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DOING THE MATH

Lived Experiences and Social Determinants of Health

Lived Experiences and Social Determinants of Health

Each person’s lived experiences can determine their health outcomes. Does the person enjoy the benefits of stable housing and quality schools? What about access to healthy foods, health care, and transportation? Even intangible things like social connectedness can enable people to thrive and live a healthy life. Where people live should not limit their ability to thrive.

Social Determinants of Health (SDoH) are the conditions where people live, learn, work, and play, and these physical, social, and economic contexts shape our health throughout our lives. Exercise is easier when communities have safe parks and sidewalks. Eating healthy is easier when families have stable incomes and easy access to quality grocery stores. Sometimes, what drives addiction to substances like tobacco, alcohol and other drugs is the stress of unstable housing, poverty, and job insecurity. Differences in education, transportation, and environmental conditions may explain why some communities are healthier than others. These differences can influence whether a person eats well, exercises, or takes up smoking.

Public Health has an important role in eliminating structural barriers to improve health. By collaborating with partners who work on issues related to housing, education, food security, built environment, health care, transportation, and economic development, the critical factors that shape the quality of communities, we can reduce inactivity, poor nutrition, and the risks of smoking. Changing these behaviors will reduce the prevalence of chronic diseases and improve the health of Coloradans.

Each person’s lived experiences can determine whether they engage in...

THREE RISKY BEHAVIORS

Tobacco Use

Tobacco use remains the #1 cause of preventable death and disease in Colorado. Smoking costs the state $1.89 billion in direct health care costs and $2 billion more in indirect costs and results in 5,100 deaths each year. Colorado now leads the nation in rates of youth vaping; 27% of high school students say they vape. Plus, many who never choose to smoke breathe secondhand smoke, putting their health at risk. Smoking causes about 80% (or 8 out of 10) of all deaths from chronic obstructive pulmonary disease. People who smoke are 25 times more likely to develop lung cancer and two to four times more likely to develop cardiovascular disease. Proven public health strategies, when implemented and resourced effectively, can reduce smoking prevalence and the use of tobacco products and protect youth from initiating tobacco product use.

Tobacco use is still the #1 cause of preventable death and disease.

Inactivity

Physical activity, along with a healthy diet, prevents weight gain and reduces the risk of developing many chronic diseases. The Centers for Disease Control and Prevention recommends that adults meet one of two requirements. They should get at least 150 minutes of moderate-intensity (e.g., walking briskly) or 75 minutes of vigorous-intensity (e.g., jogging, bicycling at ≥10 miles per hour) physical activity per week for substantial health benefits and to maintain overall health. The physical activity levels of Coloradans vary by age group, race/ethnicity and education and poverty levels. More than 50% of children and 40% of adults in Colorado do not meet physical activity guidelines. It is easier for people to participate in healthy activities when they live in neighborhoods with a supportive built environment. Well-maintained and safe parks and ways for people to safely walk or bike to everyday destinations can help people get more physical activity.

Poor Nutrition

People who eat healthy live longer and have fewer chronic diseases. In Colorado, fewer than 1 in 10 adults eat the recommended daily amount of fruits and vegetables. Almost 26% (or one in four adults) and 16% of children and youth consume one or more sugar-sweetened beverages per day. Adults and children with lower income levels eat fewer vegetables and drink more sugary drinks. Significant disparities exist between communities in Colorado. Black and Hispanic adults are less likely to eat enough vegetables (15.7%) compared with white adults (33.8%) and are more likely to consume sugary drinks daily.

The availability of healthy, affordable foods can make it easier for people to choose healthier options. However, many communities lack full-service grocery stores or consistent access to affordable fruits and vegetables. Increasing the availability of healthy foods and beverages in worksites, educational and community settings and educating people about healthier, culturally appropriate meal preparation techniques can improve the diets and the health of people across our communities.

3 risky behaviors can account for...

FOUR CHRONIC CONDITIONS

Diabetes

About 19,000 adult Coloradans are diagnosed with diabetes every year. One in three adults has prediabetes. Over a quarter of those individuals will develop Type 2 diabetes within the next three to five years without lifestyle changes. People with diabetes are at an increased risk of kidney failure, nerve damage, blindness, and cardiovascular-related diseases, such as heart attack, stroke, and dementia.

Diabetes is a costly condition; health care expenditures for people with diabetes are 2.3 times higher than those without diabetes. The US spent $327 billion on diagnosed diabetes in 2017, a 26% increase since 2012. Type 2 diabetes is both preventable and manageable through good nutrition, physical activity, and lifestyle change.

Cancer

Cancer is the leading cause of death in Colorado, ahead of heart disease, accidents, lung disease, and strokes. Each year in Colorado there are about 27,000 new cancer cases diagnosed and about 7,900 deaths due to cancer. The lifetime risk for all cancers is one in two for men and two in five for women. About 85% of cancers are diagnosed in people 50 and older, with 50% being diagnosed in people 65 and older. The Colorado Central Cancer Registry (CCCR) estimates there are about 276,000 cancer survivors in Colorado now and this number will grow to 325,000 by 2025.

Mortality and survival rates have improved in Colorado. From 1999 to 2017, cancer death rates declined from 170.9 to 129.5 per 100,000 individuals. In the same 19-year period, breast cancer death rates declined by 22.4%, prostate cancer death rates declined by 28.9%, colorectal cancer death rates declined by 35.4%, and lung cancer death rates declined by 17.6%. In 1998, for all cancers combined, the 5-year survival rate was 63.1%. For patients diagnosed between 2008 and 2012, the 5-year survival rate is 67.2%. CDPHE efforts and strategic alignments across treatment strategies and preventive efforts in Colorado have made an important contribution to this progress.

Asthma and Pulmonary Disease

Asthma is one of the most common long-term diseases in children, and many adults have asthma, too. In Colorado over 400,000 adults and 140,000 children and youth have asthma. Asthma caused more than 17,000 visits to the emergency room in 2017. Several thousand people are hospitalized each year because of their asthma. Asthma creates substantial direct and indirect economic costs, including hospitalization, medications and time off from school or work. The medical costs and school or work days missed due to asthma influence the educational and financial attainment of individuals and families, impacting the opportunities people have to achieve their full health and educational potential. Asthma often causes a lower quality of life for children who have it and the people who care for them. Many asthma exacerbations that result in medical visits and mortality can be avoided with proper treatment and care.

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis. COPD makes breathing difficult for the 16 million Americans who have this disease. Millions more people suffer from COPD, but have not been diagnosed and are not being treated. Tobacco use is the leading cause of COPD but poorly controlled asthma throughout life, exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections also play a role. People with COPD have a harder time staying healthy. Almost two-thirds of those with COPD report that it limits their levels of activity and almost a third of people with COPD reported no exercise in the last month. Although there is no cure for COPD, it can be treated.

Cardiovascular Disease

Taken together, heart disease and stroke are the leading cause of death in Colorado and in the nation. Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart's muscle, valves or rhythm, also are considered forms of heart disease. About 2,300 people in the US die of cardiovascular disease each day, an average of 1 death every 38 seconds. Nearly half of all adults in the US have some type of cardiovascular disease. In Colorado, one in four adults has high blood pressure and almost one in three has high cholesterol.

People can change their risk factors for cardiovascular disease. These risk factors include smoking, poor nutrition, low levels of physical activity, excessive weight, high cholesterol, diabetes, and high blood pressure. Quitting smoking, changes in diet, increased activity, and adhering to a medication plan for high blood pressure and cholesterol can all lower the risk of heart disease and stroke.

4 chronic diseases comprise over...

50% OF DEATHS

50% of Deaths

Cancer, heart disease and stroke, chronic lower respiratory diseases, and diabetes account for almost 55% of all deaths in Colorado. Most adult Coloradans (61.5%) have at least one chronic condition. Those with multiple chronic conditions have increased risk of death, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, conflicting medical advice, and increased health care costs. Cardiovascular disease, cancer, diabetes, and asthma cost Coloradans more than $15.3 billion in direct medical costs annually. Much of these costs are avoidable. Chronic diseases and their related health outcomes are often preventable with healthy lifestyle changes, early intervention, and adherence to treatment. CDPHE is committed to working across Colorado’s public health partners and other sectors and communities to change policies and create community environments where the healthy choice is an easy choice. CDPHE is also working with the health care sector to improve the effective delivery and use of clinical service and to connect patients and their doctors with the community resources that support the prevention and management of chronic diseases.

However, five domains of protective public health action can change this equation.

FIVE DOMAINS OF PROTECTION