Healthy Islands 01 01 11
Transcript of Healthy Islands 01 01 11
Healthy IslandsJanuary 1, 2011
OUTLINE• Healthy Islands: Mission & Goals• Ecological Framework• Food System Model• Interaction Framework Availability Accessibility Interaction
• Social Communication Strategy• Monitoring & Interventional Framework• MAPPS Framework
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HEALTHY ISLANDS: MISSION & GOALS• Mission: Healthy Islands will improve the health and quality of life of
the populations of island communities
• Goals Address the crisis of non-communicable diseases Ensure the community has access to a healthy food supply Ensure community members live in a health-promoting environment Develop the capacity of the health workforce Improve the health literacy of the population Empower community members to make healthy decisions Provide the community with a financially sustainable health system Institutionalize the program with an organization and governance model
capable of ensuring long-term viability
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ECOLOGICAL FRAMEWORK• The NCD Plan will translate into a portfolio of interventional projects• Projects will be targeted to specific areas of the ecological framework
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ECOLOGICAL FRAMEWORK
INDIVIDUALS
SOCIAL NETWORKS & GROUPS
COMMUNITY SYSTEMS
COMMUNITY TIERS & SYSTEMS
ECOLOGICAL FRAMEWORK
FOOD SYSTEM : EXCHANGE MODEL• The food system can be represented using a set of models that describe
actors, their roles and their various kinds of interactions
FOOD SYSTEM : TIERS• The food system can be represented as a series of tiers comprised of
interconnected markets
FOOD SYSTEM : VALUE CHAIN
FOOD SYSTEM : ACTOR ROLES• The (simplified) food system model consists of a series of
interconnected markets • Actors may play multiple roles within the various markets
• Farm producers provide raw materials to Food Makers• Food Makers produce food for Food Sellers• Food Sellers sell food to Food Consumers
FOOD SYSTEM : ACTORS
FOOD SYSTEM STRATEGY
FOOD SYSTEM STRATEGY
AGRICULTURAL MARKET
AGRICULTURAL MARKET
AGRICULTURAL MARKET
AGRICULTURAL MARKET
• With a farmer’s market, the farmer handles transportation to the marketplace
• With a farm stand, the consumer purchases food at the farm site
FOOD SYSTEM EXAMPLES• Farmer’s markets and farm stands represent two
highly simplified food systems; the farmer and consumer transact directly with each other
AGRICULTURAL MARKET
FOOD SYSTEM EXAMPLES• Another simple food system has roles for farmers and
consumers, with an intervening set of distributors for transportation; there is no intervening food manufacturer
• Fresh produce does not involve manufacturing or processing of foods
FOOD SYSTEM EXAMPLES• Various arrangements may exist between food sellers
such as grocery stores and supermarket chains and farmers
AGRICULTURAL MARKET
FOOD SYSTEM EXAMPLES• Schools and restaurants are two types of food
service establishments
AGRICULTURAL MARKET
AGRICULTURAL MARKET
FOOD SYSTEM : INTERMEDIARIES• The food system may include additional
intermediaries that handle distribution, warehousing and transportation functions
• Food wholesalers are sometimes present
FOOD SYSTEM: LOCAL VS EXTERNAL MARKETS• The food system may include agricultural producers
or food makers from within the local region or located externally
FOOD PRODUCTION MARKET
FOOD PRODUCTION
FOOD SYSTEM: SUPPLY CHAIN• The food system generally includes complex supply
chain arrangements between food companies and the manufacturers of various food production inputs
FOOD PRODUCTION
HOME PREPARATION
FOOD SERVICES MARKET
FOOD SYSTEM : ACTORS
• The conceptual food system with the community can be mapped to a physical marketplace with consumers and providers are defined locations
• Spatial interaction becomes an important factor in the physical market• Actors have to negotiate distance in order to transact within the
marketplace
FOOD SYSTEM: CONCEPTUAL TO PHYSICAL MARKETS
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FOOD SYSTEM: COMMUNITY SETTINGS
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INTERACTION: COMMUNITY SETTINGS• The community setting plays a key role in shaping the lived experience
of community members • Each community member occupies and transitions between various
settings during the course of any given day• Settings offer health promotion opportunities in terms of nutrition and
physical activity
Settings
•Homes (own home, others’ homes)
•Work sites
•Schools, after-school settings
•Child care settings
•Health and social welfare settings
•Other community-based settings(e.g. community centers, churches)
•Recreational sites
•Retail settings
•Restaurants, fast-food venues
•Food stores
INTERACTION FRAMEWORK : SUMMARY• The interaction framework applies to the dynamic interactions between
the community member and various resources within the community.• The resource may be another community member or a physical
resource such as food to be consumed• The framework provides a model for understanding the various
ecological factors that influence the ability of community members to engage in various activity
• A key concern is understanding how ecological factors influence interactions between geographically separated actors and resources
INTERACTION FRAMEWORK• Interactions between actors and resources involve several dimensions• Individual dimensions relate the aspects of the actor participating in
the interaction• Other interaction dimensions involve aspects of the external
environment, which mediate between the actor and the resource
ACCESSIBILITY• Accessibility plays a key role in community member activities where
interaction involves distance between the actor and the resource
ACCESS: CLIMATE AND GEOGRAPHY• The climate and geography of the region may influence the interactions
between the actor and resource
ACCESS: TRANSPORTATION NETWORK & MODALITIES• Transportation networks and the transportation options available to the
actor directly shape the accessibility of a given resource
RESOURCE AVAILABILITY AND ALTERNATIVES• Resource availability is independent from accessability• Availability relates to whether the desired resource is present at a
given location, as well as what alternative options are available
AVAILABILITY: SELECTION FACTORS• Multiple selection factors influence the actor’s choice of location and
selection of resource from available alternatives
AVAILABILITY: OTHER DIMENSIONS• More complex aspects of resource availability include the proximity of a
given resource at a given location to other desired resources or locations
INTERACTION: PROXIMITY AND TIMING• The ecological framework is focused on understanding the lived
experience of community members in terms of how their time is spent engaged in their daily activities and interacting with the various community settings.
• The community member’s day can be viewed in terms of the physical settings they occupy as well as the activities they engage in
INTERACTION: PROXIMITY AND TIMING• Proximity and timing dynamically shape the interaction between actors
and resources
INTERACTION: INDIVIDUAL DIMENSIONS• Individual dimensions influence the interaction between actors and
resources
SOCIAL COMMUNICATION STRATEGY: SUMMARY• Health promotion activities should leverage social networks Social networks provide a set of trusted relationships and communications
channels that can enable rapid dissemination of health promotion information
The social communication strategy should leverage the multiple, overlapping networks and social groups that each community member belongs to
Using multiple social communication channels raises the likelihood of reaching every community member
Relying on multiple social communication channels provides an opportunity to mutually reinforce health promotion information from independent sources
Multiple social communication channel reduce the likelihood of community members receiving inaccurate or incomplete health promotion information
The social communication strategy supports an efficient train-the-trainer approach to disseminating health promotion information
A successful social networking strategy will require strong commitment to health promotion from the trusted leadership of the various social groups
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SOCIAL NETWORK AND GROUP TYPES• Types of social groups/networks available Family: immediate/nuclear, extended kinship networks
Extended social networks: friends and acquaintances
Work groups
Community groups• Youth groups
• After-school activity groups
• Sports teams
• Volunteer groups
• Church groups
• Other neighborhood or village groups
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SOCIAL GROUP INTERFACES• The divisions of roles within a social network/group enables efficient
dissemination of health promotion information Groups may have multiple interfaces based on member roles
Group interfaces serve as a coordination point for dissemination of health promotion information
Health promotion Information may be tailored to specific group member roles
Group members playing a communications coordination role may further tailor or customize the health promotion information
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KINSHIP NETWORKS• Kinship Networks Kinship covers relationships between community members based on descent
(‘consanguinity’) and marriage (‘affinity’)
Descent networks are based on genetic relationships (immediate/nuclear and extended families)
Affinity networks describe abstract social patterns of relationships that are not based on genetics
Different cultures have differing kinship systems and terminology
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•Individuals are genetic offspring of a single union.
•Individuals may form various types of unions – with various degrees of formal significance in terms of legal or religious recognition.
•An individual may form multiple unions, giving rise to multiple sets of offspring.
•An individual may form a union with someone with offspring from an earlier union.
EXTENDED FAMILY NETWORKS• Extended Family Networks extending beyond the community member’s immediate family may
be wide-ranging and complex
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EXTENDED SOCIAL NETWORKS• Extended Social Networks Community members may participate in a wide-ranging set of informal
relationships with others in the community
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ORGANIZED COMMUNITY GROUPS• Organized Community Groups Community members may participate in organized groups with varying types
and degrees of formal group organization, membership structures and roles, and forms of participation
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WORK GROUPS• Work groups Community members may participate in the formal or informal economies
through membership in various work groups
Work groups and subgroups have various types and degrees of formal group organization, membership structures and roles, and forms of participation
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METHODOLOGY: PROBLEM ANALYSIS
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CAUSAL WEB: MACRO-ECONOMIC SYSTEM
CAUSAL WEB: FOOD MARKETS
CAUSAL WEB: BUSINESS PERFORMANCE
CAUSAL WEB: WORKFORCE HEALTH
STRATEGIC DRIVERS, GOALS AND OBJECTIVES
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TACTICAL, OPERATIONAL AND EXECUTION PLANS
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PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
PATIENT CARE EXAMPLE
MONITORING AND INTERVENTION : GROUPS
MONITORING AND INTERVENTION : SYSTEMS
MONITORING AND INTERVENTION : ENVIRONMENT
MONITORING AND INTERVENTION : ENVIRONMENT
MONITORING AND INTERVENTION : INTEGRATED
INTERVENTIONAL STRATEGY• Based on the MAPPS Framework Media Access Point of Decision Information Price Social Support Services
• Communities Putting Prevention to Work (CPPW) MAPPS is currently the framework for the CDC’s CPPW initiative
• Best-Practices Framework Evidence-based interventions drawn from the peer-reviewed literature and
expert synthesis Communities and states have found these interventions to be successful in
practice
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MAPPS FRAMEWORK• Focused on chronic diseases (non-communicable diseases) Target conditions: obesity, diabetes and cardiovascular disease Responsible for 7 of 10 deaths Vast majority of serious illness-related disability Greatest contributor to healthcare expenditures (75%)
• Addresses key risk factors Lack of physical activity Poor nutrition Tobacco use (out of scope – addressed elsewhere)
• Specific goals Decrease overweight/obesity prevalence Improve nutrition (e.g. increased fruit/vegetable consumption, reduced salt
and trans-fat) Increase levels of physical activity
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STRATEGIES AND INTERVENTIONS• High-Level Strategies Strengthen healthcare infrastructure
Reduce costs through prevention Advance public health across the lifespan Reduce health disparities Reduce risk factors Prevent and/or delay onset of chronic disease Promote wellness
• Intervention Approach Policy, systems and environmental change Communities and schools Positive behavior change related to nutrition and physical activity
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MAPPS: MEDIA
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Interventions : Media
Nutrition Physical Activity
Media and advertising restrictions consistent with federal law
Promote healthy food/drink choices Counter-advertising for unhealthy
choices
Promote increased activity Promote use of public transit Promote active transportation
(bicycling and walking) Counter-advertising for screen time
MAPPS: ACCESS
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Interventions : Access
Nutrition Physical Activity
Promote healthy food/drink choices Healthy food/drink availability Limit unhealthy food/drink
availability Reduce density of fast food
establishments Eliminate trans-fat through
purchasing actions, labeling initiatives, restaurant standards
Reduce sodium through purchasing actions, labeling initiatives, restaurant standards
Procurement policies and practices Farm to institution, including
schools, worksites, hospitals and other community institutions
Safe, attractive accessible places for activity
City planning, zoning and transportation
Require daily quality PE in schools Require daily physical activity in
afterschool/childcare settings Restrict screen time (afterschool,
daycare)
MAPPS: POINT OF PURCHASE/PROMOTION
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Interventions : Point of Purchase/Promotion
Nutrition Physical Activity
Signage for healthy vs. less healthy items
Product placement & attractiveness Menu labeling
Signage for neighborhood destinations in walkable / mixed-use areas
Signage for public transportation, bike lanes/boulevards.
MAPPS: PRICE
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Interventions : Price
Nutrition Physical Activity
Changing relative prices of healthy vs. unhealthy items (e.g. through bulk purchase / procurement / competitive pricing)
Reduced price for park/facility use Incentives for active transit Subsidized memberships to
recreational facilities
MAPPS: SOCIAL SUPPORT AND SERVICES
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Social Support & Services
Nutrition Physical Activity
Support breastfeeding through policy change and maternity care practices
Safe routes to school Workplace, faith, park,
neighborhood activity groups (e.g., walking hiking, biking)