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

Social'Determinants'of'Health:'Reducing'Health' Disparities'in'Vulnerable'Populations'Through' the'Use'of'Culturally'Responsive'Evaluation' California)WIC)Association 27 th Annual)Conference)&)Trade)Show Nicole)Henley,)PhD,)MBA Assistant)Professor Department)of)Health)Science)&)Human)Ecology California)State)University,)San)Bernardino 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/social7determinants7of7health 1 1

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<health 1 Examples)of social'determinants include: Economic)Stability Health)and)Health)Care ! Poverty • Access/to/Health/Care Social)&) ! Employment • Access/to/Primary/Care Community) ! Food/Security • Health/Literacy Context ! Housing/Stability • Social Cohesion • Civic Participation • Discrimination Education Neighborhood)and)Built)Environment • Incarceration ! High/School/Graduation • Access/to/Healthy/Foods ! Enrollment/in/Higher/Education • Quality/of/Housing ! Language/and/Literacy • Crime/and/Violence ! Early/Childhood/Education/and/Development • Environmental/Conditions https://www.healthypeople.gov/2020/topics>objectives/topic/social>determinants>of>health 1 2

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 3

Why$Address$SDOH? 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 https://ssir.org/articles/entry/the_community_cure_for_health_care 3 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,%2006 4 4

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,-2011 5 5

Behavioral6Model6for6Vulnerable6Populations Predisposing Enabling Need Health6Behavior Traditional Traditional Traditional Traditional Race/ethnicity Insurance Perceived6health Diet • • • • Gender Income Evaluated6health Exercise • • • • Education Regular6source6of6care SelfOcare • • • Age Source6of6support Adherence6to6care • • • Veteran6status Use6of6health6services • • Attitude6towards6health • Health' Outcomes Vulnerable Vulnerable Vulnerable Vulnerable Homelessness Competing6needs Perceived6health Hygiene • • • • Drug/substance6abuse Hunger Evaluated6health Food6source • • • • Sexual6orientation Public6benefits Risky6behavior • • • Criminal6behavior Transportation • • Mental6illness Case6manager • • Immigration/literacy Crime6rates • • Social6services • Adapted6from6Gelberg et6al,62000,6p1278 6 What%are%some%cultural characteristics%of%WIC% Families? 6

Theory Design Health2 in2All2 Policies! CRE Practice https://www.healthypeople.gov/2020/topics4objectives/topic/social4determinants4of4health 1 Culturally(Appropriate.Theory.and.Outcome When%culture%and% Health%in%all% POLICIES cultural%context%are% imbedded%in%the: Evidence=based% REDUCES:% PRACTICES in%the%delivery% systematic% Theory of%health%care errors,%cultural% biases,%and% Valid%and%reliable% RESULTS stereotypes Design Improved%population% health% OUTCOMES and% Practice quality%of%life Frierson.et.al.,.2010; 7 Hood,.et.al.,.2015 8 7

Health'in'All'Policies'(HiaP ) “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) of)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'Equality or' Health'Equity 8

Health,Equality,vs.,Equity 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. Braveman,,P.,,2014 10 Health'Equality'vs.'Equity Sameness Fairness Giving every Giving every person the same person access to thing the same — resources Each person must — start at the same Equity must exist place. before we can experience equality. https://publichealthonline.gwu.edu/blog/equity:vs:equality/ 9 9

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 Charge'to'YOU:'Engage'Policymakers Translate)evidence.based evaluation)research) into)policy)&)practice 10

Policies#Promoting#Health#Equity# 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. 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 (4 th 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 11