Objectives of the Presentation

1. FAHSC 2011 Annual Summer Education & Training ForumEffective and Promising Practices Addressing Social Determinants of HealthMichael L. Sells, MSPH, CHESBehavioral ScientistDiv. of Nutrition, Physical Activity & ObesityJuly 26, 2011http://www.cdc.gov/nccdphp/dnpa/

2. Objectives of the Presentation At the conclusion of the session, participants will be familiar with the following: • Overview of Key Terms and Relevant Data • CDC’s Frameworks and Approaches • Examples and promising practices • Policy, Systems and Environmental change recommendations to address the SDOH • Systematic approach to building capacity to address health inequities • Resources & Tools

3. Key Terms • Justice • Health Equity • Health Inequity • Health Disparities • Socioeconomic Factors • Social Determinants of Health

4. Health Disparities • Differences in the incidence and prevalence of health conditions and health status between groups, based on: • Race/ethnicity • Socioeconomic status • Sexual orientation • Gender • Disability status • Geographic location • Combination of these

5. Health Inequity • Systematic and unjust distribution of social, economic, and environmental conditions needed for health • Unequal access to quality education, healthcare, housing, transportation, other resources (e.g., grocery stores, car seats) • Unequal employment opportunities and pay/income • Discrimination based upon social status/other factors

6. Health Equity • The opportunity for everyone to attain his or her full health potential • No one is disadvantaged from achieving this potential because of his or her social position or other socially determined circumstance. • Distinct from health equality

7. Justice in Public Health • Justice defined: • The fair disbursement of common advantages and the sharing of common burdens. • Two Aspects of Justice • Health Improvement for the population • Fair treatment of the disadvantaged Source: Gostin, L. & Powers, M. (2006) What Does Social Justice Require for the Public’s Health? Public Health Ethics and Policy Imperatives. Health Affairs, 25:4

8. Maternal Child Health Disparities Fact Screenings & Services • The Screening Rate has risen steadily increased statewide in Florida between 2007-2009.

9. Question If there has been a steady increase in the screenings and services, then why aren’t the disparities gaps decreasing?

10. Potential Barriers/Challenges • Implementation Challenges • Varying Support • Differential enforcement • Selection factors • Relationships

11. Factors that Affect Health Smallest Impact Largest Impact Examples Counseling & Education Eat healthy, be physically active Counseling & Education Rx for high blood pressure, high cholesterol, diabetes Clinical Interventions Immunizations, brief intervention, cessation treatment, colonoscopy Long-lasting Protective Interventions Long-lasting Protective Interventions Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax Changing the Context to make individuals’ default decisions healthy Changing the Context to make individuals’ default decisions healthy Poverty, education, housing, inequality Socioeconomic Factors Socioeconomic Factors

12. Maximizing Public Health Impact • IMPACT = REACH X EXPOSURE X POTENCY • Focus on changing things that affect: • many people • with frequent exposure • and in a comprehensive way

13. CDC’s Approaches to Health Equity • The National Center for Chronic Disease Prevention and Health Promotion addresses health equity through its: • Programs • Research • Tools and resources • Leadership

14. CDC’s Approaches to Health Equity • Example Program (Teen Pregnancy Prevention Initiative): • CDC is partnering with the federal Office of the Assistant Secretary for Health (OASH) to reduce teen pregnancy and address disparities in teen pregnancy and childbirth rates. CDC - Teen Pregnancy Prevention 2010-2015 - Teen Pregnancy - Reproductive Health http://www.cdc.gov/TeenPregnancy/PreventTeenPreg.htm

15. Social-Ecological Model

16. Recommendations: Surveillance, Research, and Evaluation • Develop common indicators and data collection methods to facilitate learning across communities • Standardize measurement of progress • Standardize evaluation • Develop/evaluate environmental and policy interventions for disparate groups • Research/evidence-based • Practice based

17. Recommendations: Training and technical assistance • Facilitate peer to peer mentoring opportunities • Across health departments • Within health departments and other service providers • Translate, disseminate, and promote effective interventions to address disparities

18. Recommendations: Partnerships and other • Seek input of groups most affected by disparities • Include strategies to address disparities as part of an action plan.

19. Policies

20. Policies, Systems, and Environmental Changes • Health equity in all policies and practices. • Policies are the rules. Systems and environments are impacted (positively and/or negatively) by those rules.

21. Three Policy Streams • The following streams must occur: • Define the problem • Develop potential policies to solve the problem • Consider the role of politics and public opinion Source: Brownson, et al. (2010) Prev. Chron. Dis., 7:4.

22. Policy Considerations • Equity is a criteria for inclusion and/or prioritization of policies • Identify policies that are important to low-income communities, communities of color and other vulnerable populations • Target benefits to vulnerable populations • Prioritize the provision of resources to areas that need it most Source: Navarro, A. (2011) Advancing Equity Through Policy, Systems and Environmental Change

23. Additional Considerations • Behavioral change • Assets-based approach • Culturally & linguistically appropriate standards • Multi-level or Ecological approach • Resilience Research

24. How can we make addressing health inequalities realistic and practical? • Build internal infrastructure and capacity to achieve health equity • Systematic approach to building capacity to address health inequities

25. Steps in Operationalizing Health Equity in Programs • Enhance staff capacity (Seek training) • Leadership support and involvement • Identify partners (internal/external; coalition, workgroup…) • Inventory of existing health disparities-focused activities

26. Steps in Operationalizing Health Equity in Programs (Continued) • Identify disparities using existing data • Identify/tailor effective strategies and activities to address risk factors (Example risk factors: race, education, income and health insurance status) • Strategic planning • Prioritize activities within strategies

27. Steps in Operationalizing Health Equity in Programs (Continued) • Baseline data for evaluation • Integrate the strategic plan into program’s plan • Implement activities • Summarize and disseminate evaluation results and lessons learned Source: CDC’s Division of Nutrition Physical Activity and Obesity

28. Success Story- Genesee County REACH

29. Project Focus • African American men, women & children in zip codes: 48503, 48504, 48505, 48458 • Healthcare providers, organizational and business leaders, insurers, community leaders • Frontline staff who work directly with the Moms • Ourselves as REACH 2010 partners

30. Declining Infant Deaths

31. Focus Areas and Accomplishments • Community & Systems Change • Change Among Change Agents • Community Dialogue • Maternal & Infant Health Advocates (MIHAs) • ASSET MAPPING (Community Van Tours) • Community Media Campaign

32. Focus Areas and Accomplishments • One-Stop Village • African Culture Education Development Center • Healthy Eating • Undoing Racism Workshops • PRIDE-Medical Services • Intervention Facilitators’ Training • Cultural Competence in Health Care Course

33. Resources and Tools • Social Determinants of Health Maps http://www.cdc.gov/dhdsp/library/maps/social_determinants.htm • Promoting Healthy Public Policy through Community-Based Participatory Research: Ten Case Studies http://www.policylink.org/site/apps/nlnet/content2.aspx?c=lkIXLbMNJrE&b=5136581&ct=6996033 • Smart BRFSS: City and County Data http://apps.nccd.cdc.gov/BRFSS-SMART/

34. Resources and Tools • Prevention Institute’s Tools website http://www.preventioninstitute.org/tools.html • Communities of Practice http://www.kstoolkit.org/Communities+of+Practice • Social Determinants of Health Workbook: Promoting Health Equity http://www.cdc.gov/nccdphp/dach/chhep/pdf/SDOHworkbook.pdf

35. Practical Application Example Exercise: How would you adapt your capacity and revise one of your strategies to also address the social determinants of health?

36. Thank You! Michael L. Sells, MSPH, CHES Behavioral Scientist msells@cdc.gov 770-488-5465 http://www.cdc.gov/nccdphp/dnpa/ The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention