Exam 2 Flashcards
social determinants of health
conditions in places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes
5 domains of SDOH
o economic stability
o Education access and quality
o Health care access and quality
o Neighborhood and built environment
o Social and community context
example of how education is a strength
Good education –> better paying employment –> access to healthcare
example of how education is a weakness
lack of education – less employment opportunities –> struggle financially –> poor immunity –> poorer health, at risk for CV disease
root cause of problem example
if someone doesn’t have health care - our immediate intervention is providing health care but that doesn’t address root cause
Why don’t they have access to health care? Why do they lack insurance? They lack insurance because their job doesn’t provide adequate coverage
what level of the ecological model is this: knowledge, attitudes, behavior, self-concept, skill, developmental history
intrapersonal
what level of the ecological model is this: formal and informal social network and social support systems, including family, work group and friendship networks
interpersonal processes and primary groups
what level of the ecological model is this: social institutions and organizations characteristics, and formal and informal rules and regulations for operations
institutional
what level of the ecological model is this: relationships among organization, institutions, and informal networks with defined boundaries
Community factors
what level of the ecological model is this: local, state, and national laws and policies
public policy
racism
a system – structures, policies, practices and norms that assigns value and determines opportunity base on the way people look or the color of their skin
o Results in conditions that unfairly advantage or disadvantage others
o Can impact mental and physical health
equity
is about everyone getting what they need in order to thrive
health disparity
Must be comparing at least 2 groups
Can be age, poverty but often is race/ethnicity
PRAPARE tool
Protocol for responding to and assessing patient’s assets, risks, and experiences
Screening tool used to collect data so providers can act on patient’s SDOHs
layout for community diagnosis
o Risk of – identify the issue
o Among – population, community
o Related to – observations
o As evidenced by – data
how do we rank diagnoses
how important is it to solve
is it a positive change for the community if solved
will it improve quality of life if solved
midstream approach
individual impact: Addressing individual social needs
Include patient screening question s about social factors
Provide direct support/assistance to meet patients social needs
upstream
community impact
improve community conditions
laws, policies and regulations that create community conditions supporting health for all people
Discuss strategies to address social needs in public health through the utilization of technology.
- Now pow
- Aunt bertha
- Link NYC
health impact pyramid
The Health Impact Pyramid is a graphical representation of tiers of influence that may result from public health interventions. At the base of the pyramid, indicating interventions with the greatest potential impact, are efforts to address social determinants of health
In public health we want to make the greatest impact on the greatest number of people and that is by changing structure and infrastructure. What do we mean by this statement?
-Focus on changing policy or changing context to make it more likely to happen
CDC 5 year plan for public health
The Health Impact in 5 Years (HI-5) initiative highlights non-clinical, community-wide approaches that have evidence reporting 1) positive health impacts, 2) results within five years, and 3) cost effectiveness and/or cost savings over the lifetime of the population or earlier
how is the CDC changing the context
school based programming to increase physical activity
school based violence prevention
safe routes to school
motorcycle injury prevention
tobacco control interventions
clean syringes
Pricing strategies alcohol
Multi component worksite obesity prevention
how is the CDC impacting the SDOHs
early childhood education
clean deisel bus fleets
water flouridation
public tranportation system
home improvement loans and grants
earned income tax credits
three core functions of PH
Assessment – systemically collect, analyze and make available info on healthy communities
Policy development – promote use of scientific knowledge base in policy and decision making
Assurance – ensure provision of services to those in need
community
Any group sharing something in common
Often defined by race or ethnicity, professional or economic ties, religion, culture or shared background or interest
community health needs assessment
A process that uses quantitative and qualitative methods to systematically collect and analyze data to understand health within a specific community.
o Statistical data
o Perspectives from community members
o Collecting info about community resources
what does an ideal CHNA include (5)
o Demographics
o Health issues and outcomes
o Risk factors
o Assets and resources
o Supporting documentation
rationale/purpose of a CHNA
- Identify needs of target population
- Establish program, priorities, goals and objectives
- Identify organizations that may help meet needs or provide resources
- Create awareness of a community concern or problem
- Public health department accreditation requirement
- Identify additional resources and assets
- ACA requirement for hospitals
- Provide a systematic basis for which organizational decisions are made
- Provide baseline for an eval
- Serve as a PR tool
what 4 things do you learn from a CHNA
o Main health concerns in a community
o Main reasons for these health concerns
o Where we might want to intervene and create change
o Strengths/assets in the community
three phases of the CHNA
assessment planning
data collection and analysis
program action planning
CHNA assessment planning
o Determine purpose and objectives
o Define target population or community
o Identify major needs area and issues
o Identify existing info regarding needs areas of community
o Involve the stakeholders
o Develop project mgmt plan (PERT or Gantt chart)
chna: data collection and analysis
o Finalize context, scope and boundaries
o Gather data
o Analyze and synthesize data
o Set preliminary priorities or needs
CHNA program action planning
o Set priorities or needs
o Consider range of solutions
o Develop action plan to implement solutions
o Eval the CHNA
o Communicate results
different ways to collect primary data for CHNA
surveys
individual or group inquiry (focus groups, community forums, listening sessions, interviews)
observations (field notes, windshield survey, videos, photos)
federally funded nonprofit health centers
Federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. Federally qualified health centers provide primary care services regardless of your ability to pay.
epidemiology
- Study of the distribution and determinants of health-related states among specified populations and the application of that study to the control of health problems
purpose of epidemiology
- Discover the agent, host, and environmental factors that affect health
- Determine the relative importance of causes of illness, disability, and death
- Identify those segments of the population that have the greatest risk from specific causes of ill health
- Evaluate the effectiveness of health programs and services in improving population health
endemic
refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.
epidemic
refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.
pandemic
refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.
rates
are the number of cases occurring during a specific period; and is always dependent on the size of the population during that period
rate calculation
number of cases / population at risk
epidemiological investigation
identify problem, collect data, formulate and test hypotheses
passive surveillance
o Diseases reported by health care providers
o Simple and inexpensive
o Limited by incompleteness of reporting and variability of quality
active surveillance
o Health agencies contact health providers seeking reports
o Ensures more complete reporting of conditions
o Used in conjunction with specific epidemiologic investigation
descriptive epidemiology
describes the where and whom of the disease, allowing you to begin intervention and prevention measures.
analytic epidemiology
the epidemiologist relies on comparisons between different groups to determine the role of different causative conditions or risk factors.
looking for cause and effect
3 components of descriptive epidemiology
- Time: date of onset
- Place: geographic extent of problem and clues to place
- Person: age, sex, race, medical status
step 1 of outbreak investigation
establish existence of an outbreak
how to establish existence of outbreak (step 1)
Use data from data sources
Is it an outbreak or an epidemic?
