Evaluation to Inform Policies Aimed at Improving Health and Equity - - PowerPoint PPT Presentation

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Evaluation to Inform Policies Aimed at Improving Health and Equity - - PowerPoint PPT Presentation

Jan 16, 2023 305 likes •638 views

Healthy People: The Role for Measurement, Data, and Evaluation to Inform Policies Aimed at Improving Health and Equity in Communities Angela McGowan, JD, MPH Project Director, Office of Disease Prevention and Health Promotion, U.S. Department

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| Law and Health Policy

Healthy People: The Role for Measurement, Data, and Evaluation to Inform Policies Aimed at Improving Health and Equity in Communities

Angela McGowan, JD, MPH

Project Director, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services Twitter: @angiemcgowan

February 11, 2020

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Law and Health Policy |

Healthy People Initiative and Developing Healthy People 2030

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Law and Health Policy |

What Is Healthy People?

  • Provides a strategic framework for a

national prevention agenda that communicates a vision for improving health and achieving health equity

  • Identifies science-based, measurable
  • bjectives with targets to be achieved

by the end of the decade

  • Requires tracking of data-driven
  • utcomes to monitor progress and to

motivate, guide, and focus action

  • Offers a model for international, state,

and local program planning

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Law and Health Policy |

Evolution of Healthy People and Health Equity Across the Decades

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Target Year 1990 2000 2010 2020 2030

Overarching Goals

  • Decrease

mortality: infants–adults

  • Increase

independence among older adults

  • Increase span
  • f healthy life
  • Reduce health

disparities

  • Achieve access

to preventive services for all

  • Increase quality

and years of healthy life

  • Eliminate

health disparities

  • Attain high-quality, longer

lives free of preventable disease

  • Achieve health equity;

eliminate disparities

  • Create social and physical

environments that promote good health

  • Promote quality of life,

healthy development, healthy behaviors across life stages

  • Attain healthy, thriving lives and well-

being, free of preventable disease, disability, injury and premature death.

  • Eliminate health disparities, achieve

health equity, and attain health literacy to improve the health and well-being of all.

  • Create social, physical, and economic

environments that promote attaining full potential for health and well-being for all.

  • Promote healthy development, healthy

behaviors and well-being across all life stages.

  • Engage leadership, key constituents, and

the public across multiple sectors to take action and design policies that improve the health and well-being of all.

Leading Health Indicators 10 topics 22 indicators 12 topics 26 indicators TBD Topic Areas 15 22 28 42 40 Objectives 226 319 ~1,000 >1,200 355 *

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Law and Health Policy |

Streamlining Objectives

  • Objective Selection Criteria
  • Baseline data from 2016 or later
  • Collection of at least 2 data points

in addition to the baseline by 2030

  • Address health concerns of

national importance

  • Identification of at least 1

evidence-based intervention

  • Considerations related to health

disparities and health equity

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Healthy People 2020: ~1,200 Stage I & II Assessment: ~500 FIW Review: ~400 355*

* Number of Objectives Submitted for Public Comment

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Law and Health Policy |

Healthy People 2030 Objective Types

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  • Must address all of the core inclusion criteria
  • Targets will be set

Core Objectives

  • Focus on need to develop data sources and data collection
  • Represent high priority issues that do not have reliable baseline data,

but for which evidence-based interventions have been identified Developmental Objectives

  • Focus on need to advance research and develop evidence-base

interventions in an area

  • Represent significant opportunities for advancement in areas with

limited research, a high degree of health or economic burden (preventable or otherwise), or evidence of substantial disparities between populations Research Objectives

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Law and Health Policy |

Role for the Social Determinants of Health and Health Equity

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Law and Health Policy |

  • Poverty
  • Employment
  • Housing stability
  • Food insecurity
  • High school

graduation rates

  • Enrollment in

higher education

  • Early childhood

education and development

  • Language and

literacy

  • Access to health

services

  • Access to

primary care

  • Health literacy
  • Quality of

housing

  • Crime and

violence

  • Environmental

conditions

  • Access to healthy

foods

  • Social cohesion
  • Discrimination
  • Civic

participation

  • Incarceration

Healthy People’s Social Determinants of Health Framework and Key Issue Areas

Objectives should seek to reduce health disparities and increase health equity as much as possible, including addressing social determinants of health

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Law and Health Policy |

  • To achieve health equity, we must recognize that multiple determinants of

health and well-being interact with each other across the life span.

  • The ability of Healthy People 2030 to measure its success in achieving health

equity will depend on ongoing surveillance of health inequalities between more and less advantaged social groups.

Health Equity Issue Brief

Health equity is “attainment of the highest level of health for all people”

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Law and Health Policy |

Healthy People Data and Disparities Resources

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Law and Health Policy |

Law and Policy in Healthy People and Tools and Resources to Identify and Evaluate Evidence-Based Laws and Policies

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Law and Health Policy |

Why Use Law and Policy to Help Meet Healthy People Goals?

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Private Entities Federal State Tribal Local Law and Policy Actions Statutes & Ordinances Regulations Contract Language Handbooks Budgets Case Law Guidance Documents

Businesses Non- Profits Religious Groups

Licensure Accreditation

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Law and Health Policy |

Law and Policy in Healthy People, 1990–2020

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Decade Objectives Related to Law and Policy Topic Areas with Law and Policy Objectives Relevant Topic Areas

Healthy People 1990 4 of 226

  • bjectives

3 of 15 topic areas Toxic Agent and Radiation Control, Smoking and Health, Nutrition Healthy People 2000 27 of 319

  • bjectives*

10 of 22 topic areas Tobacco, Substance Abuse: Alcohol and Other Drugs, Violent and Abusive Behavior, Unintentional Injuries, Occupational Safety and Health, Environmental Health, Food and Drug Safety, Cancer, Diabetes and Chronic Disabling Conditions, Immunization and Infectious Diseases Healthy People 2010 23 of ~1,000

  • bjectives^

6 of 28 topic areas Environmental Health, Injury and Violence Prevention, Physical Activity and Fitness, Public Health Infrastructure, Substance Abuse, Tobacco Use Healthy People 2020 59 of >1,200

  • bjectives^

10 of 42 topic areas Adolescent Health, Early and Middle Childhood, Environmental Health, Injury and Violence Prevention, Maternal, Infant, and Child Health, Nutrition and Weight Status, Physical Activity, Preparedness, Substance Abuse, Tobacco Use

  • In HP2000, some objectives were included under more than one topic area. These duplicate objectives were given more than one
  • bjective number (e.g., 3.11 and 10.18) . For this exercise, these objectives are counted twice to reflect they are in both topic areas.

˄ In HP2010 and HP2020, some objectives are grouped under a main objective "header." The sub-objectives are the measurable

  • bjectives. The number of relevant objectives reflects all measurable objectives that are related to law and policy.
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Law and Health Policy |

Law and Health Policy Project

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Reports and Related Products

  • Reports and community “Bright Spots”

Webinar Series

  • Focused on specific Healthy People 2020 topics
  • Shares community examples of innovative uses of law

and policy to improve health outcomes

Supporting the Development of Healthy People 2030 (HP2030)

  • HP2030 Listening Session: 2018 Public Health Law

Conference

For more information: www.healthypeople.gov/2020/law-

and-health-policy

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Law and Health Policy |

Law and Policy effectively serve as the nation’s primary structural engineer, responsible for its foundation, its most important design features, and its resiliency. ~Healthy People 2030 Law and

Policy Subcommittee

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Law and Health Policy |

Law and Legal Policy Are Critical Determinants

  • f Health

Law and Policy Issue Brief: Law and Policy as Determinants of Health

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Can be direct responses to health-harming social conditions and deficiencies Perpetuate social conditions that can be harmful to health and well-being Sometimes applied selectively based on biases that affect distributions of health and well-being Are hollow without regulations, funding, and effective enforcement Can affect health and well-being based on how they are interpreted by the courts

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Law and Health Policy |

Evaluation of Laws and Policies

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Law and Health Policy |

What Works: Evidence-Based Interventions to Protect and Promote Public Health

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Law and Health Policy |

  • Laws and policies as public health

interventions

  • Laws and policies that support

public health interventions and practices What Works: The Role of Evidence-based Law and Policy in Evidence-Based

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Law and Health Policy |

Leading Health Indicator: Injury Deaths

20 Approaches to Prevent Fatal Injuries Evidence-Based Legal and Policy Strategies IVP 1-1: Injury Deaths Motor vehicle injury prevention Helmet laws, seatbelt laws, laws and ordinances to promote complete streets and holistic safe transit systems, policies to reduce drunk and impaired driving, and graduated driver licensing systems School-based violence prevention Anti-bullying legislation and policies, dating abuse policies

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Law and Health Policy |

  • Legal epidemiology * is defined as the scientific study and deployment of law as a factor in the cause,

distribution, and prevention of disease and injury in a population. The field, which has been developing during the past decade, broadens the idea of public health law to a transdisciplinary understanding that laws, legal systems, practices, and approaches have a measurable impact on public health outcomes. Legal practice applies the law, and legal epidemiology measures it.

  • CDC’s Public Health Law Program: https://www.cdc.gov/phlp/index.html
  • Temple’s Center for Public Health Law Research: http://phlr.org/
  • Policy Surveillance ^ is the systematic collection, analysis, and dissemination of laws and policies

across jurisdictions or institutions, and over time. Examples of reources:

  • Alcohol Policy Information System (APIS): https://alcoholpolicy.niaaa.nih.gov/
  • Chronic Disease State Policy Tracking System (CDC): http://nccd.cdc.gov/CDPHPPolicySearch//Default.aspx
  • CityHealth: https://www.cityhealth.org/
  • LawAtlas: The Policy Surveillance Portal (Social Determinants of Health, Housing, Health Services:

http://lawatlas.org/welcome

  • National Conference of State Legislatures (NCSL): http://www.ncsl.org/research/health.aspx
  • WORLD Policy Analysis Center: https://ph.ucla.edu/research/centers/world-policy-analysis-center

Tools to Measure and Evaluate Public Health Laws and Policies

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  • * Public Health Law Academy resources: https://www.changelabsolutions.org/good-governance/phla/legal-epidemiology
  • ^ Burris S, Hitchcock L, Ibrahim J, Penn M, Ramanathan T. Policy Surveillance: A Vital Public Health Practice Comes of Age. J Health Polit Policy Law 2016

Dec;41(6):1151-1173. https://www.ncbi.nlm.nih.gov/pubmed/27531941

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Law and Health Policy |

  • Laws and policies should be measured and evaluated like other interventions to

determine impact on health and equity.

  • Data and targets can be helpful tools
  • Surveillance of laws and policies critical
  • Law and policy can be important tools to promote health equity and to address

barriers to good health.

  • Health equity has an important role in both HP2020 and HP2030.
  • Improving health often requires working closely with other sectors (e.g., housing or

transportation).

  • Law and policy can be helpful tools to leverage.
  • HP2030 advisory committee argues law is a determinant of health.
  • Goal: evidence-based laws and policies with positive impacts on health and equity

Conclusions

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Law and Health Policy |

  • For more on the Healthy People initiative, including the

development of Healthy People 2030:

  • www.healthypeople.gov
  • For the Law and Health Policy project:
  • https://www.healthypeople.gov/2020/law-and-health-

policy/topic/nutrition-and-weight-status

  • For any other questions, please contact:
  • Angie McGowan, Project Director, ODPHP:

Angela.McGowan@hhs.gov

  • Twitter: @angiemcgowan

Contact Information

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Law and Health Policy |

EXTRA SLIDES

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Law and Health Policy |

Law and Health Policy Project

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Law and Health Policy |

  • Report - “The Role of Law and Policy in Achieving the

Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States”

  • Selected Objectives for this Report
  • NWS-14: Increase the contribution of fruits to the diets of the

population aged 2 years and older

  • NWS-15.1: Increase the contribution of total vegetables to

the diets of the population aged 2 years and older (LHI)

  • Project landing page and materials available at:

https://www.healthypeople.gov/2020/law-and-health-policy

  • Focuses on increasing fruit and vegetable intake through

increasing access, affordability, and demand

  • Four “Bright Spots” are included:
  • Minneapolis Staple Foods Ordinance, Navajo Nation’s:

Healthy Diné Nation Act, Georgia’s Growing Fit, and New York City’s Green Carts Initiative

Law and Health Policy Project Report: Increasing Fruit and Vegetable Intake

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Law and Health Policy |

Developing Healthy People 2030

Phase I Development of Framework

2018 2019

Phase II Development of Objectives

June 2017 Public Comment/Stakeholder Input March 31, 2020 2017 Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 develops recommendations for HHS Secretary Jan 2019 HP FIW develops guidance and Agency Leads develop recommendations for Healthy People 2030 framework and objectives Dec 2016

Launch

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Law and Health Policy |

Healthy People 2030 Development - Next Steps

  • Complete design of the new Healthy People 2030 website
  • Launch of Healthy People 2030 anticipated for March 31, 2020
  • HP2030 launch will include a new website (healthypeople.gov) that will be tailored to meet the

needs of Healthy People users

  • Development of Foundation Health Measures for Healthy People 2030
  • Development of the Leading Health Indicators for Healthy People 2030 (anticipated launch in

2020)

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Total Sex

  • Male
  • Female

Race/Ethnicity

  • American Indian or Alaska Native only
  • Asian only
  • Native Hawaiian or Other Pacific Islander only
  • Black or African American only
  • White only
  • 2 or more races
  • Hispanic or Latino
  • Not Hispanic or Latino
  • Black or African American only, not Hispanic or

Latino

  • White only, not Hispanic or Latino

Age Group

  • <18 years

– 0-4 years – 5-11 years – 12-17 years

  • 18-44 years

– 18-24 years – 25-44 years

  • 45-64 years

– 45-54 years – 55-64 years Age Group (continued)

  • 65 years and over

– 65-74 years – 75-84 years – 85 years and over Educational Attainment (25 years and over)

  • < High school
  • High school
  • Some college
  • Associates degree
  • 4-year college degree
  • Advanced degree

Family income (percent poverty threshold)

  • <100
  • 100-199
  • 200-399
  • 400-599
  • 600+

Family type

  • Single
  • Single parent with children
  • Married couple or partners
  • Two parent family with children
  • Other

Country of birth

  • US
  • Outside US

Disability status (18 years and over)

  • People with disabilities
  • People without disabilities

Geographic location

  • Metropolitan
  • Non-metropolitan

Health insurance status (<65 years)

  • Insured

– Private – Public

  • Uninsured

Sexual orientation

  • Straight

– Straight, Male – Straight, Female

  • Gay/Lesbian

– Gay, Male – Gay/Lesbian, Female

  • Bisexual

– Bisexual, Male – Bisexual, Female Marital status (18 years and over)

  • Married
  • Cohabiting partner
  • Divorced or separated
  • Widowed
  • Never married

Sample HP2020 Data Template

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State-Level Data and Maps

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Selection of state-level data or maps

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  • Data tool for measuring program performance
  • Framework for program planning and development
  • Goal setting and agenda building
  • Teaching public health courses
  • Benchmarks to compare state and local data
  • Way to develop nontraditional partnerships
  • Model for other plans and countries
  • Community health assessments
  • Public health accreditation

Uses of Healthy People

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