Social'Determinants'of'Health:'Reducing'Health' - - PDF document

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California)WIC)Association 27th Annual)Conference)&)Trade)Show

Nicole)Henley,)PhD,)MBA Assistant)Professor Department)of)Health)Science)&)Human)Ecology California)State)University,)San)Bernardino

Social'Determinants'of'Health:'Reducing'Health' Disparities'in'Vulnerable'Populations'Through' the'Use'of'Culturally'Responsive'Evaluation'

Healthy(People(2020

!Healthy(People(2020(highlights(the(importance(of( addressing(the(social(determinants(of(health((SDOH)(by( including(“create'social'and'physical'environments'that' promote'good'health'for'all”'as(one(of(the(four(overarching( goals(for(the(decade.

https://www.healthypeople.gov/2020/topics7objectives/topic/social7determinants7of7health1

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Social'Determinants'of'Health

!Social'factors'and'physical'conditions'in'the'environment

• where%people%are%born,%live,%learn,%work,%pray,%and%play%
• affect'people’s'health'status,'ability'to'function,'and'quality'of'life'
• Are'structural'factors'
• Not'amenable'to'individual9related'behavior'changes'
• May'limit'opportunities'for'good'health'choices'
• May'affect'a'community'as'a'whole'

Contribute'to'inequities'in'health'and'health'disparities

https://www.healthypeople.gov/2020/topics<objectives/topic/social<determinants<of<health1

Examples)of social'determinants include:

Economic)Stability !Poverty !Employment !Food/Security !Housing/Stability Education !High/School/Graduation !Enrollment/in/Higher/Education !Language/and/Literacy !Early/Childhood/Education/and/Development

https://www.healthypeople.gov/2020/topics>objectives/topic/social>determinants>of>health1

Health)and)Health)Care

• Access/to/Health/Care
• Access/to/Primary/Care
• Health/Literacy

Neighborhood)and)Built)Environment

• Access/to/Healthy/Foods
• Quality/of/Housing
• Crime/and/Violence
• Environmental/Conditions

Social)&) Community) Context

• Social Cohesion
• Civic Participation
• Discrimination
• Incarceration

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Each%SDOH%area%intersects%in%a%way%that% affects%the%health%status%of%individuals%and% communities

http://www.apano.org/blog/2016/05/19/social8determinants8of8api8health/2

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Why$Address$SDOH?

https://ssir.org/articles/entry/the_community_cure_for_health_care3

Because'50%'of'the'factors'that' impact'our'health'are'caused'by' environmental,'social,'and' economical'factors—which'can'be' changed'or'modified. Can$contribute$to$health$ disparities/health$inequities

SDOH%and%Vulnerable%Populations

!Vulnerable)populations)have)different)needs)than)the)general) population.

! Health'and'health'care'challenges'intersect'with'social'and'environmental' factors,'including'housing,'poverty,'and'inadequate'education. ! Higher)levels)of)unmet)needs/competing)needs ! More)likely)to)be)marginalized)and)experience)discrimination ! Higher)rates)of)health)disparities,)chronic)conditions,)mortality

American%Journal%of%Managed%Care,%20064

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How$do$we$provide$culturally1appropriate services$and$programs$to$address$the$ complex$needs$of$vulnerable$populations? Culture

Culture'can'be'defined'as'the'shared'experiences'of'people,'including'their' languages,'values,'customs,'beliefs,'and'more.'It'also'includes'worldviews,' ways'of'knowing,'and'ways'of'communicating.''Culturally'significant'factors' encompass,'but'are'not'limited'to,'race/ethnicity,'religion,'social'class,' language,'disability,'sexual'orientation,'age,'and'gender."" Contextual'dimensions'such"as"geographic"region"and"socioeconomic" circumstances"are"also"essential"to"shaping"culture.

American-Evaluation-Association,-20115

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Traditional

• Race/ethnicity
• Gender
• Education
• Age
• Veteran6status
• Attitude6towards6health

Vulnerable

• Homelessness
• Drug/substance6abuse
• Sexual6orientation
• Criminal6behavior
• Mental6illness
• Immigration/literacy

Predisposing Enabling Need

Behavioral6Model6for6Vulnerable6Populations

Health' Outcomes

Traditional

• Insurance
• Income
• Regular6source6of6care
• Source6of6support

Vulnerable

• Competing6needs
• Hunger
• Public6benefits
• Transportation
• Case6manager
• Crime6rates
• Social6services

Traditional

• Perceived6health
• Evaluated6health

Vulnerable

• Perceived6health
• Evaluated6health

Adapted6from6Gelberg et6al,62000,6p12786

Health6Behavior

Traditional

• Diet
• Exercise
• SelfOcare
• Adherence6to6care
• Use6of6health6services

Vulnerable

• Hygiene
• Food6source
• Risky6behavior

What%are%some%cultural characteristics%of%WIC% Families?

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Design Practice Theory

CRE

Health2 in2All2 Policies!

https://www.healthypeople.gov/2020/topics4objectives/topic/social4determinants4of4health1

When%culture%and% cultural%context%are% imbedded%in%the:

Theory Design Practice

Valid%and%reliable%RESULTS Health%in%all%POLICIES Evidence=based% PRACTICES in%the%delivery%

• f%health%care

Improved%population% health%OUTCOMES and% quality%of%life REDUCES:% systematic% errors,%cultural% biases,%and% stereotypes

Culturally(Appropriate.Theory.and.Outcome

Frierson.et.al.,.2010;7 Hood,.et.al.,.20158

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“Housing)policy)is)health)policy.)Educational)policy)is) health)policy.)Anti6violence)policy)is)health)policy.) Neighborhood)improvement)policies)are)health)policies.) Everything)that)we)can)do)to)improve)the)quality)of)life)

• f)individuals)in)our)society)has)an)impact)on)their)

health)and)is)a)health)policy.”)

• Dr. David Williams of the Harvard School of Public Health, UNNATURAL CAUSES Documentary

Health'in'All'Policies'(HiaP)

Health'Equality

• r'

Health'Equity

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Health'Disparities: preventable health'differences' between'groups'of'people.'These'differences'can'affect' how'frequently'a'disease'affects'a'group,'how'many' people'get'sick,'or'how'often'a'disease'causes'death.''' Health'Inequities:'differences'in'population'health'that' can'be'traced'to'unequal'economic'and'social' conditions that'are'systemic,)avoidable)and)inherently) unjust.

Health,Equality,vs.,Equity

Braveman,,P.,,201410

Health'Equality'vs.'Equity

https://publichealthonline.gwu.edu/blog/equity:vs:equality/9

Sameness Giving every person the same thing — Each person must start at the same place. Fairness Giving every person access to the same resources — Equity must exist before we can experience equality.

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Charge'to'YOU:'Widen'Our'Lens

Tackling)health)inequities)requires)widening)our) lens)to)bring)into)view)the)ways)in)which)SDOH,) and)even)political)power,)influence)individual) and)community)health

• Learn
• UNBLearn
• REBLearn

Translate)evidence.based evaluation)research) into)policy)&)practice

Charge'to'YOU:'Engage'Policymakers

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AB#1108:#FAIR#CHANCE#ACT#(BAN#THE#BOX) AS#OF#JANUARY#1,#2018,#THIS#BILL#BECAME#A#CALIFORNIA#LAW#THAT#GENERALLY# PROHIBITS#EMPLOYERS#OF#MORE#THAN#5#EMPLOYEES#FROM#ASKING#ABOUT#YOUR# CONVICTION#HISTORY#BEFORE#MAKING#YOU#A#JOB#OFFER.# SB#1152:#HOSPITAL#PATIENT#DISCHARGE#PROCESS:#HOMELESS#PATIENTS. BEGINNING#JANUARY#1,#2019,#ALL#HOSPITALS#IN#CALIFORNIA#MUST#DEVELOP#A# PLAN#FOR#SAFELY#DISCHARGING#PATIENTS#WITHOUT#HOMES. AB#598:#HEARING#AIDS#FOR#MINORS THIS#BILL#WILL#REQUIRE#HEALTH#INSURANCE#POLICIES#AND#PLANS#TO#COVER# HEARING#AIDS#FOR#CHILDREN. NOW#HEADS#TO#THE#ASSEMBLY#APPROPRIATIONS# COMMITTEE.

Policies#Promoting#Health#Equity#

References

1. https://www.healthypeople.gov/2020/topics5objectives/topic/social5determinants5of5health.=Retrieved=October=5,=2017. 2. http://www.apano.org/blog/2016/05/19/social5determinants5of5api5health.=Retrieved=September=27,=2018. 3. https://ssir.org/articles/entry/the_community_cure_for_health_care.=Retrieved=September=27,=2018. 4. “Who=are=the=vulnerable?”=(2006).=American)Journal)of)Managed)Care).)12(13):=S3485S352.= 5. American=Evaluation=Association.=(2011).=Public)Statement)on)Cultural)Competence)in)Evaluation.)Fairhaven,=MA:=Author.=Retrieved=from= www.eval.org.= 6. Gelberg,=L.,=and=L.=Linn.=1989.=”The=Behavioral=Model=for=Vulnerable=Populations:=Application=to=Medical=Care=Use=and=Outcomes=for= Homeless=People."=Health)Services)Research.=177(5):=291595. 7. Frierson,=H.=T.,=Hood,=S.,=&=Hughes,=G.=B.=(2010).=A=guide=to=conducting=culturally5responsive=evaluations.=In=Frechtling,=J., The)2010)userC friendly)handbook)for)project)evaluation (pp.=75596).=National=Science=Foundation. 8. Hood,=S.,=Hopson,=R.K.,=Y=Kirkhart,=K.=E.=(2015).=Culturally=responsive=evaluation.=In=Newcomer,=K.=E.,=Hatry,=H.P.,=Y=Wholey J.=S.=(Eds.),= Handbook)of)Practical)Program)Evaluation (4th Ed.).=Hoboken,=NJ:=Wiley=Publishing. 9. https://publichealthonline.gwu.edu/blog/equity5vs5equality/. Retrieved=May=5,=2018.

• 10. Braveman P.=(2014).=What=are=health=disparities=and=health=equity?=We=need=to=be=clear. Public)health)reports)(Washington,)D.C.):)1974), 129)

Suppl 2(Suppl 2),=5–8.=doi:10.1177/00333549141291S203