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Community as a Unit of Change
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- 2. Enter into thechat: Your name, a community you belong to Have you joined any new communities since the COVID-19 outbreak? Mack Giancola As the Program Manager for Comprehensive Cancer Control at LSU Health New Orleans, Chair of the Louisiana Healthy Communities Coalition (LHCC), and Outgoing Chair of the NationalAssociation of Chronic Disease Directors – Cancer Council, I have dedicated my 12+ years of public health experience and expertise to working alongside communities to improve health outcomes. My vision as a citizen, a leader, and as a researcher, is to develop and sustain the structural and human dimensions of systems such that they can continue to adapt beyond a singular complex problem. Introductions
- 3. What is Public Health? IntheChat:Why are you learning public health? “The science and art of preventing disease, prolonging life, and promoting physical and mental health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery, which will ensure to every individual in the community a standard of living adequate for the maintenance of health.” -CEAWinslow
- 4. Overview I. Part I I.Case: Louisiana Healthy Communities Coalition II. LHCC as Action Research III. Questions II. Part II I. Background of Community and Public Health II. OrganizingCommunities for Healthier Outcomes III. Competencies for Advancing Healthy Communities IV. Questions? III. Part III I. Complex Adaptive Systems II. MAPP III. Questions?
- 5. Healthy Communities, Healthy Louisiana! Mission: Support healthy,thriving communities by mobilizing them to develop and implement policy, systems and environmental changes. Given that tobacco remains the leading cause of preventable death in the world, and nearly 3 million Louisiana residents are overweight or obese, LHCC aims to stem the tide of tobacco- and obesity-related death and disease to achieve our mission and vision.
- 6. In chat: What arethe behavioral and Environmental Factors mostly called?
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- 8. Poor Health Outcomes Tobacco 20.5%(Almost 1 million) 45% of cancers: tobacco- related Costs LouisianaTaxpayers: $2 BILLION / yr 30 Comprehensive SFOs 27+% of the state now protected by SFOs
- 9. Poor Health Outcomes Obesity 36.8%(1.6 million)+ 35% Overweight (>3.5million) Complete Streets 11-17 (2017-2020) 45% of Louisianans have more than 1 sweetened drink per day Daily Fruits andVeggies (2018): 48% (Fruits), 64.5% (veggies) “Whites are nearly 20 percentage points more likely to eat vegetables on a daily basis than blacks”-BRFSS
- 10. LHCC Strategies 27% 55% 9% 9% Grant Distribution Built Environment FoodSystems Tobacco Other • Mini-Grants • Statewide Leadership and Connection • Communications • Annual Summit
- 11. Mini-Grants Example! Chat Box:What observationsdo you have about this intervention? What aspects of community does it influence? Of health?
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- 13. Statewide Team 2020 NameOrganization Shawna Shields Louisiana Public Health Institute Jamila Freightman LSUAgCenter Jessica Kemp Center for Planning Excellence Rene Mixon Louisiana Department of Health,Chronic Disease Program Bryan Hanaki Louisiana HealthcareConnections John O’Donnell LHCC Network Manager Gina Legarde Louisiana Department of Health, Regional MedicalOfficer Mikal Giancola Louisiana Cancer Prevention and Control Programs, LSU Health Sciences Center Laura Ricks Louisiana Cancer Prevention and Control Programs, LSU Health Sciences Center Taffy Morrison Louisiana Department of Health Stephanie Guillory American Cancer Society-Cancer Action Network (ACS-CAN) Ashley Gothard Louisiana Department of Health Rodney Anthony TakingAim at Cancer Louisiana Michelle Kendall Louisiana Cancer Prevention and Control Programs, LSU Health Sciences Center Rosa Martinez Louisiana Cancer Prevention and Control Programs, LSU Health Sciences Center Getting Things Done
- 14. Research and LHCC Use evaluationframeworks to understand and describe relationships in the system as opposed to isolated variables (Asada et al 2018).
- 15. Research Design What outcomes,including interim or process outcomes, do stakeholders perceive as successful & leading to structural (PSE) changes? What contributes to more successful outcomes? Action Research, Developmental Evaluation Positionality, Research Paradigm, Driving Systems Change Using mini-grantees as a sampling frame stratified by outcome (intended, unrealized, emergent) Outcome Harvest (Contribution vs Attribution) Discover unintended outcomes; outcomes unique to systems Sequential, mixed methodology (qualitative, quantitative, and integrated, Multi-case design, cross case analysis Document reviews, key informant interviews, observational data Research interventions already known to have a public health impact (e.g. complete streets, tobacco policy) in the context in which they occur to better translate action elsewhere (Honeycutt et al, 2015)
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- 17. Background: Community and Public Health Defining Community 1.Functional special units meeting basic needs for sustenance 2. Units of patterned social interaction 3. Symbolic units of collective identity
- 18. Why community as a focusof change? “The Public Health System is in Disarray” (IOM, 1988) Decades of US history of PH as health services delivery John Snow’s efforts were in urban planning waste and infrastructure Plague control- government intersection of merchants, government and transportation Roman aqueduct and water management Cross-sector collaboration University-Community Partnerships Turning point (RWJF, Kellogg Foundation, etc) Coalitions as a means of community organizing Creation of a public health system with standards
- 19. Background -CommunityCoalition ActionTheory -DirectActionOrganizing -Collective Impact -Faith Based -LaborUnions -NAESMcurrently recommends partnering with community development (historic redlining)
- 20. Researching Community Researcher Goals doingCommunity Research (Researcher Positionality)? Community Based Participatory Research Evaluating capacity, coalitions, engagement, and ultimately population outcomes for some projects Practice Based Networks, etc. Ethical Concerns? Community Research Fatigue
- 21. Part III: MAPP “Ifyou have seen one health department, you have seen one health department.” –Patrick Lenihan, Phd, MUPP Public Health in Practice MobilizingAction for Planning and Partnerships Competencies for Community Change Community as a Complex Adaptive System
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- 23. MAPP Public Health Accreditation Board (PHAB)forstate and localhealth departments State Health Assessments &State Health Improvement Plans
- 24. Public Health’s Role: Research andPractice Public Health 3.0- “The 21st Century Public Health Practitioner as ‘Chief Health Strategist.’” – Dr. KarenDeSalvo The Art of Public Health Adaptive Leadership Strategic Management* SystemsThinking* *PH-WINS Survey, 2019
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Editor's Notes
- #9 https://www.cdc.gov/mmwr/volumes/65/wr/mm6507a1.htm#T1_down http://ldh.la.gov/assets/oph/Center-PHI/BRFSS/Louisiana_BRFSS_Report_2017.pdf
- #10 https://www.cdc.gov/mmwr/volumes/65/wr/mm6507a1.htm#T1_down http://ldh.la.gov/assets/oph/Center-PHI/BRFSS/Louisiana_BRFSS_Report_2017.pdf
- #13 Slide 9 Our communications chair, Laura ricks has done a great job getting our website, healthylouisiana.org up; Our facebook page posts regular content and has ongoing engagement with 847 likes And Lake Charles, LA, with a lot of work put in by John O’Donnell, became featured on the CDC website as a success story for its complete streets policy