Week 3 MODELS FOR POPULATION HEALTH

What is population health?

“Population health is the distribution of health outcomes within a population, the determinants that influence distribution, and the policies and interventions that affect determinants.”

What do we mean by population?

• Geographically defined population such as county, state, or country

• At-risk groups

CommunityHealth vs. Population Health

Health inequality

Health inequality is defined as differences in the distribution of health status and achievement of health outcomes that exist among specific groups due to genetic or other factors that cannot be prevented or modified

• Differences in the distribution of health outcomes across populations

Health disparities

Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations

• A disproportionate number of health conditions and deaths compared with the general population

Social Determinants of Health

The non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

Health inequities

Disparities in metrics of health outcomes due to avoidable differences in social, economic, geographical, and healthcare resources that are unfair and unjust. This concept is grounded in the notion of distributive justice

Built environment

Human-made or modified environment where we live, work, and play

Health indicators

An approach to capture specific health characteristics of a particular population

True or False: the following statement refers to the term "stressor" - Tension producing stimuli that have the potential to cause disequilibrium

True

What is Public Health Nursing?

Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences

Theories/Models of population health

• Fundamental Causes

• Weathering

• Allostatic Load

• Fetal Origin

• Embodiment

• Historical Trauma

• Epigenetics

• Social Status Syndrome

Fundamental Causes

Social conditions are fundamental causes of health inequities

• Social determinants of health

Weathering Hypothesis

• Consistent exposure to stressors leads to accelerated aging

• Accelerated aging

• Chronic stress exposure

• Marginalized group

Allostatic Load Theory

The cumulative, physical "wear and tear" on the body that results from chronic, repeated exposure to stress

• Acute stress triggers the fight-or-flight response; the body builds up cortisol and adrenaline

• Long-Term Damage: When stressors never let up or recovery time is missing, these same survival hormones keep blood pressure, heart rate, and inflammation elevated, eroding health over time.

• Health Impacts: High allostatic load correlates with a higher risk of cardiovascular disease, type 2 diabetes, immune dysfunction, and major depressive disorder.

• Early warning signs, morbidity

Historical Trauma

Higher prevalence of diseases among populations that historically experienced trauma

• Collective trauma the group is experiencing continues to perpetuate

• Intergenerational trauma

Epigenetics

• External factors influence gene expression

• NOT gene mutation

• Whether/how genes are expressed

• Exposure to social/environmental and other factors affects how and what information genes can carry.

• Doesn’t change the gene

  
  

Embodiment theory

• Embodiment of material and social world

• Biological embodiment of life and work conditions

• Resulting in production and reproduction of social and biological inequities

Fetal Origin Theory

SES and environment of the mother even before conception predicts the health trajectory of the fetus in later life

Social Status Syndrome

Better social status is a better predictor of health

World Health Organization (WHO)

• Measurable Impact

• Life Expectancy (LE)

• Healthy Life Expectancy (HALE)

• Targets by 2023 (Triple billion)

Healthy People 2030

Overarching Goals:

• Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.

• Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

• Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.

• Promote healthy development, healthy behaviors, and well-being across all life stages.

• Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all

CDC

Uses the Healthy People 2030 Framework

Focusing on key areas:

• Healthcare access and quality

• Education access and quality

• Social and community context

• Economic stability

• Neighborhood and built environment

Programs & evaluation

Robert Wood Johnson (RWJF)

• Culture of Health

• Health equity at the core

• County Health Rankings & Roadmaps

THE 10 ESSENTIAL PUBLIC HEALTH SERVICES

“Public health nursing practice focuses on population health through continuous surveillance and assessment of multiple determinants of health with the intent to promote health and wellness, prevent disease, disability and premature death; and improve neighborhood quality of life. These population health priorities are addressed through identification, implementation, and evaluation of universal and targeted evidence-based programs and services that provide primary, secondary, and tertiary preventive interventions. Public health nursing practice emphasizes primary prevention with the goal of achieving health equity’ (American Nurses’ Association [ANA], 2013)

SDOH

SOCIAL DETERMINANTS AND SOCIAL NEEDS

Core Focus for Upstream Thinking

• Root Cause

• Systemic Interventions

• Equity and Justice

• Collaboration and Multilevel approach

• Long-Term Impact

Thinking Upstream