Social Determinants of Health

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Data Points Social Determinants of Health August 2018 DAVID ECCLES SCHOOL OF BUSINESS

KEM C. GARDNER POLICY INSTITUTE We are an honest broker of INFORMED RESEARCH that guides INFORMED DISCUSSIONS and leads to INFORMED DECISIONS

Social Determinants of Health What are social determinants of health? The majority of a person's health is impacted by factors outside of the health care system: genetics, social, environmental, and behavioral. Social determinants of health are the conditions in which people are born, live, learn, work, and play that affect a wide range of health risks and outcomes. (HealthyPeople.gov) Utility Needs Family & Social Support Income & Employment Food Insecurity Education Primary Secondary Housing Instability Health Behaviors Interpersonal Violence Transportation Source: Intermountain Healthcare. Kem C. Gardner Policy Institute 1

Life Expectancy Life Expectancy at Birth by Utah Small Area, 2012-2016 Note: Life expectancy can be used to gauge the overall health of a community. Source: Center for Health Data and Informatics, Utah Department of Health. 2 Social Determinants of Health

Education Utah s Educational Attainment Age 25 Years and Older, 2016 40% 35% 30% 25% 20% 15% 10% 5% 0% 8.4% 21.0% Less than high school graduate 22.9% 28.5% High school graduate (includes equivalency) 36.8% 34.1% Some college, Associate's degree 31.9% 16.3% Bachelor's degree or higher General Population Population Below Poverty Source: Kem C. Gardner Policy Institute analysis of U.S. Census Bureau 2012-2016 American Community Survey 5-Year Estimates. Poverty Utah s Percent of Population in Poverty, 2016 35% 30% 25% 20% 15% 10% 10.2% 26.4% 30.9% 16.9% 19.7% 25.7% 15.9% 22.5% 9.1% 5% 0% White alone Black or African American alone American Indian and Alaska Native alone Asian alone Race Native Some other Hawaiian race alone and Other Pacific Islander alone Two or more races Hispanic or Latino origin (of any race) Ethnicity White alone, not Hispanic or Latino Note: Poverty is defined as having poverty status anytime in the previous 12 months. Census Bureau uses a set of money income thresholds that vary by family size and composition to determine who is in poverty. Source: Kem C. Gardner Policy Institute analysis of U.S. Census Bureau 2012-2016 American Community Survey 5-Year Estimates. Kem C. Gardner Policy Institute 3

Employment Opportunities Job Growth and Decline: Change in employment since 2007 peak, Q4 2007 Q4 2017 More jobs than 2007 Fewer jobs than 2007 Source: Kem C. Gardner Policy Institute analysis of U.S. Bureau of Labor Statistics (BLS) Quarterly Census of Employment and Wages data. 4 Social Determinants of Health

Housing Percent of All Households with Severe Housing Cost Burden by Income in Utah Households % of Median Income Hoseholds with Severe Cost Burden Total Households % with Severe Cost Burden All Households Below the Median <30% 60,570 95,490 63.4% 30% = <50% 27,995 99,805 28.0% 51% = <80% 13,265 165,660 8.0% 81% = <100% 3,315 106,935 3.1% All Households Above the Median Income >100% 3,290 428,305 0.08% Note: A household that pays 50 percent or more of their income on housing costs is considered severely cost burdened. Source: HUD Comprehensive Housing Affordability Strategy (CHAS), https://huduser.gov/portal/datasets/cp.html#2006-2014. Food Insecurity Percent of Total Population with Food Insecurity in Utah, 2016 12.5% Overall, 382,490 Percent of Children with Food Insecurity in Utah, 2016 15.4% Children, 142,320 Note: At the national level, 12.9% of the total population is food insecure and 17.5% of children are food insecure. Source: Feeding America, Map the Meal Gap. Kem C. Gardner Policy Institute 5

Race/Ethnicity Population Growth by Race and Ethnicity, 2016 to 2017 Total population change: 60,585 NH Black 7% NH Asian 15% NH American Indian or Alaska Native 2% Non- Hispanic White 59% Minority 41% Hispanic 58% NH Two or More Races 14% NH Native Hawaiian or Paci c Islander 4% Note: NH = Non-Hispanic or Latino. Source: U.S. Census Bureau, Population Division, June 2018. Source: Kem C. Gardner Policy Institute analysis of U.S. Census Bureau, Population Division, June 2018. 6 Social Determinants of Health

Crime Crime Rates per 1,000 Population, 2016 Crime rate includes homicide, rape, robbery, aggravated assault, burglary, larceny, motor vehicle theft, and arson. Source: 2016 Crime in Utah Report. Utah Department of Public Safety. Kem C. Gardner Policy Institute 7

Health Care Responsibility Who is primarily responsible for improving health from the perspective of patients, physicians, and employers? 2% 2% 9% 8% 15% 4% 9% Patients 45% Physicians 23% Employers 39% 44% 75% 25% The Patient The Health Care Provider The Health Care System The Insurance Company The Employer Source: Bringing Value Into Focus: The State of Value in U.S. Health Care. (2017). University of Utah Health. Data from University of Utah Health Value in Health Care Survey. Conducted by Leavitt Partners between May 25 and July 14, 2017. Question response size: patients - 1,607; physicians - 345; employers - 216. Survey participants were asked this as a follow up question if they selected My Health Improves as one of the top five statements that best reflects what they value most when getting services from a health care provider. References Egede, L. (2006). Race, Ethnicity, Culture, and Disparities in Health care. Journal of General Internal Medicine. 21(6): 667-669. Gundersen, C., Ziliak, J. (2015, November). Food Insecurity and Health Outcomes. Health Affairs, 34(11): Food & Health. Marmot MG, Wilkinson RD, editors. (2006). Social Determinants of Health, 2 nd Edition. Oxford, England: Oxford University Press. National Center for Health Statistics. (2017). Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Robinson, F., Keithley, J. (2000). The Impacts of Crime on Health and Health Services: A Literature Review. Health, Risk & Society, 2(3), 253-266. Social Determinants of Health. (2018, July 25). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/socialdeterminants-of-health 8 Social Determinants of Health

Kem C. Gardner Policy Institute Staff and Advisors Leadership Team Natalie Gochnour, Director Jennifer Robinson, Associate Director Dianne Meppen, Director of Survey Research Pamela S. Perlich, Director of Demographic Research Juliette Tennert, Director of Economic and Public Policy Research James A. Wood, Ivory-Boyer Senior Fellow Faculty Advisors Adam Meirowitz, Faculty Advisor Matt Burbank, Faculty Advisor Senior Advisors Jonathan Ball, Office of the Legislative Fiscal Analyst Gary Cornia, Marriott School of Business Dan Griffiths, Tanner LLC Roger Hendrix, Hendrix Consulting Joel Kotkin, Chapman University Darin Mellott, CBRE Derek Miller, World Trade Center Utah Chris Redgrave, Zions Bank Bud Scurggs, Cynosure Group Wesley Smith, Western Governors University Staff Samantha Ball, Research Associate Mallory Bateman, Research Analyst DJ Benway, Research Analyst Marin Christensen, Research Associate Mike Christensen, Scholar-in-Residence John C. Downen, Senior Managing Economist Dejan Eskic, Senior Research Analyst Emily Harris, Demographic Analyst Michael T. Hogue, Senior Research Statistician Mike Hollingshaus, Demographer Thomas Holst, Senior Energy Analyst Meredith King, Research Coordinator Colleen Larson, Administrative Manager Shelley Kruger, Accounting and Finance Manager Jennifer Leaver, Research Analyst Angela Oh, Senior Managing Economist Levi Pace, Senior Economist Joshua Spolsdoff, Research Economist Laura Summers, Senior Health Care Analyst Nicholas Thiriot, Communications Director Natalie Young, Research Analyst

Partners in the Community The following individuals and entities help support the research mission of the Kem C. Gardner Policy Institute. Legacy Partners The Gardner Company Intermountain Healthcare KSL and Deseret News Larry H. & Gail Miller Family Foundation Mountain America Credit Union Mitt and Ann Romney Salt Lake City Corp. Salt Lake County University of Utah Health Utah Governor s Office of Economic Development Zions Bank Executive Partners The Boyer Company Ivory Homes Mark and Karen Bouchard Salt Lake Chamber Sorenson Impact Center WCF Insurance Sustaining Partners Clyde Companies Dominion Energy Staker Parson Companies Kem C. Gardner Policy Institute Advisory Board Conveners Michael O. Leavitt Mitt Romney Board Scott Anderson, Co-Chair Gail Miller, Co-Chair Doug Anderson Deborah Bayle Cynthia A. Berg Roger Boyer Wilford Clyde Sophia M. DiCaro Cameron Diehl Lisa Eccles Spencer P. Eccles Matt Eyring Kem C. Gardner Christian Gardner Kem C. Gardner Policy Institute Health Care Advisory Council Nathan Checketts Edward Clark Joseph Miner Clark Ivory Ron Jibson Mike S. Leavitt Kimberly Gardner Martin Derek Miller Ann Millner Sterling Nielsen Cristina Ortega Jason Perry Gary B. Porter Taylor Randall Jill Remington Love Brad Rencher Josh Romney Charles W. Sorenson James Lee Sorenson Vicki Varela Ruth V. Watkins Ted Wilson Natalie Gochnour, Director Mikelle Moore Phillip Singer Eric Hales Ex Officio Senator Orrin Hatch Governor Gary Herbert Speaker Greg Hughes Senate President Wayne Niederhauser Representative Brian King Senator Gene Davis Mayor Ben McAdams Mayor Jackie Biskupski Stephen L. Walston Chad Westover Kem C. Gardner Policy Institute Thomas S. Monson Center I 411 E. South Temple Street Salt Lake City, UT 84111 I 801-585-5618 I gardner.utah.edu DAVID ECCLES SCHOOL OF BUSINESS UNIVERSITY OF UTAH