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 of health are the conditions in which people are born, outside of the health care system: genetics, social, live, learn, work, and play that affect a wide range of environmental, and behavioral. Social determinants health risks and outcomes. (HealthyPeople.gov)

Utility Needs

Family & Income & Social Support Employment

Food Housing Insecurity Instability Primary Secondary Education Health Behaviors

Interpersonal Transportation Violence

Source: Intermountain Healthcare.

Kem C. Gardner Policy Institute 1 Life Expectancy

Life Expectancy at Birth by 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’sUtah’s Edu Educationalcational Attainm Attainmentent Age 25 Years Age and O 25lde rYears, 2016 and Older, 2016

40% 36.8% 34.1% 35% 31.9% 30% 28.5% 25% 22.9% 21.0% 20% 16.3% 15% 10% 8.4% 5% 0% Less than high High school graduate Some college, Bachelor's degree school graduate (includes equivalency) Associate'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. Source: Kem C. Gardner Policy Institute analysis of U.S. Census Bureau, 2012-2016 American Community Survey 5-Year Estimates. Census Below poverty is de ned 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. Poverty

Utah’s Percent of Population in Poverty, 2016 Utah’s Percent of Population in Poverty, 2016

35% 30.9% 30% 26.4% 25.7% 25% 22.5% 19.7% 20% 16.9% 15.9% 15% 10.2% 10% 9.1% 5% 0% White alone Black or American Asian alone Native Some other Two or Hispanic or White alone, African Indian and Hawaiian race alone more races Latino not Hispanic American Alaska and Other origin (of or Latino any race) alone Native alone Paci c Islander alone Race Ethnicity

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 Note: Life expectancy can be used to gauge the overall health of a community. composition to determine who is in poverty. Source: Kem C. Gardner Policy Institute anal ysis of U.S. Census Bureau, 2012 2016 American Community Survey 5 Year Estimates Source: Center for Health Data and Informatics, Utah Department of Health. 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 % Hoseholds with Severe Total % with Severe of Median Income Cost Burden Households 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 Population with Food Insecurity in Utah, 2016 Percent of Total Population with Food Percent of Children with Food Insecurity in Utah, 2016 Insecurity in Utah, 2016 Overall, Children, 382,490 142,320 12.5% 15.4%

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. Source: Feeding America Map the Meal Gap. Kem C. Gardner Policy Institute 5

Shares of Minority Growth by Race and Hispanic Origin, 2016-2017

Race/Ethnicity

Population Growth by Race and Ethnicity, 2016 to 2017 NH American Indian or Alaska Native NH Black 2% 7%

Total population change: 60,585 NH Asian 15%

NH Native Hawaiian or Hispanic Paci c Minority Islander Non- 58% 41% 4% Hispanic NH Two or White More Races 59% 14%

Note: NH = Non-Hispanic or Latino. Source: Kem C. Gardner Policy Institute analysis of U.S. Census Bureau, Source: U.S. Census Bureau, Population Division, June 2018. 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

WhoWho is is primarily primarily responsibleresponsible for for improving improving health health? from the perspective of patients, physicians, and employers?

2% 2% 4% 9% 9% 8% 15%

39% 45% Patients Physicians 23% Employers

44%

75% 25%

The Patient The Health Care Provider The Health Care System The Insurance Company The Employer

SouSource:rce: T Bringinghe State Value of Va Intolue Focus:in U.S The. Hea Statelth Cofa rValuee. Un inive U.S.rsi tHealthy of U tCare.ah H (2017).ealth. University of Utah Health. Data from University of Utah Health Value in Health Care Survey. Conduct- ed 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, 2nd 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/social- determinants-of-health

8 Social Determinants of Health Kem C. Gardner Policy Institute Staff and Advisors

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

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

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