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PAGE 10 <br />SOCIAL AND STRUCTURAL <br />DETERMINANTS OF HEALTH <br />These mid- and upstream factors are often called <br />social or structural determinants of health. These <br />non-medical factors influence health outcomes and <br />are the conditions in which people are born, grow, <br />work, live, and age, and the wider set of forces <br />and systems shaping the conditions of daily life. <br />As described above, community members often <br />mentioned these in the same breath as the challenge <br />they were experiencing. Similarly, while nonprofit <br />Figure 4. Upstream and Downstream Approach to Health <br />Source: Jon Warner <br />Figure 5. Root Causes of Inequities <br />organizations identified some of the workforce <br />challenges to attracting and retaining diverse <br />service providers, they also noted the high cost of <br />housing and funding limitations (e.g., funders not <br />supporting operational costs) that were barriers to <br />providing a living wage. One faith-based organization <br />representative said that: <br />“We feel that problem [living wage] acutely as a <br />church because we have to pay…we can’t compete <br />with Google, and Facebook. We’re a nonprofit, <br />a church. And so we need employees who work <br />here and who live here. It doesn’t do much good <br />to have a pastor who lives in Tracy or Modesto or <br />Stockton. So in some ways, the nonprofit world and <br />the church world face the same challenges that <br />the schools do in getting teachers here, or police <br />officers or firefighters to live here.” <br />ROOT CAUSES <br />Troughout this needs assessment, participants <br />identified several social or structural determinants <br />that helped to create the current conditions that the <br />region is experiencing. These are best understood <br />Source: Health Resources in Action (HRiA) <br />COPD <br />Cancer <br />Behavior Problems <br />Depression Hypertension <br />Diabetes <br />HeartDisease Obesity <br />Injury <br />Social Connections <br />Smoking <br />SubstanceUse Stress <br />Lack of exercise Diet <br />Falls <br />Built Environment <br />Education <br />Violence and Trauma <br />Employment <br />Housing <br />Social Environments <br />Heterosexism <br />Classism <br />Racism <br />Poverty <br />Ableism <br />Sexism <br />Structural & InstitutionalBarriers <br />Distribution of resources <br />Ageism <br />Religious Prejudice <br />Xenophobia <br />EASTERN ALAMEDA COUNTY HUMAN SERVICES NEEDS ASSESSMENTSS Page 68 of 554