Foundational Learning in Social Determinants of Health for Health Professionals by Dr. Haydee Encarnacion Garcia. Presented at the Emerging Trends in Nursing Conference at Indiana Wesleyan University on June 1, 2017.
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Encarnacion Garcia Presentation 6/1/2017
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#thisispublichealth
Foundational Learning in Social Determinants of
Health for Health Professionals
Emerging Trends in Nursing Conference
Dr. Haydee Encarnación García, PhD., MS, MPH, CHES
Director and Associate Professor
IWU-Graduate Program in Public Health
School of Health Sciences
June 1, 2017
2. Learning Outcomes
• Recognize interprofessional practice as key to effectively
addressing the social determinants of health.
• Apply health promotion and community health approaches to
improve population health.
• Demonstrate effective strategies for improving health and health
care by deepening understanding of the social determinants of
health which negatively impact health outcomes.
3. This is Public Health (TIPH) Campaign
• The This is Public Health (TIPH) campaign was created by the
Association of Schools and Programs of Public Health (ASPPH) to
brand public health and raise awareness of how public health
affects individuals, families, communities, and populations. The
simple statement – This is Public Health - has proven to be a
powerful tool in raising awareness about and support for public
health efforts.
• Please join this global effort to promote public health awareness.
https://thisispublichealth.org
4. The Institute of Medicine (1998)
• …has defined public health as
“what we, as a society, do collectively to assure the conditions for
people to be healthy.”
Most importantly, this perspective holds resonance to public health
practitioners, in proactively taking action towards improving social and
health determinant conditions which make us all healthy.
Vision: Healthy People in Healthy Communities
5. “…The determinants of health are beyond the capacity of any one practitioner or
discipline to manage….We must collaborate to survive, as disciplines and as
professionals attempting to help our communities and each other.”
—Institute of Medicine, 1999
Determinants of Health
6. Determinants of Health
“It is logical to expect that there is strength in numbers and that partnerships
can mobilize material and human resources and be more effective at achieving
desired goals than individuals working alone.”
– Karen Glanz (2012), Health Behavior and
Health Education,
8. The Role of Social Determinants in Promoting Health and
Health Equity
Source: http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and
-health-equity/
9. The Role of Social Determinants in Promoting Health and Health
Equity
11. Emerging Strategies To Address Social Determinants of Health
A number of tools and health promotion strategies are emerging to
address the social determinants of health, including:
• Use of Health Impact Assessments to review needed, proposed, and
existing social policies for their likely impact on health.
• Application of a “health in all policies” strategy, which introduces
improved health for all and the closing of health gaps as goals to be
shared across all areas of government.
Source: The National Prevention and Health Promotion Strategy. The National Prevention Strategy: America’s Plan for Better Health and
Wellness, June 2011. Available from: http://www.surgeongeneral.gov/initiatives/prevention/strategy/
12. Health for all…Addressing Health Disparities
• When you are less educated, have less information, speak a
different language, have no insurance, and are afraid, the
health care system becomes extraordinarily complex.”
» Dr. Harold Freeman, Director of the
Center to Reduce Cancer Health Disparities (2004)
13. Health for All (World Health Organization, 2000)
• “Health for all” implies the removal of the obstacles to health and
depends on continued progress in medical care and public health.
• A holistic concept calling for efforts in education, housing,
environment, communication, just as much as in medicine and public
health.
• Health does not exit in isolation. It is influenced by a complex of
social, environmental, and economic factors ultimately related to
each other.
14. Population Health: A Call for Action
• Key tenets of any population health approach are the Triple Aim
(Streifel, et.al., 2013).
– Better care
– Lower costs
– Better patient experiences
• Population health core tenets must be mastered and applied at all
point in the patient health care journey.
• Increase access to lower-cost providers
• Manage and identify high-risk patients
• Coordinate care
• Engage patients in self-management
15. Ten (10) Essential Public Health Services
Source of Ten Essential Public Health Services: Core Public Health Functions Steering Committee 1998 (Revised 2008).
16. Community health
assessment; registries
Health education and
health promotion
Investigate infectious
water-, food-, and
vector-borne disease
outbreaks
Partnerships with private
sector, civic groups, NGOs,
faith community, etc.
Identifying and sharing best
practices; participation in researchEvaluation and
continuous quality
improvement
Public health
workforce and
leadership
Strategic planning;
community health
improvement planning
Enforcement,
review of laws
Access to care,
link with
primary care
17. Foundational Capabilities for Public Health Practice
• Developing policy to effectively promote and improve health;
• Using integrated data sets for assessment, surveillance and
evaluation to identify crucial health challenges, best practices and
better health;
• Communicating with the public and other audiences to disseminate
and receive information in an effective manner for health,
including health promotion opportunities, access to care and
prevention.
• Mobilizing the community and forging partnerships to leverage
resources (funding and otherwise);
• Building new models that integrate clinical and population health;
18. Foundational Capabilities for Public Health
• Cultivating leadership, organization, management and business skills
needed to build and sustain an effective health department and
workforce to effectively and efficiently promote and improve health;
• Demonstrating accountability for what governmental public health
does directly and for those things that it oversees through
accreditation, continuous quality improvement and transparency;
and
• Protecting the public in the event of an emergency or disaster, as
well as responding to day-to-day challenges or threats, with a
cross-trained workforce.
19. Public Health Nursing Roles
• Extended beyond sick care to encompass
advocacy, community organizing,
health education, political and
social reform.
Specifically, these are roles that
involve collaboration and
partnerships with communities
and populations to address health
and social conditions and problems.
20. Public Health Nursing
• The community participation and ethnographic model is an
innovative framework that demonstrates evolving public health
nursing practice
• The community participation and ethnographic model is
especially appropriate for public health nurses working with
communities and populations because it provides a framework
that builds upon local community knowledge.
21. Public Health Nursing
• The community participation and ethnographic model builds on
assumptions underlying community-based participatory research
(CBPR) and encourages engagement of community members and
trusted community leaders in processes from problem identification
to project evaluation and dissemination.
Source: http://www.medscape.com/viewarticle/772434
22. Community-Based Participatory Research
• CBPR approach it builds partnerships with community members
across social-economic status and focuses on community assets
and resources rather than on deficits (Israel, Eng, Schulz, & Parker,
2005; Kretzmann & McKnight, 1997).
• CBPR seeks balance between community members and practitioners
or researchers through shared leadership, co-teaching, and co-
learning opportunities; it benefits from the expertise of both
community members and practitioners or researchers (Anderson,
Calvillo, & Fongwa, 2007; Isreal et al., 2005).
