Healthy Islands 01 01 11

Healthy Islands
January 1, 2011

OUTLINE
• Healthy Islands: Mission & Goals
• Ecological Framework
• Food System Model
• Interaction Framework
 Availability
 Accessibility
 Interaction
• Social Communication Strategy
• Monitoring & Interventional Framework
• MAPPS Framework

2

HEALTHY ISLANDS: MISSION & GOALS
• Mission: Healthy Islands will improve the health and quality of life of
the populations of island communities
• Goals
 Address the crisis of non-communicable diseases
 Ensure the community has access to a healthy food supply
 Ensure community members live in a health-promoting environment
 Develop the capacity of the health workforce
 Improve the health literacy of the population
 Empower community members to make healthy decisions
 Provide the community with a financially sustainable health system
 Institutionalize the program with an organization and governance model
capable of ensuring long-term viability

3

ECOLOGICAL FRAMEWORK
• The NCD Plan will translate into a portfolio of interventional projects
• Projects will be targeted to specific areas of the ecological framework

4

FOOD SYSTEM : EXCHANGE MODEL
• The food system can be represented using a set of models that describe
actors, their roles and their various kinds of interactions

FOOD SYSTEM : TIERS
• The food system can be represented as a series of tiers comprised of
interconnected markets

FOOD SYSTEM : ACTOR ROLES
• The (simplified) food system model consists of a series of
interconnected markets
• Actors may play multiple roles within the various markets

• Farm producers provide raw materials to Food Makers
• Food Makers produce food for Food Sellers
• Food Sellers sell food to Food Consumers

FOOD SYSTEM EXAMPLES
• Farmer’s markets and farm stands represent two
highly simplified food systems; the farmer and
consumer transact directly with each other

• With a farmer’s market, the farmer handles transportation to the
marketplace

• With a farm stand, the consumer purchases food at the farm site

• Another simple food system has roles for farmers and
consumers, with an intervening set of distributors for
transportation; there is no intervening food
manufacturer

• Fresh produce does not involve manufacturing or
processing of foods

• Various arrangements may exist between food sellers
such as grocery stores and supermarket chains and
farmers

• Schools and restaurants are two types of food
service establishments

FOOD SYSTEM : INTERMEDIARIES
• The food system may include additional
intermediaries that handle distribution, warehousing
and transportation functions

• Food wholesalers are sometimes present

FOOD SYSTEM: LOCAL VS EXTERNAL
MARKETS
• The food system may include agricultural producers
or food makers from within the local region or
located externally

FOOD SYSTEM: SUPPLY CHAIN
• The food system generally includes complex supply
chain arrangements between food companies and
the manufacturers of various food production inputs

FOOD SYSTEM: CONCEPTUAL TO PHYSICAL
MARKETS
• The conceptual food system with the community can be mapped to a
physical marketplace with consumers and providers are defined
locations
• Spatial interaction becomes an important factor in the physical market
• Actors have to negotiate distance in order to transact within the
marketplace

39

FOOD SYSTEM: COMMUNITY SETTINGS

40

INTERACTION: COMMUNITY SETTINGS
• The community setting plays a key role in shaping the lived experience
of community members
• Each community member occupies and transitions between various
settings during the course of any given day
• Settings offer health promotion opportunities in terms of nutrition and
physical activity
Settings
•Homes (own home, others’ homes)
•Work sites
•Schools, after-school settings
•Child care settings
•Health and social welfare settings
•Other community-based settings
(e.g. community centers, churches)
•Recreational sites
•Retail settings
•Restaurants, fast-food venues
•Food stores

INTERACTION FRAMEWORK : SUMMARY
• The interaction framework applies to the dynamic interactions between
the community member and various resources within the community.
• The resource may be another community member or a physical
resource such as food to be consumed
• The framework provides a model for understanding the various
ecological factors that influence the ability of community members to
engage in various activity
• A key concern is understanding how ecological factors influence
interactions between geographically separated actors and resources

INTERACTION FRAMEWORK
• Interactions between actors and resources involve several dimensions
• Individual dimensions relate the aspects of the actor participating in
the interaction
• Other interaction dimensions involve aspects of the external
environment, which mediate between the actor and the resource

ACCESSIBILITY
• Accessibility plays a key role in community member activities where
interaction involves distance between the actor and the resource

ACCESS: CLIMATE AND GEOGRAPHY
• The climate and geography of the region may influence the interactions
between the actor and resource

ACCESS: TRANSPORTATION NETWORK &
MODALITIES
• Transportation networks and the transportation options available to the
actor directly shape the accessibility of a given resource

RESOURCE AVAILABILITY AND ALTERNATIVES
• Resource availability is independent from accessability
• Availability relates to whether the desired resource is present at a
given location, as well as what alternative options are available

AVAILABILITY: SELECTION FACTORS
• Multiple selection factors influence the actor’s choice of location and
selection of resource from available alternatives

AVAILABILITY: OTHER DIMENSIONS
• More complex aspects of resource availability include the proximity of a
given resource at a given location to other desired resources or
locations

INTERACTION: PROXIMITY AND TIMING
• The ecological framework is focused on understanding the lived
experience of community members in terms of how their time is spent
engaged in their daily activities and interacting with the various
community settings.
• The community member’s day can be viewed in terms of the physical
settings they occupy as well as the activities they engage in

INTERACTION: PROXIMITY AND TIMING
• Proximity and timing dynamically shape the interaction between actors
and resources

INTERACTION: INDIVIDUAL DIMENSIONS
• Individual dimensions influence the interaction between actors and
resources

SOCIAL COMMUNICATION STRATEGY:
SUMMARY
• Health promotion activities should leverage social networks
 Social networks provide a set of trusted relationships and communications
channels that can enable rapid dissemination of health promotion information
 The social communication strategy should leverage the multiple, overlapping
networks and social groups that each community member belongs to
 Using multiple social communication channels raises the likelihood of
reaching every community member
 Relying on multiple social communication channels provides an opportunity to
mutually reinforce health promotion information from independent sources
 Multiple social communication channel reduce the likelihood of community
members receiving inaccurate or incomplete health promotion information
 The social communication strategy supports an efficient train-the-trainer
approach to disseminating health promotion information
 A successful social networking strategy will require strong commitment to
health promotion from the trusted leadership of the various social groups

53

SOCIAL NETWORK AND GROUP TYPES
• Types of social groups/networks available
 Family: immediate/nuclear, extended kinship networks
 Extended social networks: friends and acquaintances
 Work groups
 Community groups
• Youth groups
• After-school activity groups
• Sports teams
• Volunteer groups
• Church groups
• Other neighborhood or village groups

54

SOCIAL GROUP INTERFACES
• The divisions of roles within a social network/group enables efficient
dissemination of health promotion information
 Groups may have multiple interfaces based on member roles
 Group interfaces serve as a coordination point for dissemination of health
promotion information
 Health promotion Information may be tailored to specific group member roles
 Group members playing a communications coordination role may further
tailor or customize the health promotion information

55

KINSHIP NETWORKS
• Kinship Networks
 Kinship covers relationships between community members based on descent
(‘consanguinity’) and marriage (‘affinity’)
 Descent networks are based on genetic relationships (immediate/nuclear and
extended families)
 Affinity networks describe abstract social patterns of relationships that are
not based on genetics
 Different cultures have differing kinship systems and terminology

•Individuals are genetic offspring of a single union.

•Individuals may form various types of unions –
with various degrees of formal significance in
terms of legal or religious recognition.

•An individual may form multiple unions, giving
rise to multiple sets of offspring.

•An individual may form a union with someone
with offspring from an earlier union.

56

EXTENDED FAMILY NETWORKS
• Extended Family
 Networks extending beyond the community member’s immediate family may
be wide-ranging and complex

57

EXTENDED SOCIAL NETWORKS
• Extended Social Networks
 Community members may participate in a wide-ranging set of informal
relationships with others in the community

58

ORGANIZED COMMUNITY GROUPS
• Organized Community Groups
 Community members may participate in organized groups with varying types
and degrees of formal group organization, membership structures and roles,
and forms of participation

59

WORK GROUPS
• Work groups
 Community members may participate in the formal or informal economies
through membership in various work groups
 Work groups and subgroups have various types and degrees of formal group
organization, membership structures and roles, and forms of participation

60

METHODOLOGY: PROBLEM ANALYSIS

61

CAUSAL WEB: MACRO-ECONOMIC SYSTEM

CAUSAL WEB: BUSINESS PERFORMANCE

STRATEGIC DRIVERS, GOALS AND
OBJECTIVES

66

TACTICAL, OPERATIONAL AND EXECUTION
PLANS

67

MONITORING AND INTERVENTION : GROUPS

MONITORING AND INTERVENTION : SYSTEMS

MONITORING AND INTERVENTION :
ENVIRONMENT

MONITORING AND INTERVENTION :
INTEGRATED

INTERVENTIONAL STRATEGY
• Based on the MAPPS Framework
 Media
 Access
 Point of Decision Information
 Price
 Social Support Services

• Communities Putting Prevention to Work (CPPW)
 MAPPS is currently the framework for the CDC’s CPPW initiative

• Best-Practices Framework
 Evidence-based interventions drawn from the peer-reviewed literature and
expert synthesis
 Communities and states have found these interventions to be successful in
practice

78

MAPPS FRAMEWORK
• Focused on chronic diseases (non-communicable diseases)
 Target conditions: obesity, diabetes and cardiovascular disease
 Responsible for 7 of 10 deaths
 Vast majority of serious illness-related disability
 Greatest contributor to healthcare expenditures (75%)

• Addresses key risk factors
 Lack of physical activity
 Poor nutrition
 Tobacco use (out of scope – addressed elsewhere)

• Specific goals
 Decrease overweight/obesity prevalence
 Improve nutrition (e.g. increased fruit/vegetable consumption, reduced salt
and trans-fat)
 Increase levels of physical activity

79

STRATEGIES AND INTERVENTIONS
• High-Level Strategies
 Strengthen healthcare infrastructure
 Reduce costs through prevention
 Advance public health across the lifespan
 Reduce health disparities
 Reduce risk factors
 Prevent and/or delay onset of chronic disease
 Promote wellness

• Intervention Approach
 Policy, systems and environmental change
 Communities and schools
 Positive behavior change related to nutrition and physical activity

80

MAPPS: MEDIA
Interventions : Media

Nutrition Physical Activity
 Media and advertising restrictions  Promote increased activity
consistent with federal law  Promote use of public transit
 Promote healthy food/drink choices  Promote active transportation
 Counter-advertising for unhealthy (bicycling and walking)
choices  Counter-advertising for screen time

81

MAPPS: ACCESS
Interventions : Access

 Promote healthy food/drink choices  Safe, attractive accessible places
 Healthy food/drink availability for activity
 Limit unhealthy food/drink  City planning, zoning and
availability transportation
 Reduce density of fast food  Require daily quality PE in schools
establishments  Require daily physical activity in
 Eliminate trans-fat through afterschool/childcare settings
purchasing actions, labeling  Restrict screen time (afterschool,
initiatives, restaurant standards daycare)
 Reduce sodium through purchasing
actions, labeling initiatives,
restaurant standards
 Procurement policies and practices
 Farm to institution, including
schools, worksites, hospitals and
82 other community institutions

MAPPS: POINT OF PURCHASE/PROMOTION
Interventions : Point of Purchase/Promotion

 Signage for healthy vs. less healthy  Signage for neighborhood
items destinations in walkable / mixed-
 Product placement & attractiveness use areas
 Menu labeling  Signage for public transportation,
bike lanes/boulevards.

83

MAPPS: PRICE
Interventions : Price

 Changing relative prices of healthy  Reduced price for park/facility use
vs. unhealthy items (e.g. through  Incentives for active transit
bulk purchase / procurement /  Subsidized memberships to
competitive pricing) recreational facilities

84

MAPPS: SOCIAL SUPPORT AND SERVICES
Social Support & Services

 Support breastfeeding through  Safe routes to school
policy change and maternity care  Workplace, faith, park,
practices neighborhood activity groups (e.g.,
walking hiking, biking)

85

Healthy Islands 01 01 11

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Andere mochten auch

Andere mochten auch (15)

Ähnlich wie Healthy Islands 01 01 11

Ähnlich wie Healthy Islands 01 01 11 (20)

Healthy Islands 01 01 11