towards a new vision for health: implications for the ... · culture of health moves a shared...
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Towards a new vision for health: Implications for the workforce and
analysis
Anita Chandra
PFRH Seminar November 4th, 2015
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Roadmap
• Context for public health-culture of health, community resilience
• Opportunities and meaning for public health research and analysis
• Opportunities for public health workforce
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Culture of Health Moves a Shared Definition
Shared expectations that individual and sectors have capacity to:
• promote individual and community
well-being (as defined by physical, social, spiritual and mental health),
• create physical and social
environments that prioritize health, and
• support access to opportunities for
healthy lifestyles and quality health care for everyone.
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$3 trillion
in health care expenditures annually
18% GDP
spent on health—highest in the world
$226 billion
in lost revenue due to poor health
1 in 3
children overweight or obese
1 in 5
lack easy access to healthy practices
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RWJF calls to action building a Culture of
Health
New models emerge with
broader views of health
Health improvements
not fast enough
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Why culture? How do we define and operationalize culture?
Define action
framework
Use measures to guide work
Develop measures
Catalyze new dialogue about health
Plan for national
integration
Change data systems and what is tracked
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Culture of Health offers an action framework that can move wellbeing into local practice
What has been missing?
• Integration of the practice of government with science of wellbeing
• Coordination around a common agenda
• Consideration of local resource allocation
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Culture of Health provides an action framework for consideration of other large-
scale movements
Livability Sustainability
Wellbeing Resilience
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What does a “win” look like for Culture of Health
NARRATIVE: Changing national discourse on health and wellbeing (values and
priorities)
ACTION: Changing how we invest (national budget, human capital, training,
etc.)
ASSESSMENT: Changing what we measure (our approach to research, our
use of data, etc.)
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11
Each action area has drivers and illustrative measures
41 measures were selected based on: • Availability of national data
• Application to entire lifespan and ‘healthspan’
• Broad determinants and upstream drivers
• Use for signal value
• Appeal to multiple audiences
• Attention to equity
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Action Area 1: Making Health a Shared Value
Drivers:
• Mindset and expectations
• Sense of community
• Civic engagement
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Action Area 2: Fostering Cross-Sector Collaboration to Improve Well- Being
Drivers:
• Number and quality of partnerships
• Resource investments across sectors
• Policies that support collaboration
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Action Area 3: Creating Healthier, More Equitable Communities
Drivers: • Built environment and physical conditions
• Social and economic environment
• Policy and governance
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Action Area 4: Strengthening Integration of Health Services and
Systems Drivers:
• Access
• Consumer experience and quality
• Balance and integration
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Outcome: Improved Population Health, Well-Being, and Equity
Outcome areas:
• Improved individual and community wellbeing
• Managed chronic disease and reduced exposure to toxic stress
• Reduced health care cost
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Sentinel Communities
• Opportunity to understand CoH at the local level and identify new measures using sentinel surveillance
• Mixed methods of data collection and monitoring
• 30 communities varied by geography, sociodemographics, and innovations in health
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Resilience of governments
Resilience of government-NGO partnerships
Government 2.0 Government 2.0
Patient-centered medical homes, ACO
Environmental sustainability
Age friendly retirement villages
Civic well being
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So how did we arrive at community resilience?
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Community Resilience is Continually Developing
The ongoing and developing capacity of the community to account for its vulnerabilities and develop capabilities that aid in:
1) preventing, withstanding, and mitigating the stress of a health incident
2) recovering in a way that restores the community to a state of self-sufficiency and at least the same level of health and social functioning after a health incident
3) using knowledge from a past response to strengthen the community's ability to withstand the next health incident
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Strengthening community resilience is critical in a changing world
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We pursued resilience thinking when traditional disaster response models were not
enough
Resilience vs.
Preparedness
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Community resilience acknowledges the intersection between individuals
and organizations
EMS
Tribal Health
Schools
Animal Services
Law Enforcement
Corrections
Faith Based
NGOs
Labs
Social Services
City Planners
Transit
Fire
Civic Groups Employers
Drug Treatment
Elected Officials
Mental Health
Health
center
Public Health Dept
Parks and Rec
Nursing Homes
Neighborhood Orgs.
Home Health
ADAPTED FROM: NACCHO (MAPP website): http://www.naccho.org/topics/infrastructure/MAPP/index.cfm
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Community resilience requires building neighbor to neighbor reliance and organizational connection
Individuals/families have the knowledge to prepare for and respond to disaster
There are enough volunteers to help in a disaster
Organizations are ready and prepared to respond and recover
There are strong relationships between organizations
People can rely on each other (neighbor to neighbor)
RESILIENT COMMUNITIES RESILIENT COMMUNITIES
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Resilient communities drive residents towards a resilience mindset
Community Resilience Mindset
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Community resilience has represented the intersection of Community Health Promotion and Emergency Preparedness
Community Health Promotion
Community Resilience Emergency
Preparedness
Routine surveillance Assessment of population, structural vulnerabilities and assets
Emergency risk assessment
Community education Education about ongoing mitigation
Risk communication
Provision of direct health services (e.g., immunizations, home visiting)
Ongoing assurance of health service access; skill building (e.g., PFA)
Provision of shelters, evacuation plans, mass prophylaxis
Policy support re: health impact
Policies that prepare for routine and emergency conditions
Policy support re: disaster response and recovery
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Implications for public health research and analysis
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New movements require a more nuanced understanding of stakeholders
• Whole of community is intrinsic to planning, strategy
• New and unique partnerships required for public health to advance mission
Question: Do our models of partnership and collaboration work? Where has CPBR, etc.
worked and where has it not?
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Research requires new ways of thinking about data regimes and systems
• Government 2.0, Web 3.0
• Integration of data systems
Questions: What constitutes public health data?
How are data systems being used for ongoing adaptive capacity?
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These frameworks require consideration of people and planet together
• Intersection of social and natural sciences; infrastructure and human
• Social change theory is central
Question:
What models fully incorporate these disciplines and systems, and where does PH fit?
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Frameworks also require reconsideration of government, public-private roles
• Government role as safety net, or promoter of wellbeing
• Which P3 models will work to advance and sustain this orientation to health
Question: Where should public health departments position
themselves in resilience strengthening or advancing culture of health?
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Implications for workforce, capacity building
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Public health curriculum should consider use of narrative
• Advancing movements for transformation require new approaches to dialogue
Question: How do we train on the use of
narrative in current programs? Where is that in core competencies?
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Workforce will need to understand processes of collaboration
• Training in the development, sequencing and maintenance of collaboration
• Tools in how to advance ideas in competing and contentious contexts
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Rigor in conceptual broadness or “messiness” needs to be practiced and
discussed
• Blending disciplines and sectors means rough edges…at times
• Skill in deconstructing broad concepts and linking ideas and pathways
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Getting inside processes of change means some skill in…
• Decision analyses
• Use of networks
• Understanding of distributed knowledge pathways
• Use of technology
• Social and political context
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