Social Determinants of Health

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  • 1. Healthy Campus 2020
    Focus on Determinants of Health and Evidence-Based Actions
    Jim Grizzell, MBA, MA, CHES, ACSM-HFS, Cal Poly Pomona; Karen Moses, MS, RD, CHES, Arizona State University
    Michelle Burcin, PhD, MPH, CHES, University of South Carolina; Cynthia Burwell, EdD, CHES, Norfolk State University

2. Learning Outcomes
Explain determinants of health and action model
Define evidence-based public health
Describe how to use the Healthy People 2020 online database of evidence-based actions and strategies
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3. Agenda
Whos leading the Healthy People initiative?
Rationale for using social determinants of health and evidence-based actions
What are social determinants of health?
Steps that can be taken by Healthy People 2020 users
NASPAs campus ecology model
What is evidence-based public health?
Strategies to broaden the evidence-base for public health
For higher education: resources for identifying evidence-based actions
Resources and References
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5. Vice-Chairs and MembersHealthy People 2020 Advisory Committee
Jonathan E. Fielding, MD, MPH, MA, MBA
Director and Public Health Officer
Los Angeles County, Department of Public Health
Professor of Health Services and Pediatrics and Co-Director
UCLA Center for Healthier Children, Families and Communities
Shiriki K. Kumanyika, Ph.D, M.P.H.
Professor of Biostatistics and Epidemiology
Department: Biostatistics and Epidemiology
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and biostatistics
William Douglas Evans, PhD; Vincent Felitti, MD; Everold Hosein, PhD; Lisa Iezzoni, MD, MSc; Abby King, PhD; Ronald Manderscheid, PhD; David Owen Meltzer, MD, PhD; Eva Moya, LMSW; Patrick Remington, MD, MPH; David Siegel, MD, MPH; Adewale Troutman, MD, MPH
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6. Rationale for SDOH and EB Actions
Past Healthy People documents
Catalogues of burdenof ill-health, disability and premature death
Set of targets for reducing burden
What was missing?
Guidance on potential actions for achieving targets
Relative effectiveness of actions
Advisory Committee recommendation
Tie goals and objectives to evidence-based interventions that guide effective action and accountability
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7. Overarching Goals of Healthy People 2020
Address the factors that contribute to our collective health and illness by
calling for healthy places & supportive public policies
placing emphasis on the determinants of health
Reflect Advisory Committee recommendations
Redirect our attention from health care to health determinants
Health determinants should be a primary focus of Healthy People 2020:
health care, a secondary focus.
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Phase 1 Report: Recommendations for the Framework and Format of Healthy People 2020, October 28, 2008. Page 20.
8. Healthy Campus 2020 Overarching Goals
Create social and physical environments that promote health, safety and learning
Supports efforts to increase academic success, student retention and life long learning
Eliminate preventable disease, disability, injury, and premature death
Achieve health equity, eliminate disparities, and improve the health of the entire campus community
Promote healthy development and health behaviors across every stage of life
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9. Healthy Campus 2020 Mission
Identify nationwide health improvement priorities in higher education
Increase awareness and understanding of determinants of health, disease, and disability and the opportunities for progress
Provide measurable objectives and goals that can be used at institutions of higher education
Engage multiple constituents to take actions to strengthen policies, improve practices, and empower behavior change that are driven by the best available evidence and knowledge
Identify and promote relevant assessment, research and data collection needs
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From Sept 17-18, 2009 meeting slides
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Living and working conditions may include:

  • Psychosocial factors

19. Employment status and occupational factors 20. Socioeconomic status (income, education, occupation) 21. The natural and built c environments 22. Public health services 23. Health care servicesBroad social, economic, cultural, health, and environmentalconditionsand policies at the global, national, state, and local levels
a
Living and working conditions
Social, family and community networks
Social-Ecological Models
Individual behavior
Innate
individual traits:
age, sex, race, and
biological
factors
---
The biology of
disease
Over the life span
b
Dotted lines denote interaction effects between and among the various levels of health determinants
IOM model of multiple determinants of health used to develop Action Model for Healthy People 2020. Dahlgren, G. (1995) European Health Policy Conference: Opportunities for the Future. Vol. 11 Intersectoral Action for Health. Copenhagen: WHO Regional Office for Europe
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NOTE
* Evidence-based, HIA positive health impacts, ROI >1:1 ** SMART: Specific, measurable, achievable, relevant, time-specific
NOTE: added planning model & learning & playing conditions
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30. World Health Organization
Ottawa Charter
Healthy settings, cities, worksites, schools
Think Health Agenda and Healthy Settings to Enhance Health & Learning
We shape our [campuses]; thereafter, they shape us.
- Winston Churchill
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Social-Ecological Models
33. A New Paradigm: The Ecological Approach to Campus Health
Views the connections among health, learning, and the campus structure
Explores relationships between and among individuals and the learning communities that comprise the campus environment
This section presented by Karen Moses
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Healthy Campus 2020: Determinants of Health and Evidence-Based Actions
34. Using the Ecological Perspective on Campus
Establish a Working Group
Identify Campus Values
Assess Student Health Data
Analyze Campus Health Concerns Through an Ecological Lens:
Environmental influences
Individual influences
Develop a Plan
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Healthy Campus 2020: Determinants of Health and Evidence-Based Actions
35. Influencing Factors
Characteristics of the:
Individual
Community
Place
Organization
People
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Healthy Campus 2020: Determinants of Health and Evidence-Based Actions
36. Environmental Influences
Place
People
Behavior settings: Rituals,
student organizations
Cultural Influences:Customs,
traditions, values
Economic Forces:Student
financial stability, budget
Inhabitants:Diversity, Athletics,
Greek, campus communities, etc.
The location of the campus
The weather
The constructed designs
Landscapes
Organizational Structure
Policies
Organizational Climate
Political Climate
Conservative/liberal
Pro education?
Reinforcement and Rewards
For healthy org & indiv behaviors
Organization
Community
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Healthy Campus 2020: Determinants of Health and Evidence-Based Actions
37. Stress:Environmental Influences
Warm climate
Lack of parking
High traffic
Campus sizedistances
Crowdinglong lines
Place
People
Financial concerns
ISO global troubles
Relationships w/friends
Lack of friends/commuters
Irresponsible drinkers
Uninvolved students
Services--lack of info
Depts disconnected
Too many steps
Weak policy enforcement
Inconsistent messages
State budget crisis
Increase in tuition/fees
Rewards for over
commitment
Culture of stress
Institution
Community
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Healthy Campus 2020: Determinants of Health and Evidence-Based Actions
38. Keys to Effective Use of the Ecological Perspective
Expand the focus beyond health information and programming
Integrate responsibility for health across student affairs and academic units
Provide supportive environments and reduce barriers to optimal outcomes
Promote leadership and involvement by multiple partners
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Healthy Campus 2020: Determinants of Health and Evidence-Based Actions
39. Evidence-Based Public Health Actions
Origins of movement to EBPH, roots in EBM
Prior to 1970s: Uninformed intuition, unsystematic clinical experience, . . .*
1984: US Preventive Services Task Force
EBPH is the development, implementation, and evaluation of effective programs and polices in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models.
* Hill, E., Alpi, K., Auerbach, M., Evidence-based practice in health education and promotion: a review and introduction to resources. Health Promot Pract 2010; 11; 358 originally published online Jan 13, 2009
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40. Evidence-Based Public Health Actions
Categories of social decision making
Independent of context
Context sensitive
Anecdotal
Assessing interventions
Systematic reviews
Health impact assessments (HIAs)
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41. Sources for Evidence-Based Actions
NIAAA
www.niaaa.nih.gov/
Higher Education Center for
www.highereducationcenter.org
s
www.samhsa.gov/ebpwebguide/index.asp
Guide to
www.thecommunityguide.org/index.html
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42. Sources for Evidence-Based Actions
http://www.nrepp.samhsa.gov
Higher Education Center for Adrug
www.higheredcenter.org/prevention/strategic-planningStrategic Planning
CDCynergy Social M
Strategic & Intervention Planning
www.orau.gov/cdcynergy/soc2web/Content/phase01/phase01.htm
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43. Tags for Use in Database Queries
Settings
Government
Private health/healthcare sector
Education
Workplaces
Communities
Institutional settings
Regional/national Organizations
Users
Roles
Healthy People Objectives
Target Population
Selection criteria
Approving body
Examples and resources
Key words
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Click on image to go to web site www.nrepp.samhsa.gov/find.asp
45. Summary & Questions
Whos leading the Healthy People initiative?
Rationale for using social determinants of health and evidence-based actions
What are social determinants of health?
Steps that can be taken by Healthy People 2020 users
NASPAs campus ecology model
What is evidence-based public health?
Strategies to broaden the evidence-base for public health
For higher education: resources for identifying evidence-based actions
Healthy Campus 2020: Determinants of Health and Evidence-Based Actions
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46. Resources
Links to this presentation and reference files
www.csupomona.edu/~jvgrizzell/hc2020/acha2010presentations.htm
Presenters
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  • Jim Grizzell, MBA, MA, CHES, ACSM-HFC

47. California State Polytechnic University, Pomona 48. [email protected] 49. (909) 856-3350 50. Cynthia Burwell, EdD, CHES 51. Norfolk State University 52. [email protected] 53. (757) 823-9494 54. Karen Moses, MS, RD, CHES 55. Arizona State University 56. [email protected] 57. (480) 965-1360 58. Michelle Burcin, PhD, MPH, CHES 59. University of South Carolina 60. [email protected] 61. (803) 777-4752