Health in All Policies Approaches to Tobacco Prevention and Control

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"Health in All Policies Approaches to Tobacco Prevention and Control" at the Leading the South to Healthier Communities: Deep South Tobacco Prevention & Control Policy Institute, Aug 3-5, 2011, New Orleans, LA.

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Health in All Policies Approaches to Tobacco Prevention and Control

  1. 1. Health in All Policies Approaches to Tobacco Prevention and ControlHolly Avey, PhD, MPHDeep South Tobacco Prevention and Control Policy InstituteNew Orleans, LAAugust 3, 2011
  2. 2. Health in All Policies Approaches to Tobacco Prevention and Control• What is Health in All Policies (HiAP)?• HiAP and Social Determinants of Health Equity• HiAP Trends• HiAP Funding Opportunities• How to Make it Work
  3. 3. WHAT IS HEALTH IN ALL POLICIES?
  4. 4. Programs vs Policies• Historical focus on programs – smoker quit lines, smoking cessation educational programs• Policies can support programs – Workplace smoking ban supports workplace smoking cessation programs• Programs can drive support for policies
  5. 5. What is Health in All Policies? (HiAP)• A strategy that strengthens the link between health and other policies, creating a supportive environment that enables people to lead healthy lives
  6. 6. Health in All Policies• Considers the intentional or unintentional impact of all policies on individual or population health – Education – Housing – Transportation – Economic – Etc.
  7. 7. Health in All Policies in Context
  8. 8. Health in All PoliciesAN APPROACH WITH HIGH IMPACTAND LEVERAGE
  9. 9. The Iceberg: A Metaphor for the Level at Which We Interact With a SystemHeart disease,stroke, cancerTobacco useEnvironmentalfactors that supporttobacco useIndividual rights vspopulation health
  10. 10. Health Impact PyramidFrieden, T. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health,2010, 100(4): 590-595.
  11. 11. Health in All PoliciesAPPROACHES TO TOBACCOPREVENTION AND CONTROL
  12. 12. Working at All Levels of the Pyramid Education & counseling for smoking behaviorCessationmedications Hard-hittingTobacco ad campaignstaxes, smoke-freeworkplaces,elimination of Interventionsadvertising to increase education & economic status Frieden, T. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health, 2010, 100(4): 590-595.
  13. 13. HiAP Approaches to Tobacco Prevention and Control• Economic sector – Taxes• Labor/workplace sector – Bans in workplaces• Market sector – Limits and bans on advertising• Educational sector – Bans in educational settings• Municipal government sector – Bans in public spaces
  14. 14. Health in All PoliciesAND THE SOCIAL DETERMINANTS OFHEALTH EQUITY
  15. 15. Social Determinants of HealthThe conditions in which peopleare born, grow, live, work and age,including the health system.These circumstances are shaped bythe distribution of money, power and resourcesat global, national and local levels,which are themselves influencedby policy choices. Source: World Health Organization, 2008
  16. 16. WHAT ARE THE SOCIAL DETERMINANTSOF SMOKING?
  17. 17. Social, economic, and psychological determinants of smoking: – low education – depression – low income – low religious devotion – working class job – low religious – young age institutional – low self-esteem conservatism – low optimism – divorce – low hopeBarbou et al, 2004, Carvajal et al, 2000, Kendler et al, 1999, Simons-Morton, 2002
  18. 18. THE SOCIAL DETERMINANTS OFSMOKING AND STRUCTURAL STRESS
  19. 19. From Policy-Driven Inequity to Disparities
  20. 20. Structural Sources of Stress: Social Closure• When social and economic opportunities are restricted for certain groups• Includes restriction of access to: – Employment – Transportation – Housing – Healthcare – Education – Legal representation
  21. 21. Structural Sources of Stress: Relative Deprivation• When certain groups perceive they are deprived of resources compared to others• Includes: – Corporate welfare – Media and consumerism – Wealth gap – Property taxes
  22. 22. Social, economic, and psychological determinants of smoking: – low education – depression – low income – low religious devotion – working class job – low religious – young age institutional – low self-esteem conservatism – low optimism – divorce – low hopeBarbou et al, 2004, Carvajal et al, 2000, Kendler et al, 1999, Simons-Morton, 2002
  23. 23. Social DeterminantsAPPROACH TO DISEASE PREVENTION
  24. 24. JEWEL Project• HIV prevention intervention targeting illicit drug- using women who were involved in prostitution – HIV prevention risk reduction – making, marketing and selling of jewelry – income from the jewelry sale was associated with reduction in number of sex trade partners at follow- up(Sherman et al, 2006)
  25. 25. Microenterprise• Microenterprise interventions include: – basic life-skills training, development of commercially viable products and services, access to markets, financial training, and financial support or microfinance of some type (e.g., credit, emergency loans, tax assistance)• (Stratford et al, 2008)
  26. 26. Theories on Why Microenterprise Programs Work• Income: improves standard of living• Diversification: diversifies income streams• Compensating differential: provides non- monetary value, such as an improved outlook on life as a result of savings or ability to pay bills• Social network: develops social capital and access to resources, which further strengthens economic activity
  27. 27. Theoretical Basis for a Social Determinants Approach to Tobacco Control and Prevention• Newton & Bower (2005), Watt (2007): causal pathways to oral health status include psychological stress, sense of coherence, social status, and environmental factors• Stress is impacted by social closure and relative deprivation• Successful interventions that address social determinants incorporate life skills training that improves personal empowerment (compensating differential theory)
  28. 28. Health in All PoliciesTRENDS
  29. 29. Health in All Policies Trends• Well established in Europe, Australia• Recent establishment of National Prevention Council – National Prevention Strategy• Recent report by the Institute of Medicine• HIA as a tool for HiAP• HUD memo on Non-smoking policies in public housing
  30. 30. National Prevention, HealthPromotion, and Public Health Council• Created through health reform legislation• Members from 17 federal agencies• Chaired by the Surgeon General• Coordinates and leads federal efforts on prevention, wellness, and health promotion
  31. 31. Source: For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges; Report Release Slideshttp://www.iom.edu/~/media/Files/Report%20Files/2011/For-the-Publics-Health-Revitalizing-Law-and-Policy-to-Meet-New- Challenges/Report%20Release%20Slides.pdf
  32. 32. Source: For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges; Report Release Slideshttp://www.iom.edu/~/media/Files/Report%20Files/2011/For-the-Publics-Health-Revitalizing-Law-and-Policy-to-Meet-New- Challenges/Report%20Release%20Slides.pdf
  33. 33. Source: For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges; Report Release Slideshttp://www.iom.edu/~/media/Files/Report%20Files/2011/For-the-Publics-Health-Revitalizing-Law-and-Policy-to-Meet-New- Challenges/Report%20Release%20Slides.pdf
  34. 34. Source: http://www.apha.org/NR/rdonlyres/171AF5CD-070B-4F7C-A0CD-0CA3A3FB93DC/0/HIABenefitHlth.pdf
  35. 35. Source: http://www.hud.gov/offices/pih/publications/notices/09/pih2009-21.pdf
  36. 36. Health in All PoliciesFUNDING OPPORTUNITIES
  37. 37. Health in All Policies Funding Opportunities• HIA Funding Opportunities (CDC, Pew)• Communities Putting Prevention to Work (CDC)• Community Transformation Grants (CDC)• Other sectors (HUD – Sustainable Communities)
  38. 38. Health in All PoliciesHOW TO MAKE IT WORK
  39. 39. Health in All Policies Can Occur at Different Levels• Information-sharing• Collaboration• Integration
  40. 40. Facilitators of Health in All Policies• Leadership• Internal incentives• External pressure• Funding• “Win‐win framing” of the issues
  41. 41. Win-Win Opportunities• Health in All Policies works best when it is framed as a win-win opportunity for all involved sectors• Offers of resources such as workforce, prestige, or access to additional funding sources can foster new partnerships engaged in promoting health
  42. 42. Working at All Levels of the Pyramid Education & counseling for smoking behaviorCessationmedications Hard-hittingTobacco ad campaignstaxes, smoke-freeworkplaces,elimination of Interventionsadvertising to increase education & economic status Frieden, T. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health, 2010, 100(4): 590-595.
  43. 43. ReferencesAmerican Public Health Association. http://www.apha.org/NR/rdonlyres/171AF5CD- 070B-4F7C-A0CD-0CA3A3FB93DC/0/HIABenefitHlth.pdfAvey, H. Racial and Socioeconomic Health Disparities: Policy-Driven Inequities and Chronic Stress. Oral presentation. Academy Health Annual Research Meeting, Chicago, IL, June, 2009.Barbeau, EM, Krieger, N, and Soobader, M-J. Working Class Matters: Socioeconomic Disadvantage, Race/Ethnicity, Gender, and Smoking in NHIS 2000. American Journal of Public Health, 2004, 94(2): 269-278.Carvajal, SC, Wiatrek, DE, Evans, RI, Knee, CR, and Nash, SG. Psychosocial Determinants of the Onset and Escalation of Smoking: Cross-sectional and Prospective Findings in Multiethnic Middle School Samples. Journal of Adolescent Health, 2000;27:255–265.Frieden, T. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health, 2010, 100(4): 590-595.Institue of Medicine of the National Academies. For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges; Report Release Slides. http://www.iom.edu/~/media/Files/Report%20Files/2011/For-the-Publics-Health- Revitalizing-Law-and-Policy-to-Meet-New- Challenges/Report%20Release%20Slides.pdfIton A. Transforming public health practice to achieve health equity. Paper presented at: HealthEquity Summitt, 2009; Cambpell, CA.Kendler, KS, Neale, MC, Sullivan, P, Corey, LA, Gardner, CO and Prescott, CA. A population-based twin study in women of smoking initiation and nicotine dependence. Psychological Medicine, 1999, 29: 299-308.
  44. 44. ReferencesNational Prevention Council. http://www.healthcare.gov/center/councils/nphpphc/about/index.html#memNational Prevention Strategy http://www.healthcare.gov/center/councils/nphpphc/about/index.html#memNewton JT, Bower EJ. The social determinants of health: new approaches to conceptualizing and researching complex causal networks. Community Dent Oral Epidemiol 2005; 33: 25–34.Sherman, SG, German, D, Cheng, Y, Marks, M & Bailey-Kloche, M. The evaluation of the JEWEL project: An innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution AIDS Care, 2006; 18(1): 1-11.Simons-Morton, BG. Prospective Analysis of Peer and Parent Influences on Smoking Initiation Among Early Adolescents. Prevention Science, 2002, 3(4): 275-283.Stratford, D, Mizuno, Y, Williams, K, Courtenay-Quirk, C, and O’Leary, A. Addressing Poverty as Risk for Disease: Recommendations from CDC’s Consultation on Microenterprise as HIV Prevention. Public Health Reports, 2008 , 123:9-20.Turrell, G, Battistutta, D, and McGuffog, I. Social determinants of smoking among parents with infants. Australian and New Zealand Journal of Public Health, 2002, 26(1):30-37.US Department of Housing and Urban Development Source: http://www.hud.gov/offices/pih/publications/notices/09/pih2009-21.pdfWatt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol 2007; 35: 1–11.
  45. 45. Holly Avey, PhD, MPH Associate Project DirectorGeorgia Health Policy Center Georgia State University havey@gsu.edu 404-413-0291 www.gsu.edu/ghpc

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