• Home
  • About
    History Team Organization Plan Development Contact Us
  • Alaska Health Priorities
    Objectives, Strategies, & Actions
  • Data
    HA2030 Scorecard HA2020 Scorecard Regional Data Data Sources
  • Healthy Actions
    Successes & Activities Share your activity!
  • Health Equity
    Commitment to Racial Equity Alaska Health Equity Index Resources
  • Resources
    State Health Improvement Plan Community Capacity Review State Health Assessment Evaluation Plan Resources
  • Search

Priority Health Topic: Social Determinants of Health


Background & History

Social determinants of health are the conditions of the social and physical environments in which we live, learn, and work that influence Alaskan’s health outcomes and health equity. Social determinants of health can include access to educational and economic opportunities, quality housing, affordable healthcare, technology, community resources, transportation, and other resources for daily needs. The social determinants of health were outlined in the State Health Assessment as contributing factors to Alaskans’ health challenges.

The three objectives in this priority health topic that HA2030 aims to address are educational attainment, poverty, and housing. An objective focused on educational attainment was created after HA2020 met its target for increasing 18- to 24-year-olds obtaining a high school diploma. Because the risk factor prevalence is higher for people with less than a high school education compared to the total Alaska population, educational attainment remains a focus for improvement as an HA2030 objective. The new HA2030 objective tracks the percent of high school students who graduate within 4 years of starting 9th grade, to set a more aspirational goal and focus efforts on keeping students in school. The poverty objective was also carried forward from the HA2020 LHI measuring the population living above the federal poverty line, which did not make enough progress to meet the 2020 target. The HA2030 teams decided to keep this objective because poverty definitions consider household income level as well as household size, as a critical social determinant of health.

The HA2030 teams decided to include a third objective more specifically focused on housing: reduce the percentage of rental occupied households that exceed 50 percent of household income dedicated to housing. This was chosen because it is an actionable objective that will help focus on attaining affordable housing for all Alaskans. This objective also acts as an important social determinant of health because it is known that when housing costs exceed 30% of the household income, they are likely to negatively impact the household’s ability to meet other basic needs such as food, health care and childcare. This objective is focused on rental housing since people experiencing poverty are more likely to rent than own and there are reliable annual measures to track objective progress.

Objective 19: Increase the percent of high school students who graduate within 4 years of starting 9th grade

Target: 90%

Strategy 1: Implement evidence-based practices that create safe and supportive learning environments in schools

Safe and supportive learning environments in schools include both the physical and aesthetic surroundings and the psychosocial climate and culture of the school. Psychosocial climate includes the physical, emotional, and social conditions that affect the well-being of students and staff. Supportive learning environments can also incorporate family and community involvement to more effectively respond to the needs of students.

Students who develop a positive affiliation or social bonding with school are more likely to remain academically engaged and less likely to be involved with misconduct at school. (Simons-Morton B, Crump A, Haynie D, Saylor K. Student-school bonding and adolescent problem behavior. Health Education Research. 1999; 14(1), 99-107.) Students whose parents are involved in their education have greater academic achievement, better attendance, and lower risk behaviors. Community involvement can positively impact academic achievement and improve school related behaviors (source: Alaska School Health and Safety Framework).

Sources:

  • Multiple school climate/SEL-related strategies are shown as ‘scientifically supported ’on What works. Also child nutrition, afterschool programs, attendance interventions…each activity below is an evidence based practice
    • What works filtered by Education and Scientifically Supported (note)

Action Step 1

ActionIncrease number of educators who complete trauma engaged eLearning trainings
Measure# of educators completing trauma engaged eLearning courses
Timeframe2020-2030
Key Partners• State of Alaska, Dept. of Education and Early Development (DEED), Teaching and Learning Support
• Association of Alaska School Boards
• Alaska Children’s Trust
• Alaska Mental Health Trust Authority
• Volunteers of America 
• Providence St. Joseph Health – Alaska Region
• Alaska Dept. of Public Safety (DPS), Council on Domestic Violence and Sexual Assault,
• Alaska Department of Health and Social Services, Division of Behavioral Health

Action Step 2

ActionIncrease number of students who have access to school‐based mental health services
Measure• # of schools in Alaska that provide school based mental health services compared to the year prior

School Health Profiles measures (CDPHP):
• # of schools that report working with mental health or social services staff in health education
• # of schools where lead health teacher received professional development in emotional or mental health
Timeframe2020-2030
Key Partners• State of Alaska, Division of Behavioral Health
• Association of Alaska School Boards
• Alaska Mental Health Board
• Alaska Mental Health Trust Authority
• State of Alaska, Dept. of Education and Early Development (EED), Teaching and Learning Support
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Heath Promotion (CDPHP)

Action Step 3

ActionIncrease the number of children served by child nutrition programs (National School Lunch Program, School Breakfast Program, Summer Food Service, Afterschool Snack Program, Supper Program, etc.)
MeasureAlaska Child Nutrition Programs regular/annual reports on utilization of programs https://education.alaska.gov/cnp
Timeframe2020-2030
Key Partners• Alaska Child Nutrition Programs in Department of Education
• Alaska School Nutrition Association
• Food Bank of Alaska
• Alaska Afterschool Network
• Food Research and Action Center

Action Step 4

ActionIncrease access and capacity of quality after school programs and structured meaningful activities that are supervised by a supportive adult. Quality programs have:
• Trained supportive staff;
• A friendly and respectful climate;
• Intentional skill-building instruction (sequenced, active, focused and explicit);
• Youth centered practices (youth voice and empowerment);
• Emphasizes continuous improvement;
• Focused efforts to recruit and retain staff and students.
MeasureMain measure: Percent of 9-12th grade students who participate in organized afterschool, evening or weekend activities at least twice a week (Youth Risk Behavior Survey, odd years)

Alternative Measures:
• Percent of 6-12th grade students who participate in organized afterschool, evening or weekend activities at least twice a week (School Climate and Connectedness Survey)
• Indicators available on CDC’s School Health Profiles for secondary schools (6-12) on even years (State of Alaska, Division of Public Health, Section of CDPHP)
Timeframe2020-2030
Key Partners• Association of Alaska School Boards, Initiative for Community Engagement (ICE)
• Alaska Children’s Trust, Alaska Afterschool Network
• Center for Safe Alaskans, Anchorage Youth Development Coalition (AYDC)
• State of Alaska, Department of Education and Early Development
• State of Alaska, Division of Public Health, Office of Substance Misuse and Addiction Prevention
• RurAL CAP, Resource Basket
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion

Action Step 5

ActionImplement the Transforming Schools: A Framework for Trauma-Engaged Practice in Alaska
https://education.alaska.gov/trauma-engaged-schools
Measure• Number of districts receiving the transforming schools framework.
• Number of school districts that have received training and materials related to the Transforming Schools Implementation toolkit
Timeframe2020-2030
Key Partners• State of Alaska, Dept. of Education and Early Development (DEED), Teaching and Learning Support
• Association of Alaska School Boards
• Alaska Mental Health Board
• Anchorage Community Mental Health
• First Alaskans
• Alaska Afterschool Network
• Alaska Mental Health Trust Authority
• State of Alaska, Department of Public Safety (DPS) Council on Domestic Violence and Sexual Assault

Action Step 6

ActionIncreased implementation of attendance interventions for chronically absent students/reduction in chronically absent students
Measure• Annual Every Student Succeeds Act (ESSA) reporting https://education.alaska.gov/akessa
• Annual local district report card to the public https://education.alaska.gov/compass/report-card
Timeframe2020-2030
Key Partners• Alaska Dept. of Education and Early Development (EED), Innovation and Education Excellence (IEE)
• United Way of Anchorage
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion
• All local school districts that report to DEED

Strategy 2: Expand and strengthen quality early childhood programs

Research has shown that early childhood education programs have positive impacts on children’s cognitive, emotional and behavioral outcomes. Additionally, there is some evidence of improvements in children’s health and safety and positive effects on the parents of young children. Children enrolled in high-quality early childhood programs are more likely to graduate from high school, hold a job, and make more money and are less likely to commit a crime than their peers who do not participate. Early care and learning programs can buffer the effects of poverty and other stressors on our most vulnerable children. Quality early childhood programs that support the development of executive function and self-regulation skills, as well as support the reduction of toxic stress, offer lifelong benefits to both children and broader society. James J. Heckman, a Nobel Memorial Prize winner in Economics and an expert in the economics of human development, has proven that the quality of early childhood development heavily influences health, economic and social outcomes for individuals and society at large. There are great economic gains to be had by investing in early childhood development. In fact, every dollar invested in quality early childhood development for disadvantaged children produces a 7 percent to 10 percent return, per child, per year.

Sources:

  • Multiple ECE-related strategies are shown as ‘scientifically supported ’on What works.
    • What works filtered by Education and Scientifically Supported

Action Step 1

ActionIdentify needs and gaps in services and to articulate quality concerns through as assessment conducted by the Alaska Early Childhood Coordinating Council.
MeasureCompletion of internal reports of Alaska Early Childhood Coordinating Council http://dhss.alaska.gov/Commissioner/Pages/aeccc/default.aspx
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services (DHSS) Alaska Early Childhood Coordinating Council

Action Step 2

ActionDevelop a plan to address lack of quality early childhood programs (using as source documents Alaska’s Early Childhood Needs Assessment, Alaska’s Early Childhood Strategic Plan, and the Alaska Early Childhood Coordinating Council Strategic Report) and increase support from policy makers and decision makers
MeasureInternal reports of Alaska Early Childhood Coordinating Council http://dhss.alaska.gov/Commissioner/Pages/aeccc/default.aspx
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services (DHSS) Alaska Early Childhood Coordinating Council

Action Step 3

ActionImprove the quality of early childhood education by increasing the number of participants in Learn & Grow, Alaska SEED
Measure# of ECE programs participating in Learn & Grow Levels 1-5
# of ECE programs advancing Level of Learn & Grow quality
Nov 20, 2019: 144 Programs (Level 2 Programs = 31; Level 1 Programs = 94; ‘Enrolled Programs’ = 19)
https://www.threadalaska.org/learn-and-grow/for-educators/become-a-program/participating-programs
Timeframe2020-2030
Key Partners• thread
• Alaska SEED
• Learn & Grow
• Childcare Program Office
• Juneau’s Best Starts
• Alaska Children’s Trust-Alaska Afterschool Network
• State of Alaska, Department of Education and Early Development, Headstart Program
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion

Strategy 3: Support a career and technical education system to prepare the population for Alaska careers

Postsecondary education and training are the clearest pathways into the middle class and future economic security. The average income of college graduates is significantly higher than those with only a high school diploma, and even higher than those without a high school diploma. Middle-skill jobs are projected to account for a large proportion of job openings in the future, and the fastest growing occupations will require postsecondary education or training.

Career and technical education (CTE) is a strategy that can prepare the population for careers by effectively transitioning people from high school into post-secondary education and into employment. An effective CTE system will prepare the population with the pathways and skills needed to have successful lives and careers by providing academic, technical, professional, and overall employability skills. As well as for young people, CTE can provide pathways to chosen careers for people already in the workforce who need training to maintain or upgrade their jobs. In addition, multiple CTE delivery systems can provide equal access and quality of academic and technical programs across the state, including to rural areas.

Smooth transitions from secondary to postsecondary education and from school to work are essential for successful careers in jobs that pay living wages. There is evidence that participation in CTE can lead to increased academic achievement, higher graduation rates, greater consistency of employment, higher quality jobs, and increased future earnings. The Association for Career and Technical Education cites evidence that supports the positive impacts of CTE, including increased participation in the labor force, higher earnings, and decreased risk of dropping out of school.

Sources:

  • Multiple CTE-related strategies are shown as ‘scientifically supported ’on What works. What works filtered by Education and Scientifically Supported

Action Step 1

ActionMake transitions planned and accountable for both successful student progress and systemic cooperation by:
• Ensuring that every student has a personal learning and career plan (PLCP)
• Coordinating program development and delivery among training programs
• Developing data sharing to track student progress
Measure Carl Perkins Program data
Timeframe2020-2030
Key Partners• State of Alaska, Department of Education and Early Development, Career and Technical Education
• State of Alaska, Department of Labor and Workforce Development
• U.S. Department of Labor Office of Registered Apprenticeship, Alaska

Action Step 2

ActionAlign curricula at all training institutions to meet current industry standards including academic, professional, and technical skills, from elementary through secondary to postsecondary and professional development levels.
MeasureProgram files, Alaska DEED, Career and Technical Education
Timeframe2020-2030
Key Partners• State of Alaska, Department of Education and Early Development, Career and Technical Education
• State of Alaska, Department of Labor and Workforce Development
• Post-secondary Institutions

Action Step 3

ActionIdentify and promote career and technical education delivery models that ensure that all Alaskans have the opportunity to attain the knowledge and skills needed for further training and careers.
MeasureProgram files, Alaska DEED, Career and Technical Education
Timeframe2020-2030
Key Partners• State of Alaska, Department of Education and Early Development, Career and Technical Education
• State of Alaska, Department of Labor and Workforce Development
• Post-secondary institutions; secondary institutions and DOL

Objective 20: Reduce the percentage of rental occupied households that exceed 50 percent of household income dedicated to housing

Target: 14%

Strategy 1: Ensure adequate, safe, and affordable housing is available for all Alaskans

The relationship between poverty, housing, and income is complex. Lack of affordable housing can lead to family residential instability or homelessness, and poverty can prevent people from accessing or maintaining adequate housing. Adequate, safe, and affordable housing can prevent households from falling into poverty, and can expand opportunities for those living in poverty. Without adequate housing, accessing employment, child care, education, and transportation is difficult, making it harder for individuals to escape poverty.

Comprehensive poverty reduction strategies typically include an affordable housing component since housing is often the single biggest expenditure for families. The conventional public policy indicator of housing affordability is the percent of income spent on housing. When housing expenditures exceed 50% of household income, the household is considered to be severely burdened. When low income households are forced to spend the majority of their income on housing, an inadequate amount of money is left for other expenses including education, healthcare, food, and transportation. In addition to the economic impact of lack of affordable housing, there is evidence that living in unstable housing situations or high cost housing (as a % of income) can negatively affect health, through environmental impacts, lack of access to health care, and mental health effects. Housing also affects educational attainment and some aspects of child development.

Sources:

  • Housing’s Economic and Social Impacts, April 2007. Iowa Finance Authority. Retrieved from http://publications.iowa.gov/7969/.
  • The Links Between Housing and Poverty, 2013. Joseph Rowntree Foundation. Retrieved from http://www.jrf.org.uk/sites/files/jrf/poverty-housing-options-summary.pdf
  • Krieger, J., and Higgins, D. (2002). Housing and Health: Time Again for Public Health Action. Am J Public Health, 92(5), 758-768.
  • Evidence of effectiveness of housing voucher programs on reductions in poverty measures: Lindberg RA, Shenassa ED, Acevedo-Garcia D, et al. Housing interventions at the neighborhood level and health: A review of the evidence. Journal of Public Health Management & Practice. 2010;16(5 Suppl):S44-S52.
  • Carlson D, Haveman R, Kaplan T, Wolfe B. Long-term effects of public low-income housing vouchers on neighborhood quality and household composition. Journal of Housing Economics. 2012;21(2):101–20.
  • Eriksen MD, Ross A. The impact of housing vouchers on mobility and neighborhood attributes. Real Estate Economics. 2013;41(2):255-77.
  • Wood M, Turnham J, Mills G. Housing affordability and family well-being: Results from the housing voucher evaluation. Housing Policy Debate. 2008;19(2):367–412.

Action Step 1

ActionExpand Homeless Management Information System (HMIS) to all federal and state funded homeless programs. Improve outreach and linkages to housing resources and services. Coordinate prevention report from all potential funding sources.
Measure• % bed coverage in Homeless Management Information System (HMIS)
• % coverage in prevention report
• Use of AK Housing locator
Timeframe2020-2030
Key Partners• The Alaska Coalition on Housing and Homelessness (AKCH2)
• AK Council on the homeless (AHFC)
• Anchorage Coalition to End Homelessness

Action Step 2

ActionIncrease funding and sources of supportive services for Adults, Youth, and Families in underserved areas for Individuals and families experiencing or at-risk of homelessness
Measure• # housing units for chronic and special needs homeless
• # households served with short term assistance
• # project based rent assistance
• Establishment of coordinated homeless fund
Timeframe2020-2030
Key Partners• Alaska Men• tal Health Trust Authority
• State of Alaska, Division of Senior and Disabilities Services, Adult Protective Services
• State of Alaska, Department of Corrections
• RurAL Cap
• Catholic Social Services
• Forget Me Not – Juneau
• Volunteers of America
• Alaska Tribal Organizations
• Alaska Housing Finance Corporation
• Covenant House Alaska
• Choosing our Roots
• Providence St. Joseph Health – Alaska Region
• Shiloh Baptist – try to get full name
• Veterans Administration   
• Tribal Housing Authorities
• Tribal Health Organizations
• Tribal Non-Profits
• State of Alaska Medicaid
• DBH
• Home For Good

Action Step 3

ActionEnsure sufficient supply of permanent affordable housing by:
• Increasing affordable housing stock (# units available)
• Providing rental subsidies – additional rental assistance vouchers
Measure• # of affordable housing units added throughout Alaska
• # households assisted by rental assistance vouchers
Timeframe2020-2030
Key Partners• Alaska Housing Finance Corporation
• Cook Inlet Housing Authority
• Habitat for Humanity
• Neighbor Works
• Volunteers of America
• RurAL Cap
• AK Native Office of Native American Programs
• Tribal Housing Authorities
• Association of Alaskan Housing Authorities
• DCCED
• Alaska Municipal Management Association
• Alaska Municipal League
• AHFC Senior Housing representative

Objective 21: Increase the percentage of residents (all ages) living above the federal poverty level (as defined for AK)

Target: 90%

Strategy 1: Improve wages and benefits for the Alaskan workforce, so that individuals and families have the income needed to meet the costs of daily living

The purchasing power of individual households can be enhanced through initiatives and policies that result in greater wages. Increasing the earnings of low-income workers have historically helped to lower poverty rates without diminishing employment prospects.

Many factors account for high turnover and vacancy rates in the community service system: conditions of employment (e.g., hours of training provided), service model characteristics (e.g., staff ratios), employment context (e.g., urban location, area unemployment rates), and others (Report to Congress, 2006). However, studies have consistently attributed high turnover and vacancy rates, and especially the discrepancy between rates in community settings as opposed to institutions, to low wages and benefits. The Report to Congress indicates that between 1998 and 2002, the average wages were $11.67 an hour in public institutions and $8.68 in community services (2006, p. 19). In 2004, the starting hourly wage in large public institutions was $10.12 and the mean wage was $12.53 (Larson et al., 2005). Braddock, Hemp, and Rizzolo (2003) reported hourly wages of $11.67 in state-operated facilities and $8.68 in community settings; the poverty level was $8.19.

In Alaska, the Fair Market Rent (FMR) for a two-bedroom apartment is $1,111. In order to afford this level of rent and utilities – without paying more than 30% of income on housing – a household must earn $3,704 monthly or $44,446 annually. Assuming a 40-hour work week, 52 weeks per year, this level of income translates into a Housing Wage of $21.37.

Sources:

  • http://disabilitystudies.syr.edu/resources/DSWorkforceCrisis.aspx http://nlihc.org/oor/2013/AK
  • Dube, A. (2013). Minimum Wages and the Distribution of Family Incomes. University of Massachusetts, Amherst Working Paper. https://dl. dropboxusercontent. com/u/15038936/Dube_Minimum-WagesFamilyIncomes.pdf

Action Step 1

ActionImplement the Alaska System for Early Education Development (SEED), Alaska’s statewide professional development system for early childhood educators (ECE) in Alaska to impact and improve ECE educators’ wages and compensation including:
• 1.A Attain ECE and K-3 minimum wage parity by 2025
• 1.B Support ECE programs to establish their own pay scale that reflects experience years and education; Encourage ECE program to provide transparent pay scale information, which will provide data for leadership
• 1.C Award ECE educators’ tenure for demonstrated competency based on years of experience in the field
• 1.D Support ECE programs to develop, deliver, and document benefits packages for educators; Establish partnerships to provide universal health insurance options and retirement plans
• 1.E Seek ways to address ECE educators’ living expenses needs through innovative partnerships with public and private sectors
• 1.F Address wage and compensation issues of broader ECE community, including assistant teachers
• 2.A Further examination of specific professional development needs related to content and delivery mechanisms for Alaskan ECE educators
• 2.B Improvement of the SEED Registry to provide seamless support for ECE educators and to increase their participation
• 2.C Exploration and consideration of the unique needs of the broader ECE community, including family child care
• 2.D Offering mental health and leadership support to improve the quality of the workforce
• 2. E Implementation of entry and exit surveys to understand ECE educators’ job attitudes and turnover intention; Exploration of the possibility of providing a recruitment platform through the SEED Registry
Measure• # of enrolled eligible professionals in SEED Registry;
• # of issued SEED certificates verifying placement on the SEED Career Ladder;
• # of ECE who remain in the field for 3, 5, 10, 15, 20, 25 + years;
• # of ECE whose wages are commensurate K-3 grade educators by 2025;
• # of ECE who participate in entry and exit surveys regarding job attitudes and turnover retention;
• # of ECE program that provide benefits package;
• # ECE who are compensated for their tenure and demonstrated competency based on year of experience in the field;
• # partnerships established with public and private sectors who provide support for addressing EC educators’ living expenses
Timeframe2020-2030
Key Partners• thread
• Child Care Program Office
• SEED Steering Committee
• Learn & Grow

Strategy 2: Reduce the number of unemployed and underemployed in households that fall below the poverty level

The definition of poor in the United States is related to purchasing power and income. Employment is the one component on reducing the number of poor or those living under the poverty line.

Action Step 1

ActionImprove Alaska employment policies, procedures, or regulations around individuals with disabilities thereby increasing the number of Alaskans with disabilities who achieve and maintain employment in an integrated setting using existing funding, policies and support services, further elevating health and self-sufficiency.
(Aligned with Governor’s Council on Disabilities & Special Education State Plan)
MeasureThe success of this step can be tracked through State of Alaska DOWLD disability employment statistics and through the Governor’s Council on Disabilities and Special Education’s strategic plan implementation progress reports.
Timeframe2020-2026
Key Partners• Governor’s Council on Disabilities and Special Education
• Alaska Mental Health Trust Authority
• State of Alaska, Division of Vocational Rehabilitation
Previous Priority Health Topic: Protective Factors …………………………………………… Next Priority Health Topic: Substance Misuse

News Bulletins


PDFs now available for 2024 scorecards

May 6, 2025

Healthy Alaskans releases first set of 2030 health improvement scorecards, issues final report, scorecards from 2020 plan

January 31, 2023

Healthy Alaskans releases scorecards assessing Alaska’s health progress for 2020 and a health improvement plan for 2030 that sets goals for the next decade

February 4, 2021

State Health Improvement Plan, Healthy Alaskans 2030 (HA2030), Draft for Public Comment Released

August 5, 2020

Healthy Alaskans 2030 Sets Framework for Alaska’s Health Goals; Strengthening communities and empowering individuals

January 22, 2020

Healthy Alaskans Co-Chairs

Cheley Grigsby

Deputy Director
Division of Public Health
State of Alaska Department of Health
Cheley.Grigsby@Alaska.gov

Annette Marley, MPH

Public Health Program Specialist III
Wellness and Prevention
Division of Community Health Services
Alaska Native Tribal Health Consortium
aamarley1@anthc.org
wellnessprevention1@anthc.org

Contact HA2030

Email: healthyalaskans@alaska.gov

© 2024 Healthy Alaskans 2030