Focus on Determinants of Health and Evidence-Based Actions

1. Healthy Campus 2020 Focus on Determinants of Health and Evidence-Based Actions Jim Grizzell, MBA, MA, CHES, ACSM-HFS, Cal Poly Pomona; Karen Moses, MS, RD, CHES, Arizona State University Michelle Burcin, PhD, MPH, CHES, University of South Carolina; Cynthia Burwell, EdD, CHES, Norfolk State University

2. Learning Outcomes • Explain determinants of health and action model • Define evidence-based public health • Describe how to use the Healthy People 2020 online database of evidence-based actions and strategies 2 Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

3. Agenda • Who’s leading the Healthy People initiative? • Rationale for using social determinants of health and evidence-based actions • What are social determinants of health? • Steps that can be taken by Healthy People 2020 users • NASPA’s campus ecology model • What is evidence-based public health? • Strategies to broaden the evidence-base for public health • For higher education: resources for identifying evidence-based actions • Resources and References Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

4. Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

5. Vice-Chairs and MembersHealthy People 2020 Advisory Committee • Jonathan E. Fielding, MD, MPH, MA, MBA • Director and Public Health Officer • Los Angeles County, Department of Public Health • Professor of Health Services and Pediatrics and Co-Director • UCLA Center for Healthier Children, Families and Communities • Shiriki K. Kumanyika, Ph.D, M.P.H. • Professor of Biostatistics and Epidemiology • Department: Biostatistics and Epidemiology • University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and biostatistics • William Douglas Evans, PhD; Vincent Felitti, MD; Everold Hosein, PhD; Lisa Iezzoni, MD, MSc; Abby King, PhD; Ronald Manderscheid, PhD; David Owen Meltzer, MD, PhD; Eva Moya, LMSW; Patrick Remington, MD, MPH; David Siegel, MD, MPH; Adewale Troutman, MD, MPH Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

6. Rationale for SDOH and EB Actions • Past Healthy People documents • Catalogues of burden of ill-health, disability and premature death • Set of targets for reducing burden • What was missing? • Guidance on potential actions for achieving targets • Relative effectiveness of actions • Advisory Committee recommendation • Tie goals and objectives to evidence-based interventions that guide effective action and accountability Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

7. Overarching Goals of Healthy People 2020 • Address the factors that contribute to our collective health and illness by • calling for healthy places & supportive public policies • placing emphasis on the determinants of health • Reflect Advisory Committee recommendations • Redirect our attention from health care to health determinants • “Health determinants should be a primary focus of Healthy People 2020: • health care, a secondary focus.” Phase 1 Report: Recommendations for the Framework and Format of Healthy People 2020, October 28, 2008. Page 20. Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

8. Healthy Campus 2020 Overarching Goals • Create social and physical environments that promote health, safety and learning • Supports efforts to increase academic success, student retention and life long learning • Eliminate preventable disease, disability, injury, and premature death • Achieve health equity, eliminate disparities, and improve the health of the entire campus community • Promote healthy development and health behaviors across every stage of life Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

9. Healthy Campus 2020 Mission • Identify nationwide health improvement priorities in higher education • Increase awareness and understanding of determinants of health, disease, and disability and the opportunities for progress • Provide measurable objectives and goals that can be used at institutions of higher education • Engage multiple constituents to take actions to strengthen policies, improve practices, and empower behavior change that are driven by the best available evidence and knowledge • Identify and promote relevant assessment, research and data collection needs Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

10. From Sept 17-18, 2009 meeting slides Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

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18. Broad social, economic, cultural, health, and environmental conditions and policies at the global, national, state, and local levels a Living and working conditions Social, family and community networks Social-Ecological Models Individual behavior Innate individual traits: age, sex, race, and biological factors --- The biology of disease Over the life span b IOM model of multiple determinants of health used to develop Action Model for Healthy People 2020. Dahlgren, G. (1995) European Health Policy Conference: Opportunities for the Future. Vol. 11 – Intersectoral Action for Health. Copenhagen: WHO Regional Office for Europe 18 Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

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20. NOTE * Evidence-based, HIA positive health impacts, ROI >1:1 ** SMART: Specific, measurable, achievable, relevant, time-specific Healthy Campus 2020: Determinants of Health and Evidence-Based Actions NOTE: added planning model & learning & playing conditions

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25. World Health Organization • Ottawa Charter • Healthy settings, cities, worksites, schools “We shape our [campuses]; thereafter, they shape us.” - Winston Churchill 25 Think Health Agenda and Healthy Settings to Enhance Health & Learning

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27. Social-Ecological Models Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

28. A New Paradigm: The Ecological Approach to Campus Health • Views the connections among health, learning, and the campus structure • Explores relationships between and among individuals and the learning communities that comprise the campus environment This section presented by Karen Moses Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

29. Using the Ecological Perspective on Campus • Establish a Working Group • Identify Campus Values • Assess Student Health Data • Analyze Campus Health Concerns Through an Ecological Lens: • Environmental influences • Individual influences • Develop a Plan Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

30. Influencing Factors Characteristics of the: Individual Community Place Organization People Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

31. Environmental Influences Place People • The location of the campus • The weather • The constructed designs • Landscapes Behavior settings: Rituals, student organizations Cultural Influences: Customs, traditions, values Economic Forces: Student financial stability, budget Inhabitants: Diversity, Athletics, Greek, campus communities, etc. Organizational Structure Policies Organizational Climate Organization Political Climate Conservative/liberal Pro education? Reinforcement and Rewards For healthy org & indiv behaviors Community Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

32. Stress: Environmental Influences Warm climate Lack of parking High traffic Campus size—distances Crowding—long lines Place People Financial concerns ISO – global troubles Relationships w/friends Lack of friends/commuters Irresponsible drinkers Uninvolved students Services--lack of info Depts disconnected Too many steps Weak policy enforcement Inconsistent messages Institution State budget crisis Increase in tuition/fees Rewards for over commitment Culture of stress Community Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

33. Keys to Effective Use of the Ecological Perspective • Expand the focus beyond health information and programming • Integrate responsibility for health across student affairs and academic units • Provide supportive environments and reduce barriers to optimal outcomes • Promote leadership and involvement by multiple partners Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

34. Evidence-Based Public Health Actions • Origins of movement to EBPH, roots in EBM • Prior to 1970s: “Uninformed intuition, unsystematic clinical experience, . . .”* • 1984: US Preventive Services Task Force • EBPH “is the development, implementation, and evaluation of effective programs and polices in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models.” * Hill, E., Alpi, K., Auerbach, M., Evidence-based practice in health education and promotion: a review and introduction to resources. Health Promot Pract 2010; 11; 358 originally published online Jan 13, 2009 Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

35. Evidence-Based Public Health Actions • Categories of social decision making • Independent of context • Context sensitive • Anecdotal • Assessing interventions • Systematic reviews • Health impact assessments (HIAs) Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

36. Sources for Evidence-Based Actions • NIAAA • www.niaaa.nih.gov/ • Higher Education Center for • www.highereducationcenter.org • s • www.samhsa.gov/ebpwebguide/index.asp • Guide to • www.thecommunityguide.org/index.html Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

37. Sources for Evidence-Based Actions • http://www.nrepp.samhsa.gov • Higher Education Center for Adrug • www.higheredcenter.org/prevention/strategic-planningStrategic Planning • CDCynergy Social M Strategic & Intervention Planning • www.orau.gov/cdcynergy/soc2web/Content/phase01/phase01.htm Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

38. Tags for Use in Database Queries • Settings • Government • Private health/healthcare sector • Education • Workplaces • Communities • Institutional settings • Regional/national Organizations • Users • Roles • Healthy People Objectives • Target Population • Selection criteria • Approving body • Examples and resources • Key words Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

39. Click on image to go to web site www.nrepp.samhsa.gov/find.asp Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

40. Summary & Questions • Who’s leading the Healthy People initiative? • Rationale for using social determinants of health and evidence-based actions • What are social determinants of health? • Steps that can be taken by Healthy People 2020 users • NASPA’s campus ecology model • What is evidence-based public health? • Strategies to broaden the evidence-base for public health • For higher education: resources for identifying evidence-based actions Healthy Campus 2020: Determinants of Health and Evidence-Based Actions

41. Resources • Links to this presentation and reference files • www.csupomona.edu/~jvgrizzell/hc2020/acha2010presentations.htm • Presenters • Jim Grizzell, MBA, MA, CHES, ACSM-HFC • California State Polytechnic University, Pomona • jvgrizzell@csupomona.edu • (909) 856-3350 • Cynthia Burwell, EdD, CHES • Norfolk State University • cburwell@nsu.edu • (757) 823-9494 • Karen Moses, MS, RD, CHES • Arizona State University • karen.moses@asu.edu • (480) 965-1360 • Michelle Burcin, PhD, MPH, CHES • University of South Carolina • mburcin@mailbox.sc.edu • (803) 777-4752 Healthy Campus 2020: Determinants of Health and Evidence-Based Actions