Addressing Health Equity in Public Health Practice: Frameworks, Promising Strategies, and Measurement Considerations.

This review describes the context of health equity and options for integrating equity into public health practice. We first discuss how the conceptualization of health equity and how equity considerations in US public health practice have been shaped by multidisciplinary engagements. We then discuss specific ways to address equity in core public health functions, provide examples of relevant frameworks and promising strategies, and discuss conceptual and measurement issues relevant to assessing progress in moving toward health equity. Challenges and opportunities and their implications for future directions are identified.

A logic model for the integration of mental health into chronic disease prevention and health promotion.

Mental illnesses such as depression or anxiety affect an individual's ability to undertake health-promoting behaviors. Chronic diseases can have a profound impact on an individual's mental health; in turn, mental health status affects an individual's ability to participate in treatment and recovery. A group of mental health and public health professionals convened to develop a logic model for addressing mental health as it relates to chronic disease prevention and health promotion. The model provides details on inputs, activities, and desired outcomes, and the designers of the model welcome input from other mental health and public health practitioners.

Dementia and its implications for public health.

INTRODUCTION: With the aging of the U.S. population, a better understanding of the presentation and impact of dementia is essential to the future of public health. Dementia refers not to a single disorder but to a number of syndromes characterized by diverse behavioral, cognitive, and emotional impairments. Because dementia is costly in terms of both personal suffering and economic loss, an understanding of its prevalence, risk factors, and potential interventions is emerging as an increasingly important facet of public health and health care delivery. Recent advances in the understanding of its presentation, course, and relevant interventions have taken place. METHODS: We identified articles for review primarily by conducting a Medline search using the subject headings dementia, mild cognitive impairment, Alzheimer's disease, vascular dementia, frontotemporal dementia, and Lewy body dementia. Other relevant studies were elicited through a Medline search using the subject headings mental disorders and stigma. RESULTS: Dementia represents a diverse category of syndromes characterized by deficits in memory, cognitive function, and behavior. Symptoms associated with dementia appear to be distributed along a continuum, with even subsyndromal presentations affecting the health of older adults and meriting intervention. To promote cognitive functioning and independence among older adults, public health interventions need to facilitate both early detection and treatment of dementia. The availability of adult day care and respite services is important in maintaining the health and quality of life of individuals caring for older adults with dementia. Recent advances in the treatment of dementia may slow the course of cognitive decline, thereby enhancing the quality of life of older individuals as well as decreasing costs associated with institutional care. CONCLUSION: Despite the growing availability of pharmacologic and psychosocial interventions that are potentially helpful to people with dementia and their caregivers, the majority of older adults with dementia do not receive appropriate treatment. With the aging of the U.S. population, efforts to foster recognition of dementia and its treatments and to destigmatize them are emerging as an increasingly important facet of public health intervention.

Intervening on the social determinants of cardiovascular disease and diabetes.

Heart disease, cerebrovascular diseases, and type 2 diabetes ranked first, third, and sixth, respectively, among the leading causes of death and disability in the United States in 2000. Racial and ethnic communities (i.e., African Americans, Hispanic-Latino Americans, Native Americans and Alaska Natives, and Asian Americans and Pacific Islanders) disproportionately suffer from these chronic conditions. Traditional behavior change strategies have had some positive, but limited effects and will not likely be sufficient to eliminate these health disparities at the population level. In this commentary, the authors argue for greater intervention research directed at the social determinants of cardiovascular disease and diabetes if we are to reverse current trends in chronic disease prevalence in communities of color. The authors also call for new research questions and study designs that will increase our understanding of the social, policy, and historic context in which disparities are created as a necessary first step in developing interventions aimed at social-contextual and psychosocial risk factors. Promising programs supported by the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH 2010) program and the Division of Diabetes Translation are highlighted.