Small steps towards a big problem: Addressing the social determinants of health at the community level

David Phipps (ResearchImpact, York) wrote the following guest blog post for “Health Policies” about a new initiative with UWYR that is focused on community solutions for community health challenges arising from the social determinants of health.

Health isn’t a problem.  Not being healthy is a wicked problem.  Wicked problems are persistent social problems characterized (among other things) by:

• Lack of clarity on all stakeholders associated with the problem
• Lack of clarity on the causes of the problems
• Lack of clarity on end points and outcomes
• Interventions change the nature of the wicked problem challenging evaluation

Social determinants of health (SDOH) are wicked problems.

There is an increasing amount of attention paid to SDOH at the international, national and local levels:

• International: The World Health Organization recently released the technical paper for the World Conference on Social Determinants of Health to be held in Rio de Janeiro in October 2011.
• National: National Collaborating Centre for Determinants of Health (NCCDH) is one of six NCCs funded by the Public Health Agency of Canada (PHAC). In 2010 it released an environmental scan of the role of public health agencies in supporting policy responses to social determinants of health in Canada.
• Local: On June 22 York Region’s Human Services Planning Board release their report, Making Ends Meet which identifies poverty and income insecurity as the single human service priority for York Region.  Health indicators and outcomes are included in the planning.

But how do you tackle such large, wicked problems.  According to WHO Commission on Social Determinants of Health, all you need to do is:

1. Improve living conditions
2. Tackle inequitable distribution of power, money and resources
3. Measure and understand the problem and assess the impact of action.

I’ll get right on that. I’ll also get right on solving the upstream political issues underlying SDOH that were pointed out in a previous Healthy Policies blog.

NOT (and therein lies the problem – where do you start with a wicked problem like SDOH?)

What determines your health? / Qu’est-ce qui détermine votre santé?

By David Phipps (ResearchImpact, York)

A KM in the AM on social determinants of health brought consensus on the challenge but fell short of imagining solutions. At ResearchImpact-York we will continue this dialogue to try to nudge the discussion forward. What will you do?

La dernière matinée de mobilisation des connaissances (KM in the AM) portant sur les déterminants sociaux de la santé a permis d’arriver à un consensus concernant les défis, mais n’a pu dégager clairement des pistes de solution partagées. Chez ResearchImpact – York, nous poursuivrons le dialogue afin de faire avancer la discussions. Et vous, qu’allez-vous faire?

Denis Raphael (School of Health Policy and Management, York University has written, “the primary factors that shape the health and well-being of Canadians – the factors that will give us longer, better lives – are to be found in the actual living conditions that Canadians experience on a daily basis.” WHO defines these conditions as social determinants of health (SDOH), “the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The SDOH are mostly responsible for health inequities.” On April 12, ResearchImpact-York hosted a KM in the AM on social determinants of health (SDOH). Part of our suite of KMb services, KM in the AM is a monthly breakfast meeting where university researchers and non-academic stakeholders exchange information and sow the seeds of future collaborations.

Mina Singh and Beryl Pilkington from York’s School of Nursing presented along with Carolyn Mooi from the Heart & Stroke Foundation and Nicky Wright from the York Region District School Board. The presentations kicked off a discussion among the 18 attendees from community and municipal agencies and throughout York Region. Discussion (and there was plenty) focused on the health outcomes related to SDOH: immigration, poverty, homelessness, disability, seniors with people experiencing increased health challenges when more than one of these SDOH intersect. Everyone in the room could speak to the challenges but few were moving to solutions. Local solutions like Mississauga’s investment in community fitness program like Pilates were cited as one example. Nicky charged us to go home and help one person that evening illustrating that we all bear responsibly for being part of the solution. 

Social Determinants of Health KM in the AM- April 12

The YorkU KMb Unit will be hosting a KM of the AM event on Tuesday, April 12. The topic of the morning will focus on social determinants of health, with brief presentations by researchers and community leaders, followed by ample time for questions, discussion, and networking.

Confirmed Panelists:

• Mina Singh, Faculty of Health, York University

• Beryl Pilkington, Faculty of Health, York University

Date:       Tuesday, April 12

Time:       9:00 am to 11:30 am

Breakfast will be served at 8:45

Location: Markham Convergence Centre, 7271 Warden Ave, Markham

Space is limited. Kindly RSVP kejensen@yorku.ca to confirm your attendance.

View Larger Map

This event has been organized by the Knowledge Mobilization (KMb) Unit at York University and the York Region Community Foundation, both of which are partnering on the Living in York Region project.

KM in the AM is a series of issue based forums linking the university and community/government agencies to enhance research, the graduate student experience and knowledge mobilization.

The Living in York Region project is seeking to develop a made-in-York Region reliable baseline understanding of residents and communities’ well-being across a series of civic, economic, environmental and social indicators. The project is designed to give a voice to residents to help generate solutions to key issues affecting local communities and neighbourhoods.

Youth Diabetes Sports Camp – Mobilizing Knowledge for Exercise and Diabetes

The fourth annual York University Youth Diabetes Sports Camp has come to an end. Yet there remains plenty to celebrate. York’s KMb Unit was proud to witness the successful conclusion to a unique knowledge mobilization initiative. Being there every step of the way during the two weeks of the Diabetes Sports Camp, we experienced a valuable partnership in action that was unique in its composition. This partnership was between the youth participants at the camp who were engaged in their sport of interest (tennis, basketball, soccer or track and field) and the research team that was focused on learning more about glucose regulation during exercise and the prevention of hypoglycemia. This partnership flourished and provided everyone involved with plenty of fun, learning experiences, and invaluable data for research on type 1 diabetes metabolism.

During last year’s camp, Dr. Michael Riddell conducted a study that examined the relationship between blood glucose levels and sports performance for youth ages 6-17. These youth had their blood glucose levels monitored in real time using new technology supplied by Medtronic Canada for the week as they engaged in soccer, basketball, or tennis, and even as they slept. The goal was to see how sports performance is affected by oscillations in blood sugar levels. The study, which was published this year in the International Journal of Pediatrics, found that optimal athletic performance was observed when blood glucose levels were in the normal range. A slight deterioration in performance was observed when blood sugar levels were a little bit above the normal range. However, the study found that there was considerable deterioration in performance when blood glucose levels were lower than the normal range (4-7 mmol); this is a condition called hypoglycemia.

This year Dr. Riddell and his team are advancing this area of research by collecting data using real time glucose monitoring on a newly developed carbohydrate intake algorithm that prevents hypoglycemia during exercise. With this research, they hope to optimize nutritional strategies for the prevention of low blood sugar in young active individuals with type 1 diabetes.

This research is the first of its kind to be tested outside of the laboratory in a field setting. However, what may be equally important is the process of knowledge exchange that the Diabetes Sports Camp has facilitated. Besides the fun and excitement that the young campers got throughout the duration of the camp, they were also taught various strategies to help manage their diabetes and encouraged to share their experiences with other campers who have diabetes. In return, Dr. Riddell received important data for his research that he plans to share in an upcoming symposium at the International Society for         Pediatric and Adolescent Diabetes (ISPAD), taking place from October 27 – 30, 2010 in Buenos Aires, Argentina. This is classic KMb, bi-directional flow of knowledge that can help inform health policy, foster emerging research questions, as well as inform individual practices in safe blood sugar regulation in young patients with type 1 diabetes. This is KMb that is practical and benefits all parties involved.

Stay tuned for the KMb in Action story on the Youth Diabetes Camp which can be found on the ResearchImpact website.

Week 2 of the Youth Diabetes Camp – Overall Youth Experience

By the end of the second week of the Youth Diabetes Sports Camp, the kids have made new friendships and greatly improved their skills in sports. York’s Knowledge Mobilization Unit interviewed kids with diabetes about some of their impressions and experiences at camp.

The children with Type 1 greatly appreciate the opportunities that they are given at this camp. Overwhelmingly, the kids admire the unique nature of the camp, the first sports camp of its kind that brings together kids and adolescents with diabetes with diabetes councilors and varsity level coaches. Most importantly, they get to meet other kids with diabetes and share their challenges as well as their experience managing their condition. Many of the kids said that prior to attending this camp they had not met very many young people with their condition who are so interested in sports. At this camp, there were approximately 30 kids and adolescents with diabetes, there were counselors who have diabetes, as well as guest speakers who excel despite their disease.

Among the guest speakers at the diabetes camp was Chris Jarvis, a prominent Olympic rower and Pan Am gold medalist with type 1. Chris talked about the “highs” and “lows” while being on the Canadian National rowing team and competing in the 2004 Summer Olympics in Athens, Greece. Prior to joining the kids to play their respective sports, Mr. Jarvis spoke to the young campers about living with diabetes and overcoming numerous challenges including challenges with his glucose control and facing losses in competition. Chris spoke about the importance of “team” support in helping to facilitate his success both on and off the boat. Overall, the kids found their camp experience to be inspiring. The goal was to show that having diabetes should not hinder anyone from pursuing a career in competitive sports. And that is something that the kids certainly understood and appreciated by the end of camp.

Of course, there is also the fun factor. The kids were happy to share excitement and laughter while becoming more proficient in their favorite sport. The children were very fond of the camp counselors. They were happy to get excellent instruction from some of York’s finest varsity athletes. However, counselors were more than just the kids’ coaches. They made sure to befriend them as well and did a great job connecting on the kids’ level, making their camp experience that much more enjoyable.

The most amazing thing about this camp is the fact that, while the youth with diabetes had an overwhelmingly positive experience, they also contributed to valuable research on how sports and exercise affect glucose control and how exercise can help manage diabetes and improve quality of life. This is a prime example of knowledge mobilization and a bi-directional flow of knowledge. The kids learned new strategies on managing their diabetes while Dr. Riddell gets valuable data for his research on exercise and diabetes.

Week One of Youth Diabetes Camp – Interview with Dr. Michael Riddell

The first week of the Youth Type 1 Diabetes Sports Camp, York’s Knowledge Mobilization Unit interviewed Prof. Michael Riddell, asking him about some of his reasons and motivations for starting this camp. We also began to learn more about what the camp is all about.

Dr. Riddell was diagnosed with diabetes at the age of 14 and continued to be a very active adolescent engaging in various sports, including basketball, tennis and mountain biking throughout the time of his diagnosis. Although at the time of the diagnosis, there was limited research on the effects of sports on diabetes. Dr. Riddell eventually went on to get his PhD, specializing in energy metabolism during exercise in children and adolescents. In the ensuing years he decided to focus his research on how exercise affects blood glucose levels in persons with type 1 diabetes. 3 years ago Dr Riddell noticed that although adults with diabetes had the opportunity to go to a newly established sports camp in the U.S., none were in place for children. This set in motion the start of the Diabetes Sports Camp at York University, a unique camp in that it is the first of its kind.

Now children aged 8-16 with diabetes have the opportunity to engage in a sport of their choosing where they will receive excellent coaching from varsity athletes as well as guidance on how to best manage their condition. This camp is now run in conjunction with the York University Sports and Recreation summer camps offered to all youth between the ages of 8-16 years. Not only are children with diabetes able to develop their athletic skills in a monitored environment, but they are able to share stories and strategies with other children who have diabetes.

Dr. Riddell has been running this camp for 3 years with the aim to further his research in the field of sports, active living and their effects on diabetes. Last year’s camp was the basis for a study that has been published in the International Journal of Pediatrics last week. This research examined the relationship between blood glucose levels and sports performance in youth with Type 1. This year’s camp also has a research component focusing on the development of new strategies to prevent low blood sugar levels. Kids are mobilizing knowledge by having fun and by contributing to the study. This is what KMb is all about!

Week One of Youth Diabetes Camp – Active Living with Diabetes

Monday, July 19 was the launch of the 3rd Annual Type 1 Diabetes Youth Sports Camp at York University. Dr. Michael Riddell started the Diabetes Camp in 2007 for active children and adolescents, ages 8-16, with type 1 diabetes and the numbers have grown from just 10 kids in 2007 to about 30 this year. The Diabetes Hope Foundation, Tracey Rubinoff Diabetes Hope Fund, and Medtronic Canada are all helping to support this initiative with York University’s Department of Sports and Recreation.

The purpose of this camp is to give the opportunity to diabetic kids to excel in their favorite sport, along with non diabetic kids of similar age and sporting skill levels, as well as to help manage their condition through active living. This is done through an on-site clinical care team of nurses, physiologists and athletic therapists who work along side the exceptional coaching staff and varsity athletes. The kids with diabetes are encouraged to discuss their diabetes care with the on-site team and help is provided from athletes with diabetes who serve as diabetes councilors to assist with blood glucose monitoring and by sharing some of their own strategies on modifications to insulin and or carbohydrate intake. The kids have the opportunity to get together and share stories about active living with their diabetes. The sports offered this year include a focus on either basketball, track and field, soccer, or tennis and a free swim is offered every day from 2-3 in the varsity pool.

The first day of filming the camp for an upcoming KMb in Action story, the children had an opportunity to get acquainted with the sport of their choosing as well as with one another. The next day there was plenty of chatter and laughter as well as enthusiasm and eagerness to excel in their respective sports. The kids get coached at university level by varsity athletes and special guests who also have diabetes. This perfect mix of excellent instruction in sports as well as instruction on management of diabetes informed by cutting edge research creates a really fun atmosphere for the children and makes for a great learning experience. Last year’s study looked at blood glucose levels and sports performance which is published now online at the International Journal of Pediatrics. This year’s study is using a special carbohydrate intake algorithm devised by Dr. Riddell and his research team (Jill Milliken and Dylan Kelly) to help prevent low blood sugar. For the remainder of the two weeks of the Diabetes Camp, the children’s blood glucose levels will be monitored in real time throughout the day, using the Medtronic GuardianRT, as they engage in various sports. Dr. Riddell hopes that the camp and experience of the children participating will help inform his research on diabetes and its impact on sports performance.

This is a great example of knowledge mobilization and turning research into action. Stay tuned for more highlights in the coming weeks.

Social Inclusion for Health and Well Being in Program Evaluation – Thursday, April 30

The York Institute of Health Research led a dynamic and participatory conference that drew a capacity audience of almost 100 registrants. Supported by the Ministry of Research and Innvoaiton and York University, YIHR is home to an emerging Evaluation Unit that will be offering evaluation services and capacity building. The KM Unit at York was invited to prepare a poster presentation demonstrating its capacity to support program evaluation and social inclusion collaboration via the knowledge broker model. There were a number of conversations that ensued and there was much interest and curiosity from many participants who were not familiar with knowledge mobilization or the capacity that York has built to support KM. Conference organizers were successful in bringing together numerous presenters who shared their experiences and beliefs for social inclusion that promote health and wellness. Program evaluation is important to ensure that programs are aligned to achieve these objectives. Keynote presenter, Daniele Zanotti of the United Way of York Region, summarized the day well with this comment, “This work is the essential ingredient to get communities working together”. Following a morning of panel presentations participants were able to engage in workshops led by university researchers and their community collaborators.

People are invited to visit the YIHR web site for more information on the conference, including copies of all poster presentations and PowerPoint presentations from panel presenters.

Social Inclusion and Program Evaluation Models to Support Social Innovation

Social Inclusion for Health and Well Being in Program Evaluation – April 30

York Institute for Health Research (YIHR)
Social Inclusion for Health and Well Being in Program Evaluation
Thursday April 30, 2009, 8:30am-5:00pm, York University

The York Institute for Health Research is hosting a full-day workshop on program evaluation and social inclusion to launch their a program eavluation centre. The day includes a keynote address by Daniele Zanotti, CEO of the United Way for York Region, presentations by academic and community partners, and workshops on evaluation including arts-based evaluation and program evaluation methodology.

This event brings together academic and community researchers and professionals from health and health-related areas to share their knowledge and experiences in evaluating access and equity goals in program outcomes, as well as the strengths and challenges of applying social inclusion principles to program evaluation processes.

Issues of diversity and social inclusion have an impact on how programs and services are delivered to meet a wide range of client needs. Thus, diversity and social inclusion are critical to the evaluation of programs and their effectiveness. Funding agencies increasingly expect community organizations to conduct evidence-based program evaluations to demonstrate that their programs are making a difference for their diverse clients, and that their programs achieve social inclusion goals.

Objectives
Through attending this workshop, you will:
• Learn methods and tools for program evaluation;
• Learn the importance of social inclusion and evaluation in designing your project
• Learn about innovative program evaluation projects;
• Learn about the challenges of doing program evaluations;
• Develop networking opportunities for future research and program alliances, including connecting with the Centre for Program Evaluation;
• Share resources for professional use and development;
• Learn from funding bodies about programs, resources, expectations and trends for social inclusion and doing program evaluation with diverse populations.

Intended Audience
This event provides an opportunity for academics, community and advocacy group members, policy analysts, funders, independent and student researchers to share their experiences and knowledge of program evaluation and research on diversity and social inclusion.

Researchers and professionals from a diverse range of health/healthcare, health-related and policy sectors including, but not limited to, women’s, ethno-specific, disability, lesbian/gay/bisexual/ transgender/queer (LGBTQ), Aboriginal, senior, youth and immigrant health services, and diversity, access and equity groups will attend panel sessions and workshops, and be invited to share poster presentations on the conference topic from a variety of disciplines.

Registration is $25 and space is limited so act now! The registration deadline is April 15th, 2009. To receive a registration form, please contact Dr. Yuka Nakamura at nakamura@yorku.ca.

Health Promotion and Prevention KM in the AM – Feb 24

The YorkU KM Unit will be hosting its next KM of the AM event on Tuesday, February 24th. The topic of the morning will health promotion and prevention, with brief presentations by a university researcher and a community agency representative, followed by ample time for questions, discussion, and networking.

Confirmed Speakers:
- Alison Macpherson, Associate Professor, Faculty of Health, York University
- Anne Lessio, Senior Planner, Central LHIN

Date: Tuesday, February 24

Time: 8:45 to 10:45 am. Breakfast will be served at 8:45. The meeting will start at 9:00.

Location: York Regional Police District 2 Station
171 Major Mackenzie Drive West
Richmond Hill

View Larger Map

Space is limited. Kindly RSVP kejensen@yorku.ca to confirm your attendance.