Intersectoral Action & the Social Determinants of Health: What's the Evidence?

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Intersectoral Action and the Social Determinants of

Health:

What’s the evidence?

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What’s the evidence? National Collaborating Centre for Determinants of

Health. (2012). Assessing the impact and effectiveness of intersectoral action on the social determinants of health: An expedited systematic review. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

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Participant Side Panel in WebEx

Welcome! This webinar has been made possible with support from the

Canadian Institutes of Health Research

Intersectoral Action and the Social

Determinants of Health:

What’s the evidence?

Maureen Dobbins Scientific Director Tel: 905 525-9140 ext 22481 E-mail: [email protected]

Kara DeCorby Administrative Director

Lori Greco Knowledge Broker

Lyndsey McRae Research Assistant

Robyn Traynor Research Coordinator

The Health Evidence Team

Heather Husson Project Manager

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Evidence

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Knowledge Translation

Supplement Project

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Review National Collaborating Centre for Determinants of

Health. (2012). Assessing the impact and effectiveness of intersectoral action on the social determinants of health: An expedited systematic review. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University.

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Questions?

National Collaborating Centre for Determinants of Health

Sume Ndumbe-Eyoh [email protected]

Hannah Moffatt [email protected]

Knowledge Translation Specialists

About the National Collaborating Centre for Determinants of Health

• Our work – Translate and share evidence to influence interrelated

determinants and advance health equity

• Our focus – Social determinants of health (SDH) & health equity

• Our audience – All organizations that make up the public health sector in

Canada – The practitioners, decision makers and researchers who

work within public health

Visit us at www.nccdh.ca

Pan-Canadian

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• Resource Library • Health Equity Clicks: Community • Health Equity Clicks: Organizations • Networking events & workshops

Summary Statement: NCCDH(2012) P General population I Any population health intervention, involving an intersectoral

relationship, related to the social determinants of health (SDOH and health equity

C Health equity O Health Outcomes: measures of morbidity/mortality, quality o

life, adherence to healthcare, etc. SDOH Outcomes: income/income distribution, employment, housing, etc. Policy Outcomes: societal-level legislative changes, and organizationallevel policies/programs

Quality Rating: 8 (strong)

Summary of Included Studies

Included articles met several relevance criteria: • Any design/population health intervention re: SDOH & health equity • Explicit mention of intersectoral relationship • Outcomes : health, SDOH, or policy • Published in English or French between Jan 2001-Jan 2012 • Set in one of: Norway, Finland, Denmark, Sweden, Australia, New

Zealand (NZ), Canada, the United States (US), or the United Kingdom (UK)

Total of17 articles included: 1 systematic review, 14 quantitative studies

& 2 qualitative studies

Overall Considerations Evidence of effectiveness for some upstream, midstream, and

downstream interventions Role of the public health sector was not always clearly

described in the primary studies, however intervention descriptions can be accessed in Table 2 of the review.

Interventions targeted very specific populations so findings may not be generalizable to a different population and/or setting.

Long-term effectiveness remains unclear. Public health decision makers should advocate for development

and funding of research assessing impact of intersectoral collaborations, particularly those focused on upstream interventions.

General Implications Public health SHOULD consider: Intervening in early childhood, given positive effect for kids,

especially for early literacy among children of low-income mothers Upstream interventions to improve housing and employment

conditions, evidence of impact for other SDH is limited Midstream interventions to improve employment/working

conditions, child literacy, dental health, housing, and organizational change

Downstream interventions to increase access to oral health services, immunization rates, appropriate use of primary health care services, and referrals from school readiness checks.

What’s the evidence? Upstream Interventions Employment/working conditions: interagency

agreements in multiple US states led to a 25% yearly increase in supported employment over 5 years in adults with disabilities

Housing: national legislation to improve housing

conditions among Australian indigenous communities led to slight improvements of infrastructure components but no impact on hygienic conditions

consider implementing upstream interventions that appear effective, knowing the current evidence-base is limited

so cautioning that advocating for additional, long-term impact

assessment of upstream interventions is needed

Implications: Practice & policy Upstream Interventions

What’s the evidence? Midstream Interventions

Employment/working conditions (2 studies) – improvements in employment (76.7% of participants obtaining employment) and improved working conditions with 5 workplace changes

Childhood Literacy (1 study) – improved early literacy behaviours, increased parents reporting showing books to their infants daily (53.67% in 2001, 69.44% in 2003), reading aloud to children daily (33% in 2001, 53.70% in 2003), and participation in the Raising a Reader program (4.3% in 2001 and 16.7% in 2003).

Midstream Interventions, cont.

Housing(1 study) – all households received helpful housing modifications, with decreased hospital admissions for those up to 34 years old, decreased housing-related, preventable hospital admissions.

Social & Physical Environments (3 studies) - Eight projects resulting from a collaborative demonstrated organizational change and

advocacy projects at multiple levels, but had no impact on program integration or policy School-based break time snacking reduced indicators of childhood dental disease (DMFT

changed from 1.13, CI [0.85, 1.40] in year 1 to 1.58, CI [1.28, 1.89] in year 2) and increased number of filled permanent teeth in lower SES schools over time: mean 0.49, CI [0.20, 0.77] Year 1 and 1.05, CI [0.69, 1.14] Year 2.

Chronic disease coalition did not report health outcomes but initiated a number of programs, policies, and practices with outcomes not yet available

implement school-based break-time snack initiatives as an avenue to address childhood dental disease

consider interventions that address employment/working conditions and childhood literacy, dental health and housing

explore collaboratives for community-based and school-based organizational change, and potential to advocate at multiple levels

consider that it is unclear as to whether improvements lasted long-term

Implications: Practice & policy Midstream Interventions

What’s the evidence? Downstream Interventions Oral health: school- and home visit-based oral health education

program led to 32% of children being cavity-free at three years, as opposed to 8% at study-onset (n=58), with more children having a primary dental health practitioner and/or receiving preventive care

Mental health: school-based mental health service led to a decrease in peer problems and hyperactivity within the intervention group, but number of problems were still higher compared to the control group

Immunization: study involving 23 organizations targeting those < 5 years of age saw an overall increase in immunization rates of 46% to 80.5%

Downstream Interventions, cont. Case coordination & case management, with

community-based health education and physical activity for youths and seniors showed 45% of participants established a primary care provider, with 40% fewer ER visits (p < .05), and decreased patients with poor diabetic control from 78% to 48% (p < .05).

School readiness checks in a rural, economically-disadvantaged community (e.g. oral and vision screening, behavioural assessment) from trained healthcare professionals maintained a 50% referral rate over 10 months

School-based asthma education intervention showed no impact on urgent health services or school attendance in low-income ethnic minority families.

implement interventions that improve access to education and preventive/restorative dental care through school- or community-based screening and/or referrals for oral health and access to care

consider that individual studies demonstrate downstream interventions improve some aspects of mental health of refugee children, immunization coverage, chronic disease management, and school readiness

No evidence to support school-based asthma education for low-income, ethnic minority families at this time

Implications: Practice & policy Downstream Interventions

General Implications Public health SHOULD promote / support / implement:

Intervening in early childhood Upstream interventions to improve housing and

employment conditions Midstream interventions to improve employment/

working conditions, child literacy, dental health, housing, and organizational change

Downstream interventions to increase access to oral health services, immunization rates, appropriate use of primary health care services, and referrals from school readiness checks

Questions?

Contact us: Sume Ndumbe-Eyoh [email protected]

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