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.
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).
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.
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.
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.
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.
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.
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