Healthy IslandsJanuary 1, 2011
OUTLINE•   Healthy Islands: Mission & Goals•   Ecological Framework•   Food System Model•   Interaction Framework     Ava...
HEALTHY ISLANDS: MISSION & GOALS• Mission: Healthy Islands will improve the health and quality of life of  the populations...
ECOLOGICAL FRAMEWORK• The NCD Plan will translate into a portfolio of interventional projects• Projects will be targeted t...
ECOLOGICAL FRAMEWORK
INDIVIDUALS
SOCIAL NETWORKS & GROUPS
COMMUNITY SYSTEMS
COMMUNITY TIERS & SYSTEMS
ECOLOGICAL FRAMEWORK
FOOD SYSTEM : EXCHANGE MODEL• The food system can be represented using a set of models that describe  actors, their roles ...
FOOD SYSTEM : TIERS• The food system can be represented as a series of tiers comprised of  interconnected markets
FOOD SYSTEM : VALUE CHAIN
FOOD SYSTEM : ACTOR ROLES• The (simplified) food system model consists of a series of  interconnected markets• Actors may ...
FOOD SYSTEM : ACTORS
FOOD SYSTEM STRATEGY
FOOD SYSTEM STRATEGY
AGRICULTURAL MARKET
AGRICULTURAL MARKET
AGRICULTURAL MARKET
AGRICULTURAL MARKET
FOOD SYSTEM EXAMPLES• Farmer’s markets and farm stands represent two  highly simplified food systems; the farmer and  cons...
AGRICULTURAL MARKET
FOOD SYSTEM EXAMPLES• Another simple food system has roles for farmers and  consumers, with an intervening set of distribu...
FOOD SYSTEM EXAMPLES• Various arrangements may exist between food sellers  such as grocery stores and supermarket chains a...
AGRICULTURAL MARKET
FOOD SYSTEM EXAMPLES• Schools and restaurants are two types of food  service establishments
AGRICULTURAL MARKET
AGRICULTURAL MARKET
FOOD SYSTEM : INTERMEDIARIES• The food system may include additional  intermediaries that handle distribution, warehousing...
FOOD SYSTEM: LOCAL VS EXTERNALMARKETS• The food system may include agricultural producers  or food makers from within the ...
FOOD PRODUCTION MARKET
FOOD PRODUCTION
FOOD SYSTEM: SUPPLY CHAIN• The food system generally includes complex supply  chain arrangements between food companies an...
FOOD PRODUCTION
HOME PREPARATION
FOOD SERVICES MARKET
FOOD SYSTEM : ACTORS
FOOD SYSTEM: CONCEPTUAL TO PHYSICALMARKETS• The conceptual food system with the community can be mapped to a  physical mar...
FOOD SYSTEM: COMMUNITY SETTINGS40
INTERACTION: COMMUNITY SETTINGS• The community setting plays a key role in shaping the lived experience  of community memb...
INTERACTION FRAMEWORK : SUMMARY• The interaction framework applies to the dynamic interactions between  the community memb...
INTERACTION FRAMEWORK• Interactions between actors and resources involve several dimensions• Individual dimensions relate ...
ACCESSIBILITY• Accessibility plays a key role in community member activities where  interaction involves distance between ...
ACCESS: CLIMATE AND GEOGRAPHY• The climate and geography of the region may influence the interactions  between the actor a...
ACCESS: TRANSPORTATION NETWORK &MODALITIES• Transportation networks and the transportation options available to the  actor...
RESOURCE AVAILABILITY AND ALTERNATIVES• Resource availability is independent from accessability• Availability relates to w...
AVAILABILITY: SELECTION FACTORS• Multiple selection factors influence the actor’s choice of location and  selection of res...
AVAILABILITY: OTHER DIMENSIONS• More complex aspects of resource availability include the proximity of a  given resource a...
INTERACTION: PROXIMITY AND TIMING• The ecological framework is focused on understanding the lived  experience of community...
INTERACTION: PROXIMITY AND TIMING• Proximity and timing dynamically shape the interaction between actors  and resources
INTERACTION: INDIVIDUAL DIMENSIONS• Individual dimensions influence the interaction between actors and  resources
SOCIAL COMMUNICATION STRATEGY:SUMMARY• Health promotion activities should leverage social networks      Social networks p...
SOCIAL NETWORK AND GROUP TYPES• Types of social groups/networks available      Family: immediate/nuclear, extended kinshi...
SOCIAL GROUP INTERFACES• The divisions of roles within a social network/group enables efficient  dissemination of health p...
KINSHIP NETWORKS• Kinship Networks      Kinship covers relationships between community members based on descent       (‘c...
EXTENDED FAMILY NETWORKS• Extended Family      Networks extending beyond the community member’s immediate family may     ...
EXTENDED SOCIAL NETWORKS• Extended Social Networks      Community members may participate in a wide-ranging set of inform...
ORGANIZED COMMUNITY GROUPS• Organized Community Groups      Community members may participate in organized groups with va...
WORK GROUPS• Work groups      Community members may participate in the formal or informal economies       through members...
METHODOLOGY: PROBLEM ANALYSIS61
CAUSAL WEB: MACRO-ECONOMIC SYSTEM
CAUSAL WEB: FOOD MARKETS
CAUSAL WEB: BUSINESS PERFORMANCE
CAUSAL WEB: WORKFORCE HEALTH
STRATEGIC DRIVERS, GOALS ANDOBJECTIVES66
TACTICAL, OPERATIONAL AND EXECUTIONPLANS67
PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
MONITORING AND INTERVENTION : GROUPS
MONITORING AND INTERVENTION : SYSTEMS
MONITORING AND INTERVENTION :ENVIRONMENT
MONITORING AND INTERVENTION :ENVIRONMENT
MONITORING AND INTERVENTION :INTEGRATED
INTERVENTIONAL STRATEGY• Based on the MAPPS Framework        Media        Access        Point of Decision Information  ...
MAPPS FRAMEWORK• Focused on chronic diseases (non-communicable diseases)        Target conditions: obesity, diabetes and ...
STRATEGIES AND INTERVENTIONS• High-Level Strategies      Strengthen healthcare infrastructure      Reduce costs through ...
MAPPS: MEDIAInterventions : Media               Nutrition                       Physical Activity Media and advertising r...
MAPPS: ACCESSInterventions : Access               Nutrition                        Physical Activity Promote healthy food...
MAPPS: POINT OF PURCHASE/PROMOTIONInterventions : Point of Purchase/Promotion               Nutrition                     ...
MAPPS: PRICEInterventions : Price               Nutrition                        Physical Activity Changing relative pric...
MAPPS: SOCIAL SUPPORT AND SERVICESSocial Support & Services               Nutrition                     Physical Activity...
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Healthy Islands 01 01 11

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Healthy Islands 01 01 11

  1. 1. Healthy IslandsJanuary 1, 2011
  2. 2. OUTLINE• Healthy Islands: Mission & Goals• Ecological Framework• Food System Model• Interaction Framework  Availability  Accessibility  Interaction• Social Communication Strategy• Monitoring & Interventional Framework• MAPPS Framework2
  3. 3. HEALTHY ISLANDS: MISSION & GOALS• Mission: Healthy Islands will improve the health and quality of life of the populations of island communities• Goals  Address the crisis of non-communicable diseases  Ensure the community has access to a healthy food supply  Ensure community members live in a health-promoting environment  Develop the capacity of the health workforce  Improve the health literacy of the population  Empower community members to make healthy decisions  Provide the community with a financially sustainable health system  Institutionalize the program with an organization and governance model capable of ensuring long-term viability3
  4. 4. ECOLOGICAL FRAMEWORK• The NCD Plan will translate into a portfolio of interventional projects• Projects will be targeted to specific areas of the ecological framework4
  5. 5. ECOLOGICAL FRAMEWORK
  6. 6. INDIVIDUALS
  7. 7. SOCIAL NETWORKS & GROUPS
  8. 8. COMMUNITY SYSTEMS
  9. 9. COMMUNITY TIERS & SYSTEMS
  10. 10. ECOLOGICAL FRAMEWORK
  11. 11. FOOD SYSTEM : EXCHANGE MODEL• The food system can be represented using a set of models that describe actors, their roles and their various kinds of interactions
  12. 12. FOOD SYSTEM : TIERS• The food system can be represented as a series of tiers comprised of interconnected markets
  13. 13. FOOD SYSTEM : VALUE CHAIN
  14. 14. FOOD SYSTEM : ACTOR ROLES• The (simplified) food system model consists of a series of interconnected markets• Actors may play multiple roles within the various markets• Farm producers provide raw materials to Food Makers• Food Makers produce food for Food Sellers• Food Sellers sell food to Food Consumers
  15. 15. FOOD SYSTEM : ACTORS
  16. 16. FOOD SYSTEM STRATEGY
  17. 17. FOOD SYSTEM STRATEGY
  18. 18. AGRICULTURAL MARKET
  19. 19. AGRICULTURAL MARKET
  20. 20. AGRICULTURAL MARKET
  21. 21. AGRICULTURAL MARKET
  22. 22. FOOD SYSTEM EXAMPLES• Farmer’s markets and farm stands represent two highly simplified food systems; the farmer and consumer transact directly with each other• With a farmer’s market, the farmer handles transportation to the marketplace• With a farm stand, the consumer purchases food at the farm site
  23. 23. AGRICULTURAL MARKET
  24. 24. FOOD SYSTEM EXAMPLES• Another simple food system has roles for farmers and consumers, with an intervening set of distributors for transportation; there is no intervening food manufacturer• Fresh produce does not involve manufacturing or processing of foods
  25. 25. FOOD SYSTEM EXAMPLES• Various arrangements may exist between food sellers such as grocery stores and supermarket chains and farmers
  26. 26. AGRICULTURAL MARKET
  27. 27. FOOD SYSTEM EXAMPLES• Schools and restaurants are two types of food service establishments
  28. 28. AGRICULTURAL MARKET
  29. 29. AGRICULTURAL MARKET
  30. 30. FOOD SYSTEM : INTERMEDIARIES• The food system may include additional intermediaries that handle distribution, warehousing and transportation functions• Food wholesalers are sometimes present
  31. 31. FOOD SYSTEM: LOCAL VS EXTERNALMARKETS• The food system may include agricultural producers or food makers from within the local region or located externally
  32. 32. FOOD PRODUCTION MARKET
  33. 33. FOOD PRODUCTION
  34. 34. FOOD SYSTEM: SUPPLY CHAIN• The food system generally includes complex supply chain arrangements between food companies and the manufacturers of various food production inputs
  35. 35. FOOD PRODUCTION
  36. 36. HOME PREPARATION
  37. 37. FOOD SERVICES MARKET
  38. 38. FOOD SYSTEM : ACTORS
  39. 39. FOOD SYSTEM: CONCEPTUAL TO PHYSICALMARKETS• The conceptual food system with the community can be mapped to a physical marketplace with consumers and providers are defined locations• Spatial interaction becomes an important factor in the physical market• Actors have to negotiate distance in order to transact within the marketplace39
  40. 40. FOOD SYSTEM: COMMUNITY SETTINGS40
  41. 41. INTERACTION: COMMUNITY SETTINGS• The community setting plays a key role in shaping the lived experience of community members• Each community member occupies and transitions between various settings during the course of any given day• Settings offer health promotion opportunities in terms of nutrition and physical activity Settings •Homes (own home, others’ homes) •Work sites •Schools, after-school settings •Child care settings •Health and social welfare settings •Other community-based settings (e.g. community centers, churches) •Recreational sites •Retail settings •Restaurants, fast-food venues •Food stores
  42. 42. INTERACTION FRAMEWORK : SUMMARY• The interaction framework applies to the dynamic interactions between the community member and various resources within the community.• The resource may be another community member or a physical resource such as food to be consumed• The framework provides a model for understanding the various ecological factors that influence the ability of community members to engage in various activity• A key concern is understanding how ecological factors influence interactions between geographically separated actors and resources
  43. 43. INTERACTION FRAMEWORK• Interactions between actors and resources involve several dimensions• Individual dimensions relate the aspects of the actor participating in the interaction• Other interaction dimensions involve aspects of the external environment, which mediate between the actor and the resource
  44. 44. ACCESSIBILITY• Accessibility plays a key role in community member activities where interaction involves distance between the actor and the resource
  45. 45. ACCESS: CLIMATE AND GEOGRAPHY• The climate and geography of the region may influence the interactions between the actor and resource
  46. 46. ACCESS: TRANSPORTATION NETWORK &MODALITIES• Transportation networks and the transportation options available to the actor directly shape the accessibility of a given resource
  47. 47. RESOURCE AVAILABILITY AND ALTERNATIVES• Resource availability is independent from accessability• Availability relates to whether the desired resource is present at a given location, as well as what alternative options are available
  48. 48. AVAILABILITY: SELECTION FACTORS• Multiple selection factors influence the actor’s choice of location and selection of resource from available alternatives
  49. 49. AVAILABILITY: OTHER DIMENSIONS• More complex aspects of resource availability include the proximity of a given resource at a given location to other desired resources or locations
  50. 50. INTERACTION: PROXIMITY AND TIMING• The ecological framework is focused on understanding the lived experience of community members in terms of how their time is spent engaged in their daily activities and interacting with the various community settings.• The community member’s day can be viewed in terms of the physical settings they occupy as well as the activities they engage in
  51. 51. INTERACTION: PROXIMITY AND TIMING• Proximity and timing dynamically shape the interaction between actors and resources
  52. 52. INTERACTION: INDIVIDUAL DIMENSIONS• Individual dimensions influence the interaction between actors and resources
  53. 53. SOCIAL COMMUNICATION STRATEGY:SUMMARY• Health promotion activities should leverage social networks  Social networks provide a set of trusted relationships and communications channels that can enable rapid dissemination of health promotion information  The social communication strategy should leverage the multiple, overlapping networks and social groups that each community member belongs to  Using multiple social communication channels raises the likelihood of reaching every community member  Relying on multiple social communication channels provides an opportunity to mutually reinforce health promotion information from independent sources  Multiple social communication channel reduce the likelihood of community members receiving inaccurate or incomplete health promotion information  The social communication strategy supports an efficient train-the-trainer approach to disseminating health promotion information  A successful social networking strategy will require strong commitment to health promotion from the trusted leadership of the various social groups53
  54. 54. SOCIAL NETWORK AND GROUP TYPES• Types of social groups/networks available  Family: immediate/nuclear, extended kinship networks  Extended social networks: friends and acquaintances  Work groups  Community groups • Youth groups • After-school activity groups • Sports teams • Volunteer groups • Church groups • Other neighborhood or village groups54
  55. 55. SOCIAL GROUP INTERFACES• The divisions of roles within a social network/group enables efficient dissemination of health promotion information  Groups may have multiple interfaces based on member roles  Group interfaces serve as a coordination point for dissemination of health promotion information  Health promotion Information may be tailored to specific group member roles  Group members playing a communications coordination role may further tailor or customize the health promotion information55
  56. 56. KINSHIP NETWORKS• Kinship Networks  Kinship covers relationships between community members based on descent (‘consanguinity’) and marriage (‘affinity’)  Descent networks are based on genetic relationships (immediate/nuclear and extended families)  Affinity networks describe abstract social patterns of relationships that are not based on genetics  Different cultures have differing kinship systems and terminology •Individuals are genetic offspring of a single union. •Individuals may form various types of unions – with various degrees of formal significance in terms of legal or religious recognition. •An individual may form multiple unions, giving rise to multiple sets of offspring. •An individual may form a union with someone with offspring from an earlier union.56
  57. 57. EXTENDED FAMILY NETWORKS• Extended Family  Networks extending beyond the community member’s immediate family may be wide-ranging and complex57
  58. 58. EXTENDED SOCIAL NETWORKS• Extended Social Networks  Community members may participate in a wide-ranging set of informal relationships with others in the community58
  59. 59. ORGANIZED COMMUNITY GROUPS• Organized Community Groups  Community members may participate in organized groups with varying types and degrees of formal group organization, membership structures and roles, and forms of participation59
  60. 60. WORK GROUPS• Work groups  Community members may participate in the formal or informal economies through membership in various work groups  Work groups and subgroups have various types and degrees of formal group organization, membership structures and roles, and forms of participation60
  61. 61. METHODOLOGY: PROBLEM ANALYSIS61
  62. 62. CAUSAL WEB: MACRO-ECONOMIC SYSTEM
  63. 63. CAUSAL WEB: FOOD MARKETS
  64. 64. CAUSAL WEB: BUSINESS PERFORMANCE
  65. 65. CAUSAL WEB: WORKFORCE HEALTH
  66. 66. STRATEGIC DRIVERS, GOALS ANDOBJECTIVES66
  67. 67. TACTICAL, OPERATIONAL AND EXECUTIONPLANS67
  68. 68. PATIENT CARE EXAMPLE
  69. 69. PATIENT CARE EXAMPLE
  70. 70. PATIENT CARE EXAMPLE
  71. 71. PATIENT CARE EXAMPLE
  72. 72. PATIENT CARE EXAMPLE
  73. 73. MONITORING AND INTERVENTION : GROUPS
  74. 74. MONITORING AND INTERVENTION : SYSTEMS
  75. 75. MONITORING AND INTERVENTION :ENVIRONMENT
  76. 76. MONITORING AND INTERVENTION :ENVIRONMENT
  77. 77. MONITORING AND INTERVENTION :INTEGRATED
  78. 78. INTERVENTIONAL STRATEGY• Based on the MAPPS Framework  Media  Access  Point of Decision Information  Price  Social Support Services• Communities Putting Prevention to Work (CPPW)  MAPPS is currently the framework for the CDC’s CPPW initiative• Best-Practices Framework  Evidence-based interventions drawn from the peer-reviewed literature and expert synthesis  Communities and states have found these interventions to be successful in practice78
  79. 79. MAPPS FRAMEWORK• Focused on chronic diseases (non-communicable diseases)  Target conditions: obesity, diabetes and cardiovascular disease  Responsible for 7 of 10 deaths  Vast majority of serious illness-related disability  Greatest contributor to healthcare expenditures (75%)• Addresses key risk factors  Lack of physical activity  Poor nutrition  Tobacco use (out of scope – addressed elsewhere)• Specific goals  Decrease overweight/obesity prevalence  Improve nutrition (e.g. increased fruit/vegetable consumption, reduced salt and trans-fat)  Increase levels of physical activity79
  80. 80. STRATEGIES AND INTERVENTIONS• High-Level Strategies  Strengthen healthcare infrastructure  Reduce costs through prevention  Advance public health across the lifespan  Reduce health disparities  Reduce risk factors  Prevent and/or delay onset of chronic disease  Promote wellness• Intervention Approach  Policy, systems and environmental change  Communities and schools  Positive behavior change related to nutrition and physical activity80
  81. 81. MAPPS: MEDIAInterventions : Media Nutrition Physical Activity Media and advertising restrictions  Promote increased activity consistent with federal law  Promote use of public transit Promote healthy food/drink choices  Promote active transportation Counter-advertising for unhealthy (bicycling and walking) choices  Counter-advertising for screen time81
  82. 82. MAPPS: ACCESSInterventions : Access Nutrition Physical Activity Promote healthy food/drink choices  Safe, attractive accessible places Healthy food/drink availability for activity Limit unhealthy food/drink  City planning, zoning and availability transportation Reduce density of fast food  Require daily quality PE in schools establishments  Require daily physical activity in Eliminate trans-fat through afterschool/childcare settings purchasing actions, labeling  Restrict screen time (afterschool, initiatives, restaurant standards daycare) Reduce sodium through purchasing actions, labeling initiatives, restaurant standards Procurement policies and practices Farm to institution, including schools, worksites, hospitals and82 other community institutions
  83. 83. MAPPS: POINT OF PURCHASE/PROMOTIONInterventions : Point of Purchase/Promotion Nutrition Physical Activity Signage for healthy vs. less healthy  Signage for neighborhood items destinations in walkable / mixed- Product placement & attractiveness use areas Menu labeling  Signage for public transportation, bike lanes/boulevards.83
  84. 84. MAPPS: PRICEInterventions : Price Nutrition Physical Activity Changing relative prices of healthy  Reduced price for park/facility use vs. unhealthy items (e.g. through  Incentives for active transit bulk purchase / procurement /  Subsidized memberships to competitive pricing) recreational facilities84
  85. 85. MAPPS: SOCIAL SUPPORT AND SERVICESSocial Support & Services Nutrition Physical Activity Support breastfeeding through  Safe routes to school policy change and maternity care  Workplace, faith, park, practices neighborhood activity groups (e.g., walking hiking, biking)85

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