Intersectoral Action & the Social Determinants of Health: What's the Evidence?
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Intersectoral Action & the Social Determinants of Health: What's the Evidence?

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Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health, hosted a 90 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487),......

Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health, hosted a 90 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), presenting key messages and implications for practice in the area of social determinants of health on Wednesday September 19, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Sume Ndumbe-Eyoh, Knowledge Translation Specialist at the National Collaborating Centre for Determinants of Health.

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  • 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome!Intersectoral Action and the Social Determinants of Health: What’s the evidence? In partnership with: You will be placed on hold until the webinar begins.The webinar will begin shortly, please remain on the line.
  • 2. What’s the evidence? National Collaborating Centre for Determinants of Health. (2012). Assessing the impact and effectiveness of intersectoral action on the social determinants of health: An expedited systematic review. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University. ENGLISH - http://nccdh.ca/resources/entry/assessing- the-impact-and-effectiveness-of-intersectoral-action-on- the-SDOH FRENCH - http://nccdh.ca/fr/resources/entry/assessing- the-impact-and-effectiveness-of-intersectoral-action-on- the-SDOH
  • 3. Participant Side PanelHousekeeping in WebEx Use Q&A to post comments/questions during the webinar  ‘Send’ questions to All (not privately to ‘Host’) Connection issues  Recommend using a wired Internet connection (vs. wireless), to help Q&A prevent connection challenges WebEx 24/7 help line: 1-866-229-3239
  • 4. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! Intersectoral Action and the Social Determinants of Health:What’s the evidence?
  • 5. The Health Evidence Team Kara DeCorby Heather Husson Administrative Director Project ManagerMaureen DobbinsScientific DirectorTel: 905 525-9140 ext 22481E-mail: dobbinsm@mcmaster.ca Lori Greco Robyn Traynor Lyndsey McRae Knowledge Broker Research Coordinator Research Assistant
  • 6. What is www.health-evidence.ca? Evidence inform Decision Making
  • 7. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  • 8. Knowledge Translation Supplement Project CIHR-funded KTB-112487
  • 9. Review National Collaborating Centre for Determinants of Health. (2012). Assessing the impact and effectiveness of intersectoral action on the social determinants of health: An expedited systematic review. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.
  • 10. EvaluationPlease check your email for the evaluation survey link after the webinar. It take 5 minutes to complete!If you did not personally register for the webinar, please e-mail Jennifer McGugan at mcgugj@mcmaster.ca to be sent the survey
  • 11. Questions?
  • 12. National Collaborating Centre forDeterminants of Health Sume Ndumbe-Eyoh Hannah Moffatt seyoh@stfx.ca hmoffatt@stfx.ca Knowledge Translation Specialists
  • 13. About the National Collaborating Centrefor Determinants of Health• Our focus – Social determinants of health (SDH) & health equity• Our audience – All organizations that make up the public health sector in Canada – The practitioners, decision makers and researchers who work within public health• Our work – Translate and share evidence to influence interrelated determinants and advance health equity Visit us at www.nccdh.ca
  • 14. Pan-Canadian
  • 15. Visit us at www.nccdh.ca• Resource Library• Health Equity Clicks: Community• Health Equity Clicks: Organizations• Networking events & workshops
  • 16. Summary Statement:NCCDH(2012)P General populationI Any population health intervention, involving an intersectoral relationship, related to the social determinants of health (SDOH and health equityC Health equityO Health Outcomes: measures of morbidity/mortality, quality o life, adherence to healthcare, etc. SDOH Outcomes: income/income distribution, employment, housing, etc. Policy Outcomes: societal-level legislative changes, and organizational level policies/programsQuality Rating: 8 (strong)
  • 17. Summary of Included Studies Included articles met several relevance criteria: • Any design/population health intervention re: SDOH & health equity • Explicit mention of intersectoral relationship • Outcomes : health, SDOH, or policy • Published in English or French between Jan 2001-Jan 2012 • Set in one of: Norway, Finland, Denmark, Sweden, Australia, New Zealand (NZ), Canada, the United States (US), or the United Kingdom (UK) Total of17 articles included: 1 systematic review, 14 quantitative studies & 2 qualitative studies
  • 18. Overall Considerations Evidence of effectiveness for some upstream, midstream, and downstream interventions Role of the public health sector was not always clearly described in the primary studies, however intervention descriptions can be accessed in Table 2 of the review. Interventions targeted very specific populations so findings may not be generalizable to a different population and/or setting. Long-term effectiveness remains unclear. Public health decision makers should advocate for development and funding of research assessing impact of intersectoral collaborations, particularly those focused on upstream interventions.
  • 19. General ImplicationsPublic health SHOULD consider: Intervening in early childhood, given positive effect for kids, especially for early literacy among children of low-income mothers Upstream interventions to improve housing and employment conditions, evidence of impact for other SDH is limited Midstream interventions to improve employment/working conditions, child literacy, dental health, housing, and organizational change Downstream interventions to increase access to oral health services, immunization rates, appropriate use of primary health care services, and referrals from school readiness checks.
  • 20. What’s the evidence?Upstream Interventions Employment/working conditions: interagency agreements in multiple US states led to a 25% yearly increase in supported employment over 5 years in adults with disabilities Housing: national legislation to improve housing conditions among Australian indigenous communities led to slight improvements of infrastructure components but no impact on hygienic conditions
  • 21. Implications: Practice & policyUpstream Interventions consider implementing upstream interventions that appear effective, knowing the current evidence-base is limited so cautioning that advocating for additional, long-term impact assessment of upstream interventions is needed
  • 22. What’s the evidence?Midstream Interventions Employment/working conditions (2 studies) – improvements in employment (76.7% of participants obtaining employment) and improved working conditions with 5 workplace changes Childhood Literacy (1 study) – improved early literacy behaviours, increased parents reporting showing books to their infants daily (53.67% in 2001, 69.44% in 2003), reading aloud to children daily (33% in 2001, 53.70% in 2003), and participation in the Raising a Reader program (4.3% in 2001 and 16.7% in 2003).
  • 23. Midstream Interventions, cont. Housing(1 study) – all households received helpful housing modifications, with decreased hospital admissions for those up to 34 years old, decreased housing-related, preventable hospital admissions. Social & Physical Environments (3 studies) -  Eight projects resulting from a collaborative demonstrated organizational change and advocacy projects at multiple levels, but had no impact on program integration or policy  School-based break time snacking reduced indicators of childhood dental disease (DMFT changed from 1.13, CI [0.85, 1.40] in year 1 to 1.58, CI [1.28, 1.89] in year 2) and increased number of filled permanent teeth in lower SES schools over time: mean 0.49, CI [0.20, 0.77] Year 1 and 1.05, CI [0.69, 1.14] Year 2.  Chronic disease coalition did not report health outcomes but initiated a number of programs, policies, and practices with outcomes not yet available
  • 24. Implications: Practice & policyMidstream Interventions implement school-based break-time snack initiatives as an avenue to address childhood dental disease consider interventions that address employment/working conditions and childhood literacy, dental health and housing explore collaboratives for community-based and school- based organizational change, and potential to advocate at multiple levels consider that it is unclear as to whether improvements lasted long-term
  • 25. What’s the evidence?Downstream Interventions Oral health: school- and home visit-based oral health education program led to 32% of children being cavity-free at three years, as opposed to 8% at study-onset (n=58), with more children having a primary dental health practitioner and/or receiving preventive care Mental health: school-based mental health service led to a decrease in peer problems and hyperactivity within the intervention group, but number of problems were still higher compared to the control group Immunization: study involving 23 organizations targeting those < 5 years of age saw an overall increase in immunization rates of 46% to 80.5%
  • 26. Downstream Interventions,cont. Case coordination & case management, with community-based health education and physical activity for youths and seniors showed 45% of participants established a primary care provider, with 40% fewer ER visits (p < .05), and decreased patients with poor diabetic control from 78% to 48% (p < .05). School readiness checks in a rural, economically- disadvantaged community (e.g. oral and vision screening, behavioural assessment) from trained healthcare professionals maintained a 50% referral rate over 10 months School-based asthma education intervention showed no impact on urgent health services or school attendance in low- income ethnic minority families.
  • 27. Implications: Practice & policyDownstream Interventions implement interventions that improve access to education and preventive/restorative dental care through school- or community-based screening and/or referrals for oral health and access to care consider that individual studies demonstrate downstream interventions improve some aspects of mental health of refugee children, immunization coverage, chronic disease management, and school readiness No evidence to support school-based asthma education for low-income, ethnic minority families at this time
  • 28. General ImplicationsPublic health SHOULD promote / support / implement: Intervening in early childhood Upstream interventions to improve housing and employment conditions Midstream interventions to improve employment/ working conditions, child literacy, dental health, housing, and organizational change Downstream interventions to increase access to oral health services, immunization rates, appropriate use of primary health care services, and referrals from school readiness checks
  • 29. Questions?Contact us: Sume Ndumbe-Eyoh seyoh@stfx.ca
  • 30. Online Conversation Please continue to discuss this topic on Health Equity Clicks: Communityhttp://nccdh.ca/community/post/webin ar-intersectoral-action-for-health- equityLogin with your Health Equity Clicks: Community username and password or register if you aren’t a member yet.
  • 31. EvaluationPlease check your email and complete the evaluation survey for this webinarIf you did not receive an email with a link to the survey, please e-mail Jennifer McGugan: mcgugj@mcmaster.ca Thank you for your participation!