social determinants of health

social determinants of health

Objectives:

At the end of this activity, the student will be able to:

1. Identify social determinants of health present in assigned community (socioeconomic status, education, neighborhood and physical environment, employment, social support networks).

2. Identify healthcare resources that are available in the community.

3. Analyze actual health of the assigned community, utilizing resources to gather vital statistics, such as morbidity and mortality data.

4. Create a list of strengths and weaknesses of the community.

5. Prioritize weaknesses to identify the highest priority need of the community.

6. Identify community resources (actual, available resources or proposed resources) to address the highest priority problem.

7. Share community assessment and analysis in a formal, group presentation.

 

Course Outcomes

This activity aligns with several of the course outcomes as stated below:

1. Examine health delivery systems and resources available at the global, national, state, and local levels.

2. Examine effective methods for health promotion and health maintenance for individuals, families, and communities at every stage of development.

3. Analyze the environmental, biological, and psychosocial risk factors for disease and disability.

 

 

 

General Directions

 

Working in a small team, you will conduct a formal assessment of a community to which you have been assigned. The assessment will involve a walking or windshield survey which is validated and expanded upon through a deeper dive into demographic and health-related databases/websites available here:

https://researchguides.uic.edu/c.php?g=252323&p=1683295

 

 

Items Needed

 

· Digital camera/phone

· Map or layout of the neighborhood/community

· Mode of transportation (not needed if conducting walking survey)

· Masks if unable to practice social distancing

 

Part 1: Assessment

 

1. Your clinical group will be assigned a neighborhood to survey.

2. Review the Windshield Survey Components handout and PowerPoint (see Brightspace Lecture PPTS).

3. Review Community Tool Box resources for Windshield Survey:

https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/windshield-walking-surveys/main

4. Use Google Maps (or other navigation software) to identify boundaries of assigned area.

5. Collect assessment data on essential demographic and other aspects of the community using the guidelines below: [Support your assessment data with actual images/videos taken with your camera or available online]

 

The essential components of the Community Assessment are listed below:  

 

Race and Ethnicity: Data and/or a description of the community demographics for the community. Be sure to identify any specific data that helps support the existence of your identified health problem or that may impact your health promotion project. Evaluate the racial identity of the community (e.g. is the area well integrated?) Consider the following questions. Are there indices of ethnicity, various types of ethnic food stores, ethnic churches, private schools related to ethnicity, signs and information in a language other than English?

 

Culture : Analyze the cultural data and assess the cultural dynamics within the community that influence the community’s health beliefs or health status.

 

Religion :  Include the various types of churches and places of worship.  It would be beneficial to learn the number of available churches in the area, all of the different denominations and representation of differing religions, and the number of churches in a ratio comparison to the number of people in the community.

Politics :  Determine if the community is very swayed politically or is predominantly of one party affiliation.  Identify evidence of political activism, such as campaign signs, political billboards, or other evidence of political influence.

 

Boundaries:   You may include the street boundaries for the community, as well as any physical demarcation that defines the community boundaries:

· Is it a natural boundary such as a river or a lake?

· Is it a man-made boundary such as train tracks?

· Is there a noticeable difference in the socioeconomic level in comparison to neighboring communities?  Do the individual neighborhoods vary in socioeconomic status?

 

Housing and zoning:   You may want to evaluate the typical single family, multi-family, alternative housing, and assisted living type homes for the area.  A visual map showing the boundaries of the community is always helpful.  Make a note of whether or not the residences have a large number of real estate signs on them.  Supportive data could also include:

· any specific areas (and the size of the area) in which houses were in disrepair,

· how many homes were for sale

· how many single-family homes in comparison to multi-family dwellings or senior living complexes,

· average home market price,

· any data regarding proportion of young families with children compared to retirees

· any changes in residency, recent trends in real estate (are the new construction homes build where previous existing homes were torn down? Or was there still available space in this established community?)

 

Open Space:  Determine the open spaces throughout the community, including vacant lots, green spaces, undeveloped areas, nature areas, and parks.  Supportive data could also include:

· How many open spaces, parks, or green spaces are available?

· Does the community appear to be focused on open space availability, parks, divided streets with trees or landscapes parkways?

· Are there minimum lot sizes?

· How many of these parks and green spaces are park district owned?

· How many of these are City owned?

· How many of these are State owned? Forest preserve district owned?

· Are the people really utilizing the available spaces?

 

“Commons”:   Commons refers to areas or establishments in which people gather, socialize, spend leisure time, or use for recreation (e.g. walking, biking, and walking their dogs).  What are the most popular neighborhood hangouts and what subgroup(s) of the population are drawn to those particular places to hang out? Supportive data may include:

· The “closed” hang out places that may be unfriendly to strangers or newcomers?

· Is there any gang activity?

· Popular bars or nightlife?

· Places that draw younger people (Jr. High, high school)?

 

Safety: Is the community safe? Environmental aspects or physical aspects that may compromise safety (e.g. community decay, traffic safety issues, road and sidewalk accessibility and quality, crime rates, lighting, safe drinking water, air quality). How do the community safety issues impact your identified community problem or issue?

Signs of community decay:  Identify any areas of the community in which there is evidence of decline of resources, or community decay?

· Abandoned cars,

· Visible trash in the street,

· Levels of noticeable pollution,

· Abandoned houses, businesses, and unfinished structures (boarded up buildings),

· Increased numbers of homeless or panhandlers

 

Media: Identify the types of local media available for the community residents.  Does the town have its own paper?  Does the area have its own cable television station?  What types of magazines and print materials are circulated?  (These types of things you will usually find in the front of cafes and stores). Are they bilingual to needs of community?   Do you notice outdoor antennas or dishes?

 

Stores, Services and Service Centers:   Evaluate the service industry in the area including various stores and businesses within the community, social service agencies, community outreach programs, recreation centers, e.g. a local YMCA, and other service industries. The community health nurse should analyze access to food, fitness, and health services availability.

· What is your evaluation of the availability of resources/stores?

· Are there many fast food restaurants in comparison to healthier restaurants?

· Is this considered a food desert?

· Are there significantly more entertainment options (movie theaters, bowling alleys, etc.) than green space?

· Are there a high number of fitness and exercise service centers?

· What is your evaluation of the services available?

 

Schools: Describe the educational system for the community including public, private, and alternative schools. Supportive evidence is helpful for the community nurse to make assessments about the community.  Remember schools range from pre-schools to colleges and universities. Supportive data may include:

· How many schools are in the area and which level of student to they serve?

· How many private school options are there in this community? What types of private institutions are represented (religious affiliation, Montessori, academic driven)?

· What are the public schools rating/ranking?

· What is the high school graduation rate? How does it compare to the state or national averages?

 

Transportation: Include photos of cars, buses, trains, ferries, trolleys, bicycles, and pedestrians.  Photos of people utilizing the various types of transportation would be appropriate for your windshield survey.  Noting the safety measures (bike lanes, safe crosswalks, etc.) is helpful.   Which type(s) of transportation seems to be the most predominant in the community?

· Is the public transportation accessible and provide good transportation options for community residents?

· Where is the closest/local airport?

· What are the major highways that are close to the area?

 

Health Status of the Community : Evaluate the vital health statistics for the area. For example, note what mortality rates are. And morbidity rates for chronic conditions in particular.  Is there a specific health problem with a high incidence/prevalence rate in the community or a health problem within the community related to the environment (e.g. a problem of air pollution and high community rates of respiratory infection)? Is there high risk of non -communicable disease (e.g. Lead exposure)? Are there high risks of communicable diseases? (e.g. Tuberculosis; Covid-19)

 

Case Management: How is the community health presently being monitored? What current collaboration is taking place and what is required to provide continuity of care in the community treatment plan? What stakeholders can you identify? Include Federal, State, local, and private agencies that may be involved. Include the major hospitals and identified that medical/dental/vision/addiction services were readily available. Are there any collected statistics and data to show how readily available healthcare services are in the community? How are people with minimal or no insurance provided care or access to care?

 

Part 2: Analysis of Assessment Data

 

1. Based on your observations from the windshield survey, identify strengths of the community.

2. List and prioritize 5 potential community risk factors (weaknesses).

3. Identify community resources that may help address the highest priority weakness (either currently in existence or something you propose to help address this problem).

 

Part 3: Presentation

 

Create a presentation of your findings using the rubric below. The presentation should be visually appealing and well delivered, utilizing technology and media to convey the material.

 

Part 4: Peer Review/Compare and Contrast

1. BEFORE the due date, review the presentation of the other students in your clinical group.

2. Critically assess each other’s presentation and offer suggestions for improvement to meet all elements of rubric.

3. Compare your results with the results from the other section of your clinical group. Notice similarities and differences in categories assessed. Pay special attention to health outcomes (morbidity, mortality, incidence of disease) and demographic differences (race, ethnicity, income levels).

4. Summarize your comparison and provide a reflection on this experience (2 paragraphs minimum) to identify lessons learned.

5. Submit ALL sections (Parts 1-4) by assignment due date.

 

Grading Rubric:

Presentation Possible Points Points

Earned

Comments
Discusses each of the 15 elements succinctly Total of 75 points.    
Race and Ethnicity 5    
Culture 5    
Religion 5    
Politics 5    
Boundaries 5    
Housing and Zoning 5    
Open Space 5    
“Commons” 5    
Safety 5    
Media 5    
Stores, Service Centers 5    
Schools 5    
Transportation 5    
Health Status of the Community 5    
Case Management 5    
Community Strengths 5    
Community Weaknesses/Risk Factors 5    
Community resources to address highest priority risk factor 5    
Reflection on comparison of neighborhoods

· Health outcomes comparison (2.5)

· Demographic comparison (2.5)

5    
Presentation is professional, creative, logically organized, and clear in content. Reflection is provided. 2.5    
Correct APA formatting and citations, grammar, spelling. 2.5    
Total Points Possible 100    

[This activity is worth 20 clinical hours]

 
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