Social Environment - The Guide to Community Preventive ...

1 Chapter 3 The Social EnvironmentEarly Childhood DevelopmentRECOMMENDED INTERVENTIONC omprehensive, Center-Based, Early Childhood Development Programs for Low-Income Children120 HOUSINGRECOMMENDED INTERVENTIONT enant-Based Rental Assistance Programs122 INSUFFICIENT EVIDENCE TO DETERMINE EFFECTIVENESS OF THE INTERVENTION*Mixed-Income Housing Developments125 Culturally Competent Health CareINSUFFICIENT EVIDENCE TO DETERMINE EFFECTIVENESS OF THE INTERVENTION*Programs to Recruit and Retain Staff Who Reflect the Cultural Diversity of the Community Served127 Use of Interpreter Services or Bilingual Providers for Clients with Limited English Proficiency128 Cultural Competency Training for Healthcare Providers130 Use of Linguistically and Culturally Appropriate Health Education Materials131 Culturally Specific Healthcare Settings132 Social environments lacking basic resources healthy food, safe housing,living-wage jobs, decent schools, supportive Social networks, access to healthcare and other public and private goods and services present the highestpublic health risk for serious illness and premature ,2 Understand-ing why this happens requires an ecologic approach to population health,one that recognizes that individuals and communities interact with theirphysical and Social health as a product, inpart, of Social conditions facilitates the identification of relationships be-tween Social determinants and health outcomes that may be amenable tocommunity *Insufficient evidence means that we were not able to determine whether or not the intervention Task force approved the recommendations in this chapter in 2000 2001.

2 The research on whichthe findings are based was conducted from 1966 to 2000. This information has been previously pub-lished in the American Journal of Preventive Medicine [2003; 24(suppl 3):12 79] and the MMWR Rec-ommendations and Reports series [2002; 51(no. RR-1):1 8].This book is out of print. For current reviews, visit fundamental premise of the Community Guide s Social environmentand health model (Figure 3 1) is that access to societal resources determinescommunity health of living, culture and history, socialinstitutions, built environments, political structures, economic systems, andtechnology are all societal resources that a population draws upon to sustainhealth. Patterns of exposure to risk vary among socioeconomic groups andare associated with a fundamental access to , whetherat the Community , family, or personal level, provides such resources asknowledge, money, power, and prestige, which can be used to avoid or bufferexposure to health risks.

3 Poverty, on the other hand, with all of its attendantburdens, also powerfully influences health status. An impoverished Social en-vironment is a potential source of stressors ( , high-crime neighborhood orjob scarcity) as well as resources ( , after-school programs or homelessshelters).6 8In this chapter, we focus on three broad areas of the Social environmentthat affect health: early childhood development, affordable housing, and cul-turally competent health care. These three topics, covering broad and essen-tial areas, represent just a small beginning of the review of evidence that inter-ventions can effectively address the Social conditions that influence AND RECOMMENDATIONS FROM OTHER ADVISORY GROUPST able 3 1 shows the goals and objectives outlined in Healthy People 20109forall three topics covered in this chapter: early childhood education, housing,The Social Environment115 Figure 3 framework illustrating the conceptual approach used in systematic reviews ofinterventions in the Social Environment to improve Community health.

4 (Reprinted from Am J Prev Med,Vol. 24, No. 3S, Anderson LM et al., Methods for conducting systematic reviews of the evidence ofeffectiveness and economic efficiency of interventions to promote healthy Social environments, p. 26,Copyright 2003, with permission from American Journal of Preventive Medicine.)This book is out of print. For current reviews, visit 3 Healthy People 20109 Goals and Objectives Directly Relevant to the Social Environment2010 ObjectivePopulation BaselineObjectiveEarly Childhood Development: Maternal and Child HealthIncrease the proportion of preg-Pregnant women74% (1998)90%nant women who receive early and adequate prenatal care (Objective 16 6b)Reduce:(Both 1998) low birthweight (LBW) (16 10a) very low birthweight (VLBW) (16 10b)Reduce the occurrence of devel-opmental disabilities per 10,000 people:(Both 1991 94) Mental retardation (16 14a)All131a124 Cerebral palsy (16 14b) Autism spectrum disorder Developmental(16 14c) Epilepsy (16 14d)DevelopmentalEarly Childhood Development: Educational and Community -Based ProgramsIncrease high school completion Adolescents/85% (1998)90%among 18- to 24-year-olds (7 1)young adultsHousing.

5 Educational and Community -Based ProgramsIncrease the proportion of Tribal American Indian Developmentaland local health service areas or communitiesjurisdictions that have estab-lished a Community health pro-motion program that addresses multiple Healthy People 2010 focus areas (7 10)Culturally Competent Health Care: Educational and Community -Based ProgramsIncrease the proportion of pa-AllDevelopmentaltients who report that they are satisfied with the patient educa-tion they receive from their healthcare organization (7 8)Increase the proportion of local Health Vary by health departments that have departmentsconditionestablished culturally appropri-ate and linguistically competent Community health promotion and disease prevention pro-grams (7 11)116 This book is out of print. For current reviews, visit culturally competent health care. Objectives and recommendations spe-cific to each topic are listed Childhood DevelopmentThe National Education Goals panel (created in 1994 by the Goals 2000: Edu-cate America Act) established a national priority for research in education:improve learning and development in early childhood so that all children canenter kindergarten prepared to learn and succeed in elementary and second-ary school.

6 Two goals of this panel are directly relevant 1 states that By the year 2000, all children in America will start schoolready to learn. 10 Two objectives toward achieving that goal are: (1) Childrenwill receive the nutrition, physical activity experiences, and health careneeded to arrive at school with healthy minds and bodies, and to maintainthe mental alertness necessary to be prepared to learn, and the number oflow-birthweight babies will be significantly reduced through enhanced pre-natal health systems; and (2) All children will have access to high-quality anddevelopmentally appropriate preschool programs that help prepare childrenfor school. Goal 2 was to increase the high school graduation rate to at least90% by the year Institute of Medicine s Committee on Capitalizing on Social Scienceand Behavioral Research to Improve the Public s Health issued correspondingThe Social Environment117 Table 3 ObjectivePopulation BaselineObjectiveCulturally Competent Health Care: Programs Using Communication to Improve HealthIncrease the proportion of per-AllDevelopmentalsons who report that their healthcare providers have satis-factory communication skills (11 6) Culturally Competent Health Care: Programs to Improve Access to Appropriate, Quality Mental Health ServicesIncrease the number of States, AllDevelopmentalTerritories, and the District of Columbia with an operational mental health plan that ad-dresses cultural competence (18 13)aChildren aged 8 years in metropolitan Atlanta having an IQ of 70 or aged 8 years in metropolitan book is out of print.

7 For current reviews, visit in of their nine recommendations apply toearly childhood education interventions: Recommendation 2: Rather than focusing on a single or limited number ofhealth determinants, interventions on Social and behavioral factors shouldlink multiple levels of influence ( , individual, interpersonal, institu-tional, Community , and policy levels). Recommendation 6: High-quality, center-based early education programsshould be more widely implemented. Future interventions directed at in-fants and young children should focus on strengthening other processes af-fecting child outcomes such as the home Environment , school and neigh-borhood influences, and physical health and FY 2000 2006 Strategic Plan of the Department of Housing andUrban Development12included four goals related to housing programs whoseaim is to reduce residential segregation by income. These goals and their cor-responding objectives are:Goal 1:Increase the availability of decent, safe, and affordable housing inAmerican : By 2005, the number of families with children, elderly house-holds and persons with disabilities with worst-case housing needs willdecrease by 30% from 1997 levels.

8 (Worst-case housing needsare definedas the needs of unassisted very-low-income renters who pay more thanhalf of their income for housing or live in severely substandard housing.)Goal 2: Ensure equal opportunity in housing for all : Segregation of racial and ethnic minorities and low-incomehouseholds will 3:Promote housing stability, self-sufficiency, and asset developmentof families and : The annual percentage growth in earnings of families in publicand assisted housing 4:Improve Community quality of life and economic : The share of households located in neighborhoods with extremepoverty low- and moderate-income residents, the share with a goodopinion of their neighborhood of public housing are more satisfied with their safety. (Note:For the purposes of this measure, a good opinion of the neighbor-118 Risk Behaviors and Environmental ChallengesThis book is out of print. For current reviews, visit is defined as a response of 7 10 on a 10-point scale assessing overall opinion of neighborhood.)

9 Culturally Competent Health CareIn March 2001, the Department of Health and Human Services Office of Mi-nority Health published National Standards for Culturally and LinguisticallyAppropriate Services in Health Care (CLAS).13 The CLAS standards were de-veloped to provide a common understanding and a consistent definition ofculturally and linguistically appropriate healthcare services. Additionally, theywere proposed as one means of correcting inequities in the provision ofhealth services and making healthcare systems more responsive to the needsof all clients. Ultimately, the standards aim to eliminate racial and ethnic dis-parities in health status and improve the health of the entire interventions selected for this review complement the recommendedCLAS standards for linguistic and cultural competency by examining the ex-tent to which meeting some of these standards results in improved processesand outcomes of used for the reviews are summarized in Chapter 10.

10 Specific meth-ods used in the systematic reviews of the Social Environment have been de-scribed elsewhere14and are available at logic framework depicting the conceptual approach used in reviews ofinterventions in the Social Environment to improve Community health is pre-sented in Figure 3 EFFICIENCYA systematic review of economic evaluations was conducted for all recom-mended interventions ( , those shown to be effective), and a summary ofeach economic review is presented with the related intervention. The meth-ods used to conduct these economics reviews are summarized in Chapter AND FINDINGSThis section presents a summary of the findings of the systematic reviewsconducted to determine the effectiveness of the selected interventions in thistopic area. Three areas were reviewed: early childhood development, hous-ing, and culturally competent health Social Environment119 This book is out of print. For current reviews, visit Childhood DevelopmentInfancy and early childhood are periods of opportunity for growth as well asvulnerability to in poverty can affect a child s cognitive andbehavioral development, which, in turn, affects readiness for ,17 Achild s readiness when starting school is related to motivation and intellec-tual performance in subsequent years and is therefore critical to establishinga trajectory for successful educational attainment.