CREATING HEALTH FOR ALL

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Oct 28, 2013 (4 years and 12 days ago)

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CREATING HEALTH FOR ALL

Julie Willems Van Dijk RN PhD

Associate Scientist/Deputy Director

County Health Roadmaps

June 12, 2013

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ACKNOWLEDGEMENTS


Robert Wood Johnson Foundation


Including Abbey Cofsky, Paul Kuehnert, Michelle Larkin, Jim Marks,
Joe Marx, Naima Wong


Wisconsin
County Health Rankings & Roadmaps

Team


Including Bridget Catlin,
Patrick
Remington, David Kindig, Angela
Russell, Amanda Jovaag, Alison
Bergum, Kate Konkle, Karen
Odegaard, Jan O’Neill


Our Partners


Including Burness Communications, Community Catalyst, United
Way Worldwide, ASTHO, NACCHO, NNPHI, Dartmouth Institute,
CDC, NCHS

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GOALS


Explore concepts of health disparities, health equity and
multiple determinants of health


Identify strategies for creating health for all in your
community


Discussion

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HEALTH DISPARITIES



“Health
disparities refer to differences between groups of
people. These differences can affect how frequently a
disease affects a group, how many people get sick, or
how often the disease causes death
.” (NIH, 2013)


The term health disparities refers to population
-
specific
differences in the presence of disease, health outcomes,
quality of health care and access to health care services
that exist across racial and ethnic groups.
(NCSL, 2013)

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HEALTHY PEOPLE 2020 WILL TRACK DISPARITIES


Race and ethnicity


Gender


Sexual identity and orientation


Disability status or special health care needs


Geographic location (rural and urban)


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HEALTH EQUITY


Differences in population health status and mortality
rates that are systemic, patterned, unfair, unjust, and
actionable. (Margaret Whitehead)


A
ttainment
of the highest level of health for all people.
Achieving health equity requires valuing everyone equally
with focused and ongoing societal efforts to address
avoidable inequalities, historical and contemporary
injustices, and the elimination of health and health care
disparities
. (Healthy People 2020)


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WHY IS
JASON

IN THE HOSPITAL?

http://www.youtube.com/watch?v=EI_Z
-
N1qeeo

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EVANS &
STODDART

MULTIPLE DETERMINANTS
OF HEALTH, 1994

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DAHLGREN G, WHITEHEAD M. POLICIES AND STRATEGIES TO
PROMOTE SOCIAL EQUITY IN HEALTH. STOCKHOLM, 1991

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RWJF
COMMISSION TO BUILD A HEALTHIER AMERICA.

OVERCOMING OBSTACLES TO HEALTH,
2008

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INSTITUTIONAL

POWER

Corporations &

other businesses

Gov't agencies

Schools


RISK

FACTORS


Smoking

Nutrition

Physical activity

Alcohol & other


drugs

Violence


NEIGHBORHOOD
CONDITIONS


Physical environment


Land use


Transportation


Housing


Residential segregation


Social environment


Experience of class


Experience of racism


Experience of gender


Cultural assimilation


/isolation


Population histories


DISEASE

& INJURY


Infectious disease

Chronic disease

Injury (intentional


& unintentional)


MORTALITY



Infant mortality

Life
expectancy




SOCIAL

INEQUALITIES

Class

Race/ethnicity

Gender

Immigration

Status
s


GENETICS

Social Factors

Health Status

UPSTREAM

DOWNSTREAM

iNDIVIDUAL

HEALTH

KNOWLEDGE

FRAMEWORK FOR UNDERSTANDING HEALTH INEQUITIES

BAY AREA REGIONAL HEALTH INEQUITIES INITIATIVE


HEALTH
EDUCATION

HEALTHCARE

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DO WE KNOW HOW MUCH EACH OF THE MAJOR
DETERMINANTS CONTRIBUTES TO HEALTH?

a.
Historical perspective

b.
Literature review

c.

Analysis of ability to predict health
outcomes

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HISTORICAL PERSPECTIVE


1930
-
1950: Sanitary revolution and
improvements in
environmental health


1950
-
1970: Increasing role of
health care


1970
-
1990: Contribution of
health behaviors

(smoking/diet/exercise) increases


1990
-
present
: Social and economic
determinants

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REVIEW OF THE LITERATURE

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REVIEW OF THE LITERATURE


The oft cited McGinnis et al (2002) paper states:
"...using the best available estimates, the impacts of
various domains on early deaths in the US distribute
roughly as follows:


genetic predispositions, about 30%;


social circumstances, 15%;


environmental exposures, 5%;


behavioral patterns, 40%; and


shortfalls in medical care, 10%.”


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ANALYTIC APPROACH

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SPEAKING TO OUR PARTNERS


Avoid jargon

such as social determinants


Connect with messages they believe in


One fact

not dozens


Offer solutions


Incorporate the role of personal
responsibility


Mix
conservative & progressive
values


Focus on improving health for all

(From
A New Way to Talk About the Social Determinants of Hea
lth, Robert Wood Johnson
Foundation,
2010)

http://www.rwjf.org/vulnerablepopulations/product.jsp?id=66428



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WORK TOGETHER

Tobacco use

HEALTH BEHAVIORS

Diet & exercise

Alcohol use

Sexual activity

CLINICAL CARE

Access to care

Quality of care

SOCIAL & ECONOMIC
FACTORS

Education

Employment

Income

Family & social support

Community safety

PHYSICAL
ENVIRONMENT

Environmental quality

Built environment


Addiction specialists


Educators


Advocacy groups


Policymakers


Faith leaders


Wellness coordinators


Bar owners/tenders


Healthcare providers


Community members


Healthcare providers


Ombudsmen


Community members


Advocacy groups


Business owners


Educators


Advocacy groups


Policymakers


United Way


Law enforcement


Labor unions


Neighborhood
organizations


Economic development


Community members


Planning/zoning


Transportation


Community members


Foresters

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ASSESS AND FOCUS


Look at data from ALL determinant areas


Disaggregate data by race, ethnicity, income, education,
gender, geography


Treat all determinant areas as actionable


CHIPs MUST look beyond health behaviors and access to
care to include priorities from the social and economic
factors that influence health

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Positive Findings


85% contained data from all four health
factor areas


85% discussed special populations


78% had some disaggregated data (most
commonly disaggregated by age or
gender)


85% had conducted some type of primary
data collection

Room for Improvement



20% had sought feedback from the
community about the CHA/CHIP and
incorporated that feedback into the plan


14% of 458 priorities were focused on
social or economic factors

RESULTS FROM ANALYSIS OF WI’S
CHA’S
/CHIP’S

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CHOOSE EFFECTIVE POLICIES






www.countyhealthrankings.org/roadmaps/what
-
works
-
for
-
health

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SPECTRUM OF PREVENTION
WWW.PREVENTIONINSTITUTE.ORG

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http://www.cdc.gov/about/grand
-
rounds/archives/2010/download/GR
-
021810.pdf

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NATIONAL PREVENTION STRATEGY

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NATIONAL PREVENTION STRATEGY (P. 23)

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SOCIAL ECOLOGICAL MODEL (MCELROY, BIBEAU,
STECKLER, & GLANZ, 1988)

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SOCIAL ECOLOGICAL MODEL IN PRACTICE

Obesity

Education

Individual

Weight Reduction

Exercise

Programs

Attend class

Do homework

Family/Interpersonal

Family Nutrition Classes

Active Family Challenge

Attend parent teacher

conferences

Turn off the TV

Institutional

Healthy Nutritional Choices

Competitive

Pricing

Activity

Challenges

Point of Decision Prompts

Service learning

Early intervention for truancy

Community

Bike

and Walking Trails

Safe Routes to School

Families and Schools
Together (FAST)

Mentoring Programs

Policy

Junk Food Tax

Transfat

Bans

Reduce class size

School reform

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SOCIAL ECOLOGICAL MODEL(S) LEFT VERSION:
MCELROY ET AL, 1988; RIGHT VERSION: LINDA RAE
MURRAY, 2010

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Annual
prize


Honoring outstanding
community efforts and
partnerships


Winning communities receive a
$25,000 cash prize

ROADMAPS TO HEALTH
PRIZE

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THEMES


Care about making a difference


Lead in a way that brings and keeps people together


Partnership means relationship


Meaningful engagement of the community


Focus first and resources will come


The whole is greater than the parts

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NEW
ORLEANS

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QUESTIONS

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STAYING CONNECTED






e
-
Newsletter: chr@match.wisc.edu




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THANK YOU

Julie Willems Van Dijk RN PhD

Deputy Director, County Health Roadmaps

University of Wisconsin Population Health Institute

608
-
263
-
6731

willemsvandi@wisc.edu