MPH Foundational Competencies (CEPH) Upon successful completion of Milestone Two, you will be able to: Southern New Hampshire University PHE 500 Final Project Milestone Two Guidelines and Rubric MPH Foundational

Public Health Knowledge (FKO) Upon successful completion of Milestone Two, you will be able to: ● II. Outcomes Discuss the means by which structural bias, social inequities, and racism undermine health and create challenges to achieving health equity at organizational, community, and societal levels [CEPH.06] Discuss the science of primary, secondary, and tertiary prevention in population health, including health promotion, screening, etc. [FKO.05] Explain behavioral and psychological factors that affect a population's health [FKO.09] Explain the social, political, and economic determinants of health and how they contribute to population health and health inequities [FKO.10] Overview Milestone Two: Public Health Issue Analysis For Milestone Two, you will expand on your previous work by analyzing the public health issue. More specifically, you will deconstruct the issue by analyzing its components-its evolution/historical underpinnings, its priority population or targeted community, its strategies and methods, and its relevant stakeholders. This milestone is graded with the Final Project Milestone Two Rubric and is due at the end of Module Four. Prompt The following critical elements must be addressed. (Note: Section numbering is consistent with the final project prompt.) Public Health Issue Analysis a) Provide a historical public health perspective about your issue, expanding on the introduction. Elaborate on the public health issue's evolution from Milestone One by examining the evidence or data from your three publications. Since each source should have a different publication year, each publication illustrates an understanding of the issue with respect to a particular period in time. Compare these sources and summarize the similarities and differences. Provide examples, as needed. b) Analyze the population/community through the lens of WHO's conceptual framework for action on the social determinants of health. Southern New Hampshire University This section is the core focus for Milestone Two. Please access and review the World Health Organization's conceptual framework for action on the social determinants of health (CSDH) by going to the World Health Organization's Social Determinants of Health Publications webpage and downloading the document. Chapter 5 contains the CSDH. For the health intervention and its related public health issue, please address all of the following areas within your analysis. CSDH Element 1 - Socioeconomic and Political Contexts: The first element of CSDH constructs the socioeconomic and political contexts related to a health issue and related public health efforts by using six dimensions. Considering the definitions for each dimension of CSDH (Section 5.4 in the WHO resource link above), please explain how each dimension relates to the public health issue and its population/community. You do not need to spend time summarizing the definition for each dimension in your analysis. To be clear, summarize the contexts for the following dimensions: O Governance Macroeconomic Policy Social Policies Public Policies Cultural and Societal Values O Epidemiologic Conditions CSDH Element 2 – Structural Determinants and Socioeconomic Position: Structural determinants generate social stratification and divisions in society and define individual socioeconomic position within hierarchies of wealth, prestige, and power. They are embedded in key institutions and processes of the socioeconomic and political context. Examples include income, education, occupation, social class, gender, and race. Please analyze the structural determinants by addressing the following: O Analyzing the Socioeconomic Position: Begin this part by examining socioeconomic position as it relates to the public health issue (and population/community). The role of social stratification. Specifically, explain how wealth (i.e., economic situation), prestige (i.e., status situation), or power (i.e., parties—political, agenda-centered, etc.) may connect to the public health issue/intervention and the population/community. ■ Explain how social differentiation (through wealth, prestige, or power) may affect health outcomes. (Note: This approach to social stratification is called the three-component theory of stratification by Max Weber, if you need to search the library for more information.) Analyzing the Structural Determinants: Begin this part by reviewing the concept of structural determinants within the CSDH. Provide examples of how the health intervention may have targeted these determinants by making connections with the general public health strategies/initiatives and the targeted population or community. ■ Please conclude this part by discussing how structural determinants relate to the cross-cutting determinants of social capital and social cohesion. Provide evidence to support your claims. CSDH Element 3 – Intermediary Determinants: Intermediary determinants are factors that directly shape individual health choices and outcomes and through which structural determinants operate. They span material circumstances, psychosocial circumstances, and behavioral and biological factors and these determinants have a relationship with the society's health system. Examples include the nearby shop that sells cigarettes and alcohol, tensions among local leaders in a slum community, or the nonfunctioning rural health Southern New Hampshire University center that lacks essential medicines and health personnel. To address the intermediary determinants, summarize the relationship between the health issue/intervention (and community/population) and the following: [PHE-500-02] Material Circumstances Behavioral and Biological Factors O Psychosocial Circumstances O Health System Connections With Health Equality O Study the public health issue by reviewing peer-reviewed literature (via the library) or by using public health data tools. Summarize the priority population or community, using the following: O Describe the health disparity or disparities common to the population or community. Explain why these disparities could make these factors health inequities. Support your responses with evidence. ■ I Describe the health determinants: What are the health determinants that may relate to these health disparities/inequities? Please include evidence to support your claims. Proximal and distal determinants: Discuss the proximal (downstream) or distal (upstream) determinants related to the health intervention's priority population or community. Identify any determinants that cannot be defined as proximal or distal (i.e., midstream) and ensure to add an explanation. Modifiable and non-modifiable determinants: Discuss the modifiable (e.g., exposure to hazard, access to healthcare) or nonmodifiable (e.g., age, sexual orientation, race/ethnicity) determinants related to the health intervention's priority population or community. O O UPSTREAM ● SOCIAL INEQUITIES Class Race/Ethnicity Immigration Status Gender Sexual Orientation INSTITUTIONAL INEQUITIES Corporations & Businesses Government Agencies Schools Laws & Regulations Not-for-Profit Organizations Southern New Hampshire University Strategic Partnerships Advocacy Physical Environment Land Use Transportation Housing Residential Segregation Exposure to Toxins LIVING CONDITIONS Economic & Work Environment Employment Income Retail Businesses Occupational Hazards A PUBLIC HEALTH FRAMEWORK FOR REDUCING HEALTH INEQUITIES BAY AREA REGIONAL HEALTH INEQUITIES INITIATIVE Emerging Public Health Practice Social Environment Experience of Class, Racism, Gender, Immigration Culture - Ads - Media Violence Service Environment Health Care Education Social Services Community Capacity Building Community Organizing Civic Engagement POLICY RISK BEHAVIORS Smoking Poor Nutrition Low Physical Activity Violence Alcohol & Other Drugs Sexual Behavior Individual Health Education DISEASE & INJURY Communicable Disease Chronic Disease Injury (Intentional & Unintentional) Health Care Case Management DOWNSTREAM MORTALITY Infant Mortality Life Expectancy Current Public Health Practice (Source: Bay Area Regional Health Inequities Initiative (BARHII) Conceptual Framework, 2006) A text-only version of this image is availabled in Module Four of your course. c) Analyze the issue's challenges to achieving health equity at all levels. Summarize the health inequities from the previous section. Challenges with achieving health equity: Analyze the factors that may create challenges to achieving health equity (such as structural bias, social inequities, and racism). Explain how these factors undermine the health status of the community or population. Social ecological model and health equity: Analyze the challenges to achieving health equity at the following levels of the social ecological model: societal, community, and organizational levels. Prevention Mental Health Services Culturally/Linguistically Appropriate and Competent Services Income Security Housing Neighborhood Safety/Collective Efficacy Environmental Quality Southern New Hampshire University Transforming the conditions in which people are BORN, GROW, LIVE, WORK and AGE for optimal health, mental health & well-being. HEALTHY PEOPLE HEALTHY COMMUNITY HEALTHY ENVIRONMENT HEALTHY SOCIETY ACHIEVING HEALTH & MENTAL HEALTH EQUITY AT EVERY LEVEL Health Care Child Development, Education, and Literacy Rates Food Security/ Nutrition Built Environments Discrimination/ Minority Stressors !! 821 (Source: Bay Area Regional Health Inequities Initiative (BARHII) Conceptual Framework, 2006) A text-only version of this image is available in Module Four of your course. O Throughout this section, please explain how these behavioral and psychological factors may affect a population's health status. Analyze public health theories related to the issue. O Summarize two public health theories (e.g., health behavior theories; communication theories; and even public health models, frameworks, approaches, etc.) that have been used to inform public health strategies for this issue. (Note: The intervention may not specify the exact theory used. In this instance, you will need to work backwards from the information provided to align with a common public health theory.) O Conclude this section by explaining the importance of evidence in advancing public health knowledge. O Be sure to substantiate your claims with examples and evidence. Analyze stakeholder contributions./nMilestone Two Public Health Issue Analysis: Expand on your previous work by analyzing the selected public health issue. More specifically, you will deconstruct the issue by analyzing its components-its evolution/historical underpinnings, its priority population or targeted community, its strategies and methods, and its relevant stakeholders. Remember, you are expected to incorporate scholarly sources to support your response. Please include in-text citations and add your sources to the bottom of this document under the "References" section. Historical: Provide a historical public health perspective about the issue by comparing evidence or data from three sources from different time periods and summarizing their similarities and differences. Historical a. [Insert text about time period A.] b. [Insert text about time period B.] c. [Insert text about time period C.] d. [Insert text about similarities and differences.] A. WHO's Conceptual Framework: Analyze the population/community through the three CSDH Elements of WHO's conceptual framework for action on the social determinants of health: CSDH Element 1 Socioeconomic and Political Contexts a. [Insert text about Governance.] b. [Insert text about Macroeconomic Policy.] c. [Insert text about Social Policies.] d. [Insert text about Public Policies.] e. [Insert text about Cultural and Societal Values.] f. [Insert text about Epidemiologic Conditions.] CSDH Element 2 Structural Determinants and Socioeconomic Position a. [Insert text about Socioeconomic Position.] b. [Insert text about Structural Determinants.]/na. [Insert text about Material Circumstances.] b. [Insert text about Behavioral and Biological Factors.] c. [Insert text about Psychosocial Circumstances.] d. [Insert text about the Health System.] CSDH Element 3 Intermediary Determinants B. Health Equity: Below, analyze the issue's challenges to achieving health equity. Health Disparity [Insert text.] Health Determinants a. [Insert text about proximal health determinants.] b. [Insert text about distal health determinants.] c. [Insert text about determinants that cannot be defined as proximal or distal.] d. [Insert text about modifiable determinants.] e. [Insert text about nonmodifiable determinants.] [Insert text.] Equity Challenges Equity Social Ecological Model a. [Insert text about the challenges at the societal level.] b. [Insert text about the challenges at the community level.] c. [Insert text about the challenges at the organizational level.] Theories a. [Insert text about Public Health Theory A.] b. [Insert text about Public Health Theory B.] c. [Importance of evidence in advancing public health knowledge]/nStakeholder Contributions a. [Insert text about a public health agency, position, or role-primary stakeholders.] b. [Insert text about a public health agency, position, or role-secondary stakeholders.] c. [Insert text about a public health agency, position, or role-key stakeholders.]