Health Equity: 08/06/12

Monday, August 6, 2012

[EQ] Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities

CDC Health Equity Resource Toolkit for State Practitioners
Addressing Obesity Disparities

CDC - Division of Nutrition, Physical Activity, and Obesity

Center for Training and Research Translation’s (Center TRT) – 2012

Available online PDF [94p.] at: bit.ly/OZu0sh

“……..The goal is to increase the capacity of state health departments and their partners to work with and through communities to implement effective responses to obesity in populations that are facing health disparities. The Toolkit’s primary focus is on how to create policy, systems, and environmental changes that will reduce obesity disparities and achieve health equity.

For the purpose of this Toolkit, “policy” refers to procedures or practices that apply to large sectors which can influence complex systems in ways that can improve the health and safety of a population. States are already conducting activities to address obesity across populations.

This Toolkit provides guidance on how to supplement and compliment existing efforts. It provides evidence-informed and real-world examples of addressing disparities by illustrating how the concepts presented can be promoted in programs to achieve health equity using three evidence-informed strategies as examples:

1. Increasing access to fruits and vegetables via healthy food retail with a focus on underserved communities.

2. Engaging in physical activity that can be achieved by increased opportunities for walking with
a focus on the disabled community, and other subpopulations that face disparities.

3. Decreasing consumption of sugar drinks with an emphasis on access to fresh, potable (clean) water with
a particular focus on adolescents and other high consumers.

Though the Toolkit utilizes these three strategies as examples, the planning and evaluation process described in the Toolkit can be applied to other evidence-informed strategies to control and prevent obesity.

This Toolkit purpose is to inform state programs that seek to address obesity with a focus on health equity. …”

“….The Toolkit is designed to give an overview of a suggested process for planning, implementing, and evaluating a program to address obesity disparities.

The Toolkit begins with an introduction of the burden of obesity in the U.S. and some of the disparities in the experience of that burden.
Then it provides a description of a recommended conceptual framework, the Social Ecological Model, and
follows with seven Sections which discuss the steps and ongoing considerations of the process.

Each Section contains
1) a basic description of the steps of the process and suggested evidence-informed actions to help address obesity disparities,
2) practical tools for carrying out activities to help reduce obesity disparities, and
3) a “real-world” case study of a successful state-level effort to address obesity with a focus on health equity that is particularly relevant to the content in that section. Hyperlinks to additional resources are included throughout.

In addition to the resources, tools, and examples within each Section of the Toolkit, the Appendices provide resource lists …”

Contents

Introduction

I. Purpose and Intended Target Audience of the Toolkit

II. Toolkit Organization, Content, and Use

III. Health Disparities in Obesity and Obesity-related Risk Factors: Scope of the Problem

Determinants of Obesity 1

Health Disparities in Obesity

IV. Defining Key Terms

Conceptual Framework

Incorporating Health Equity into the Obesity Prevention Planning Processes

I. Program Assessment and Capacity Building

II. Gathering and Using Data to Identify and Monitor Obesity Disparities through a Health Equity Lens

Types of Data

Using Data to Identify and Prioritize Populations

III. Multi-sector Partnerships, Non-Traditional Partnerships, and Community Engagement

Why Partner?

The Importance of Multi-sector Partnerships and Community/Participatory Approaches

With Whom to Partner?

How to Identify Partners

A Multi-sector Partnership to Bring Affordable, Nutritious Food to Underserved Communities in Pennsylvania

IV. Applying a Health Equities Lens to the Design and Selection of Strategies

V. Monitoring and Evaluating Progress

CDC Framework for Program Evaluation

Policy/Program Evaluation Planning Framework

Tools for Evaluating Policy and Environmental Change

California’s Policy Solutions to Improve Access to Safe Physical Activity Environments

VI. Ensuring Sustainability

Frameworks for Ensuring Sustainability

Ensuring the Sustainability of Policy and Environmental Change within your Organization

Ensuring the Sustainability of Policy and Environmental Change Externally

The Coalition Approach

A Sustainable Environmental Solution to Promote Physical Activity of Youth in Connecticut

VII. Developing Culturally Relevant Health Communication Strategies

Adapting Healthy Stores and Healthy Corner Stores Programs to At-Risk Populations

Conclusion

References

Appendices

I. Appendix A. Additional Resources for Improving Access and Availability of Healthy Foods

II. Appendix B. Additional Resources for Improving the Beverage Environment

III. Appendix C. Additional Resources for Improving Safe, Accessible Physical Activity Environments

IV. Appendix D. Resources Included in the Toolkit, by Section

Gayle Holmes Payne, Ph.D. Lead Behavioral Scientist - Program Development and Translation Team Lead - Division of Nutrition, Physical Activity, and Obesity
National Center for Chronic Disease Prevention and Health Promotion - CDC Centers for Disease Control and Prevention

KMC/2012/SDE
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Link - URL correction [EQ] Social determinants of health: The role of social protection in addressing social inequalities in health

Social determinants of health:
The role of social protection in addressing social inequalities in health

Barbara Rohregger

Deutsche Gesellschaft für - Internationale Zusammenarbeit (GIZ) GmbH

Eschborn/ Germany

Available online at:
http://www.gtz.de/de/dokumente/giz2011-en-social-determinants-of-health.pdf

“…….The social, economic and political context in which people grow, live, work and age has enormous impact on their health status. These wider structural determinants of health lie largely outside the health sector. The level and coverage of social protection systems is one key determinant. Social protection measures and mechanisms directly contribute to poverty reduction and human resource development by providing recipients with in-kind or cash transfers. They also allow beneficiaries to gain better access to social services, including health facilities, drugs, etc.

“….Falling ill is one of the most important social and economic risks; illness not only generates costs in terms of treatment; it also has major economic implications with regard to loss of income and labour supply. Especially the most vulnerable are more likely to become sick while at the same time they are less able to cope with it; amongst others they lack adequate social protection mechanisms that allow them to cover the costs of treatment and drugs and overcome a temporary loss of income…..”

KMC/2012/SDE
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[EQ] Infectious Disease, Injury and Reproductive Health

Copenhagen Consensus 2012 Challenge Paper

Infectious Disease, Injury and Reproductive Health

Dean T. Jamison 2; Prabhat Jha 3; Ramanan Laxminarayan 4; Toby Ord 5

This paper was prepared with partial support from the Disease Control Priorities Network Project funded by the Bill & Melinda Gates Foundation.
2 Department of Global Health, University of Washington, Seattle.

3 Canada Research Chair of Health and Development, Centre for Global Health Research, St. Michael’s Hospital and University of Toronto, Canada

4 Public Health Foundation of India, Delhi.

5 Department of Philosophy, University of Oxford.

Available online PDF [94p.] at: http://bit.ly/RiTwJD

This paper identifies key priorities for the control of infectious disease, injury and reproductive problems for the Copenhagen Consensus 2012 (CC12). It draws directly upon the disease control paper (Jamison, Bloom and Jha, 2008) from Copenhagen Consensus 2008 and the AIDS vaccine paper for the Copenhagen Consensus Rethink HIV project (Hecht and Jamison, 2011). This paper updates the evidence and adjusts the conclusions of the previous work in light of subsequent research and experience. For CC12 noncommunicable diseases are being treated in a separate paper (Jha, Nugent, Verguet, Bloom and Hum, 2012) that complements this one.

All these papers build on the results of the Disease Control Priorities Project (DCPP).6 The DCPP engaged over 350 authors and estimated the cost-effectiveness of 315 interventions. These estimates vary a good deal in their thoroughness and in the extent to which they provide regionally-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of disease control opportunities.7 We will combine this body of knowledge with the results from research and operational experience in the subsequent four years.

The DCPP concluded that some interventions are clearly low priority. Others are worth doing but either address only a relatively small proportion of disease burden or simply prove less attractive than a few key interventions. This paper identifies 6 key interventions in terms of their cost-effectiveness, the size of the disease burden they address, the amount of financial protection they provide, their feasibility of implementation and their relevance for development assistance budgets. The resulting ‘dashboard’ of indicators underpins overall judgments of priority.

Separate but related papers for Copenhagen Consensus 2012 Challenge Papers CC12 deal with:

- Malnutrition (Hoddinott et al, 2012) http://bit.ly/O1pd6V with

- Water and sanitation (Rijsberman and Zwane, 2012) http://bit.ly/Ms5cJC with

- Population growth (Kohler, 2012) http://bit.ly/MJ0jr0 and

- Education (Orazem, 2012) http://bit.ly/NjWd8i .

Before turning to the substance of the paper it is worth briefly stating our perspectives on the roles of the state and of international development assistance in financing health interventions. There are major positive externalities associated with control of many infections and there are important public goods aspects to health education and R&D. On one view the rationale for state finance is to address these market failures and to address needs of vulnerable groups. Our view is rather different…..”

Contents

1. Progress and Challenges

1.1 Progress

1.2 Remaining challenges

2. The Economic Benefits of Better Health

2.1 Health and income

2.2 Health and economic welfare

3. Cost-Benefit Methodology

3.1 Cost-effectiveness analysis broadly and narrowly construed

3.2 Defining and redefining DALYs

3.3 The value of a DALY

3.4 The cost of a DALY

4. Child and Reproductive Health

4.1 Under-5 health problems and intervention priorities

4.2 Worm infections in school-age children

4.3 Delivering reproductive and child health interventions

5. HIV/AIDS

5.1 Prevention of HIV transmission

5.2 AIDS vaccine development

5.3 Antiretroviral treatment of AIDS

6. Control of Tuberculosis

7. Opportunities for Disease Control

Appendix A: Sensitivity Analysis

References

KMC/2012/SDE
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[EQ] Social determinants of health: The role of social protection in addressing social inequalities in health

Social determinants of health:
The role of social protection in addressing social inequalities in health

Barbara Rohregger

Deutsche Gesellschaft für - Internationale Zusammenarbeit (GIZ) GmbH

Eschborn/ Germany

Available online at: http://bit.ly/Ms21Sn

KMC/2012/SDE
Twitter http://twitter.com/eqpaho

Thank you.

[EQ] The Impact of Daycare Programs on Child Health, Nutrition and Development in Developing Countries

The Impact of Daycare Programs on Child Health, Nutrition and Development in Developing Countries:
a systematic review

Jef L Leroy, International Food Policy Research Institute, Washington DC

Paola Gadsden, Instituto Nacional de Salud Pública, México

Maite Guijarro, Centro de Investigación y Docencia Económicas, México

The International Initiative for Impact Evaluation (3ie)

Available online PDF [46p.] at: http://bit.ly/PzEvNm

“…..Urbanization and increases in female labor market participation have increased the demand for non-parental childcare in many low and middle-income countries. Especially in formal sector jobs, work and caring for one’s child cannot be combined. Government daycare programs currently under way in several developing countries seek to promote labor force participation through relieving one of the most pressing constraints faced by working parents, especially mothers, i.e. access to reliable and affordable childcare. Whilst there are a number of impact evaluations of day care interventions in developing countries, no systematic review of the literature has been conducted.

We conducted a systematic review of impact evaluations examining the impact of daycare interventions on the health, nutrition and development of children under five years of age in low- and middle-income countries. The second objective was to use a program impact theory approach to identify the pathways through which daycare may improve child outcomes.
The third and final objective was to review the available information on the demand for daycare services.

The review was restricted to intervention studies (defined as studies evaluating the impact of an exogenous change in daycare provision or utilization on child outcomes) using experimental or quasi-experimental methods (e.g. propensity score matching), as well as regression-based methods to control for potential self-selection of program participation. A comprehensive and systematic search of the unpublished and published literature dating back to 1980 was conducted. No language restrictions were imposed. Papers were excluded based on study scope, type and quality.

Only 6 studies (all conducted in Latin America) met our inclusion criteria. In general, large positive effects on measures of short and longer term child development were found. Due to inconsistent results, no conclusions can be drawn with respect to the impact on child health and nutrition. More rigorously conducted studies on the impact of daycare programs in low and middle income countries are needed. These should be conducted in a variety of settings and provide a clear description of the counterfactual care scenarios. Intermediary variables that help explain the pathways of impact need to be measured and taken into account in the analyses…” [AU]

KMC/2012/FCH
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