What Works? Social and Economic Opportunities to Improve Health For All Review

Posted Monday November 05, 2018 by healthgap



By Jude Luke, Center for Closing the Health Gap

To improve the lives of those in our communities, change must occur. Specifically, change that affects the social and economic structures that underlie communities can bring about an improvement in the lives of residents. The truth, however, is that there is no one strategy that can bring about the changes needed in a community to make the lives of everyone better. Rather, a conjoined effort to address social and economic efforts, which often are overlooked, is essential. The What Works? paper outlines steps towards improving three main facets of communities: Employment, Education, and Social Support

Why are these three domains of great interest for improving communities? Social and economic opportunities are key to living long, healthy lives. Individuals with an education live longer, healthier lives, and this effect is observed to even pass on to children. Income and health have very strong correlations with each other. Employment, the source of income, provides a range of choices in factors like housing, food, and child care which are essential in supporting healthy lifestyles. Social support is also essential to good health. Individuals with more support and communication with others tend to live longer and have more access to support/resources during times of need. In this review paper, key initiatives in each of these three domains will be expanded upon and explored.

How do we improve educational opportunities? Improving early childhood education by providing universal pre-kindergarten (SS) is one option. Universal Pre-K is offered to all 4 year old children within a state, regardless of family income. The program enrolls a variety of students and is proven to lead to increased cognitive skills, academic achievement, and a reduction in academic disparity. Additionally, universal prekindergarten programs already employed in Oklahoma and Georgia have proven to be extremely effective for minority/low-income children and financially beneficial for these children’s families [1].

To have successful students, schools have to sustain environments that support learning. One option to achieve this goal is a school breakfast program (SS). Breakfast programs offer students a balanced breakfast that is accessibly served in hallways before the school day begins. Low income students who qualify for the program are eligible to access free or reduced-cost breakfast, and the schools receive subsidies for each breakfast served. Breakfast programs have been shown to reduce disparity, provide increased food security, higher academic achievement, and better nutrition for students. Additionally, school breakfast programs have been implemented successfully across the nation, with low-income students reaping most of the benefit of this program [2].

When examining how to increase high school graduation rates, an option to consider is alternative high schools (SS) for at-risk students. Alternative high schools provide educational opportunities for students whose needs do not fit the traditional high school model, whether that is due to behavioral, academic, or social issues. These schools have low student to teacher ratios, flexible structure, and a supportive environment. Alternative high schools are strongly shown to increase graduation rates for at-risk students, decrease disparity, and have been successfully employed across the nation [3].

High School Graduation by Racial/Ethnic Groups, 2014-15

How do we improve income and employment prospects for members of our community? Large disparities exist in employment between healthy and unhealthy individuals, as well as across racial groups. One way to increase employability is through Adult Vocational Training (SS). Vocational training helps adults to acquire skills and knowledge specific to jobs through education and certification programs. Programs tend to assist with professional development and most often serve those with little to no job experience or education. Vocational training has been evidenced to produce increased employment opportunities and income for participants, as well as reduce disparities in employment. Government sponsored vocational training exists across the country, but funding for these programs has fallen by over 40% over the past decade [4].

To create a work environment which is supportive of communities, one initiative to pursue is paid family leave (SS). Paid Family Leave allows employees to take compensated time off of work for occasions like a recent birth or illness in the family. Benefits of this program are increased participation in the labor force, better health outcomes, improved mental health, and increased breastfeeding rates. Strong evidence demonstrates paid family leave leading to a higher retention of mothers in the labor force after birth and better child health outcomes. Paid Family Leave has been adopted in 4 states and a few cities. It is worth noting that the United States is the only OECD (Organization for Economic Co-operation and Development) country to not provide paid paternal leave [5].

One idea for improving income prospects for community members and supporting asset development are Matched Dollar Incentives for Saving Tax Refunds (SE). Matched dollar programs offer matching deposits for money saved from tax returns for primarily low to moderate income families. These programs require a minimum amount placed in savings, followed by a waiting deposit period, after which time deposits can be withdrawn and matching funds can be received. These programs have been demonstrated to promote higher savings amongst participants as opposed to non-participants, reduction in financial disparity, and increased financial stability. Two programs, SaveUSA and $aveNYC, have created a model that provides a 50% dollar match for pledged amounts, and this model has been expanded to cities like Houston, San Antonio, Newark, and Tulsa [6].

Unemployment by Racial Groups, 2016

Social support typically stems from our connections and relationships with family, friends, and acquaintances. Communities with rich social connections are able to provide members with greater support, access to resources, and less isolation. When examining how to increase social connectedness, Intergenerational Mentoring (EO) is something to consider. Intergenerational mentoring programs exist to establish a relationship between older adults and at-risk children/adolescents. This form of mentoring is observed to increase self-worth in both mentors and mentees and inspire the development of a meaningful relationship. Additionally, mentees were observed to report higher academic achievement, social development, decreased substance use, and overall positive educational outcomes. Intergenerational mentoring exists across the country, with locations in areas like Philadelphia, Washington DC, and Virginia [7].

Mental health is an aspect of care that is often overlooked. Disparities in mental health especially impact low-income and colored individuals. Programs like the Employee Assistance Program (SE) (EAP) are pivotal in promoting mental health. EAPs are confidential services located in the workplace that provide accessibility to mental health through counseling and referrals. Service can be conducted internally by counselors or referred externally by a contracted vendor. These services usually operate for free to employees. EAPs have been shown to improve mental health, reduce depression and absenteeism, and improve social relationships. The EAP model has grown increasingly popular, with 85% of employees in large (over 500 workers) businesses having access to them. Vermont is the only state with state infrastructure to support comprehensive EAP models in the public and private sector [8].

When focusing on the neighborhood structure, social capital is an important concept to consider. Social capital is the aspects of our community that help us to build beneficial relationships and networks to promote trust and foster community. An example of this are Community Centers (EO). Community centers are public areas where members can go to for any number of reasons, like socializing, attending events, recreation, and seeking support. Community centers are likely to improve socialization between community members and help to reduce isolation. Centers that emphasize technology access catalyze positive youth development and strong peer-peer relationships. These centers are also likely to help reduce disparity through promoting access to resources and recreational facilities like basketball courts. Community centers are extremely common in the US, mostly in urban areas. However, their prevalence in high-income areas is indicative of the need for further development in low-income areas to help create a stronger sense of community [9].

With all of these potential strategies to help bring about a positive change in a community, it may be difficult to decide on the best course of action. Some things to keep in mind as the community engagement effort proceeds are the context, community, and stakeholders. Not every strategy works for every community. It is important to consider realistically if an idea would be a good fit for a community based on those who are most in need of support and the general consensus of the community surrounding the idea. Some communities are not always ready for change. One way to understand how the community may feel is to include the community in the planning process. It is important to involve actual residents from diverse backgrounds in the planning stages to help build up the support for change. Also important to consider are the stakeholders in moving forward with a strategy. Some potential stakeholders are the public, political stakeholders, and implementers. It is vital to gain the support of and carefully balance the interests of each party in order to progress on the path to change.

 

Sources

Paper of reference can be found here

[1] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/universal-pre-kindergarten

[2] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/school-breakfast-programs

[3] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/alternative-high-schools-for-at-risk-students

[4] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/adult-vocational-training

[5] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/paid-family-leave

[6] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/matched-dollar-incentives-for-saving-tax-refunds

[7] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/intergenerational-mentoring

[8] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/employee-assistance-programs-eap

[9] http://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/policies/community-centers

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