HJAR May/Jun 2023

determinants of health, as I think they’re really instrumental to both medicine and public health, these determinants start in the environments in which we are born, live, and work and affect a wide range of health risks and outcomes. The amount of services one has access to, like health- care and education, as well as social envi- ronments, like culture and violence, may result in long-term health inequities such as injuries, chronic disease, and decreased life expectancy. What influences health in these social determinants? I always like to call them “building blocks” because I think you build everything on top of it — things like eco- nomic stability, education access, health- care access, the built environment, and social and community context. When you take one of these, like access to healthcare, if you don’t have access to healthcare or insurance, you’re less likely to get preven- tative screenings, less likely to get vacci- nations, so more likely to have long-term health consequences. Another example I really like is when you look at environmental conditions. If you have one of those blighted lots, one of those areas you look through and it has vacant buildings, you’re less likely to walk through that park or that area. When green- ing is done there, that brings together com- munities, increases physical activity, and decreases crime. So, the environment you are in truly impacts your health, and these are things that we can change. What do we do as providers? One thing the National Academy of Medicine and the American Association of Medical Colleges have now recommended is screening for social needs. We can do that in clinical set- tings — identifying the social needs and then working with community-based groups to really provide those services. And then what do we do on the other side from the health department or public health? Look at the data in the community. What are some of the underlying drivers, the inequi- ties, the issues that we need to rise up and really elevate? And then how do we work across sectors with the healthcare system to ensure that we are doing those linkages? I think public health also has a significant role when it comes to talking about evi- dence-based practices and what some of those programs that need to be evaluated or scaled up are. An example is at CDC, we now have a community health worker program. This was launched during COVID given the need that we saw to be much more in the field, and this program is focused on resilient communities and really links community health workers as front-line public health workers. Not only were they instrumental in ensuring that more populations were vaccinated, but they’re trusted. They’re trusted messengers and can also do things like cancer screening, talk about high blood pressure, link to community groups and resources. In some states now through some of our CDC funding, they are expanding their community health workers pilot across the state and facilitating things like peer-to- peer learning and regional networks. What I think is really important is they’re also now doing social needs screenings in commu- nities that have lower incomes and link- ing these community members to services — intervening early with trusted members with community resources. Focusing on a few other CDC programs, SET-NET or Surveillance for Emerging Threats to Mothers and Babies was started during Zika. I think Zika was one of those many diseases that really caught us all by surprise because as we kept learning more and more about it, there were so many more things we didn’t learn like being sexually transmitted, having congenital defects, all these things. It was a very complex dis- ease. So, we set up this network to moni- tor throughout pregnancy and then early childhood. But when we did this, we realized there were some areas of the country that certainly were experiencing more of this. So, we included field staff in those areas to help collect the data but also educate the “More than half of the adults in the U.S. have experienced one [instance of childhood trauma] in their lifetime, and one in six have experienced four or more. When you look at how this has a cumulative effect on health, what you see is that the more ACEs you have, the more likely you are to have these chronic health conditions; and they are actually associated with five of the 10 leading causes of death.”