Hosted by Patagonia Health
Presenter: Dr. Colleen Bridger
Moderator: Amanda Girard
Our presenter today is Dr. Colleen Bridger.
Dr. Bridger holds:
- An undergraduate degree in International Development from the School for International Training
- A Master of Public Health from the University of North Carolina at Chapel Hill
- A Ph.D. in Health Services Research from UNC Charlotte
She is passionate about solving complex issues such as poverty, transportation, teen pregnancy, infant mortality, violence, youth smoking, and childhood trauma.
Prior to launching her consulting business, Dr. Bridger served as:
- Assistant City Manager for San Antonio, Texas
- Director of the San Antonio Metropolitan Health District
- Director of the Orange County Health Department in North Carolina
She has spent much of her career leading local health departments in North Carolina and San Antonio. Through her consulting company, she now works with nonprofits, foundations, and government organizations to address complex problems using a public health and ecological approach. Her current work focuses on mental health, public health, and education initiatives.
We are very happy to have Dr. Bridger with us today to share her expert knowledge on the Social Determinants of Health.
Thank you, Amanda, and good afternoon, everyone.
Today, we’re going to talk about social determinants of health—a topic that has gained much attention, especially since the pandemic highlighted what public health professionals have been saying for decades: the factors outside the healthcare system play a far greater role in good health than our funding structures would suggest.
However, there’s a challenge. Everyone seems to have a different understanding, definition, or framework for addressing the social determinants of health. As a result, we’ve fallen into the trap of “knowing it when we see it,” but not clearly defining it.
Key Points Covered
During this webinar, we will:
- Examine two different frameworks for addressing social determinants of health
- Discuss how power, or lack thereof, plays a role in health outcomes
- Explore the concept of Health Justice
- Review examples of how the City of San Antonio has addressed these issues through a health justice lens
Two Frameworks for Understanding Social Determinants of Health
The two main frameworks are:
- Healthy People 2030
- World Health Organization (WHO) definition
Healthy People 2030
Healthy People 2030 identifies five domains for addressing social determinants of health:
- Economic Stability
- Education Access and Quality
- Neighborhood and Built Environment
- Healthcare Access and Quality
- Social and Community Context
Each domain includes specific objectives. For example:
- Economic Stability: Improve income and reduce poverty, unemployment, and hunger.
- Education Access and Quality: Increase educational opportunities from early learning through college.
- Neighborhood and Built Environment: Address environmental health, asthma, housing, broadband access, and motor vehicle safety.
- Healthcare Access and Quality: Expand care and improve quality, an area where public health has strong experience.
- Social and Community Context: Increase social support and mental health resources.
Overall, the Healthy People 2030 framework includes nearly 100 objectives across these domains.
WHO Definition
The World Health Organization frames social determinants of health under three categories:
- Improve daily living conditions — The circumstances in which people are born, grow, live, work, and age.
- Tackle the inequitable distribution of power, money, and resources.
- Measure and understand the problem, then assess the impact of action.
While the WHO and Healthy People 2030 share many goals, the key difference lies in the explicit inclusion of power dynamics by the WHO. Healthy People 2030 tends to discuss these issues indirectly through topics such as civic participation, discrimination, and social cohesion.
Power and Social Cohesion
When comparing WHO and Healthy People 2030 approaches to social cohesion:
- WHO’s approach emphasizes upstream, systemic changes and frameworks centered on equity and power.
- Healthy People 2030’s approach focuses more on interventions for individuals or groups “we want to help,” rather than dismantling systems of inequity.
This reflects a fundamental difference: the WHO aims to change power structures, while Healthy People 2030 aims to assist within them.
Health Justice
The WHO approach aligns closely with what I call Health Justice—a concept not yet widely discussed in the U.S.
Health Justice = Social Justice + Health Equity
- Social Justice: Equal rights and equitable opportunities for all.
- Health Equity: Conditions that allow all people to achieve optimal health, recognizing and addressing historical injustices.
The San Francisco AIDS Foundation defines Health Justice as:
“The attainment of health equity actualized when structural factors no longer determine health outcomes. Health justice is reached when all people possess the economic, social, and political power and resources to make decisions about their bodies and health.”
Applying Health Justice: The San Antonio Example
As Assistant City Manager for San Antonio, I helped lead the city’s Recovery and Resiliency Plan during the COVID-19 pandemic. This initiative took a health justice approach to recovery.
Guiding Principles
- Public health and safety as the top priority
- An equity lens in all actions
- Creative use of braided funding streams
- A focus on community resilience and generational wellbeing
Focus Areas
- Workforce Development: Job training and long-term funding via a new sales tax initiative.
- Housing Security: Creating resource hubs to address root causes of housing instability.
- Digital Inclusion: $25 million investment to expand broadband for students and families.
- Small Business Support: Stabilizing small businesses affected by the pandemic.
- Health Response: Strengthening testing, vaccination, and emergency medical systems.
A public dashboard on the City of San Antonio’s website tracks progress and outcomes for these initiatives.
Strategic Growth Plan for the Health Department
Following the pandemic, the city also developed a Strategic Growth Plan to double the health department’s funding over five years, eventually shifting to full city funding.
Focus Areas
- Mental Health: Addressing the community’s mental health needs and reducing stigma.
- Health Justice: Operationalizing equity resolutions into actionable programs.
- Access to Care: Building community-driven systems for equitable access.
- Technology and Infrastructure: Modernizing systems to prevent the challenges experienced during COVID-19.
Audience Q&A Highlights
On Technology and Infrastructure
- Challenge: Fragmented systems and outdated processes (including reliance on fax machines).
- Solution: Push for electronic lab reporting and interoperable systems that are user-friendly.
On Screening Tools
- North Carolina’s Medicaid managed care program provides a good model for social determinants screening.
- Dr. Bridger emphasized focusing on systemic solutions rather than screening individuals, to better address root causes.
On Data and Measurement
- Effective evaluation requires collecting the right data at the right time.
- The U.S. framework emphasizes measurable results, while WHO focuses more on systemic inequities.
On Renewed Interest in Social Determinants
- The pandemic and the social justice movement brought visibility to long-standing inequities.
- Public health’s role is now more visible but also more demanding than ever.
On Federal Push for Data Integration
- There’s hope for federal support to better connect public health data with healthcare and behavioral health systems.
- However, Dr. Bridger cautioned against letting the pursuit of perfect data delay critical systemic reforms.
If you would like to contact Dr. Colleen Bridger, you can reach her at:
📧 colleen@seabridgerconsulting.com
🌐 www.colleenbridgerconsulting.com
