Georgia Grantmakers Alliance 2011


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Karen Minyard, GHPC Director, presented "Social Determinants of Health Equity and Levels of Potential Impact in the System: Opportunities for Leverage" at the Georgia Grantmakers Alliance in Macon, GA on August 25, 2011.

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  • 38th in Premature Death41st in Infant Mortality40thin Cardiovascular Deaths47thin Infectious Disease28th in Obesity Prevalence37thin Per Capita Public Health Spending45th in On-Time High School Graduation
  • Georgia Grantmakers Alliance 2011

    1. 1. Social Determinants of Health Equity and Levels of Potential Impact in the System: Opportunities for Leverage<br />Karen J. Minyard, Ph.D.Executive Director<br />Georgia Health Policy Center<br />Georgia State University <br />
    2. 2. Georgia Health Policy CenterA Research Center at Georgia State University <br /><ul><li>Provides evidence-based research, program development, and policy guidance locally, statewide, and nationally
    3. 3. Focuses on solutions to the most complex issues facing health </li></ul> care today including: insurance coverage, children’s health, health care reform, and the development of urban and rural health systems<br /><ul><li>Works in more than 200 communities across the U.S.</li></li></ul><li>Health<br />
    4. 4. How Healthy Are Georgians?<br />Health Status by County <br />
    5. 5. 5<br />Georgia’s Health Ranking Among States: 2010<br />
    6. 6. Factors Influencing Health Status<br />Schroeder, Steven A., We Can Do Better -- Improving the Health of the American People, N Engl J Med 2007 357: 1221-1228<br />
    7. 7. Social Determinants of Health Equity <br />
    8. 8. Health Disparities<br />The unequal burden in disease morbidity and mortality rates experienced by ethnic/racial groups as compared to the dominant group.<br />Source: Healthy People 2010, US HHS, 2000<br />
    9. 9. Social Determinants of Health<br />The conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.<br />Source: World Health Organization, 2008<br />
    10. 10. Community-Level Determinants of Health Equity<br />Source: Grantmakers in Health, 2009; Institute of Medicine, 2008; PolicyLink, 2002; Prevention Institute, 2003<br />
    11. 11. Health Equity Best Practices<br />CDC’s The Community Guide:<br /><ul><li>Community Preventive Services Task Force
    12. 12. Identified 200 community-based interventions in six areas
    13. 13. Reviews in three areas complete
    14. 14. Early childhood development = effective
    15. 15. Affordable and safe housing = effective
    16. 16. Access to culturally competent healthcare systems = insufficient evidence</li></ul>Evidence-based interventions:<br /><ul><li>Housing Mobility Policies
    17. 17. Early Childhood Development</li></ul>Source: Anderson et al., 2003; CDC, 2009; Williams et al., 2008<br />
    18. 18. National Examples of Early Childhood Development Best Practices<br />Nurse-Family Partnership <br /><ul><li>Nurse home visit program for low-income, first-time parents
    19. 19. Significant outcomes:
    20. 20. Reduced risks for antisocial behaviors for children
    21. 21. Reduced childhood injury
    22. 22. Reduced child abuse, maternal crime & substance abuse
    23. 23. Improved prenatal outcomes
    24. 24. Increased school readiness for children
    25. 25. Increased maternal employment & father involvement
    26. 26. ROI=$5 for every $1 spent</li></ul>Source:<br />
    27. 27. National Examples of Early Childhood Development Best Practices<br />Harlem Children’s Zone <br /><ul><li>97 block-area in Central Harlem, New York
    28. 28. Promise Academy Charter schools & 22 birth-to-college community programs
    29. 29. Baby College, The Three Year Old Journey, Get Ready for Pre-K, Harlem Gems
    30. 30. Significant outcomes:
    31. 31. 100% of Harlem Gems school ready for 6 consecutive years
    32. 32. 97-100% of 3rd graders at-level in math & English language arts
    33. 33. 97% of 8th graders at-level in math
    34. 34. vs 7% avg for Black 8th graders
    35. 35. Closing Black-White achievement gap</li></ul>Source: Dobbie & Fryer, 2009<br />
    36. 36. A Lesson in North Karelia<br />In the 1970’s, North Karelia, Finland was plagued by exceedingly high deaths from cardiovascular disease<br />“It was a question of general lifestyle of the community - not just some people with high risk factors. The whole environment had to change - the food industry, restaurants, cafeterias, supermarkets.”<br />- PekkaPuska, Project Director <br />
    37. 37. A Lesson in North Karelia<br /> What they did:<br />Towns were pitted against each other in cholesterol-lowering competitions. <br />Food-labeling laws were changed <br />The national school-lunch program got a major overhaul <br />They convinced bread companies to use less salt and replace butter with vegetable oil <br />They made sure walking paths were clear <br />They passed laws to provide facilities for their citizens to get exercise <br /> Results:<br />The smoking rate dropped from 52% to 31%<br />Coronary heart disease mortality fell by 73%<br />Lung cancer mortality dropped by 71% <br />All-cancers mortality dropped by 49%<br />Overall mortality declined 45%<br />6 to 7 extra years of life expectancy were added<br />
    38. 38. Levels of Impact<br />
    39. 39. Sustainability Institute, adapted from other versions from the organizational learning field<br />
    40. 40. Philanthropic Collaborative for a Healthy Georgia <br />Individual Providers<br />Incentives for Collaboration<br />Change the System/Policy/Environment<br />
    41. 41. Opportunities for Leverage<br />
    42. 42. Strategic AlignmentTriple-Layer Chess<br />National <br />State<br />Local<br />
    43. 43. Visit <br />or follow us on Facebook for more information and resources. <br />