Unlocking the understanding of Social Determinants of Health

Transcription

1 Unlocking the understanding of Social Determinants of Health And it s effect on health outcomes Deborah Wyatt-O Neal, MSN Meghan Murphy, MSW April 30,

2 Presentation Objectives Describe social determinants and how they affect HIV acquisition and engagement in care. Describe strategies to address social determinants and support engagement in care. 2

3 Ice Breaker 3

4 Social Determinants of Health The conditions in which people are born, grow, live, work and age, including the health system. These conditions are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. 4 World Health Organization

5 Health Disparity Health Disparity is the term used in epidemiology to describe differences, variations and disproportions in the health status of individuals or groups. It is a descriptive term. No value judgment is necessarily implied. Adapted from: 1) Kawachi,I., Subramanian, S., & Almeida-Filho (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health: 56: ) Carter-Pokras, O., & Baquet, C. (2002). What is a health disparity? Public Health Reports, 17:

6 Health Equity Health Equity is attainment of the highest level of health for all people. (U.S. Department of Health and Human Services [DHHS] definition) Centers for Disease Control and Prevention. Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; October

7 Health Inequity Health Inequity refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice Kawachi,I., Subramanian, S., & Almeida-Filho (2002). A glossary for health inequalities. Journal of Epidemiology and Community Health: 56 7

8 A Social Determinants of Health Perspective Power, wealth, education, s and racial discrimination, ge equity, stigma Health care access, health ca quality, housing conditions, security Social support and community networks Risky and healthy behaviors, diet and nutrition, self-esteem, perceptions, stress Genetic predispositions, disease

9 Common SDH Low Economic Status Poverty Stigma Homophobia Homelessness 9

10 Effects on Health Outcomes Inequality at birth Physical inactivity & obesity Alcohol & drug use Depression/mental health Low self-esteem & risky sexual behaviors 10

11 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention Dec MMWR (60), 2011

12 Sonoma County Data Overall: of the 1,345 individuals living with HIV, 52% are virally suppressed *Estimate based on CDC data indicating that 12.8% of persons with HIV are undiagnosed Data from the Annual Report on HIV/AIDS in Sonoma County, October

13 SDH and the Continuum of Care The Bar Before the Bar National Alliance of State and Territorial AIDS Directors (NASTAD) and the National Coalition of STD Directors (NCSD). Addressing Stigma: A Blueprint for improving HIV/STD Prevention 13 and Care Outcomes for Black & Latino Gay Men

14 Focusing on Stigma and Homelessness Stigma Impact on linkage to and engagement in care Homelessness Over 65 homeless HIV+ individuals in Sonoma County Compounding SDH barriers 14

15 STIGMA A powerful discrediting social label that radically changes the way an individual views themselves and are viewed as persons. 15

16 Stigma can intensify if someone has a disease or condition which is: Stigma life-threatening contagious associated with behavior associated with moral fault visible HIV 16

17 Homelessness 17

18 Homelessness The experience of homelessness exacerbates HIV disease and hinders treatment. According to a New York study, formerly homeless people were four times more likely to get medical care once they had been placed in supportive housing than when they were in case management. Housing also increases the likelihood of receiving and adhering to ARTs 18 (National Alliance to End Homelessness, 2006).

19 Lessons Learned from the Ryan White hotel/motel project 19

20 Project Results 20

21 Responding to SDH Eliminating Barriers to care Identify barriers Identify intervention points Create change 21

22 Interventions for the individual level 22

23 Why Strengths-Based? It s a Game Changer It redirects the focus from deficits, problems, and weakness to mobilizing, capitalizing and developing an individual s strengths to promote health

24 Traditional Model of Care PROVIDER Fix Him/Her CLIENT Fix Me INSTITUTIO Fix It THE CHALLENGE 24

25 Being Strengths-Based Provider Means Discovering how to recognize strengths Helping clients identify their strengths Assist clients to build upon existing competencies and effectively addressing concerns

26 Living with HIV in Mississippi

27 Identifying Strengths Guidelines Look everywhere No strength is too small No strength is to big Look in the past, present and future Look under flaws to find more strengths

28 Community Level Interventions - Talking about SDH 28

29 Components of an Effective Message Simple language Credibility Compelling Fact Offer Solutions Balance Values Focus broadly 29

30 Messaging SDH Identify the problem Identify the stakeholder/audience What s wrong? Think about the persuasive messages Think about delivery mechanism Craft a statement Why does it matter? What should be done about it? Directions Considerations 30

31 Recommendations for Integrating SDH Integrating Strength Based Approach across all programs/roles Include more descriptive language of the levels of SDH at work in the community. Identify what level (individual, community, structural) of impact the intervention is intended to address. Include SDH language in planning documents. 31

32 Next Steps 32

33 Before we go Any questions? Deborah Wyatt-O Neal RN, MSN Meghan Murphy, MSW 33