A Community Health Worker Intervention to Address the Social Determinants of Health Through Policy Change

What is known about this topic• Advocacy is considered a key public health strategy for redressing health inequities.• There is evidence that public health's advocacy role has not been fully realised; the reasons for this are unclear. What this paper adds• A systematic collation and critical analysis of the conceptual and empirical literature on public health advocacy focused on health equity is provided.• Public health is constrained in its health equity advocacy efforts by neoliberal conceptualisations of health problems, and by multiple barriers at the level of individual public health practitioners, institutions and the social environment. AbstractThe public health (PH) sector is ideally situated to take a lead advocacy role in catalysing and guiding multi-sectoral action to address social determinants of health inequities, but evidence suggests that PH's advocacy role has not been fully realised. The purpose of this review was to determine the extent to which the PH advocacy literature addresses the goal of reducing health and social inequities, and to increase understanding of contextual factors shaping the discourse and practice of PH advocacy. We employed scoping review methods to systematically examine and chart peer-reviewed and grey literature on PH advocacy published from January 1, 2000 to June 30, 2015. Databases and search engines used included: PubMed, CINAHL, PsycINFO, Social Sciences Citation Index, Google Scholar, Google, Google Books, ProQuest Dissertations and Theses, Grey Literature Report. A total of 183 documents were charted, and included in the final analysis. Thematic analysis was both inductive and deductive according to the objectives. Although PH advocacy to address root causes of health inequities is supported theoretically and through professional practice standards, the empirical literature does not reflect that this is occurring widely in PH practice. Tensions within the discourse were noted and multiple barriers to engaging in PH advocacy for health equity were identified, including a preoccupation with individual responsibilities for healthy lifestyles and behaviours, consistent with the emergence of neoliberal governance. If the PH sector is to fulfil its advocacy role in catalysing action to reduce health inequities, it will be necessary to address advocacy barriers at multiple levels, promote multi-sectoral efforts that implicate the state and corporations in the production of health inequities, and rally state involvement to redress these injustices.

show abstract

“…, Ingram et al . ). There is also discussion in the literature about the need for physicians (Bullen & Neuwelt , Ochoa & Nash , Tillmann et al .…”

Section: Resultsmentioning

confidence: 97%

“…), improving transportation infrastructure and addressing structural violence resulting from border security policy for underserved border (migrant) populations in the southern USA (Ingram et al . ); developing physical activity resources in low‐income neighbourhoods (García et al . ), reduce tobacco‐related disparities (Garcia et al .…”

Section: Resultsmentioning

confidence: 99%

Does public health advocacy seek to redress health inequities? A scoping review

Cohen

Marshall

2016

Health Soc Care Community

105

View full text Add to dashboard Cite

show abstract

“…In 2009, the AzPRC began to collaborate with 5 health-focused organizations to develop and implement Action for Health (Acción Para La Salud), an intervention designed to train and guide CHWs in community advocacy to address the social determinants of health as described by Schachter et al (2014) and Ingram et al (2014). Acción's curriculum is "grounded in the theory and principles of action learning, emphasizing learning by doing, teamwork, real-world projects, and reflection."…”

Section: The Acción Para La Salud Intervention In Southern Arizonamentioning

confidence: 99%

The Impact of Integrating Community Advocacy Into Community Health Worker Roles on Health-Focused Organizations and Community Health Workers in Southern Arizona

Reinschmidt

Ingram

Schachter³

et al. 2015

Journal of Ambulatory Care Management

Self Cite

View full text Add to dashboard Cite

Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions.

show abstract

“…Current approaches to SDH generally focus on population-level and policy interventions. Public policy that seeks to achieve sustainable improvements in the SDH, (50) 14 (50) 6 (25) 7 (29) 3 (12.5) 8 (33) 18 (75) 6 (25) 12 (50) 6 (25) 6 (25) HMP= Health Management and Policy, C= Clinical, SS= Social Science, OS= Other Specialty such as income, education, housing, food security, and area conditions, can create positive and sustainable health effects (36)(37)(38). Significant improvements in population health are likely when the SDH are addressed (39).…”

Section: Discussionmentioning

confidence: 99%

Macroeconomic policies and increasing social-health inequality in Iran

Zaboli

Seyedin

Malmoon

2014

Int J Health Policy Manag

View full text Add to dashboard Cite

Background: Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. Methods: This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. Results: Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. Discussion: It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary.

show abstract

A Community Health Worker Intervention to Address the Social Determinants of Health Through Policy Change

Cited by 38 publications

References 10 publications

Does public health advocacy seek to redress health inequities? A scoping review

Does public health advocacy seek to redress health inequities? A scoping review

The Impact of Integrating Community Advocacy Into Community Health Worker Roles on Health-Focused Organizations and Community Health Workers in Southern Arizona

Macroeconomic policies and increasing social-health inequality in Iran

Contact Info

Product

Resources

About