CDC and States: Partnering to CDC and States: Partnering to Achieve Health Equity Achieve Health Equity Michael L. Sells, MSPH, CHES Behavioral Scientist Program Development and Evaluation Branch Division of Nutrition, Physical Activity & Obesity Centers for Disease Control and Prevention The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention
Transcript
CDC and States: Partnering to CDC and States: Partnering to Achieve Health Equity Achieve Health Equity
Michael L. Sells, MSPH, CHESBehavioral Scientist
Program Development and Evaluation BranchDivision of Nutrition, Physical Activity & Obesity
Centers for Disease Control and Prevention
The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention
Objectives of the Presentation
• Overview of Key Terms• CDC’s priorities for achieving health equity
and eliminating health disparities• Health disparities-focused strategies across
the behavioral target areas • Example approaches from the states
Key Terms
• Justice• Health Equity• Health Disparities• Socioeconomic Factors • Social Determinants of Health
Justice in Public Health
• Justice defined: – The fair disbursement of common advantages and
the sharing of common burdens.• Two Aspects of JusticeTwo Aspects of Justice
• Health Improvement for the population• Fair treatment of the disadvantaged
Source: Gostin, L. & Powers, M. (2006) What Does Social Justice Require for the Public’s Health? Public Health Ethics and Policy Imperatives. Health Affairs, 25:4
LargestImpact
SmallestImpact
Factors that Affect HealthExamples
Eat healthy, be physically active
Rx for high blood pressure, high cholesterol, diabetes
Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax
Socioeconomic Factors
Changing the Contextto make individuals’ default
decisions healthy
Long-lasting Protective Interventions
Counseling & Education
ClinicalInterventions
Long-lasting Protective Interventions
Changing the Contextto make individuals’ default
decisions healthy
Socioeconomic Factors a
CDC’s Health Protection Goals
Healthy People in Every Stage of Life All people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life.
Healthy People in Healthy Places The places where people live, work, learn, and play will protect and promote their health and safety, especially those people at greater risk of health disparities. Source: www.cdc.gov/osi/goals/
Health Disparities Identified as a Strategic Priority by the Division of Nutrition Physical Activity & Obesity
Mission:To achieve health equity in physical activity, nutrition, and healthy weight across the United States and abroad through the elimination of health disparities.
Goal:to achieve health equity by developing and sustaining the capacity and resources of DNPAO to reduce and eventually eliminate disparities in nutrition, physical activity and obesity among different segments of the population in collaboration with the NCCDPHP, as well as internal and external partners.
• Four Phases (infrastructure, planning, execution and evaluation)
• Infrastructure and Planning Phases– Logic Model– Strategic Plan
• Focus Areas• Objectives
Convergence Model of Health Disparities
PA F&VEDSSB TV BF
TargetBehaviors:
Developed by: Michael Sells, MSPH, CHES
Convergence Model of Health Disparities
PA F&VEDSSB TV BF
TargetBehaviors:
Health Disp.Risk Factors:
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RFRF
Developed by: Michael Sells, MSPH, CHES
Convergence Model of Health Disparities
PA F&VEDSSB TV BF
TargetBehaviors:
Health Disp.Risk Factors:
RF RF RF RF RFRF RFRFRF RF RF
RFRFRF RF RF
RFRF
Macro LevelHealth Disparities:
EducationEducation IncomeIncome RaceRace
Developed by: Michael Sells, MSPH, CHES
Operationalizing Health Equity at CDCOperationalizing Health Equity at CDC
1. Establish staff capacity and/or infrastructure
2. Inventory of existing activities
3. Identify the disparities with data
4. Strategic planning
5. Prioritize activities6. Baseline data for
evaluation7. Final strategic plan8. Implement activities
Source:CDC’s Division of Nutrition Physical
Activity and Obesity
Examples of approaches and opportunities in DNPAO
• Health Impact Assessments• Facilitation of the Navajo Nation Worksite
Breastfeeding Law• Dietary Quality and Breastfeeding Expert Panels• Evaluability Assessments• Food desert information recently submitted to H.H.S.
that informed the White House Initiative • COCOMO Measures
Examples of Approaches and Opportunities in DNPAO (Cont.)
• Health Disparities-focused Strategies based on the top three strategies across the six Behavioral Target Areas
• Expert Panel, Curriculum and Toolkit• Publish, Partnerships & Technical Assistance• Policy approach-The zoning regulation in Los Angeles
that resulted in a moratorium on fast food restaurants.
Reducing Dietary Quality Disparities Expert Panel
Priority RecommendationsHealthy Food Retail:
State partnerships should have diverse representation including community representatives, grocery store owners, agricultural players, distributors, and other nontraditional partners to
give insight into kind of store and products needed to ensure successful and sustainable store change. Business associations, Hispanic coalitions, and other community organizations and
advocates may be much more connected to communities to add appropriate context to plans to change retail environment t han state partners. (ex. Using girl scouts to take pictures of sidewalks to show city council)
Menu Labeling/Nutrition Standards:
Addressing healthy food access in general may be more pertinent to address disparities in communities before menu labeling because increasing access to healthy foods and increasing
choices is important not just labeling what is unhealthy Sugar Sweetened Beverages:
Beware of unintended consequences (promote diet soda and 100% juice by taxing SSB). We need to come to a consens us about how we feel about all artificially sweetened beverages
including diet drinks; need to have consistent policy/definition/standard; consistent messaging ‘Choose only water?’ water is the cheapest from disparities perspective; no matter
what the stra tegy is; but all (government and private) need to be on the same page
• Panel Session I – Community– Improve health promotion efforts targeting African Americans
• Panel Session II – Medical Care– Encourage hospitals to provide an alternative to formula bags
• Panel Session III – Employment– Provide employers with breastfeeding-friendly policies and have CDC
and state govts. set stds. /models, etc.• Panel Session IV – Infrastructure
– Develop a website on African American Breastfeeding, associated with social marketing campaign
Examples of Health Disparity Focused Strategies by Target Area
• Breastfeeding– Maternity care
practices– Peer Support – Educating mothers– Media and social
marketing
• Physical Activity– Enhanced physical
education in schools
– Social support interventions in community settings
• Fruits and Vegetables– Include or expand
Farm-to-Where-You-Are Programs
– Increase access to fruits and vegetables in emergency food programs
• Sugar Sweetened Beverages– Ensure ready access
to safe drinking water of acceptable quality
– Limit access to sugar sweetened beverages
Examples of Health Disparity Focused Strategies by Target Area
• Television Viewing– Develop and
implement curricula to reduce TV/screen time
• Energy Density– Promote menu
labeling– Improve geographic
accessibility of supermarkets in underserved areas
Examples of Health Disparity Focused Strategies by Target Area
Examples from States
• North Carolina - Community Gardens• Montana – Trail adaptation for older adults• Georgia – Accessibility and teaching
behavioral skills in partnership with WIC• Indiana – funding local minority coalitions• New York – Partnering with diabetes program
to work with American Indian populations
State Programs Health Disparities Inventory
State Program Name Program Description Target Audience Target Areas
Setting
1 Arkansas Pick a Better Snack Implement the Pick a Better Snack program in elementary schools throughout the state.
R/E -General population SP-Pre-K, K, Elem
FV School-based
2 Arkansas NAPP SACC Support expansion o f the Nutrition and Physical Activity Se lf-Assessment for Child Care (NAP SACC) Program in at leastfive new chi ld care centers in low-income areas.
R/E -General population SP-Low-income
PA, NUTR Child-care
3 Arkansas Living Well wi th Disabil ity Program
Expand the L iving Well wi th a Disabil ity Program in and other environments in which people with d isab ilities gather.
R/E- General population, SP-Disability, handicapped population
PA, NUTR Independent living centers
4 Arkansas Peer Exercise Program to Promote
Facil ita te Peer Exercise Program Promotes Independence (PEPPI) in at least 40 sites and conduct 6-month follow up fitnessassessments in four new PEPPI sites. Sites that serve a higher proportion of African Americans and in geograph ic areas withhigher prevalence of obesi ty and other chron ic diseases wil l be targeted.
R/E-Black or AA, TP- Older 65+
PA Faith -based, senior centers
5 Colorado GIS Mapping Develop specific GIS Maps for reg ional and state planning. The maps make possib le the comparison of health metrics wi th demograph ic characte risti cs.
R/E- General population, SP-low-income
Not specified
OTHER
6 Georgia Faith-based Toolkit The Live Healthy In Faith Toolkit was designed to provide guidance to the faith community in establishing hea lth promotion programs that focus on better nutri ti on and enhanced physical activi ty. This guide provides activi ty suggestions and step-by-step instructions for making changes in your environment that w ill support the healthy behaviors. Increase capacity among fa ith-based organiza tions to implement and sustain healthy eating, breastfeeding, and physical activity initiatives.
R/E- General population
PA/NUTR Faith -based
Criteria for identifying Health Disparities-focused Strategies
• The strategy targets specific populations that are disproportionately impacted by obesity, poor nutrition, or lack of adequate physical activity as identified through one or more of the following risk factors: low income, racial/ethnic minority group(s); persons with less than or equal to high school diploma; gender; rural or urban geographic locations; and persons with disabilities.
• The strategy is either evidence-based or practice-based if it (1) has been successfully evaluated or (2) has been piloted in the populations experiencing the risk factor(s) physical activity.
Potential Strategies and Interventions for States
• Farm to fork • Urban Agriculture• Seed funding • Active + passive policies• Health marketing (old +
new approaches)
• Equity in built environments
• Multi-disciplinary collaborations
• Training of lay health workers
Consider these factors as we seek to become more culturally
competent1. Respect2. It is a process3. Different beliefs4. Learn about other cultures5. Work with other groups6. Genuine desire
Source: Smith, R. Ethnicity & Culture (2008)
Considerations• Policy strategies
– Passive: require no action on the part of the at-risk individuals
– Active: require cooperation from the at-risk individuals
Source: Gielen & Girasek (2001). Integrating Perspectives on the Prevention of Unintentional
Injuries. Integrating Behavioral with Social Sciences
A rising tide will not lift all boats if some boats have holes in them. Let’s work together to achieve health equity and patch up the holes by addressing health disparities and social determinants of health.
