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2018

Understanding Health Equity in a Public Health Setting Defining Health Equity and Social Determinants of Health Desiree Jonas, MPH Florida Department of Health. 2018. Overview. Seven Florida Health Performs Health Equity Social Determinants of Health Sociodemographic Data Cliff Analogy

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2018

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  1. Understanding Health Equity in a Public Health SettingDefining Health Equity and Social Determinants of HealthDesiree Jonas, MPHFlorida Department of Health 2018

  2. Overview • Seven Florida Health Performs • Health Equity • Social Determinants of Health • Sociodemographic Data • Cliff Analogy • Department Health Equity Initiatives

  3. Florida Department of Health Priorities

  4. Definitions • Health Equity: The assurance of the conditions for optimal health for all people • Health Inequality: A difference in the distribution or allocation of relevant health resources between groups • Health Inequity: A subset of health inequalities that are modifiable, associated with social disadvantage and considered ethically unfair

  5. Social Determinants of Health • Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks General Socioeconomic, Cultural, and Environmental Conditions • Social and Community Networks • Individual Behaviors

  6. From Dropout to Incarceration

  7. From Dropout to Incarceration

  8. From Dropout to Incarceration

  9. From Dropout to Incarceration • Lack of Social Support • Poor Physical & Mental Health • Violence & Bullying • Limited Access to Health Care • Poor Physical & Mental Health • Lack of Safe Housing • Lack of Affordable Housing Chronic Absenteeism • Incarceration • Unintended Pregnancy • Parental Separation • Household Violence • Lack of Education • Decreased Earning Potential

  10. Social Determinants of Health Health Outcomes

  11. Data

  12. Impact of Health Disparities 1.Centers for Disease Control and Prevention. [CDC Health Disparities and Inequalities Report — United States, 2013] MMWR 2013;62 (Suppl 3):[1-47] 2.David Satcher et al., What if We Were Equal? A Comparison of The Black-White Mortality Gap in 1960 And 2000 Health Affairs 24, no.2 (2005):459-464

  13. Sociodemographic Disparities

  14. Eliminating Health Disparities in Florida RWJF. (2016, January). Florida State Health Gaps Report. Retrieved March 08, 2017, from http://www.countyhealthrankings.org/health-gaps/florida

  15. Eliminating Health Disparities in Florida RWJF. (2016, January). Florida State Health Gaps Report. Retrieved March 08, 2017, from http://www.countyhealthrankings.org/health-gaps/florida

  16. Data Sources for Social Determinants of Health

  17. Data Sources for Social Determinants of Health

  18. Social Determinant of Health Indicators

  19. Social Determinants of Health Indicators

  20. Social Determinants of Health Variables

  21. Health Disparities

  22. Health Disparities

  23. Health Disparities Educational Inequalities Individual and Behavioral Factors Inadequate Access to Health Care Environmental Threats

  24. Health Disparities: How do Disparities Arise • Differences in the quality of care received within the health care system • Differences in access to health care, including preventive and curative services • Differences in life opportunities, exposures and stresses that result in differences in underlying health status

  25. Cliff Analogy Three Dimensions of Health Intervention • Providing health services • Addressing the social determinants of health • Addressing the social determinants of equity Jones, C. P. & Jones, C. Y. & Perry, G. S. & Barclay, G. & Jones, C. A. (2009). Addressing the Social Determinants of Children’s Health: A Cliff Analogy. Journal of Health Care for the Poor and Underserved 20(4), 1-12. The Johns Hopkins University Press. Retrieved March 8, 2017, from Project MUSE database.

  26. Cliff Analogy Primary Prevention Secondary Prevention (safety net programs) Tertiary Prevention (medical care) Jones, C. P. & Jones, C. Y. & Perry, G. S. & Barclay, G. & Jones, C. A. (2009). Addressing the Social Determinants of Children’s Health: A Cliff Analogy. Journal of Health Care for the Poor and Underserved 20(4), 1-12. The Johns Hopkins University Press. Retrieved March 8, 2017, from Project MUSE database.

  27. Cliff Analogy Primary Prevention Differences in Access to Care Secondary Prevention (safety net programs) Differences in Exposures and Opportunities (social determinants of health) Tertiary Prevention (medical care) Differences in Quality of Care (Ambulance Travel Time, Non-Working Equipment) Jones, C. P. & Jones, C. Y. & Perry, G. S. & Barclay, G. & Jones, C. A. (2009). Addressing the Social Determinants of Children’s Health: A Cliff Analogy. Journal of Health Care for the Poor and Underserved 20(4), 1-12. The Johns Hopkins University Press. Retrieved March 8, 2017, from Project MUSE database.

  28. Cliff Analogy Primary Prevention Secondary Prevention (safety net programs) Social Determinants Of Health Tertiary Prevention (medical care) Jones, C. P. & Jones, C. Y. & Perry, G. S. & Barclay, G. & Jones, C. A. (2009). Addressing the Social Determinants of Children’s Health: A Cliff Analogy. Journal of Health Care for the Poor and Underserved 20(4), 1-12. The Johns Hopkins University Press. Retrieved March 8, 2017, from Project MUSE database.

  29. Disparity Domains

  30. Disparities in Health Determinants

  31. Health Equity

  32. Achieving Health Equity • Valuing all individuals and populations equally • Recognizing and rectifying historical injustices • Providing resources according to need Jones CP 2010, adapted from the National Partnership for Action to End Health Disparities.

  33. Incorporating Health Equity into a Program

  34. Addressing the Social Determinants of Health

  35. Incorporating Health Equity into a Program

  36. Health Literacy

  37. Cultural Competency • Having an awareness of one’s own cultural identity and views about difference, and the ability to learn and build on the varying cultural and community norms of patients/customers • Improves access to high quality health care

  38. Health Equity Initiatives

  39. Health Equity Initiatives

  40. Health Equity Interventions

  41. Department of Health Initiatives • Health Equity Council • Florida Healthy Babies • Faith Based Initiatives • Heart Health Plus • Community Health Workers • Medication Adherence • Asthma Home Visiting Program • Medication Therapy Managment

  42. Things to Remember

  43. Health Equity Across the Life Span Supporting Positive Life Trajectories

  44. References • Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008 • CDC. (2015, February 10). Health Equity. Retrieved January 17, 2017, from https://www.cdc.gov/chronicdisease/healthequity/ • Robert Wood Johnson Foundation. (2016, October 19). The Relationship Between School Attendance and Health. Retrieved January 30, 2017, from http://www.rwjf.org/en/library/research/2016/09/the-relationship-between-school-attendance-and-health.html

  45. Questions Florida Department of Health Division of Community Health Promotion Bureau of Chronic Disease Prevention (850) 245-4430

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