Presentation on theme: "Tackling Health Disparities A Population Health Approach"— Presentation transcript:
1Tackling Health Disparities A Population Health Approach Lauri Andress, Ph.D March 6, 2009Texas Society for Public Health Education Spring Conference 20091
2ObjectivesA common framework to identify a health disparities project based on population health principles. Creating a basic health disparities intervention based on population health principles.
3Population Health Definition Dunn & Hayes, 1999, p. S7“The health outcomes of a group of individuals, including the distribution of outcomes within the group.”Measured by health status indicators that have been influenced bySocial, economic and physical environmentsPersonal health practicesIndividual capacity and coping skillsHuman biologyEarly childhood development, and health servicesConcerned about the interactions between the SDOH and health outcomes.
4Population HealthGeoffrey Rose British epidemiologistFocusing on population level variables such as socioeconomic position or environmental pollution would have greater utility in prevention strategies, because removal of such factors would potentially decrease the incidence of disease as opposed to strategies where small numbers of people have been exposed to a high risk, i.e., heart diseaseMeasures to improve public health, relating as they do to such obvious and mundane matters as housing, smoking, and food, may lack the glamour of high-technology medicine, but what they lack in excitement they gain in their potential impact on health, precisely because they deal with the major causes of common disease and disabilities. Rose, Geoffrey, The strategy of preventive medicine. Oxford (Oxford University Press), 1992.
5Schematic definition of the field of population Health outcomes anddistributionin a populationDependent variablesPatterns of healthDeterminants overthe life courseIndependent variablesPolicies & InterventionsAt the individual and sociallevelsInfant mortalityDiabetesCancerChild-Early childhood ed.Teen- Social inclusion,Adult-Income, wealth, autonomyWhat Is Population Health?David Kindig, MD, PhD, and Greg Stoddart, PhD(Am J Public Health. 2003;93:380–383)
6Social Determinants of Health Social determinants of health [SDH] refer to both specific features of and pathways by which societal conditions affect health and that potentially can be altered by informed action.As determinants, these social processes and conditions are conceptualized as “essential factors” that “set certain limits or exert pressures,” albeit without necessarily being “deterministic” in the sense that were circumstances to change the outcome would change as well.”
7Health Equity An approach to public health that includes: a well-structured set of scientific evidence anda political and educational ideology to encourage reflection on and changes in usual public policy practices.
8What causes social status and what is the result of social status? Cultural ToolkitShared values, language, religion, rituals, norms of behavior, and systems of belief. A set of distinctive spiritual, material, intellectual, and emotional features a society uses to interpret phenomena, data and experiences.Social StructureCultural ToolkitInstitutions, systems, policies, regulationsLabor marketEducational system, policiesSocial inclusion- exclusionSocial welfare stateAccess to productive resources & social goodsWhat causes social status and what is the result of social status?Social StatusPower & wealth ImbalancesAbsence of civic capacity & Political InfluenceHealth inequitiesInequitable distribution of the Social Determinants of HealthLack of affordable housingJob securityHazardsCommunity decayPoverty –low wagesTransportationPsychosocial StressUnhealthy behaviorsAndress, 2007
10The Explanatory ModelImproving population health requires that we examine social, genetic, and physical environments.Currently it is believed that these determinants of population health may influence multiple risk factors and health outcomes by shapingSocial inclusionindividual health behaviorsaccess to living conditions,lifestyles,goods and services such as healthcare and social services.Many of these factors involve public policy decisions made by government.In some cases these policy decisions and issues can undermine population health by influencing those social determinants of health leading to health inequities.
11Implications for Action State of the Art in Research on Equity in Health. Barbara StarfieldJournal of Health Politics, Policy and Law, Vol. 31, No. 1, February 2006.Increase inequitiesEfforts to improve overall distribution of healthBehavior change strategiesdependent on education, material wealth, or social connectednessPrevention and management of some illness- material wealthDecrease inequitiesPolicy changesMust be aimed at decreasing the inequity, Ex. Legislation to de-lead gasoline reduced overall lead levels but not in low income kidsPrimary care infrastructure if wide spread and accessiblenot disease strategiesPolicies directed at infants and childrenPhysical and social environments policies…… strategiesdesegregation, affirmative action, green space, zoning
12Health Equity Readiness Competencies Values IdeologyScientific evidenceTheoriesSDOHKnowledgePublic PolicyPolitical efficacyMulti-sectoredcollaborationSocial changeethosNeutral implementerof policy directives emanatingfrom the policymaker, orthe public administrator as anagent of change, usingautonomous judgment to operatein ways that may change societalarrangementsAgenda settingSocial movementsCommunity organizing
13Health Equity Initiatives BehavioralLifestyleUpstreamDownstreamEducate landlordsVouchers to eradicate triggers-smokers, moving feesState lawHome salesFamilyeducationon asthmatriggersHomeassessmentsLegal aide with rental issues2005 Houston MSA, women aremore likely than men to report current asthma…. Blacks and Hispanics are more likely toreport current asthma than whitesHealth disparitiesHealth inequitiesContext, structural,SDOHThe factsHealth outcomesAsthma
14Health Equity Initiatives BehavioralLifestyleUpstreamDownstreamExamine sewage systemLaw building on flood plainsTreat infectionCouncil w. Planning authorityTarget bacteriaResidents from routine andmanual occupations, were living inless expensive housing areas.Residents in one community-Sewage in flood waterHealth disparitiesHealth inequitiesContext, structural,SDOHOutbreak of diarrheal infectionThe factsHealth outcomes
15Health Equity Readiness Checklist How far upstream can you go?Will there be a change in a fundamental SDOH that affects a large number of people?Who is on your team?Anyone from outside health?What is the role of the community?Does it enhance the autonomy of the community?Does it increase civic- political participation?Did the community select the issue?Were you invited in to help?What is the health equity value?Any SDOH theories and research to support?Who gets helped and how? i.e., the gradient, the bottom, close the gapWhat is your role?professional expert/technician- the autonomous technician;facilitator- enabling face-to-face discourse; andAdvocate- social critic- protecting citizens from societal conditions