Introduction to Public Health November 7, 2004 Community Assessment with Health Disparities Groups...
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Transcript of Introduction to Public Health November 7, 2004 Community Assessment with Health Disparities Groups...
Introduction to Public HealthNovember 7, 2004
Community Assessment with Health Disparities Groups
Judith Bradford, Ph.D.
Community Health Research Initiative
Survey and Evaluation Research Lab
Communities
Of geography, such as a group of Census tracts, or a county or city
Of individuals with shared characteristics, such as demographic and/or other personal characteristics
Of affiliation, such as faith communities
Critical Concepts
Community health is profoundly affected by the collective behaviors, attitudes, and beliefs of everyone who lives in/belongs to the community.
Partnerships are effective tools for improving health in communities.
Core Issues and Challenges Definition of community members -- who is
in the community? Trustworthy understanding of their
characteristics and needs. Feasible methods of gathering needed
information about them. Effective methods for involving community
members in assessment and interpretation.
Healthy People Movement
1979: The Surgeon General’s Report on Health Promotion and Disease Prevention
1980: Promoting Health/Preventing Disease
HP2000: National Health Promotion and Disease Prevention Objectives
Healthy People 2010
Overarching purpose: promoting health and preventing illness, disability, and premature death
... grounded in science, built through public consensus, and designed to measure progress
Healthy People 2010
Two overarching goals: Increase quality and years of life Eliminate health disparities
Format: 467 objectives to improve health, organized into 28 focus areas.
HP2010 Perspective
…increase life expectancy and quality of life over the next 10 years by helping individuals gain the knowledge, motivation, and opportunities they need to make informed decisions about their health
…encourages local and state health leaders to develop community-wide and statewide efforts that promote healthy behaviors, create healthy environments, and increase access to high-quality health care.
Subgroups of Concern for Eliminating Disparities
Differences that occur by…. gender race or ethnicity education or income disability living in rural localities sexual orientation
Major HP2010 Data Sources National Health Interview Survey (NHIS) National Health and Nutrition Examination Survey (NHANES) National Vital Statistics System - Mortality (NVSS-M) School Health Policies and Programs Study (SHPPS) National Survey of Family Growth National Vital Statistics System - Natality (NVSS-N) National Hospital Discharge Survey National Household Survey on Drug Abuse (NHDA) National Profile of Local Health Departments (NPLHD) Behavioral Risk Factor Surveillance System (BRFSS) HIV/AIDS Case Surveillance System Youth Risk Behavior Surveillance System (YRBSS) Medical Expenditure Panel Survey (MEPS)
10 Leading Health Indicators
Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior Mental health Injury and violence Environmental quality (social) Immunization Access to health care
Public Health Infrastructure
HP2010 Goal: Ensure that ... health agencies have the infrastructure to provide essential public health services effectively
Data and information systems Workforce Public health organizations Resources Prevention research
Essential Public Health Services
Monitor heath status Diagnose and investigate Inform, educate, and empower Mobilize community partnerships Develop policies and plans Enforce laws and regulations Link people to personal health services Assure a competent health care workforce Evaluate effectiveness, accessibility, and quality Research for new insights and solutions
Focus Areas - 1 Access to quality
health services Arthritis,
osteoporosis, and chronic back conditions
Cancer Chronic kidney
disease Diabetes
Disability and secondary conditions
Educational and community-based programs
Environmental health Family planning Food safety Health communication
Focus Areas - 2
Heart disease and stroke
HIV Immunization and
infectious diseases Injury and violence
prevention Maternal, infant, and
child health
Medical product safety
Mental health and mental disorders
Nutrition and overweight
Occupational safety and health
Oral health
Focus Areas - 3
Physical activity and fitness
Public health infrastructure
Respiratory diseases Sexually transmitted
diseases
Substance abuse Tobacco use Vision and hearing
Limitations of Current System forHP2010 Community Assessment
“Disparities populations” …. are not always easy to find are sometimes difficult to define (and
therefore to count) may be poorly understood by the “system” may have low political/social priority may even be considered less valuable or
otherwise inconvenient
For example, sampling for heath needs of LGBT communities
What’s the question?
Who is in the community?
On a scale of 1 - 10….
How complete are available data?
How difficult to obtain currently unavailable data?
Which sampling strategies are most effective?
Using existing data sets
How to determine the distribution of identified cases in a geographic area defined by Census tracts?
(using same-sex HH data from 1990 & 2000; difficulty 2)
How to capture reliable data on the local health priorities of sexual minority African American women?
No existing federal data system contains directly relevant data.
Successful example: Community forum and priority setting through partnership with community organizations.
Difficulty: 8
How to determine the HIV risks and prevention needs of Transgender persons in Virginia?
No existing federal data system will do this. Web-based and mail-back surveys. Strategies: set up field study with regional
managers and gatekeepers from; careful translation of concepts; even more careful selection of survey administrators.
Anticipated difficulty: 10
Conclusions
Current public health data systems are inadequate for comprehensive community assessment.
There is a “disconnect” between HP2010 goals and readiness of public health infrastructure to fully respond.
Additional assessment methods must be carefully chosen to fit the community of interest and challenges it presents.
Effective participation by community of interest is critical.
The need for social-behavioral research
…the nature of human relationships – the degree to which an individual is interconnected and embedded in a community – is vital to an individual’s health and well-being as well as to the health and vitality of entire populations.
Berkman LF, Glass T. Social integration, social networks, social support and health, in Social Epidemiology, Berkman LF and Kawachi I, Eds. New York: Oxford University Press, 2000.
What are our major challenges in conducting LGBT assessments?
1. Acknowledging, accepting disparities within LGBT communities.
2. Placing higher priority on least understood areas.
3. Recognizing the power and implications of cultural context for LGBT health.
4. Finding common cause and forming strong affiliations to work across dividing lines.
So many questions…
1. Who is the population we wish to study?
2. What factors influence their lives and lead to health disparities?
3. What are the questions we need to ask and answer?
4. What methods are best to use?5. How do we put it all together?
Social-Ecological Model for Levels of Influence
McElroy KR, Bibeau D, Steckler A, Glanz . An ecological perspective on health promotion programs. Health Education Quarterly 15:351-377, 1988.
Interpersonal: family, friends, peers that provide social identity, support and identity
Individual: awareness, knowledge, attitudes, beliefs, values, preferences
Public Policy: local, state and federal government policies, regulations, and laws
Community: social networks, standards and practices among organizations
Institutional/Organ-izational: rules, policies, procedures, environment, and informal structures within an organization or system
Community-based participatory research
CBPR…1. recognizes community as a unit of identity2. builds on strengths and resources within the
community3. Facilitates collaborative, equitable
partnership in all phases of the research4. Promotes co-learning and capacity building
among all partners5. Integrates and achieves a balance between
research and action for the mutual benefit of all partners
CBPR…6. emphasizes local relevance of public health problems
and ecological perspectives that recognize and attend to the multiple determinants of health and disease.
7. involves systems development through a cyclical and iterative process.
8. disseminates findings and knowledge gained to all partners and involves all partners in the dissemination process.
9. involves a long-term process and commitment.
Minkler M, Wallerstein N (Eds.). Community Based Participatory Research for Health. San Francisco: Jossey-Bass & Co., 2003.
Contributions to the field of social and behavioral health from LGBT health disparities studies
1. Communities cannot be usefully studied without their own participation, through partnership and with mutual accountability.
2. As we do this work together, we are learning, and with each step forward, there is a general increase in knowledge. We are using what we learn.
3. LGBT community research provides a model for use by others – a foundation that can be built upon to address and to learn from diversity.