community health and wellness renée volny, do, mba interim associate director health policy...
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Community Health and Wellness
Renée Volny, DO, MBAInterim Associate DirectorHealth Policy Leadership FellowshipSatcher Health Leadership Institute
Objectives• Discuss the importance of healthy communities• Discuss the determinants of health and their impact on
community health• Describe the relationship between health policy and
determinants of health• Relate health policy to community organization activities• Describe the roles of community organizations and leaders in
informing health policy
Healthy Communities• Good health status• Health promoting behaviors• Nutritional access• Educational opportunities• Job opportunities• Good air quality• Green space• Transportation/Accessibility• Safe neighborhoods• Social supports/networks• Access to healthcare
• Shorter Lives, Poorer Health• IOM 2013 report• Lowest life expectancy among
17 peer countries• Poorer health outcomes• infant mortality and low birth
weight• injuries and homicides• adolescent pregnancy and
sexually transmitted infections• HIV and AIDS• drug-related deaths• obesity and diabetes• heart disease• chronic lung disease • disability
Nearly 25% of adults have a diagnosable mental illness or substance use disorder
Disproportionate percentage (40%) of cigarettes smoked by 25% of population
Impacts of Determinants of Health• Access to medical care (15-20%)• Physical & social environment (20-25%)• Genetics/biological factors (20-25%)• Human behavior (40%)
Which of the above do you think has the most impact on health?
Actual causes of death in the US, McGinnis & Foege, 1993
Impacts of Determinants of Health• Access to medical care• Physical & social environment• Genetics/biological factors• Human behavior
Which of the above do you think has the most impact on health?
Obesity by race/ethnicity/gender
QuickStats: Prevalence of Obesity* Among Adults Aged ≥20 Years, by Race/Ethnicity and SexNational Health and Nutrition Examination Survey, United States, 2009–2010
Substance abuse by employment status
Employment status at admission, aged 16 and older: TEDS 1998-2008
Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Data received through 8.31.09.
Social determinants of health• Conditions in which people are born, grow, live, work and
age, including the health system- World Health Organization
circumstances are shaped by the distribution of money, power and resources at global, national and local levels
SDOH, Behaviors, Health Outcomes
Nearest fresh produce store 10 miles away
Lack of transportation(social determinants)
Under-consumption of fresh fruits/veggiesOver consumption of processed food(behavior)
Obesity/heart dz/diabetes(health outcome)
(not always a linear relationship)
Health Disparities
• Underlying causes• Inalterable conditions• Individual lifestyle• Education/Income• Living conditions• Health system• Discrimination• Policies
DETERMINANTS OF HEALTH
• Which baby has the longer life expectancy? Why?
• Now switch…
Impact of poor health
CDC NIOSH Worker Health Chartbook, 2004
Days Away from Work Due to Anxiety, Stress, and Neurotic Disorders Compared to Days Lost for All Injuries and Illness
Importance of Healthy Communities• Educational opportunities• Workforce development• Economic gains/contributions• Social supports/networks• Productivity• Safety
Health Policy
• Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. • An explicit health policy can achieve several things:• It defines a vision for the future which in turn helps to
establish targets and points of reference for the short and medium term. • It outlines priorities and the expected roles of different
groups. • It builds consensus and informs people.
World Health Organization
Informing Health Policy
• An issue is identified, but there is no policy to address it.• Undocumented immigrant health, health literacy
• Policy is in place, but it needs modification (ineffective or undesired outcomes)• Sexual education policies in schools
• Policy is in place but, barriers to implementation• Health Information Technology in underserved communities
• There is often a gap between science and policy (impact analysis, evidence-based policy)• Breastfeeding in the workplace
Advocacy
• Public support for or recommendation of a particular cause or policy.• Advocacy activities• Training• Protest• Visiting legislators• Community education and awareness• Fundraising• Petitions
Affordable Care Act
• National level policy• March 2010: Signed into law• June 2012: Upheld by Supreme Court
• Major components address:• Quality, Affordable Health Care for All Americans• The Role of Public Programs• Improving the Quality and Efficiency of Health Care• Prevention of Chronic Disease and Improving Public Health• Health Care Workforce
Role of community leaders and organizations • Needs assessment of community• Pick an issue and do that well• Educate yourself, then…• Educate the community• Advocate on community’s behalf• Meet the community where it is• Involve the community• Know the community’s capacity/resources• Develop and cultivate partnerships• Follow up and follow through• Empower your community