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• What is a healthy community?

Groundswell Mural, Bronx, NY

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

Access and proximity to grocery store

USDA

Healthy People 2010

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?

Behaviors: who and why?

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

Obesity by education/gender

Health status by income

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…

Who cares?

We all should!

Impact of poor health

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

Impact of poor health

The National Survey of Children’s Health (NSCH)

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

Healthy People 2010

Policy Behavior

Policy

• National level• State level• Local level• Organizational level

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

•Programs•Advocacy•Research

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

Thank you!

Health Policy Leadership Fellowship Program

Post-doctoral fellowshipopportunity

http://shli.msm.edu