Presentation is loading. Please wait.

Presentation is loading. Please wait.

Practical Strategies Lauri Andress, MPH, J.D., Ph.D. June, 2010 Senior Health Equity Analyst Center to Eliminate Health Disparities University of Texas.

Similar presentations


Presentation on theme: "Practical Strategies Lauri Andress, MPH, J.D., Ph.D. June, 2010 Senior Health Equity Analyst Center to Eliminate Health Disparities University of Texas."— Presentation transcript:

1 Practical Strategies Lauri Andress, MPH, J.D., Ph.D. June, 2010 Senior Health Equity Analyst Center to Eliminate Health Disparities University of Texas Medical Branch Developing Chronic Disease Programs around the Social Determinants of Health

2 Identify 3 key elements of SDOH and the potential relevance of a social determinants of health (SDOH) perspective to chronic disease prevention. Describe 2 distinctions between universal and targeted interventions and the relevance of each to a comprehensive approach to population health planning at the local level Describe 2 ways SDOH research and a population perspective can be applied to health planning processes at the local level. Objectives

3 A shorthand for the broad and complex array of social, political, economic, environmental and cultural factors which strongly impact health status and equity. The structural determinants and conditions of daily life…responsible for a major part of health inequities……. Commission on the SDOH 'the distribution of power, income, goods and services, Locally, nationally, and globally…[and] the visible circumstances of people's lives - their access to high quality schools and education, their conditions of work and leisure, their homes, communities, towns and cities - and their chances of leading a flourishing life.' Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health: Commission on Social Determinants of Health final report. Geneva: World Health Organization Commission on Social Determinants of Health; Social Determinants of Health

4 Economy SOCIAL DETERMINANTS OF HEALTH Urban Planning Schools/ Education Employment/ Job Quality Community Safety Housing Options Transportation Options Governance Economic Development Social Determinants of Health

5 Conceptual Framework-Pathways & Entry Points Social ContextSocial stratification Differential exposure Social deprivation Unemployment Illiteracy Deprived neighborhoods Adverse intrauterine life Differential vulnerability Less access to: Health services Early detection Healthy food Differential outcomes Poverty Overcrowding Poor housing Differential consequences Rheumatic heart disease Chagas disease Lifetime exposure to advertising of fast foods, tobacco, vehicle use, disposable income, urban infrastructure, physical inactivity, high calorie intake, high salt intake, high saturated fat diet, tobacco use, lack of control over life and work, high deprivation neighborhoods Raised cholesterol, raised blood sugar, raised blood pressure, overweight, obesity, lack of access to health information, health services, social support and welfare assistance, poor health care-seeking behavior Higher incidence, frequent recurrences, higher case fatality, co morbidities High out-of-pocket expenditure, poor adherence, lower survival, loss of employment, loss of productivity and income, social and financial consequences, entrenchment in poverty, disability, poor quality of life AgeEconomic development, urbanization, globalization Equity, social determinants and public health programmes. Edited by Erik Blas and Anand Sivasankara Kurup 2010, 300 pages ISBN World Health Organization 2010 Determinants: a. Government policies: influencing social capital, infrastructure, transport, agriculture, food. b. Health policies at macro, health system and micro levels. c. Individual, household and community factors: use of health services, dietary practices, lifestyle. a Tobacco use c b b Obesity b a a b a

6

7 Six broad intervention approaches Social and environmental conditions favorable to health, Behavioral patterns that promote health, Low population risk, Few events and rare deaths, Fully functional capacity/low risk of recurrence, and Good quality life until death Texas Plan to Reduce Cardiovascular Disease and Stroke 2008 Texas Council on Cardiovascular Disease and Stroke 2008 Legislative Report

8 Major non-modifiable risk factors are: heredity, male gender, and increasing age. Modifiable risk factors are smoking, high cholesterol, high blood pressure, overweight and obesity, and physical inactivity. Another major risk factor for CVD is diabetes mellitus. Risk Factors Texas Council on Cardiovascular Disease and Stroke 2008 Legislative Report

9 Risk Factors for the Risk Factors? Obesity Smoking Physical Inactivity

10 Kickbusch Adelaide April Obesity: A Test Case for 21 st Century Health A complex system of determinants Involves a plethora of actors who fulfill many different functions in society. Risk patterns are local, national, global Local- the absence of playgrounds or lack of bicycle lanes); national (e.g. the lack of food labeling or advertising requirements) and global. (Foresight Report) Both the problem and the solution are systemic. Such systemic challenges can only be resolved through great political commitment at all levels of government and in many sectors of society……..

11 SDOH as Risk Factors Cardiovascular Disease Obesity Access to Healthy Food Income Transportation system Community development; Planning Agricultural Policies

12 The links between agriculture and health: an intersectoral opportunity to improve the health and livelihoods of the poor C Hawkes, M Ruel - Bulletin of the world Health Organization vol.84 no.12 Genebra Dec Conceptual framework of the links between agriculture and health

13 Risk Factors & Possible Policy Responses Policy sector - Farming & Agriculture Goal to ensure nutrition include: Farm and Commodity Policy; WIC policy Means available: Grants. Agricultural policy framework Examples: Animal and plant breeding; price and income supports; acreage limits and storage programs Adapted from LANG ET AL. (2009). FOOD POLICY- INTEGRATING HEALTH, ENVIRONMENT & SOCIETY

14 Risk Factors & Possible Policy Responses Policy sector - Agricultural Research and Productivity; Processing Goal to ensure nutrition include: Agricultural productivity; investments in agricultural research and technology; more efficient agricultural machinery, agricultural chemicals and fertilizers, genetic improvements in crops, and changes in farm management techniques Means available: Intellectual property rights Examples: Product reformulation. Change fat content in meat regulations Adapted from LANG ET AL. (2009). FOOD POLICY- INTEGRATING HEALTH, ENVIRONMENT & SOCIETY

15 Risk Factors & Possible Policy Responses Policy sector - Housing and Community Development- Related Policy Goal to ensure nutrition include: Improving access to health enhancing foods Means available: zoning and land-use planning decisions that determine the relationship of residential to commercial land uses Examples: Transportation decisions; Location of stores through town-neighborhood planning Adapted from LANG ET AL. (2009). FOOD POLICY- INTEGRATING HEALTH, ENVIRONMENT & SOCIETY

16 Risk Factors & Possible Policy Responses Policy sector - Federal Trade Commission, Food & Drug Administration, USDA Goal to ensure nutrition include: Change thinking about food to reshape demand Means available: Advertising, Labeling Examples: Controls on marketing to children. Reform Nutrition Labeling and Education Act of 1990 (NLEA) Adapted from LANG ET AL. (2009). FOOD POLICY- INTEGRATING HEALTH, ENVIRONMENT & SOCIETY

17 Inequity and CVD Equity, Social Determinants and Public Health Programmes. (2010). Edited by Erik Blas and Anand Sivasankara Kurup. WHO, WHO Press, 1211 Geneva 27, Switzerland ISBN

18 Risk Factors & Possible Policy Responses Priority Public Health Conditions Level Socioeconomic Context & Position Social Determinants and Pathways Social Status, Education, Occupation, Poverty, Parents Social class, Ageing of Population, Poor governance Main Entry Points Define, institutionalize, protect and enforce human rights to education, employment, living conditions and health; Redistribution of power and resources in populations Interventions Universal primary education Programs to alleviate under nutrition in women of childbearing age and pregnant women Tax-financed public services, including education and health Multifaceted poverty reduction strategies at country level, including employment opportunities

19 Risk Factors & Possible Policy Responses Priority Public Health Conditions Level Differential exposure Social Determinants and Pathways Poor living conditions in childhood Community structures Control over life and work Marketing; Television exposure Psychosocial and work stress Unemployment High-deprivation neighborhoods; Residence: urban/rural Availability of preventive health services Health-related behaviors Main Entry Points Strengthen positive and counteract negative health effects of modernization Community infrastructure development Reduce affordability of harmful products Increase availability of and accessibility to healthy food Interventions International trade agreements that promote availability-affordability of healthy foods International agreements on marketing of food to children Use tobacco tax for promotion of health of the population Develop urban infrastructures to facilitate physical activity Government legislation and regulation, e.g. tobacco advertising &pricing Voluntary agreement with industry, e.g. trans fats and salt in processed food User-friendly food labelling to help customers to make healthy food choices

20 Priority Public Health Conditions Level Differential vulnerability Social Determinants and Pathways Access to education plus Access to welfare assistance Health care-seeking behaviors Co-morbidity Lack of social support Health care-seeking behaviors plus Accessibility of health services Under nutrition Physical inactivity Access to health education Gender Main Entry Points Subsidize healthy items to make healthy choices easy choices Compensate for lack of opportunities Empower people Interventions Provide healthy meals free or subsidized to schoolchildren Subsidize fruits and vegetables in worksite canteens and restaurants Facilitate a price structure of food commodities to promote health, e.g. lower price for low-fat milk Improve early case detection of individuals with diabetes and hypertension by targeting vulnerable groups, e.g. deprived neighbourhoods, slum dwellers Improve population access to health promotion by targeting vulnerable groups in health education programmes Combine poverty reduction strategies with incentives for utilization of preventive services, e.g. conditional cash transfers, vouchers Provide social insurance and fee exemptions for basic preventive and curative health interventions Education and employment opportunities for women

21 Inequity and CVD (contd)

22

23 Statement of Intent to Pursue Health Equity Strategies The ODH is committed to the elimination of health inequities. All applicant agencies must submit a statement which outlines the intent of this application to address health disparities. This statement should not exceed 1 ½ pages and must: (1) explain the extent in which health disparities are manifested within the health status (e.g., morbidity and/or mortality) or health system (e.g., accessibility, availability, affordability, appropriateness of health services) focus of this application; (2) identify specific group(s) who experience a disproportionate burden for the disease or health condition addressed by this application; and (3) identify specific social and environmental conditions which lead to health disparities (social determinants). This statement must be supported by data. The following section will provide a basic framework and links to information to understand health equity concepts. This information will also help in the preparation of this statement as well as respond to other portions of this application. Options for Action-Grants

24 Questions & Answers

25 Miscellaneous slides


Download ppt "Practical Strategies Lauri Andress, MPH, J.D., Ph.D. June, 2010 Senior Health Equity Analyst Center to Eliminate Health Disparities University of Texas."

Similar presentations


Ads by Google