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 Healthy Campus 2020

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 Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 2 2

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 3

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Vice-Chairs and Members Healthy 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 5

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 6

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.” Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 7 Phase 1 Report: Recommendations for the Framework and Format of Healthy People 2020, October 28, Page 20.

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 8

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 9

10 From Sept 17-18, 2009 meeting slides

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Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 18 Over the life span IOM model of multiple determinants of health used to develop Action Model for Healthy People Dahlgren, G. (1995) European Health Policy Conference: Opportunities for the Future. Vol. 11 – Intersectoral Action for Health. Copenhagen: WHO Regional Office for Europe Social-Ecological Models

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

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

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

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 Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 28 This section presented by Karen Moses

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 29

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

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

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

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 33

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 34

Evidence-Based Public Health Actions Categories of social decision making 1. Independent of context 2. Context sensitive 3. Anecdotal Assessing interventions 1. Systematic reviews 2. Health impact assessments (HIAs) Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 35

Sources for Evidence-Based Actions NIAAA Higher Education Center for s Guide to Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 36

Higher Education Center for Adrug Strategic Planning CDCynergy Social M Strategic & Intervention Planning Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 37 Sources for Evidence-Based Actions

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 38

Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 39 Click on image to go to web site

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 40

Resources Links to this presentation and reference files Presenters Healthy Campus 2020: Determinants of Health and Evidence-Based Actions 41 Jim Grizzell, MBA, MA, CHES, ACSM-HFC California State Polytechnic University, Pomona (909) Cynthia Burwell, EdD, CHES Norfolk State University (757) Karen Moses, MS, RD, CHES Arizona State University (480) Michelle Burcin, PhD, MPH, CHES University of South Carolina (803)