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Training Community Residents to Address Social Determinants of Health in Underresourced Communities.

Wennerstrom, Ashley; Sliver, Julia; Pollock, Miranda; Gustat, Jeanette
| Idioma(s):
Disparities in chronic disease and life expectancy remain a significant public health problem and are largely attributable to social determinants of health. Community health workers (CHWs) promote health equity through individual- and community-level activities, and leadership and advocacy skills training make CHWs more likely to catalyze structural change. CHWs are increasingly being integrated into clinical practices to support care management, creating a need for new grassroots community-level advocates. We adapted for community residents an existing CHW training curriculum focused on social determinants of health and effecting community change. We offered 36 hours of training at community-based locations in New Orleans, Louisiana. We assessed baseline civic and community participation and pre- and postknowledge for each lesson. Among 43 enrollees, 42 completed the program. The majority were Black (92.7%), female (92.7%), and retired or unemployed (77.5%), with a median age of 61.5 years. In the past year, 85% of participants had volunteered, 57.1% had been involved with a community organization, and 32.4% had contacted the city council. Participants demonstrated statistically significant increases in knowledge in 5 of 6 lessons. Our success in increasing knowledge of advocacy among a civically engaged group suggests that trainees may become community leaders in addressing social determinants of health.
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Why public health matters today more than ever: the convergence of health and social policy.

Littlejohns, Lori Baugh; Smith, Neale; Townend, Louise
| Idioma(s):
We argue that public health matters more today than ever because it is uniquely positioned as a meeting point or fulcrum between health care and social welfare policy perspectives on the social determinants of health. It combines a grounding in the sciences of biomedicine and epidemiology with the moral imperatives of social advocacy. Health cannot be delivered through health care policy alone and neither can social welfare policy ensure the well-being of all citizens on its own. Social policy is at a disadvantage because it does not engender universal consent the way health policy can. While the way that illness should be addressed is debated, it should be addressed to be not contested, as is social welfare for vulnerable populations. The convergence of health and social policy to address the social determinants of health means public health advocacy must explicitly leverage biomedicine to provide materialist and substantive arguments and social welfare to provide the normative and moral arguments. We conclude that a new model of public health advocacy or social lobbying is necessary to effectively raise concerns that health care-focused thinking will not, but with potential heft that social welfare, historically, has not been able to command.
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Learner Reactions to Activities Exploring Racism as a Social Determinant of Health.

Dennis, Syeachia N; Gold, Rachel S; Wen, Frances K
| Idioma(s):
BACKGROUND AND OBJECTIVES: Racism's impact on health has been well documented. Health professional programs are beginning to help learners understand this social determinant of health through curricular integration of education related to racism. Yet educators are hesitant to integrate these concepts into curricula because of lack of expertise or fear associated with learner responses to this potentially sensitive topic. The purpose of this study is to describe the responses of learners to learning sessions on racism as a social determinant of health (SDOH) highlighting structural, personally-mediated, and internalized racism. METHODS: Two separate groups-a family and community medicine (FCM) residency program (N=23) and a community health leadership program (N=14)-participated in lectures and workshops on internalized, personally-mediated, and structural sources of racism, and tours introducing them to the local community's historical roots of structural racism, including discussions/reflections on racism's impact on health and health care. Mixed-methods evaluation consisted of learner assessments and reflections on the experiences. RESULTS: FCM sessions received a positive reception with session averages of 4.15 to 4.75, based on a Likert-type scale (1=did not meet expectations to 5=exceeded expectations). Thematic analysis of community health leadership participant reflections showed thought processing connected to a better understanding of racism. Overall, themes from both programs reflected positive experiences of the sessions. CONCLUSIONS: Our preliminary study findings suggest that educators who encounter internal or external barriers to integrating racism-related concepts into curricula might find that these concepts are well received. This study lays the groundwork for further research into best practices for integration of curriculum on racism as an SDOH for medical schools, residency programs, and other related educational settings.
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Expert Consensus on Inclusion of the Social Determinants of Health in Undergraduate Medical Education Curricula.

Mangold, Karen A; Bartell, Tami R; Doobay-Persaud, Ashti A; Adler, Mark D; Sheehan, Karen M
| Idioma(s):
PURPOSE: Accreditation bodies have mandated teaching social determinants of health (SDH) to medical students, but there has been limited guidance for educators on what or how to teach, and how to evaluate students' competence. To fill this gap, this study aimed to develop an SDH curricular consensus guide for teaching the SDH to medical students. METHOD: In 2017, the authors used a modified Delphi technique to survey an expert panel of educators, researchers, students, and community advocates about knowledge, skills, and attitudes (KSA), and logistics regarding SDH teaching and assessment. They identified the panel and ranked a comprehensive list of topics based on a scoping review of SDH education studies and discussions with key informants. A total of 57 experts were invited. RESULTS: Twenty-two and 12 panelists participated in Delphi round 1 and 2, respectively. The highest ranked items regarding KSA were: "Appreciation that the SDH are some of the root causes of health outcomes and health inequities" and "How to work effectively with community health workers." The panel achieved consensus that the SDH should comprise 29% of the total curricula and be taught continuously throughout the curriculum. Multiple-choice tests were ranked lowest as an assessment method and patient feedback was ranked highest. Panelists noted that SDH content must be a part of standardized exams to be prioritized by faculty and students. CONCLUSIONS: An expert panel endorsed essential curricular content, teaching methods, and evaluation approaches that can be used to help guide medical educators regarding SDH curriculum development.
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The Role of Collective Efficacy in Reducing Health Disparities: A Systematic Review.

Butel, Jean; Braun, Kathryn L
| Idioma(s):
Many improvements in health equity are spearheaded by community collaborations working to change policy and social norms. But how can collective efficacy (CE), defined as the willingness and ability of a group to work toward a common good, be increased? Eight articles reporting on interventions aiming to reduce health disparities by improving CE were found for this systematic literature review. All studies showed improvements in CE and most found reduction in disparities, but operationalization of CE varied. Findings support a model of how CE can address health disparities, which can guide standardization of CE interventions and measures.
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Social Network Gap Analysis Evaluation: A Case Study of the Southeastern Health Equity Council.

Bright, Candace Forbes; Cozart, Thometta; Bagley, Braden; Scott, Hannah; Dennis, Jonathan
| Idioma(s):
Despite the growing emphasis on collaboration in public health, there remains a dearth of literature providing tools for the evaluation of coalitions and councils. This study employed social network gap analysis as an evaluation tool. Survey data collected from the Southeastern Health Equity Council members were used to assess connections among members as a whole, by committee, by state, and by health specialty area. Analysis of how well Southeastern Health Equity Council met the representation outlined in its strategic plan was also conducted. Recommendations for improving the network and opportunities to effectively recruit and advance the work of Southeastern Health Equity Council are discussed.
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Determinação ou determinantes sociais da saúde: texto e contexto na américa latina/ Social determination or social determinants of health: text and context in latin america/ Determinación o determinantes sociales de la salud: texto y contexto en américa latina

Borghi, Carolina Michelin Sanches de Oliveira; Oliveira, Rosely Magalhães de; Sevalho, Gil
| Idioma(s): Portugués
Resumo Determinação social da saúde e determinantes sociais da saúde têm se apresentado como sinônimos em um contexto de retomada do tema. A concepção de determinação e determinantes e a historicidade desses modelos teóricos transcende o plano acadêmico, ao se considerar a particularidade envolvendo saúde pública, saúde coletiva e medicina social, em que ciência e política se relacionam estreitamente. Ao se delinearem diferenças entre essas denominações, procura-se neste ensaio recuperar, no plano teórico, a elaboração de determinação social da saúde, destacando sua relação com o conhecimento produzido na América Latina e sua repercussão no Brasil, bem como as influências dos paradigmas científicos, epistemológicos, arcabouços teóricos e projetos em disputa nesse campo. Para abranger dimensões políticas e acadêmicas que os modelos teóricos comportam, recorremos ao auxílio de autores que transitam entre diferentes campos de conhecimento. Sem a pretensão de esgotar todos os possíveis pontos de contemplação que nossa incursão proporcionou, apresentamos uma síntese de nossa concepção do modelo teórico de determinantes sociais da saúde e sobretudo de determinação social da saúde, que propomos desmembrar em duas categorias, determinação estrutural e determinação estrutural-relacional, para, ao enfatizar epistemologicamente a complexidade, permitir melhor contemplação de avanços teóricos e metodológicos. Abstract The social determination of health and the social determinants of health have been presented as synonyms in a context in which this topic is being revisited. The conception of determination and determinants and the historicity of these theoretical models transcend the academic realm, once we consider the particularity involving public health, collective health, and social medicine, in which science and politics have a close relationship. Through the description of the differences between these two terms, our aim in this essay was to bring back, in theory, the elaboration of the social determination of health, highlighting its relationship with the knowledge produced in Latin America and its repercussions in Brazil, as well as the influences of the scientific and epistemological paradigms, the set of theories, and the projects that are in dispute in this field. In order to encompass the academic and political dimensions contained in the theoretical models, we sought the help of authors that move among different fields of knowledge. Without the intention of covering all of the points of observation that our incursion provided, we present a summary of our conception of the theoretical model of the social determinants of health and, chiefly, of the social determination of health, which we suggest should be divided into two categories, structural determination and structural-relational determination, in order to enable a better observation of the theoretical and methodological improvements, by emphasizing complexity epistemologically. Resumen La determinación social de la salud y los determinantes sociales de la salud se han presentado como sinónimos en un contexto de reanudación del tema. La concepción de determinación y determinantes, y la historicidad de estos modelos teóricos, transcienden el plano académico, al considerarse la particularidad que implica salud pública, salud colectiva y medicina social, en donde ciencia y política están estrechamente relacionadas. Al establecerse diferencias entre éstas denominaciones, en este ensayo se busca recuperar, en el plano teórico, el desarrollo de la determinación social de la salud, destacando su relación con el conocimiento producido en América Latina y su repercusión en Brasil, así como las influencias de los paradigmas científicos, epistemológicos, marcos teóricos y proyectos en disputa en este campo. Para abarcar dimensiones políticas y académicas que los modelos teóricos comportan, recurrimos a la ayuda de autores que transitan entre diferentes campos de conocimiento. Sin la pretensión de agotar todos los posibles puntos de vista que nuestra incursión proporciona, presentamos una síntesis de nuestra concepción del modelo teórico de determinantes sociales de la salud y principalmente de la determinación social de la misma, que proponemos desmembrar en dos categorías, determinación estructural y determinación estructural-relacional, de manera que al enfatizar epistemológicamente la complejidad, permita una mejor visión de los avances teóricos y metodológicos.
Resultados  1-10 de 61.215