VIPP Social determinants of health

Access to healthcare:

Goal 1: Improve Access to and Utilization of Health care, Including Behavioral Health care 

Most Utahns will need some kind of health care during their life. Unfortunately, health care is unaffordable for many Utahns. Health insurance coverage covers all or some costs of care and protects people from very high expenses. People with health insurance are more likely than people without health insurance to regularly visit a primary health care provider and to have routine preventive care. Those without health insurance coverage and those who are under-insured often have to delay seeking care and find services difficult to afford.  Additionally, those living in poverty are at especially high risk for delaying care for conditions that eventually lead to hospitalization. Because these delays are associated with longer hospital stays and potentially poorer health outcomes, interventions that reduce delays are especially important.

According to the Centers for Disease Control and Prevention’s technical packages on the prevention of violence, the following are the evidence-based, evidence informed, or promising approaches for increasing access to health care. Support policy changes that improve access and utilization of health care, including behavioral health care, early intervention, and health education.

Approaches

1. Strengthen access and delivery of suicide care.

  • Coverage of mental health conditions in health insurance policies.
  • Reduce provider shortages in underserved areas.
  • Enhanced primary care.
  • Coverage of mental health conditions in health insurance policies.

2. Intervene to lessen harms and prevent future risk 

  • Post-vention.
  • Safe reporting and messaging about suicide.
  • Hospital-community partnerships.
  • Treatment to prevent problem behavior and further involvement in violence.

3. Support victims/survivors to lessen harms

  • Victim-centered services.
  • Patient-centered approaches.
  • Treatment and support for survivors of interpersonal violence, child  maltreatment, and teen dating violence.
  • Treatment to lessen harms of violence exposures.
  • Treatment for sexual violence victims.
  • Treatment for at-risk children/families to prevent problem behavior including sex offending.
  • Treatment to lessen harms of abuse and neglect exposure.

4. Connect injury survivors with resources

Success is:

  • Increasing the proportion of Utahns who report having medical insurance.
  • Decreasing the proportion of Utahns unable to access health care due to cost.
  • Increasing the proportion of Utahns with a usual primary care provider.
  • Decreasing the number of preventable hospital admissions.

Community connectedness:

Goal 5: Promote individual, family, and community connectedness

Connectedness encompasses both family connection and support, as well as community violence. Connectedness is a shared protective factor across suicide, falls, substance abuse, motor vehicle, interpersonal violence, child maltreatment, and traumatic brain injury topic areas.

Evidence-based or evidence informed approaches to promote individual, family, and community connectedness:

1. Conduct mentoring programs.
2. Develop after-school programs.
3. Conduct peer norm programs.
4. Hold community engagement activities.

Success is:

  • Increase the number of days that a family eats together.
  • Increase the proportion of residents living in same neighborhood for 5 or more years.
  • Decrease the number of poor mental health days in the past 7 days.
  • Increase the percentage of registered voters voting in last election.
  • Increase the number of civic, social, religious, political, and business organizations per 10,000.

Physical environment:

Goal 4: Enhance the physical environment to improve safe and healthy living

The Physical Environment consists of both the natural environment and the built environment. The physical environment profoundly affects health and safety from the air we breathe and water we drink, to the transportation and infrastructure to which we have access. Considering the physical environment in our injury and violence prevention work opens up many opportunities to be creative and to collaborate with non-traditional partners in meaningful ways that can help improve health and safety for whole communities and populations.

Approaches

Evidence-based or evidence informed approaches to enhance the physical environment to improve safe and healthy living:

1. Modify the physical and social environment.
2. Reduce exposure to community-level risks through environmental approaches.
3. Street outreach and community norm change.
4. Improve school climate, safety, and monitoring in schools.
5. Improve organizational policies and workplace climate.
6. Modify the physical and social environments of neighborhoods.
7. Reduce access to lethal means among persons at risk for suicide or violence.
8. Organizational policies and culture.

Success is:

  • Decreasing the number of violent crime per 100,000 people.
  • Decreasing the proportion of days where air quality is >100 μg/m3.
  • Decreasing the average commute hours per year.
  • Increasing the number of workers commuting by walking, cycling or transit.
  • Increasing the percentage of the population living within 1⁄2 -mile of a park, beach, or open space greater than 1 acre.
  • Increasing the number of civic, social, religious, political, and business organizations per 10,000 people.
  • Decreasing the proportion of the population lacking adequate access to food.
  • Decreasing the percentage of low-income households who do not live close to a grocery store.

Social norms:

Goal 3: Encourage social norms that promote safety and health

Social norms are the values, beliefs, attitudes, and/or behaviors shared by a group of people. Social norms vary by social group, and individuals may alter their behavior to conform to different groups. Social norms can protect against violence, but they can also encourage violence. For instance, cultural acceptance of violence, either as a normal method of resolving conflict or as a usual part of rearing a child, is a risk factor for all types of interpersonal violence.

The social norms approach to health promotion assumes that people have misperceptions of the attitudes and behavior of others in their peer groups or communities. For example, a perception might be that most adolescents in Utah vape nicotine, but the data show us that only 12.4% of Utah adolescents actually vape. This misperception may be used by individuals to justify vaping thereby increasing the prevalence.

Additionally, people are less likely to speak out against a perceived norm, reinforcing social tolerance of it. The social norms approach seeks to correct these misperceptions by giving people a more realistic sense of the actual social norms in the community. Social norms approaches such as bystander interventions have also reported some success in changing the attitudes of male peer groups towards risky sexual behaviors.

Approaches

Evidence-based or evidence informed approaches to enhance the physical environment to improve safe and healthy living:

  1. Change misperceptions about community social norms through education.
  2. Increase access and utilization of peer norm programs.
  3. Provide campaigns to support parents and positive parenting.
  4. Encourage policies shown to reduce corporal punishment.
  5. Bystander approaches.
  6. Mobilizing men and boys.
  7. Trauma informed approach.
  8. Street outreach.
  9. Community norms change programs.
  10. Enhance primary care to include screening assessments (eg, SEEK).
  11. Ensure services are victim-centered.
  12. Continue effective treatment modalities with affected clients.

Success is:

  • Increase the number of community organizations per 100,000 population.
  • Decreasing the proportion of days where air quality is >100 μg/m3.
  • Increase the High School cohort graduation rate.
  • Increase the percentage of registered voters voting the last election.
  • Decrease the percentage of children who report neglect or physical/sexual abuse.