Department of Public Health Leadership and Practice, Gillings School of Global Public Health (Dr Johnson), Department of Health Policy and Management (Drs Wiesman and Hassmiller), Department of Maternal and Child Health (Dr Cilenti), Gillings School of Global Public Health (Ms Oruganti), University of North Carolina School of Social Work (Dr Jensen), The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Public Health Manag Pract. 2024;30(6):823-831. doi: 10.1097/PHH.0000000000001938. Epub 2024 Sep 10.
The Public Health 3.0 (PH3.0) framework encourages local health departments (LHDs) to address the social determinants of health (SDOHs) that impact health equity.
This study sought to understand how often LHDs are working to address SDOH, which SDOHs are most often being addressed, as well as the mix of strategies that have been proposed to address this work.
We reviewed recent Community Health Improvement Plans (CHIPs) to analyze the current involvement of LHDs in addressing SDOH.
CHIPs published from 2020.
Accredited LHDs from across the United States (n = 80).
We developed a qualitative guidebook to characterize CHIP strategies based on the SDOH domain they addressed and the strategic mechanism they proposed.
Across our entire sample, CHIPs were roughly 1.5 times more likely to address Health Care Access than Food Insecurity and Access to Healthy Food (65%), Neighborhood Infrastructure (61%), or Affordable Housing (65%), and they were 3 to 4 times more likely to address Health Care Access than Safe Housing (23%), Education Access and Quality (31%), or Economic Stability (24%). Across all major domains, a few concerned policy changes and a handful focused on improving systems or developing the built environment. Most strategies focused on service provision through events or the education of the public and professionals on health-related topics.
The results of this study demonstrate that not all SDOHs are addressed equally by LHDs within their CHIPs. There is significant variation in how SDOHs are addressed along at 2 dimensions: first, in the likelihood that a CHIP addresses the domain and, second, in the mechanism by which each domain is addressed. Practically, the list of strategies we documented from the 80 CHIPs included in our sample may serve as the basis for strategies that other communities may wish to consider when addressing SDOH.
公共卫生 3.0（PH3.0）框架鼓励地方卫生部门（LHD）解决影响健康公平的健康社会决定因素（SDOH）。
本研究旨在了解 LHD 解决 SDOH 的频率、最常解决的 SDOH 以及提出的解决这一问题的各种策略。
我们审查了最近的社区健康改善计划（CHIP），以分析 LHD 目前在解决 SDOH 方面的参与情况。
CHIP 发布于 2020 年。
来自美国各地的认证 LHD（n=80）。
我们制定了一个定性指南，根据他们所解决的 SDOH 领域和提出的战略机制来描述 CHIP 策略。
在我们的整个样本中，CHIP 解决健康保健获取问题的可能性是解决食品安全和获取健康食品（65%）、社区基础设施（61%）或负担得起的住房（65%）的大约 1.5 倍，解决健康保健获取问题的可能性是解决安全住房（23%）、教育机会和质量（31%）或经济稳定（24%）的 3 到 4 倍。在所有主要领域，有一些关注政策变化，有一些则专注于改善系统或发展建筑环境。大多数策略都侧重于通过活动提供服务，或对公众和专业人士进行与健康相关的主题教育。
这项研究的结果表明，并非所有的 SDOH 都在 LHD 的 CHIP 中得到平等解决。在 CHIP 中，SDOH 的解决方式存在显著差异，具体表现在两个维度上：首先，CHIP 是否解决该领域的问题，其次，每个领域的解决机制。实际上，我们从样本中的 80 个 CHIP 中记录的策略清单可能成为其他社区在解决 SDOH 时可能希望考虑的策略的基础。
