Newly released Oregon State Health Assessment focuses on social determinants of health

The Oregon Health Authority (OHA) released its 2018 Oregon State Health Assessment (SHA) Tuesday. The 220 page assessment is produced every five years to report on the overall health of Oregon and will be used by the OHA to identify priorities and strategies for the 2020 – 2024 State Health Improvement Plan.

This year’s assessment reports on five key areas  – social determinants of health, environmental health, prevention and health promotion, access to clinical preventive services, and communicable diseases. Importantly, for the first time the SHA elevates the social determinants of health to a level on par with systemic and clinical improvements emphasizing a more holistic approach to health which has been advocated in recent years. Explains Katrina Hedberg, MD, state health officer and epidemiologist at OHA’s Public Health Division,

“What we know is that a person’s health is inextricably tied to educational outcomes, employment and wages, and access to affordable housing,” Hedberg says. “These are all areas where we found Oregon falls short.”

The assessment found that Oregon has made improvements in several areas including:

  • Reduction in opioid-related deaths;
  • Reduction in rates of HIV infection;
  • Increasing rates of immunization among 2-year-olds;
  • Lower rates of teen pregnancy and births;
  • Lower smoking rates among adults and teenagers.

Despite the gains, Oregon was the 20th healthiest state in the country in 2017, according to the United Health Foundation’s Annual Health Rankings, which is down from 13th in 2012 and eighth in 2011. Oregon’s low standing in education, housing affordability and food insecurity have contributed to a decline in the state’s relative health standing nationally. For example, the assessment reports that over half of Oregonians report paying more than 30% of their income for housing, a common measure of affordability.

Oregon also ranks 44th in the country in food insecurity, meaning that individuals lack regular access to nutritional and safe food. Food-insecure adults are more likely to have poor health, diabetes, high blood pressure, high cholesterol, heart disease, and obesity. Children in food-insecure households are more likely to have poor health, behavior problems, poorer developmental outcomes, and be less ready to learn in school.

The SHA also highlights health disparities for people of color, people with disabilities, people with low income, people who identify as LGBT, and people living in rural and frontier areas of the state. Minority populations, other than Asian, faired worse than their Caucasian counterparts in almost every measure of health, leaving great room for improvement. It points out,

“As Oregon becomes a more racially and ethnically diverse state, addressing health inequities related to race and ethnicity becomes more important. Racial and ethnic categories reflect social constructs rather than biology or genetics.”

The assessment concludes by admitting that Oregon faces significant challenges to improving the state’s health and suggests that the best way to address those challenges is through increased planning and inter-agency coordination.

“Improving the overall health of Oregon is not a task for the public health or health care systems alone; rather, it will require state and local public health authorities to work with social service, transportation, planning, education, and economic development agencies; private business leaders, not-for-profit organizations, academic institutions, policymakers, tribal officials, and the public to address Oregon’s health challenges.”