In order to achieve sustainable changes to policies, systems, and living environments that will allow all people to achieve their maximum possible health, professionals working in public health and many other sectors must gain an understanding of Public Health 3.0 (PH3.0) including its rationale and methods, and the skills for this new approach to their work.
A PH3.0 Lunch and Learn Workshop Series is proposed for this audience in order to increase their capacity to implement contemporary, intersectoral, equitable, transformative public health practices across a range of organizational settings. The workshop would be most suitable for mid-career professionals, but would also be informative for early career professionals and leadership. It will consist of a series of five 90-minute “lunch and learn” sessions intended to introduce the interrelated concepts health determinants, equity, and health in all policies. A pre/post evaluation will be conducted at registration and at the conclusion of the series.
After participating in the workshop, professionals will be prepared to:
Define common terminology used in addressing health, health determinants, and equity
Describe social determinants of health and equity (SDOHE) and Health in All Policies (HiAP) frameworks, tools, and associated metrics
Incorporate historical perspectives of various forms of structural and social determinants into mindset of action
Identify approaches to leveraging multi-sector partners and perspectives to advance health and equity
Identify evidence-informed approaches for framing the importance of SDOHE and the strategies for improving it
Recognize how policy, research, and practice can address SDOHE by engaging across sectors
Identify common goals and interrelated performance measures across sectors
Workshop Agenda
Content Outline
Part 1: Definitions and Background
Part 2: Systems View of Sectors
Part 3: Metrics and Measures
Part 4: Making the Case/Communications
Part 5: Putting Lessons into Action
Part 1: Definitions and Background
Definitions & Terminology
Frameworks for Health Equity and Social Determinants: Multiple frameworks will be presented and discussed.
Presentation on history – of the concept and action both within public health and deeper historical perspectives of injustice
Illustrations of equity – each breakout grou work with a different figure and discusses strengths and weaknesses in terms of definitions/frameworks presented earlier
Commission on Social Determinants of Health (CSDH), Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. 2008, World Health Organization: Geneva.
U.S. Department of Health and Human Services, Healthy People 2020.
Kawachi, I., A glossary for health inequalities. Journal of Epidemiology and Community Health, 2002. 56(9): p. 647
Penman-Aguilar, A., Talih, M., Huang, D., Moonesinghe, R., Bouye, K., & Beckles, G. (2016). Measurement of health disparities, health inequities, and social determinants of health to support the advancement of health equity. Journal of public health management and practice: JPHMP, 22(Suppl 1), S33. https://www.ncbi.nlm.nih.gov/pubmed/26599027
Time
Activity
Description
Associated Goal(s)
11:30
Session arrival
Facilitators should be online and welcome participants on arrival
12:00
Overview
Overview of the series and today’s agenda
1,2,3,6
12:05
Welcome
General welcome
12:10
Empty the cup activity
‘What’s up?’ pairs / reflective listening
12:20
Introductions of participants and facilitators
Introductions around the room (including facilitators). Timed to keep at 1 min or less per person. Name, position, and one icebreaker
6,7
12:40
Personal reflections on why you do the work you do
Facilitator call from participant list/cpo-facilitator take notes: Why are you here? What are some of the personal values that led to your work in public health? Thinking about the current issues present in your work, how are these values being violated?
6,7
12:55
Definitions
– Terminology – start with common definitions – Table discussion: Given your personal reflection from earlier, what is your reaction to these definitions? – Brief sharing of any insights with the room
1
1:10
Background on SDOHE
– Presentation on history – of the concept and action both within public health and deeper historical perspectives of injustice – Illustrations of equity
2,3
1:30
Adjourn
Part 2: Systems View of Sectors
Systems Thinking Primer: with examples from multiple sectors/topics, including consideration of unintended consequences
HiAP/HIA as a Systems Approach to SDOHE:
Introduction to Health in All Policies a
Introductory-level information to HiAP practice in the US:
Deep dive on HiAP examples and directly engaging with community members impacted by housing policy decisions. For reference see the following materials:
Engaging partners and stakeholder perspectives: What are participants’ experiences with convening? What happens when different perspectives come together? Build off previous table work to think through some specific ideas for identified stakeholders relative to table ‘issue’ – make point that there are likely other perspectives from within public health in addition to non-health perspectives that can enlighten approach
Exercise:
Systems exercise building off of simple stock and flow diagram to identify causes of causes within a topic of concern for each table. Considering where causes ‘fit’ in iceberg schematic, and then using that to identify who needs to be engaged and at what ‘level’ of intervention. Result is a systems-informed list of non-health sector stakeholders needed for action around social determinants. Some emphasis on implications of whom is engaged and how from equity perspective
Partner/Stakeholder discussion focused on strategies for engagement
Resources
Donella Meadows: Meadows, D. H. (2008). Thinking in systems: A primer. chelsea green publishing. https://wtf.tw/ref/meadows.pdf
Calancie, L., Anderson, S., Branscomb, J., Apostolico, A. A., & Lich, K. H. (2018). Peer Reviewed: Using Behavior Over Time Graphs to Spur Systems Thinking Among Public Health Practitioners. Preventing chronic disease, 15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798221/
Presentation: Systems thinking primer with examples from multiple sectors/topics, including consideration of unintended consequences
2,3,4
12:35
Exercise: Network Mapping
Network Mapping to Identify Stakeholders and Potential Partners
3,4,6,7
12:55
Engaging Partners
Full group discussion: Engaging non-traditional Stakeholders and Partners
4,6,7
1:10
HiAP/HIA Overview
HiAP/HIA Overview as a Systems Approach to SDOHE
2,4,5
1:30
Adjourn
Part 3: Metrics and Measures
Data, Disparities, and Determinants
Disaggregating data: How population health statistics can mask or reveal disparity/ inequity; The issue of large-scale aggregate data
Tracing disparities by geography, socioeconomic indicators, and other factors to distinguish inequitable distribution
Gaps between data availability and SDOHE research questions
Cases, rates, rankings, sourcing denominators
Case study
Discussion of limitations and advantages of different data sources and approaches to optimizing utility and accuracy
Trajectory of data sources that make it easier to identify inequities and social determinants.
Demonstrate ways that multiple data sources can be used in tandem to identify health needs under different circumstances.
EXERCISE: Metric(s) from another sector that has importance for you/your work –overlap with systems mapping exercise
Engaging Communities in Measurement: Community-based participatory research / citizen science – equity and empowerment
Community research partner guest speaker
Data Driven Action: How do you evaluate SDOHE efforts? Evaluating SDOHE efforts – measuring change in disparities, assessing change in communities.
Examples of evaluation considerations in process, impact, and outcome
Success in stakeholder engagement
Partnerships and sutainability
Equitable access to the intervention
Reducing rates vs closing gaps
Secondary and system effects
Evaluation frameworks from CDC guides, health in all policies initiatives, systems thinking, and others
Incorporating stakeholders and partners in evaluation
Time
Activity
Description
Associated Goal(s)
11:30
Session arrival
12:00
Overview
Introduction to Part 3
12:05
Welcome
General welcome
12:10
Empty the cup activity
Rename yourself
12:20
Data, Disparities, and Determinants
How population health statistics can mask disparity/inequity
2,3,6,7
12:35
Exercise: Cross-sector Measures
Metric(s) from another sector that has importance for your work – overlap with systems mapping exercise
1,2,4,6,7
12:55
Engaging Communities in Measurement
Community-based participatory research / citizen science – equity and empowerment
2,4,5
1:10
Data Driven Action: How do you evaluate SDOHE efforts?
Brief presentation and group discussion: Evaluating SDOHE efforts – measuring change in disparities, assessing change in communities.
2,5,6,7
1:30
Adjourn
Part 4: Making the Case/Communications
Identifying your audience
To get upstream, public health must connect with diverse decision-makers, across multiple levels – community, local, state and national.
How might health professionals vs. non-health professionals vs. general public vs. policy makers perceive messages or information differently?
Varied perspectives, values and political views, and many not explicitly connected to health
Evidence informed framing and terminology
How frames work and why we need to use them in communications
Choosing frames and language for different audiences
Frames to avoid: Any variation of equal, equality or equalizing; leveling playing field; creating balance; unjust/injustice; outrage; immoral; unconscionable.
Participants reflect on ways they’ve heard these concepts presented previously – for good or bad
Exercise: Framing results of your system map and metrics from previous sessions for your target audience
Facilitated full group discussion of stakeholders and settings they encounter, with guided discussion of categories and responses
1,5,6,7
12:35
Evidence-informed Framing
Presentation on framing and terminology
5,6,7
12:55
Audience Response
In breakout groups, discuss ways that different audiences may respond to provided communication sample Report out to full group with feedback
3,4
1:10
Exercise: Developing Messages
In groups, develop and practice messaging related to the system map and key metrics the participant worked on in previous sessions
1,5,6
1:30
Adjourn
Part 5: Putting Lessons into Action
Exercise: Applying these tools in your work – participants will spend most of this session identifying problems they need to solve within their organization, community, or projects. Colleagues or multisectoral dyads may work together. Participants will be placed into small affinity groups in order to discuss their ideas with peers.
Refined system map
Relevant metrics and evidence
Audience and messaging strategy
PH3.0 Tools
Based on exercise output, facilitators will highlight some HiAP and equity tools that may help participants take next steps
Synthesis:
Reflect on what was learned during the workshop and next steps
Time
Activity
Description
Associated Goal(s)
11:30
Session arrival
12:00
Overview
Introduction to Part 5
1-6
12:05
Welcome
General welcome
12:10
Empty the cup activity
‘What’s up?’ pairs / reflective listening
12:15
Review
Briefly review prior 4 sessions and describe exercise; identify affinity groups for breakout
2,3
12:25
Final Exercise
Work through process for individual goals Report out
6,7
1:00
PH 3.0 Tools
Presentation on tools, skipping to most relevant
2,3
1:10
Discussion
Full room reflection of what’s been learned and how it could change their practice
Healing Public Health 