an environmental approach to community health jeremy ... · session 1 an environmental approach to...

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…