THE WEBINAR WILL BEGIN SHORTLY The audio portion of this webinar is being broadcast through your computer speakers. If your computer does not have sound capabilities, or you cannot hear, please call 1-866-740-1260 and enter access code 7560161 The slides for this presentation were e-mailed to registrants yesterday. If you did not receive them, please visit www.naccho.org/accreditation/webinars and select today s program If you need technical assistance, please e-mail alahn@naccho.org The Social Determinants of Health in Assessment and Planning: Challenges and Solutions Monday, March 30 2015 3:00PM ET Barbara Laymon, MPH Lead Program Analyst Assessment & Planning 1
Speakers Allison Young, Applied Public Health Informatics Fellow (APHIF), Orange County Health Department in Hillsborough, NCC Mike Fliss, Public Health Informatics Manager, Orange County Health Department in Hillsborough, NC Elizabeth (Liz) Burpee Community Health Improvement Program Lead, New Orleans Health Department (NOHD) Katherine Cain, Manager of Strategic Performance & Partnerships, New Orleans Health Department Learning objectives Discuss the significance of the social determinants of health Identify methods of assessing the social determinants of health in communities or smaller geographic areas. Develop implementation activities and community support around the social determinants of health. Use the Community Health Improvement Matrix in implementation planning. 2
Healthy habitats for humans The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. (World Health Organization) World Health Organization conceptual framework http://www.who.int/sdhconference/resources/conceptualframeworkforactiononsdh_eng.pdf 3
Vehicle miles driven and obesity rates In addition to obesity, research also suggests that commuting is associated with an increased risk of developing high blood pressure, high cholesterol, depression, anxiety, and social isolation, all of which can impair the quality and length of life. 4
PREVENTION LEVEL 3/30/2015 Breastfeeding and education level % Breastfeeding by Education 2009 < High school 39.7 High school 37.0 Some college 44.1 Associate s degree 46.8 4-year degree 61.8 Advanced degree 68.1 Source: National Immunization Survey Community Health Improvement Matrix Objective: Tertiary Secondary Primary Contextual Individual Interpersonal Organizational Community Public Policy INTERVENTION LEVEL 5
PREVENTION LEVEL 3/30/2015 Community Health Improvement Matrix Objective: Increase Breastfeeding Tertiary ACEs & Moms Secondary Visiting Nurses BF Pumps Available Baby-friendly Hospitals Primary Contextual Prenatal Education La Leche League BF Room at Work Maternity Leave Local Values Living Wages Supporting Laws Individual Interpersonal Organizational Community Public Policy INTERVENTION LEVEL Social Determinants NACCHO Mike Dolan Fliss MSW UNC Current Epidemiology PhD student at UNC-CH in progress Former Public Health Informatics Manager Orange County Health Department Allison Young MPH UNC CDC Applied Public Health Informatics Fellow Orange County Health Department 6
OVERVIEW Outline Context County profile and Community Health Assessment Data driven decision making Dashboards, indicators & policy menus Social Determinants Family Success Alliance Indicators Policies CONTEXT County Profile Demographics: Largest towns: Chapel Hill & Carrboro, Hillsborough (relatively rural) Pop:140,000 Comparably well-resourced on the whole In North Carolina Triangle (Raleigh, Durham, Chapel Hill) Includes a college town : University of North Carolina, Chapel Hill (+30,000 students) Most health indicators look good on the whole, e.g Leading NC in teen lowest birth-rate First county in state to distribute Naloxone to combat overdose & first overdose reversals by a police department (Carrboro) Comprehensive smoke-free public places rule by board of health but with significant neighborhood pockets of disparities: income and health Highest gini coefficient in state Large urban / rural divide in transportation, access to resources, etc. Race and income disparities on many health indicators 7
CONTEXT CHA Priorities Process Primary and secondary data collection Community workshops and prioritization process Priorities guiding policy, program and clinical work of health department Priorities (2011-2015) Physical Activity & Nutrition Substance Abuse and Mental Health Access to Care ^ Broadly includes social determinants, including insurance and transportation CONTEXT Data driven decision making Staffing Positions refactored & CDC interns requested, training-in-place to increase capacity for Public Health Informatics Community workshops and prioritization process Priorities guiding policy, program and clinical work of health department Community Health Dashboards At a glance view of essential indicators Evidence-Based Policy Menus For action by board of health and public health coalition ( Healthy Carolinians ) collaborators. Access to care: Aggregated Medicaid recipients vs. clinics [red] & bus stops [blue]. Estimated 3,000 residents w/o vehicle outside of bus access zone. 8
CONTEXT CONTEXT 9
SOCIAL DETERMINANTS In response to commissioner call, data collected on children s poverty: 17% of children in Orange are in below the poverty level. Drop in many key indicators of children s poverty. Initial indicator set lowest hanging fruit AD HOC: POVERTY & MAPPING Locating poverty Successful interventions invariably place-based (see Harlem Children s Zone) With small populations, block groups are large and heterogeneous. 10
AD HOC: POVERTY & MAPPING Finding small neighborhoods: Creating zones with small neighborhoods: Attempt to adjust for population density Use multiple data layers for assurance Drill to neighborhoods with distinct types if possible An aggregate indicator calculated for every 1/4 mile block with >30 residential addresses of any type. Datasources: (1) residential structure type from Land Records/GIS (2) active housing choice vouchers from housing (3) children on medicaid from DHHS (4) clinic patients from the health department. Roughly follows school / district (2) boundaries. Ground truth ed these assessments with community. No individual address information is represented on this map. Blue: Schools. Orange-Red-Black color ramp: Neighborhoods of increasing Poverty Index. Size is number of residential addresses within neighborhood FAMILY SUCCESS ALLIANCE Family Success Alliance Collective Impact Initiative to reduce the negative impacts of social determinants on health of children and families living in Orange County neighborhoods Alliance is composed of: schools, non profit organizations, health providers, and government agencies (OCHD is the backbone organization) 11
FAMILY SUCCESS ALLIANCE Poverty Reduction through Collective Impact INDICATORS Draft of Pipeline Indicators 12
INDICATORS INDICATORS 13
INDICATORS INDICATORS CHA SDOH Indicators Similar approach to FSA Align Healthy People 2020 and Healthy NC 2020 indicators Social Determinants of Health Divided into 4 Categories Environmental Community Income/Cross-cutting Access to Mental and Physical Health Care 14
INDICATORS Social Determinants of Health Indicators Environmental 1. Affordable Housing-more than 30% of Income spent on rent (ACS)** 2. Affordable Housing- Number of Household Jobs afford FMR (NLIHC) 3. Access to Physical Activity Rate /100,000 (Census/NC-HIP) 4. Food Environment Index (USDA) 5. % fast food restaurants (Census) 6. % Limited access healthy food (USDA/NC-HIP) Community 1. Marriage and Outcomes 2. 4 YR Graduation rate (CCD/DPI)*** 3. Homicides (NVSS-M)* 4. % children in single-parent Households (ACS/NC-HIP) 5. Social and Emotional Support Lacking (BRFSS) 6. Violent Crime Rate (DOJ) 7. Homelessness (NCCEH/HUD: HMIS/AHAR/PIT) * Healthy People 2020 Indicator, ** Healthy NC 2020 Indicator, *** Healthy People and HNC2020 Indicator INDICATORS Social Determinants of Health Indicators Income/ Cross Cutting 1. Gini Coefficient 2. % Poverty (CPS/Census)** 3. % Unemployed (LAUS/NC-HIP) 4. % Children eligible Free and Reduced Lunch (NCES) Access to Mental and Physical Health Care 1. ACA eligibility/enrollment (enrollamer/hhs) 2. Primary Care Physician Rate (NC HIP) 3. Nurse Practitioner Rate (NC HIP)* 4. Dentist Rate (NC HIP) 5. Psychologist Rate (NC HIP) 6. % Uninsured (NHIS/SAHIE/NC-HIP)* 7. % with Primary Care Physician (BRFSS, NC-HIP)* * Healthy People 2020 Indicator, ** Healthy NC 2020 Indicator, *** Healthy People and HNC2020 Indicator 15
INDICATORS Challenges with Identifying SDOH Indicators Finding sub-county (neighborhood) data Identifying indicators that can be both surveillance and program measures, without knowing interventions/policies will be implemented Privacy and security concerns Differences in data storage Many SDOH indicators are either not collected, difficult to define, or under reported POLICIES Challenges with Identifying Policies Still trying to identify evidence-based policies and interventions to address these indicators Open to your feedback! 16
QUESTIONS? Thanks! Mike Dolan Fliss MSW UNC Current Epidemiology PhD student at UNC-CH in progress Former Public Health Informatics Manager Orange County Health Department fliss@email.unc.edu Allison Young MPH UNC CDC Applied Public Health Informatics Fellow Orange County Health Department ayoung@orangecountync.gov The Social Determinants of Health in Assessment and Planning Liz Burpee, MPH, MSW Community Health Improvement Program Lead Katherine Cain, MPH Manager of Strategic Performance and Partnerships 17
New Orleans Population: 378,715 Black or African American 60.2%; White 33.0%; Hispanic or Latino 5.2%; Asian 2.9% Whites have a median annual income almost double that of African Americans ($57,031 v. $30,167) 52% of working-age African American men currently unemployed 39% of children live in poverty 17% of residents are uninsured African Americans ages 18-64 twice as likely to be uninsured than white adults. African American children under 18 are 3.5x more likely to be uninsured than white kids 150 murders in 2014: African Americans 8x more likely to die of homicide than whites 41% of African Americans are obese vs. 30% of whites African Americans significantly more likely than whites to have any chronic condition 25 year gap in life expectancy between zip codes New Orleans Health Department VISION To serve New Orleanians as a 21 st century health department and a model for the nation, capable of improving population health through datadriven decision making and policy development Strategic Priorities: Improve Access to Health Care; Prevent Violence; Promote Healthy Lifestyles; Enrich Family Health; Prepare for Emergencies; Enhance Health Department Infrastructure PHAB Accredited June 2014 18
CHIP and Social Determinants CHIP Priority Area Access to Physical and Behavioral Health Care Violence Prevention Healthy Lifestyles Family Health Social Determinants of Health Social Determinant Example Marketplace outreach & enrollment Promotion of restorative approaches Silver Bike Friendly City Award Best Babies Zone HIA and HiAP Health Impact Assessment Mentorship received from NACCHO courtesy of the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trust Redevelopment of blighted former school building in a historic African American neighborhood into a fresh foods market Purpose: To inform programming at the market to maximize health benefit of increased availability of fresh fruits and vegetables to neighborhood residents Partnered with private development company and City community development agencies Strong community representation Used existing data & literature; collected new data via intercept survey and focus groups with vulnerable populations (e.g. elderly, youth) Provided recommendations to store owner on affordability, cooking classes, outdoor programming, marketing/outreach, and employee recruitment 19
Current Efforts: Health in All Policies SOCIAL DETERMINANTS OF HEALTH GOAL: Create social and physical environments that promote good health for all Objective 1: Develop a HiAP policy statement Objective 2: Meet with other City departments and collaborate on equity work Objective 3: Design and implement communications plan to gain support for cross-departmental equity work Challenges and Opportunities We need Staff & budget to expand HiAP work Favorable political climate We have Likely allies across City government e.g. N.O. Redevelopment Authority, Network for Economic Opportunity Experience on collaborative projects with City s economic and redevelopment agencies Collaboration opportunities e.g. Lafitte Greenway, Resilience Strategy Development, Choice Neighborhoods Initiative Strong community partners 20
PREVENTION LEVEL 3/30/2015 Thank you Liz Burpee, MPH, MSW Community Health Improvement Program Lead New Orleans Health Department ecburpee@nola.gov (504) 658-2706 Katherine Cain, MPH Manager of Strategic Performance & Partnerships New Orleans Health Department klcain@nola.gov (504) 658-2572 Community Health Improvement Matrix Objective: Tertiary Secondary Primary Contextual Individual Interpersonal Organizational Community Public Policy INTERVENTION LEVEL 21
Prevention Levels: Prevention levels refer to the range of activities that can reduce health risks. Intervention Levels: Intervention levels are built on a socioecological model that recognizes different factors that affect health. Healthy People 2020 model https://www.healthypeople.gov/ 22
Resources Research brief downloadable from http://eweb.naccho.org/eweb/dynamicpage.aspx?webcode=proddetailadd&ivd_prc_prd_key=eb57 57f1-8b2c-4426-a6bb- 6a036174c151&ivd_qty=1&Action=Add&site=naccho&ObjectKeyFrom=1A83491A-9853-4C87-86A4- F7D95601C2E2&DoNotSave=yes&ParentObject=CentralizedOrderEntry&ParentDataObject=Invoice %20Detail Coming soon to NACCHO s website Community Health Improvement Matrix (CHIM) Template Facilitator s Guide for working with hospitals and community groups Coming in June A chance to be a part of a pilot project on the CHIM 23
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