health Statistics

23. From: Satcher et al. Health Affairs 2005;24:459-64.

25. County Life Expectancies by Race Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. PLoS Medicine Vol. 3, No. 9, e260 doi:10.1371/journal.pmed.0030260

26. Murray CJ, Kulkarni S, Ezzati M. Eight Americas: new perspectives on U.S. health disparities. Am J Prev Med 2005;29(5 Suppl 1):4-10. 8.2 74.9 66.7 Black high-risk urban 8 6.9 74.6 67.7 Black poor rural South 7 6.4 75.9 69.6 Black middle America 6 6.6 75.9 69.4 Western Native Americans 5 6.1 77.8 71.8 White poor Appalachia/ Mississippi Valley 4 5.0 80.2 75.2 Middle America 3 5.6 81.8 76.2 White low-income rural Northland 2 4.9 87.7 82.8 Asians 1 Female–male difference in life expectancy Female life expectancy at birth Male life expectancy at birth General description America

30. Age-Adjusted Mortality (1991-2000) Disparity of 24-29%

32. From: Woolf SH, Johnson RE. Am J Public Health 2004;94:2078-81

33. From: Woolf SH, Johnson RE. Am J Public Health 2004;94:2078-81

34. Am J Public Health. 2007;97:679–683

38. Educational attainment, by race and ethnicity

39. Mortality rates, by educational attainment

40. Am J Public Health. 2007;97:679–683

51. U.S. Census Bureau, American Community Survey Reports, ACS-09, Income, Earnings, and Poverty: Data From the 2007 American Community Survey, U.S. Government Printing Office, Washington, DC, 2008.

55. Proportion of Deaths in Virginia Associated With Reduced Household Income

56. Absolute Number of Deaths in Virginia That Would be Averted