Population-Focused Health Guidelines
National prevention strategy 7 priorities
-Tobacco Free Living -Preventing Drug Abuse and Excessive Alcohol use -Healthy Eating -Active Living -Injury and Violence Free -Living -Reproductive and Sexual Health -Mental and Emotional Well-Being
Mobilize
-What is the vision and mission of the coalition? -Why do I want to bring people together? -Who should be represented? -Who are the potential partners (organizations and businesses) in my community? Start by mobilizing key individuals and organizations into a coalition. Look for partners who have a stake in creating healthy communities and who will contribute to the process. Aim for broad representation. Next, identify roles for partners and assign responsibilities. This will help to keep partners engaged in the coalition. For example, partners can: -Facilitate community input through meetings, events, or advisory groups. -Develop and present education and training programs. -Lead fundraising and policy initiatives. -Provide technical assistance in planning or evaluation. we need stake holders and ppl w/ resources and influence
National prevention strategic directions
1. Healthy and Safe Community Environments; 2. Clinical and Community Preventive Services; 3. Empowered People; 4. Elimination of Health Disparities For each strategic direction and priority - specified set of actions to be taken by the federal gov't
USDA
29 Agencies and Offices Center for Nutrition Policy and Promotion -Dietary Guidelines Food and Nutrition Service -WIC -SNAP
Physical Activity Guidelines for Americans
4 Agencies: -DHHS, Office of Disease Prevention and Health Promotion -CDC -NIH -President's Council on Fitness, Sports & Nutrition Recommendations for ≥ 6 years of age 1st Edition - 2008
March 2014: Progress Update
4/26 (15.4%) indicators - met target or showed improvement Noteworthy Progress: -Fewer adults smoking cigarettes -Fewer children exposed to secondhand smoke -More adults meeting physical activity targets -Fewer adolescents using alcohol or illicit drugs
MAPP - Mobilizing for action through planning and partnerships
6-Phase Community-driven planning tool for improving community/population health: Organizing - identify and engage partners, begin planning process Visioning - develop a shared community vision Assessments - 4 main assessments -Community Themes and Strengths Assessment -How can we use a community's strengths to counteract its limitations? -Local Public Health System Assessment -Community Health Status Assessment -Forces of Change Assessment -Understand context and what influences policymakers -Saving controversial issues for when policymakers first get elected as opposed to at election time (if they vote a certain way, they may lose voters) Strategic Issues - using the findings from the assessment to identify priorities Goals/Strategies - set goals for the priorities and identify strategies for addressing issues Action Cycle - continuous/interactive: Planning, Implementation, Evaluation
Healthy People 2020 12 Topic Areas (26 Leading Health Indicators)
Access to health services Clinical Preventive Services Environmental Quality Injury and Violence Maternal, Infant and Child Health Mental Health Nutrition, Physical Activity and Obesity Oral Health Reproductive and Sexual Health Social Determinants Substance Abuse Tobacco
National Guideline Clearinghouse
Administered by Agency for Healthcare Research and Quality Publicly available site for clinical practice guidelines across multiple specialties Professional organizations
Women, Infants and Children (WIC) Supplemental Nutrition Program
Administered through USDA, Food and Nutrition Service Target Population: Low-income, nutritionally at-risk: -Pregnant women (through pregnancy and up to 6 weeks after birth or after pregnancy ends). -Breastfeeding women (up to infant's 1st birthday) -- huge incentive for women to continue breastfeeding -Non-breastfeeding postpartum women (up to 6 months after the birth of an infant or after pregnancy ends) -Infants (up to 1st birthday). -WIC serves 53 percent of all infants born in the United States. -Children up to their 5th birthday. Federal-based implemented through states; solely federally-funded
Assess
Assess both needs and assets (resources) in your community. This will help you get a sense of what you can do, versus what you would like to do. Work together as a coalition to set priorities. What do community members and key stakeholders see as the most important issues? Consider feasibility, effectiveness, and measurability as you determine your priorities. Start collecting state and local data to paint a realistic picture of community needs. The data you collect during the assessment phase will serve as baseline data. Baseline data provide information before you start a program or intervention. They allow you to track your progress. It is the nurses' responsibility to assess the community
Healthy People 2020 4 Overarching Goals/mission statement
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. We operationalize these goals through the objectives
2016 Further Research Priorities
Clinical Preventive Services That Deserve Further Research: Screening for Autism Spectrum Disorder in Young Children Screening for Chlamydia and Gonorrhea in Men Tobacco Smoking Cessation (Electronic Nicotine Delivery Systems) in Adults Vitamin Supplementation (Nutrients and Multivitamins) to Prevent Cancer and Cardiovascular Disease Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer Screening for Skin Cancer in Adults Evidence Gaps Relating to Specific Populations That Deserve Further Research: Screening for Breast Cancer in African American Women Screening for Cervical Cancer in Hispanic and African American Women Screening for Colorectal Cancer in African Americans and American Indians/Alaska Natives
Preventive Task forces and guidelines
Community Preventive Services Task Force U.S. Preventive Services Task Force
Dietary Guidelines for Americans
Every 5 years, required by law Joint - USDA and HHS USDA - Center for Nutrition Policy and Promotion (CNPP) Includes a Scientific Advisory Committee Food lobbyists have influence on how this report is made 8 versions since 1980 Current guidelines (8th edition) for 2015-2020 For ages ≥ 2 years Basis for federal food, nutrition, health programs and policies -School lunch programs Basis for federal nutrition education used to inform USDA and HHS food programs, such as USDA's National School Lunch Program and School Breakfast Program, which feed more than 30 million children each school day, and the Special Supplemental Nutrition Program for Women, Infants and Children, which uses the Dietary Guidelines as the scientific underpinning for its food packages and nutrition education program with about 8 million beneficiaries.
Supplemental Nutrition Assistance Program (SNAP) - "Food Stamps"*name changed in 2008
Federally funded, state-administered Low-income households Benefits: food, plants or seeds that grow food Not Allowed: alcoholic beverages, cigarettes or tobacco, house supplies, medicines, vitamins, pet foods or any non-food items.
implement
First, create a detailed workplan that lays out concrete action steps, identifies who is responsible for completing them, and sets a timeline and/or deadlines. Make sure all partners are on board with the workplan. Next, consider identifying a single point of contact to manage the process and ensure that things get done. Be sure to share responsibilities across coalition members. Do not forget to periodically: Bring in new partners for a boost of energy and fresh ideas. Check in with existing partners often to see if they have suggestions or concerns. Get the word out: develop a communication plan. Convene kick-off events, activities, and community meetings to showcase your accomplishments (and partners).
National prevention strategy
Headed by surgeon general Created through the Affordable Care Act Administered by the National Prevention Council, comprising 20 federal departments, agencies, offices
Healthy People
Initial report created in 1979 by the U.S. Public Health Service/Surgeon General The initial pop. health guideline Managed by the Office of Disease Prevention and Health Promotion (ODPHP) within DHHS -Collaborative effort involving many federal agencies -Public comment/input with the release of new draft reports Current Report: Healthy People 2020 -Released in 2010 - 10 year goals HP predates the NPS, but is a foundational resource for the strategic directions and priorities
MyPlate
Launched by First Lady Michelle Obama in June 2011, MyPlate is part of a larger communication initiative based on the 2010 Dietary Guidelines for Americans with the goal of helping consumers make better food choices.
Center for Nutrition Policy and Promotion (CNPP)
Major Projects -Dietary Guidelines for Americans -MyPlate initiative -Formerly MyPyramid, Food Guide Pyramid -SuperTracker -Healthy Eating Index
Federal agencies aligned with the NPS
Many non-traditional health partners
Current challenges for the National Prevention Strategy
Must survive external challenges from political opponents, as well as those looking for cost savings -Must be framed as a strategy for containing costs -May be more expensive short term, but how do we save money long-term? -Moved to the Office of the Surgeon General Must sustain the commitment and participation of the relevant federal agencies -Incentives for participation Must move beyond a narrow definition of prevention to further expand attention to health within non-health agencies (addressing the multiple, social determinants of health) -Incentives for participation and funding of programs in these agencies -Health in all policies and how do we get them involved This has been called the health care slush fund
Track/evaluate
Plan regular evaluations to measure and track your progress over time. Consider partnering with a local university or state center for health statistics to help with data tracking. Some things to think about when you are evaluating data over time: Data Quality: Be sure to check for standardization of data collection, analysis, and structure of questions. Limitations of Self-Reported Data: When you are relying on self-reported data (such as exercise frequency or income), be aware of self-reporting bias. Data Validity and Reliability: Watch out for revisions of survey questions and/or the development of new data collection systems. This could affect the validity of your responses over time. (Enlist a statistician to help with validity and reliability testing.) Data Availability: Data collection efforts are not always performed on a regular basis. This is important because if you need funding/support, you will need to be able to explain how you will evaluate the progress/efficacy of your interventions
U.S. Preventive Services Task Force guidelines
Recommendations for Primary Care Practice operates at the individual level Established in 1984 Since 1998, the Agency for Healthcare Research and Quality (AHRQ) has been authorized by the U.S. Congress to convene the Task Force and to provide ongoing scientific, administrative, and dissemination support to the Task Force Independent panel of nationally recognized, non-federal researchers experienced in primary care, prevention, evidence-based medicine, and research methods; Member disciplines: family medicine, internal medicine/geriatrics, preventive medicine, pediatrics/adolescent medicine, Ob/Gyn, nursing, counseling/behavioral medicine, public health, and health policy. They are not bureaucrats in Washington... Charged by Congress to: Review the scientific evidence for clinical preventive services and Develop evidence-based recommendations for health care providers --> considered by many to be the gold standard for clinical preventive services Provide an annual report to Congress that identifies critical evidence gaps in research related to clinical preventive services and recommends priority areas that deserve further examination. Medicare/caid/insurance companies may choose to only pay for evidence-based care
WIC benefits
Supplemental nutritious foods Nutrition education and counseling at WIC clinics Screening and referrals to other health, welfare and social services
The community Guide: Methodology and Ratings
Systematic Review, including an economic evaluation RATINGS: RECOMMENDED - strong or sufficient evidence that the intervention is effective. The categories of "strong" and "sufficient" evidence reflect the Task Force's degree of confidence that an intervention has beneficial effects. They do not directly relate to the expected magnitude of benefits. The categorization is based on several factors, such as study design, number of studies, and consistency of the effect across studies RECOMMENDED AGAINST - strong or sufficient evidence that the intervention is harmful or not effective. INSUFFICENT EVIDENCE - available studies do not provide sufficient evidence to determine if the intervention is, or is not, effective. This does NOT mean that the intervention does not work. It means that additional research is needed to determine whether or not the intervention is effective. Task Force findings may include a rationale statement that explains why they made a recommendation or arrived at other conclusions. The majority of studies are rated as insufficient evidence, but it doesn't mean you should not do it; it just means we aren't definite that it will work -This could be due to Wrong population or non-specific to a certain population
Community Preventive Services Task Force guidelines
The Guide to Community Preventive Services: The Community Guide operates at the population/community level Collection of evidence-based findings to promote community/population health Administered by the Community Preventive Services Task Force Established in 1996 an independent, nonfederal, unpaid panel of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and policies to improve health. Its members represent a broad range of research, practice, and policy expertise in community preventive services, public health, health promotion, and disease prevention. The fifteen Task Force members are appointed by the Director of the Centers for Disease Control and Prevention (CDC).
how WIC is delivered
WIC is a Federal grant program Congress authorizes a specific amount of funds each year operates through 1,900 local agencies in 10,000 clinic sites, in 50 State health departments, 34 Indian Tribal Organizations, the District of Columbia, and five territories (Northern Mariana, American Samoa, Guam, Puerto Rico, and the Virgin Islands) WIC participants receive checks or vouchers to purchase specific foods each month -Have to get monthly check ups to receive benefits Limited amount of funds Specific foods purchased through WIC - promotes better nutrition habits and diet quality
Plan
What is our goal? What do we need to do to reach our goal? Who will do it? How will we know when we have reached our goal? A good plan includes clear objectives and concrete steps to achieve them. The objectives you set will be specific to your issue or community; they do not have to be exactly the same as the ones in Healthy People 2020. Consider your intervention points. Where can you create change? Think about how you will measure your progress. How will you know if you are successful?
Physical Activity Guidelines for Americans - 2nd edition underway
Winter 2015/2016 - HHS solicited nominations for the Physical Activity Guidelines Advisory Committee Summer 2016 - Committee members are appointed, The Committee holds its first public meeting, Review of current scientific evidence begins, Public comment database is opened Fall 2016 to Winter 2016/2017 - The Committee holds additional public meetings, The Committee reviews current scientific evidence Winter 2017/2018 - The Committee issues its scientific advisory report to the HHS Secretary, The Committee's scientific advisory report is available to public for comment Winter 2017/2018 to Summer 2018 - HHS considers the Committee's scientific recommendations and public and agency comments, HHS prepares the second edition of the Physical Activity Guidelines Late 2018 - HHS releases the Physical Activity Guidelines for Americans, 2nd Edition 2018 and Beyond - The updated recommendations from the second edition of the Guidelines are implemented in federal initiatives, programs, and resources such as Let's Move! initiatives; physical activity data collection and monitoring; and Healthy People national public health objectives
Healthy Eating Index (HEI)
a measure of diet quality that assesses conformance to federal dietary guidance. USDA's primary use of the HEI is to monitor the diet quality of the US population
SuperTracker
a visually appealing, comprehensive, state-of-the-art resource designed to assist individuals as they make changes in their life to reduce their risk of chronic disease and maintain a healthy weight. Consumers can choose a variety of features to support nutrition and physical activity goals: personalize recommendations for what and how much to eat and amount of physical activity; track foods and physical activity; customize features such as recipes, goal setting, virtual coaching, weight tracking, journaling; and measure progress with comprehensive reports.
What are some of the greatest challenges in assuring the success of the National Prevention Strategy (check all that apply): a. Funding cuts b. Lack of collaboration across agencies c. Assuring the appropriate collaboration to address the multiple determinants of health, particularly those determinants not traditionally considered part of healthcare. d. Its overlap with Healthy People 2020.
a. Funding cuts b. Lack of collaboration across agencies c. Assuring the appropriate collaboration to address the multiple determinants of health, particularly those determinants not traditionally considered part of healthcare.
A public health nurse is working with the City Council and the County Board of Health to assure safe pedestrian and bike pathways for the downtown business district of Town Y. This nurse is addressing which of the Healthy People 2020 goals? a. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. b. Achieve health equity, eliminate disparities, and improve the health of all groups. c. Create social and physical environments that promote good health for all. d. Promote quality of life, healthy development, and healthy behaviors across all life stages.
c. Create social and physical environments that promote good health for all.
Through an extensive database assessment of the county, the public health county nurse manager has identified that his county has higher rates of chlamydia (a common sexually transmitted disease (STD)) among 10-17 year olds than any neighboring county or the state. His next step to begin to address this issue should be to: a. Find out what kind of sex and health education is offered in the middle and high schools. b. Place STD education brochures in all the pediatrician offices in the county. c. Mobilize key partners in the community who are important stakeholders in addressing STDs among children and adolescents. d. Plan to offer after-hours clinic appointments for adolescents to get screened and treated in the health department.
c. Mobilize key partners in the community who are important stakeholders in addressing STDs among children and adolescents.
