an environmental approach to community health jeremy ... · session 1 an environmental approach to...
TRANSCRIPT
SESSION 1SESSION 1
An Environmental An Environmental
Approach to Approach to
Community Community
HealthHealth
www.preventioninstitute.orgwww.preventioninstitute.org
Jeremy Cantor, MPHJeremy Cantor, MPH
Omar SahakOmar Sahak
The California EndowmentThe California EndowmentHealth ExChange Academy
Health Equity Training Series
Born in West Oakland, an African American person Born in West Oakland, an African American person can expect to die almost 15 years earlier than a can expect to die almost 15 years earlier than a
White person born in the Oakland Hills.White person born in the Oakland Hills.
SOURCE: Life and Death from Unnatural Causes – Health and Social Inequity in Alameda County. Alameda County Public Health Department. August 2008
�� Supports open dialogueSupports open dialogue
�� Promotes peer to peer learningPromotes peer to peer learning
�� Encourages reflection for growthEncourages reflection for growth
Our goal is to create a learning environment that:Our goal is to create a learning environment that:
Group AgreementGroup Agreement
�� Start and end on timeStart and end on time
�� Ask questionsAsk questions
�� Respect each otherRespect each other
�� Participate fullyParticipate fully
�� Network beyond who you knowNetwork beyond who you know
�� Turn off cell phones and PDATurn off cell phones and PDA’’ss
�� Have fun!Have fun!
Group AgreementGroup Agreement
What’s health got to do with it?
Photo Courtesy of Latino Health AccessPhoto Courtesy of Latino Health Access
Photo courtesy of http://spacedust.atspace.com/soccer_archery.html
Photo Courtesy of Latino Health AccessPhoto Courtesy of Latino Health Access
HEALTHHEALTHHEALTHHEALTHHEALTHHEALTHHEALTHHEALTH
BEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIORBEHAVIOR
ENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENTENVIRONMENT
Is it just behavior?Is it just behavior?
210 calories 210 calories
1.5 ounces1.5 ounces
The Food EnvironmentThe Food Environment
20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago TodayTodayTodayTodayTodayTodayTodayToday
Source:Source: Portion Distortion II Interactive Quiz, Portion Distortion II Interactive Quiz,
http://hp2010.nhlbihin.net/portion/portion2.cgi?action=http://hp2010.nhlbihin.net/portion/portion2.cgi?action=question&numberquestion&number=1=1
How many How many
calories are calories are
in todayin today’’s s
muffin?muffin?
210 calories 210 calories
1.5 ounces1.5 ounces
The Food EnvironmentThe Food Environment
20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago TodayTodayTodayTodayTodayTodayTodayToday
Source:Source: Portion Distortion II Interactive Quiz, Portion Distortion II Interactive Quiz,
http://hp2010.nhlbihin.net/portion/portion2.cgi?action=http://hp2010.nhlbihin.net/portion/portion2.cgi?action=question&numberquestion&number=1=1
500 calories 500 calories
4 ounces4 ouncesDifference:Difference:
290 calories290 calories
390 calories 390 calories
1.5 cups1.5 cups
The Food EnvironmentThe Food Environment
20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago TodayTodayTodayTodayTodayTodayTodayToday
Source:Source: Portion Distortion II Interactive Quiz, Portion Distortion II Interactive Quiz,
http://hp2010.nhlbihin.net/portion/portion2.cgi?action=http://hp2010.nhlbihin.net/portion/portion2.cgi?action=question&numberquestion&number=1=1
How many How many
calories are in calories are in
todaytoday’’s chicken s chicken
Caesar salad?Caesar salad?
390 calories 390 calories
1.5 cups1.5 cups
The Food EnvironmentThe Food Environment
20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago20 Years Ago TodayTodayTodayTodayTodayTodayTodayToday
Source:Source: Portion Distortion II Interactive Quiz, Portion Distortion II Interactive Quiz,
http://hp2010.nhlbihin.net/portion/portion2.cgi?action=http://hp2010.nhlbihin.net/portion/portion2.cgi?action=question&numberquestion&number=1=1
790 calories 790 calories
3.5 cups3.5 cupsDifference:Difference:
400 calories400 calories
It is unreasonable to expect It is unreasonable to expect It is unreasonable to expect It is unreasonable to expect It is unreasonable to expect It is unreasonable to expect It is unreasonable to expect It is unreasonable to expect
that people will change their that people will change their that people will change their that people will change their that people will change their that people will change their that people will change their that people will change their
behavior behavior behavior behavior behavior behavior behavior behavior easilyeasilyeasilyeasilyeasilyeasilyeasilyeasily when so many when so many when so many when so many when so many when so many when so many when so many
forces in the social, cultural, and forces in the social, cultural, and forces in the social, cultural, and forces in the social, cultural, and forces in the social, cultural, and forces in the social, cultural, and forces in the social, cultural, and forces in the social, cultural, and
physical environment physical environment physical environment physical environment physical environment physical environment physical environment physical environment
conspire against such change.conspire against such change.conspire against such change.conspire against such change.conspire against such change.conspire against such change.conspire against such change.conspire against such change.
““
””Institute of MedicineInstitute of Medicine
70%70%
10%10%
20%20%
4%4%
96%96%
$2.2 Trillion$2.2 Trillion
Current Health Care SpendingCurrent Health Care Spending
Factors Influencing
Health
National Health
Expenditures
SOURCE: SOURCE: Centers for Disease Control and Prevention, Blue Sky Initiative,Centers for Disease Control and Prevention, Blue Sky Initiative,
University of California at San Francisco, Institute of the FutuUniversity of California at San Francisco, Institute of the Future, 2000re, 2000
Behaviors & Behaviors &
EnvironmentEnvironment
70%70%
Health Care, 10%Health Care, 10%
GeneticsGenetics
20%20%
4%4%
96%96%
$2.2 Trillion$2.2 Trillion
Current Health Care SpendingCurrent Health Care Spending
Factors Influencing
Health
National Health
Expenditures
SOURCE: SOURCE: Centers for Disease Control and Prevention, Blue Sky Initiative,Centers for Disease Control and Prevention, Blue Sky Initiative,
University of California at San Francisco, Institute of the FutuUniversity of California at San Francisco, Institute of the Future, 2000re, 2000
Behaviors & Behaviors &
EnvironmentEnvironment
70%70%
Health Care, 10%Health Care, 10%
GeneticsGenetics
20%20%
Prevention, 4%Prevention, 4%
Medical ServicesMedical Services
96%96%
$2.2 Trillion$2.2 Trillion
Current Health Care SpendingCurrent Health Care Spending
Factors Influencing
Health
National Health
Expenditures
SOURCE: SOURCE: Centers for Disease Control and Prevention, Blue Sky Initiative,Centers for Disease Control and Prevention, Blue Sky Initiative,
University of California at San Francisco, Institute of the FutuUniversity of California at San Francisco, Institute of the Future, 2000re, 2000
Prevention for a Healthier AmericaPrevention for a Healthier America
http://http://www.preventioninstitute.orgwww.preventioninstitute.org/documents//documents/
PreventionforaHealthierAmerica_7_08.pdfPreventionforaHealthierAmerica_7_08.pdf
�� 5.6:1 ROI5.6:1 ROI
�� $16 billion savings $16 billion savings in 5 yearsin 5 years
Multiplier EffectMultiplier Effect
a systematic process that promotes healthy behaviors and a systematic process that promotes healthy behaviors and
environments and reduces the likelihood or frequency of environments and reduces the likelihood or frequency of
an incident, condition, or illness occurring.an incident, condition, or illness occurring.
taking action to prevent problems from occurring
before the onset of symptoms
MOVINGMOVING
UPSTREAMUPSTREAM““““““““We are still standing We are still standing We are still standing We are still standing We are still standing We are still standing We are still standing We are still standing
on the bank of the river, on the bank of the river, on the bank of the river, on the bank of the river, on the bank of the river, on the bank of the river, on the bank of the river, on the bank of the river,
rescuing people rescuing people rescuing people rescuing people rescuing people rescuing people rescuing people rescuing people
who are drowning. who are drowning. who are drowning. who are drowning. who are drowning. who are drowning. who are drowning. who are drowning.
We have not gone to We have not gone to We have not gone to We have not gone to We have not gone to We have not gone to We have not gone to We have not gone to
the head of the river the head of the river the head of the river the head of the river the head of the river the head of the river the head of the river the head of the river
to keep them to keep them to keep them to keep them to keep them to keep them to keep them to keep them
from falling in. from falling in. from falling in. from falling in. from falling in. from falling in. from falling in. from falling in.
That is the That is the That is the That is the That is the That is the That is the That is the
21st century task.21st century task.21st century task.21st century task.21st century task.21st century task.21st century task.21st century task.””””””””
Gloria SteinemGloria Steinem
Photo Source: http://static.flickr.com/90/207590972_a30260c293_b.jpg
The Prevention ContinuumThe Prevention Continuum
Responses Responses
AFTER AFTER
SYMPTOMS SYMPTOMS
OR RISKOR RISK
of illness or of illness or
injuryinjury
ResponsesResponses
AFTER AFTER
ONSETONSET
of illness of illness
or injuryor injury
Approaches Approaches
that take placethat take place
BEFOREBEFORE
illness or illness or
injuryinjury
PRIMARYPRIMARY SECONDARYSECONDARY TERTIARYTERTIARY
The Prevention Continuum:The Prevention Continuum: LeadLead
PRIMARYPRIMARY
SECONDARYSECONDARY
TERTIARYTERTIARY
The Prevention Continuum:The Prevention Continuum:
Lead screening programs, treatment of Lead screening programs, treatment of
children with high levels, removal of lead children with high levels, removal of lead
paint from householdspaint from households
Treatment, support, and rehabilitation of Treatment, support, and rehabilitation of
children with lead poisoning diseasechildren with lead poisoning disease
Banning lead in gasoline, paint, drinking Banning lead in gasoline, paint, drinking
water pipes, and other productswater pipes, and other products
LeadLead
PRIMARYPRIMARY
SECONDARYSECONDARY
TERTIARYTERTIARY
Los Angeles, CALos Angeles, CA
Albuquerque, Albuquerque,
NMNM
Austin, Austin,
TXTX
Boston, Boston,
MAMA
Charlotte, NCCharlotte, NC
Cleveland, OHCleveland, OH
Columbus, OHColumbus, OH
El Paso, TXEl Paso, TX
Fort Worth, TXFort Worth, TX
Houston, TXHouston, TX Jacksonville, FLJacksonville, FL
Long Beach, CALong Beach, CAMemphis, TNMemphis, TN
Nashville, TNNashville, TN
New Orleans, LANew Orleans, LA
New York, NYNew York, NY
Oklahoma City, OKOklahoma City, OK
Philadelphia, PAPhiladelphia, PA
Phoenix, AZPhoenix, AZ
San Antonio, TXSan Antonio, TX
San Diego, CASan Diego, CATucson, AZTucson, AZ
Tulsa, OKTulsa, OK
Virginia Beach, VAVirginia Beach, VA
Washington, DCWashington, DC
Honolulu Honolulu
HIHI
Mesa, AZMesa, AZ
Baltimore, MDBaltimore, MD
Madison, MSMadison, MS
Atlanta, Atlanta,
GAGA
Las Vegas, NVLas Vegas, NV
Oakland, CAOakland, CA
Dallas, TXDallas, TX
Chicago, Chicago,
ILIL
Denver, CODenver, CO
Detroit, MIDetroit, MI
Kansas City, MOKansas City, MO
Milwaukee, WIMilwaukee, WI
Omaha, NEOmaha, NESan Francisco, CASan Francisco, CA
San Jose, CASan Jose, CA
Seattle, WASeattle, WA
Fresno, CAFresno, CA
Indianapolis, INIndianapolis, IN
Portland, ORPortland, OR
Sacramento, CASacramento, CA
www.preventioninstitute.orgwww.preventioninstitute.org/UNITY/UNITY
UpfrontUpfront(PRIMARY)(PRIMARY)
Mentoring, mental health services, family Mentoring, mental health services, family
support services, conflict resolution/interruptionsupport services, conflict resolution/interruption
Mental health services, successful reentryMental health services, successful reentry
Positive early care and education, positive Positive early care and education, positive
social and emotional development, parenting social and emotional development, parenting
skills, quality afterskills, quality after--school programs, youth school programs, youth
leadership, social connections in leadership, social connections in
neighborhoods, economic developmentneighborhoods, economic development
In the In the
ThickThick(SECONDARY)(SECONDARY)
AftermathAftermath(TERTIARY)(TERTIARY)
The Prevention ContinuumThe Prevention Continuum
The Prevention Continuum:The Prevention Continuum: DiabetesDiabetes
PRIMARYPRIMARY
SECONDARYSECONDARY
TERTIARYTERTIARY
�� Child Restraint and Safety Belt UseChild Restraint and Safety Belt Use
�� Smoking PreventionSmoking Prevention
�� Minimum Drinking Age LawsMinimum Drinking Age Laws
�� Childhood ImmunizationsChildhood Immunizations
�� Motorcycle and Bicycle Helmet LawsMotorcycle and Bicycle Helmet Laws
�� Reduced Lead Levels in ChildrenReduced Lead Levels in Children
Child Restraint & Child Restraint &
Safety Belt UseSafety Belt Use
Oh, Britney…