Figure 1 - uploaded by Latrice Rollins
Content may be subject to copyright.
Application of the McKinlay Model for health promotion to policy by the TCC

Application of the McKinlay Model for health promotion to policy by the TCC

Source publication
Article
Full-text available
Health disparities have persisted despite decades of efforts to eliminate them at the national, regional, state and local levels. Policies have been a driving force in creat­ing and exacerbating health disparities, but they can also play a major role in eliminat­ing disparities. Research evidence and input from affected community-level stakeholders...

Contexts in source publication

Context 1
... McKinlay Model for Health Promotion, initially developed to promote healthy behaviors such as physical activity and nutrition, has been adapted for targeting the elimination of health disparities. 17,18 The TCC grounded its work in the McKinlay Model ( Figure 1) and applied this model to policy. The model identifies three levels of policy interventionthe individual level (downstream), the community level (midstream) and the societal/decision-makers level (upstream). ...
Context 2
... McKinlay Model for Health Promotion, initially developed to promote healthy behaviors such as physical activity and nutrition, has been adapted for targeting the elimination of health disparities. 17,18 The TCC grounded its work in the McKinlay Model ( Figure 1) and applied this model to policy. The model identifies three levels of policy interventionthe individual level (downstream), the community level (midstream) and the societal/decision-makers level (upstream). ...

Citations

... 19-22 24 25 Applying an equity lens to policies goes beyond disaggregating data by sociodemographics to considering 'social, behavioral, economic and environmental determinants, and (working) collaboratively with community stakeholders'. 26 Systematic reviews of population-level general tobacco control interventions and policies for youth and adults found a majority to have negative, mixed or unclear impacts on inequities. [27][28][29] This has led to calls to adopt an equity perspective to tobacco control policymaking 30 and use theory as a guide. ...
... The PROGRESS framework allows for the extension of analysis of prevalence data towards 'social, behavioral, economic and environmental determinants'. 26 Yet, even with the simple PROGRESS analysis, we found very little data that allow a determination of the impact of WTS policies on equity. Further, we found a disconnect between the equity indicators included in a policy and the prevalence data collected, and neither seemed to inform the other. ...
Article
Introduction The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take into consideration its specificities as a mode of smoking. In parallel, a growing body of literature points to the potential of evidence-based tobacco control policies to increase health inequities. This paper updates a previous global review of waterpipe tobacco policies and adds an equity lens to assess their impact on health inequities. Methods We reviewed policies that address WTS in 90 countries, including 10 with state-owned tobacco companies; 47 were included in our final analysis. We relied primarily on the Tobacco-Free Kids organisation’s Tobacco Control Laws website, providing access to tobacco control laws globally. We categorised country tobacco policies by the clarity with which they defined and addressed waterpipe tobacco in relation to nine FCTC articles. We used the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital) framework for the equity analysis, by reviewing equity considerations referenced in the policies of each country and including prevalence data disaggregated by equity axis and country where available. Results Our results revealed very limited attention to waterpipe policies overall, and to equity in such policies, and highlight the complexity of regulating WTS. We recommend that WTS policies and surveillance centre equity as a goal. Conclusions Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.
... The commitment of the AAP to the well-being of all children requires that it not only address a wide spectrum of adversities but, also, that it speak against public policies, social constructs, and societal norms that perpetuate the ongoing, chronic precipitants of toxic stress responses such as poverty 87,88 and racism 166 and for public policies that promote relational health, inclusion, and equity. 111,[188][189][190][191] ...
Article
By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.
... Empirical evidence suggests a central role for public policy in producing or shifting the drivers of inequity (8). There is also some evidence that targeted national policies have improved disparities in access and use of health services in the Americas (9)(10)(11). However, there is little agreement on whether good policy planning or effective programming is responsible for the documented advances. ...
Article
There is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.
... 11 Policies can help to mitigate health disparities and inform how long-standing and emerging health priorities are addressed. 13 National policies are the impetus for funding allocations and grant programs; they are toplevel statements that set priorities for action. However, it is unclear how current national policies in Australia address health disparities in people with CKD. ...
Article
Full-text available
Objective: To describe how the Australian Government Department of Health policies address equity in the management of chronic kidney disease (CKD). Methods: We searched the websites of the Australian Government Department of Health, Kidney Health Australia, Australian Indigenous HealthInfoNet and the National Rural Health Alliance for policies using the search terms: kidney, renal and chronic. Results: We included 24 policies that addressed groups of people that experience health inequities: 23 addressed Aboriginal and Torres Strait Islander peoples, 18 rural/remote communities, 12 low socioeconomic status groups, six culturally and linguistically diverse communities and four addressed gender disparities. The scope of the policies ranged from broad national frameworks to subsidised access to health services and medicines. Only two policies explicitly addressed equity for patients with CKD. Conclusion: CKD outcomes are highly variable across population groups yet Australian Government policies that address access to and the experience of care are limited in both number and their attention to equity issues. Implications for public health: In Australia, some groups of people with CKD have a substantially higher risk of mortality and morbidity than the general CKD population. We advocate for the development and implementation of policies to attain equity for people with CKD.
... Exploratory multivariable logistic regression analyses are used to quantify these inequalities, generate hypotheses, and provide guidance for future cascade research in Manitoba. In conjunction with future research to understand why identified inequalities exist across the cascade [6] and how these inequalities contribute to health inequities [13], our examination of the cascade through an equity lens [18,19] will provide Manitoba's provincial care program with evidence needed to develop patient-centred care plans that meet the needs of heterogeneous client subgroups, and to advocate for policy changes addressing inequities in HIV care across the province. ...
Article
Full-text available
Background Manitoba is a central Canadian province with annual rates of new HIV infections consistently higher than the Canadian average. National surveillance statistics and data from the provincial HIV care program suggest that epidemiological heterogeneity exists across Manitoba. New HIV cases are disproportionately reported among females, Indigenous-identifying individuals, and those with a history of injection drug use. Given the heterogeneity in acquisition, it is of interest to understand whether this translates into inequalities in HIV care across Manitoba. Methods A sample of 703 participants from a clinical cohort of people living with HIV in Manitoba, with data current to the end of 2017, was used to conduct cross-sectional, disaggregated analyses of the HIV care cascade to identify heterogeneity in service coverage and clinical outcomes among different groups receiving HIV care in Manitoba. Equiplots are used to identify and visualize inequalities across the cascade. Exploratory multivariable logistic regression models quantify associations between equity variables (age, sex, geography, ethnicity, immigration status, exposure category) and progression along the cascade. Adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) are reported. Results Equity analyses highlight inequalities in engagement in and coverage of HIV-related health services among cohort participants. Equiplots illustrate that the proportion of participants in each cascade step is greater for those who are older, white, non-immigrants, and report no history of injection drug use. Compared to those living in Winnipeg, participants in eastern Manitoba have greater odds of achieving virologic suppression (AOR[95%CI] = 3.8[1.3–11.2]). The odds of Indigenous participants being virologically suppressed is half that of white participants (AOR[95%CI] = 0.5[0.3–0.7]), whereas African/Caribbean/Black participants are significantly less likely than white participants to be in care and retained in care (AOR[95%CI] = 0.3[0.2–0.7] and 0.4[0.2–0.9], respectively). Conclusions Inequalities exist across the cascade for different groups of Manitobans living with HIV; equiplots are an innovative method for visualizing these inequalities. Alongside future research aiming to understand why inequalities exist across the cascade in Manitoba, our equity analyses can generate hypotheses and provide evidence to inform patient-centred care plans that meet the needs of diverse client subgroups and advocate for policy changes that facilitate more equitable HIV care across the province.
... Policy can have powerful effects on the complex, multisectoral factors that influence the population-level morbidity, mortality, and health disparities of these and other diseases. [1][2][3][4] Public health policy approaches comprise laws, regulations, incentive systems, or other standardized procedures and practices aimed at influencing institutional and individual behavior to improve health and health equity. 5,6 Laws and policies that were not designed to achieve health-related objectives also can have important, albeit unintended, health effects. ...
... This original research was sponsored by the National Institutes on Minority Health and Health Disparities (NIMHD) at NIH, through funding for the Transdisciplinary Collaborative Center (TCC) for Health Disparities Research at Morehouse School of Medicine under the leadership of Dr. David Satcher, Founder and Senior Advisor of the Satcher Health Leadership Institute and 16th Surgeon General of the United States. The TCC highlights collaborative and health policy innovations that address upstream and modifiable risks to attaining health equity [22][23][24][25]. The M-ACO will continue to explore and prioritize such interventions for testing and scaling across the ACO and similar practices serving high risk patient populations, including dual eligible Medicare beneficiaries. ...
Article
Full-text available
Accountable Care Organizations (ACOs) seek sustainable innovation through the testing of new care delivery methods that promote shared goals among value-based health care collaborators. The Morehouse Choice Accountable Care Organization and Education System (MCACO-ES), or (M-ACO) is a physician led integrated delivery model participating in the Medicare Shared Savings Program (MSSP) offered through the Centers for Medicare and Medicaid Services (CMS) Innovation Center. The MSSP establishes incentivized, performance-based payment models for qualifying health care organizations serving traditional Medicare beneficiaries that promote collaborative efficiency models designed to mitigate fragmented and insufficient access to health care, reduce unnecessary cost, and improve clinical outcomes. The M-ACO integration model is administered through participant organizations that include a multi-site community based academic practice, independent physician practices, and federally qualified health center systems (FQHCs). This manuscript aims to present a descriptive and exploratory assessment of health care programs and related innovation methods that validate M-ACO as a reliable simulator to implement, evaluate, and refine M-ACO’s integration model to render value-based performance outcomes over time. A part of the research approach also includes early outcomes and lessons learned advancing the framework for ongoing testing of M-ACO’s integration model across independently owned, rural, and urban health care locations that predominantly serve low-income, traditional Medicare beneficiaries, (including those who also qualify for Medicaid benefits (also referred to as “dual eligibles”). M-ACO seeks to determine how integration potentially impacts targeted performance results. As a simulator to test value-based innovation and related clinical and business practices, M-ACO uses enterprise-level data and advanced analytics to measure certain areas, including: 1) health program insight and effectiveness; 2) optimal implementation process and workflows that align primary care with specialists to expand access to care; 3) chronic care management/coordination deployment as an effective extender service to physicians and patients risk stratified based on defined clinical and social determinant criteria; 4) adoption of technology tools for patient outreach and engagement, including a mobile application for remote biometric monitoring and telemedicine; and 5) use of structured communication platforms that enable practitioner engagement and ongoing training regarding the shift from volume to value-based care delivery.
... 15 Important in this discussion, is the role of "health-in-all" policies to promote health equity, and the adaption of existing models to evaluate multilevel (ie, downstream, midstream, and upstream) policy interventions using a health equity lens. 16 Taken together, the Transdisciplinary Collaborative Center for Health Disparities Research embodies an innovative approach, T x ™, which moves research from translational to transformational, 17 and seeks to shorten the timeline to adoption and implementation in clinical and/or community settings. The center also recognizes the need to assess impact, by conducting participatory evaluations using research logic models, and evaluations of both processes and outcomes. ...
Article
Ethn Dis. 2019;29(Suppl 2):317-320; doi:10.18865/ed.29.S2.317.
Article
Background For informal carers of people with life-limiting illness, social welfare policy related to income support and housing has been associated with varied psychosocial issues, yet remains relatively under-explored. An intersectional approach offers potential to illuminate diverse experiences and implications. Aim To explore the way in which caring in the context of life-limiting illness is framed within welfare policy, to articulate inequities encountered by carers, and to identify policy and practice recommendations. Design The Intersectionality-Based Policy Analysis (IBPA) Framework was used to situate findings of a broader qualitative study. Setting/participants Data were collected via semi-structured interviews with participants who were bereaved carers ( n = 12), welfare workers ( n = 14) and palliative care workers ( n = 7), between November 2018 and April 2020, in an Australian region associated with socioeconomic disadvantage. Five elements of IBPA were applied to the products of analysis of this data. Results Use of the IBPA Framework revealed that representations of carers and causes of their welfare needs in policy were underpinned by several assumptions; including that caring and grieving periods are temporary or brief, and that carers have adequate capacity to navigate complex systems. Policy and processes had differentiated consequences for carers, with those occupying certain social locations prone to accumulating disadvantage. Conclusions This intersectional analysis establishes critical exploration of the framing and consequences of welfare policy for carers of people with life-limiting illness, presented in a novel conceptual model. Implications relate to intersectoral development of structural competency, responsiveness to structurally vulnerable carers in clinical practice, and needed policy changes.
Article
Objective: We provide guidance for considering equity in rapid reviews through examples of published COVID-19 rapid reviews. Study design and setting: This guidance was developed based on a series of methodological meetings, review of internationally renowned guidance such as the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for equity-focused systematic reviews (PRISMA-Equity) guideline. We identified Exemplar rapid reviews by searching COVID-19 databases and requesting examples from our team. Results: We proposed the following key steps: 1. involve relevant stakeholders with lived experience in the conduct and design of the review; 2. reflect on equity, inclusion and privilege in team values and composition; 3. develop research question to assess health inequities; 4. conduct searches in relevant disciplinary databases; 5. collect data and critically appraise recruitment, retention and attrition for populations experiencing inequities; 6. analyse evidence on equity; 7. evaluate the applicability of findings to populations experiencing inequities; and 8. adhere to reporting guidelines for communicating review findings. We illustrated these methods through rapid review examples. Conclusion: Implementing this guidance could contribute to improving equity considerations in rapid reviews produced in public health emergencies, and help policymakers better understand the distributional impact of diseases on the population.