Community Health and Wellness

1. Community Health and Wellness Renée Volny, DO, MBA Interim Associate Director Health Policy Leadership Fellowship Satcher Health Leadership Institute

2. 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

3. Healthy Communities • What is a healthy community? Groundswell Mural, Bronx, NY

4. 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

6. 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

8. Nearly 25% of adults have a diagnosable mental illness or substance use disorder Disproportionate percentage (40%) of cigarettes smoked by 25% of population

9. Access and proximity to grocery store USDA

10. Healthy People 2010

11. 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

12. 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?

13. Behaviors: who and why?

14. Obesity by race/ethnicity/gender QuickStats: Prevalence of Obesity* Among Adults Aged ≥20 Years, by Race/Ethnicity and Sex National Health and Nutrition Examination Survey, United States, 2009–2010

15. Obesity by education/gender

16. Health status by income

17. 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.

18. 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

19. SDOH, Behaviors, Health Outcomes (not always a linear relationship) Nearest fresh produce store 10 miles away Lack of transportation (social determinants) Under-consumption of fresh fruits/veggies Over consumption of processed food (behavior) Obesity/heart dz/diabetes (health outcome)

20. 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…

21. Who cares? We all should!

22. Impact of poor health

23. Impact of poor health Days Away from Work Due to Anxiety, Stress, and Neurotic Disorders Compared to Days Lost for All Injuries and Illness CDC NIOSH Worker Health Chartbook, 2004

24. Impact of poor health The National Survey of Children’s Health (NSCH)

25. Importance of Healthy Communities • Educational opportunities • Workforce development • Economic gains/contributions • Social supports/networks • Productivity • Safety

26. Policy Behavior Healthy People 2010

27. Policy • National level • State level • Local level • Organizational level

28. 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

29. Informing Health Policy • Programs • Advocacy • Research

30. 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

31. Advocacy • Public support for or recommendation of a particular cause or policy. • Advocacy activities • Training • Protest • Visiting legislators • Community education and awareness • Fundraising • Petitions

32. 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

33. 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

34. Thank you! Health Policy Leadership Fellowship Program Post-doctoral fellowship opportunity http://shli.msm.edu