Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health, hosted a 90 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), presenting key messages and implications for practice in the area of social determinants of health on Wednesday September 19, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Sume Ndumbe-Eyoh, Knowledge Translation Specialist at the National Collaborating Centre for Determinants of Health.

1. This webinar has been made possible with support from the
Canadian Institutes of Health Research
Welcome!
Intersectoral Action and the
Social Determinants of
Health:
What’s the evidence?
In partnership with:
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2. What’s the evidence?
 National Collaborating Centre for Determinants of
Health. (2012). Assessing the impact and effectiveness
of intersectoral action on the social determinants of
health: An expedited systematic review. Antigonish,
NS: National Collaborating Centre for Determinants
of Health, St. Francis Xavier University.
 ENGLISH - http://nccdh.ca/resources/entry/assessing-
the-impact-and-effectiveness-of-intersectoral-action-on-
the-SDOH
 FRENCH - http://nccdh.ca/fr/resources/entry/assessing-
the-impact-and-effectiveness-of-intersectoral-action-on-
the-SDOH

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4. This webinar has been made possible with support from the
Canadian Institutes of Health Research
Welcome!
Intersectoral Action
and the Social
Determinants of
Health:
What’s the evidence?

5. The Health Evidence Team
Kara DeCorby Heather Husson
Administrative Director Project Manager
Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca
Lori Greco Robyn Traynor Lyndsey McRae
Knowledge Broker Research Coordinator Research Assistant

6. What is www.health-evidence.ca?
Evidence
inform
Decision Making

7. Why use www.health-evidence.ca?
1. Saves you time
2. Relevant & current evidence
3. Transparent process
4. Supports for EIDM available
5. Easy to use

8. Knowledge Translation
Supplement Project
CIHR-funded KTB-112487

9. Review
 National Collaborating Centre for Determinants of
Health. (2012). Assessing the impact and effectiveness
of intersectoral action on the social determinants of
health: An expedited systematic review. Antigonish,
NS: National Collaborating Centre for Determinants
of Health, St. Francis Xavier University.

10. Evaluation
Please check your email for the evaluation
survey link after the webinar.
It take 5 minutes to complete!
If you did not personally register for the webinar,
please e-mail Jennifer McGugan at
mcgugj@mcmaster.ca
to be sent the survey

11. Questions?

12. National Collaborating Centre for
Determinants of Health
Sume Ndumbe-Eyoh Hannah Moffatt
seyoh@stfx.ca hmoffatt@stfx.ca
Knowledge Translation Specialists

13. About the National Collaborating Centre
for Determinants of Health
• Our focus
– Social determinants of health (SDH) & health equity
• Our audience
– All organizations that make up the public health sector in
Canada
– The practitioners, decision makers and researchers who
work within public health
• Our work
– Translate and share evidence to influence interrelated
determinants and advance health equity
Visit us at www.nccdh.ca

14. Pan-Canadian

15. Visit us at www.nccdh.ca
• Resource Library
• Health Equity Clicks: Community
• Health Equity Clicks: Organizations
• Networking events & workshops

16. Summary Statement:
NCCDH(2012)
P General population
I Any population health intervention, involving an intersectoral
relationship, related to the social determinants of health (SDOH
and health equity
C Health equity
O Health Outcomes: measures of morbidity/mortality, quality o
life, adherence to healthcare, etc. SDOH Outcomes:
income/income distribution, employment, housing, etc. Policy
Outcomes: societal-level legislative changes, and organizational
level policies/programs
Quality Rating: 8 (strong)

17. Summary of Included
Studies
 Included articles met several relevance criteria:
• Any design/population health intervention re: SDOH & health equity
• Explicit mention of intersectoral relationship
• Outcomes : health, SDOH, or policy
• Published in English or French between Jan 2001-Jan 2012
• Set in one of: Norway, Finland, Denmark, Sweden, Australia, New
Zealand (NZ), Canada, the United States (US), or the United
Kingdom (UK)
 Total of17 articles included: 1 systematic review, 14 quantitative studies
& 2 qualitative studies

18. Overall Considerations
 Evidence of effectiveness for some upstream, midstream, and
downstream interventions
 Role of the public health sector was not always clearly
described in the primary studies, however intervention
descriptions can be accessed in Table 2 of the review.
 Interventions targeted very specific populations so findings may
not be generalizable to a different population and/or setting.
 Long-term effectiveness remains unclear.
 Public health decision makers should advocate for development
and funding of research assessing impact of intersectoral
collaborations, particularly those focused on upstream
interventions.

19. General Implications
Public health SHOULD consider:
 Intervening in early childhood, given positive effect for kids,
especially for early literacy among children of low-income mothers
 Upstream interventions to improve housing and employment
conditions, evidence of impact for other SDH is limited
 Midstream interventions to improve employment/working
conditions, child literacy, dental health, housing, and organizational
change
 Downstream interventions to increase access to oral health
services, immunization rates, appropriate use of primary health
care services, and referrals from school readiness checks.

20. What’s the evidence?
Upstream Interventions
 Employment/working conditions: interagency
agreements in multiple US states led to a 25% yearly
increase in supported employment over 5 years in
adults with disabilities
 Housing: national legislation to improve housing
conditions among Australian indigenous communities
led to slight improvements of infrastructure
components but no impact on hygienic conditions

21. Implications: Practice & policy
Upstream Interventions
 consider implementing upstream interventions
that appear effective, knowing the current
evidence-base is limited
so cautioning that
 advocating for additional, long-term impact
assessment of upstream interventions is needed

22. What’s the evidence?
Midstream Interventions
 Employment/working conditions (2 studies) –
improvements in employment (76.7% of participants
obtaining employment) and improved working
conditions with 5 workplace changes
 Childhood Literacy (1 study) – improved early
literacy behaviours, increased parents reporting
showing books to their infants daily (53.67% in 2001,
69.44% in 2003), reading aloud to children daily (33% in
2001, 53.70% in 2003), and participation in the Raising
a Reader program (4.3% in 2001 and 16.7% in 2003).

23. Midstream Interventions,
cont.
 Housing(1 study) – all households received helpful housing
modifications, with decreased hospital admissions for those up to 34
years old, decreased housing-related, preventable hospital
admissions.
 Social & Physical Environments (3 studies) -
 Eight projects resulting from a collaborative demonstrated organizational change and
advocacy projects at multiple levels, but had no impact on program integration or policy
 School-based break time snacking reduced indicators of childhood dental disease (DMFT
changed from 1.13, CI [0.85, 1.40] in year 1 to 1.58, CI [1.28, 1.89] in year 2) and
increased number of filled permanent teeth in lower SES schools over time: mean 0.49,
CI [0.20, 0.77] Year 1 and 1.05, CI [0.69, 1.14] Year 2.
 Chronic disease coalition did not report health outcomes but initiated a
number of programs, policies, and practices with outcomes not yet available

24. Implications: Practice & policy
Midstream Interventions
 implement school-based break-time snack initiatives as an
avenue to address childhood dental disease
 consider interventions that address employment/working
conditions and childhood literacy, dental health and
housing
 explore collaboratives for community-based and school-
based organizational change, and potential to advocate at
multiple levels
 consider that it is unclear as to whether improvements
lasted long-term

25. What’s the evidence?
Downstream Interventions
 Oral health: school- and home visit-based oral health education
program led to 32% of children being cavity-free at three years, as
opposed to 8% at study-onset (n=58), with more children having a
primary dental health practitioner and/or receiving preventive care
 Mental health: school-based mental health service led to a
decrease in peer problems and hyperactivity within the intervention
group, but number of problems were still higher compared to the
control group
 Immunization: study involving 23 organizations targeting those
< 5 years of age saw an overall increase in immunization rates of
46% to 80.5%

26. Downstream Interventions,
cont.
 Case coordination & case management, with
community-based health education and physical activity for youths
and seniors showed 45% of participants established a primary care
provider, with 40% fewer ER visits (p < .05), and decreased patients
with poor diabetic control from 78% to 48% (p < .05).
 School readiness checks in a rural, economically-
disadvantaged community (e.g. oral and vision screening, behavioural
assessment) from trained healthcare professionals maintained a 50%
referral rate over 10 months
 School-based asthma education intervention showed
no impact on urgent health services or school attendance in low-
income ethnic minority families.

27. Implications: Practice & policy
Downstream Interventions
 implement interventions that improve access to
education and preventive/restorative dental care through
school- or community-based screening and/or referrals
for oral health and access to care
 consider that individual studies demonstrate downstream
interventions improve some aspects of mental health of
refugee children, immunization coverage, chronic disease
management, and school readiness
 No evidence to support school-based asthma education
for low-income, ethnic minority families at this time

28. General Implications
Public health SHOULD promote / support / implement:
 Intervening in early childhood
 Upstream interventions to improve housing and
employment conditions
 Midstream interventions to improve employment/
working conditions, child literacy, dental health, housing,
and organizational change
 Downstream interventions to increase access to oral
health services, immunization rates, appropriate use of
primary health care services, and referrals from school
readiness checks

29. Questions?
Contact us: Sume Ndumbe-Eyoh seyoh@stfx.ca

30. Online Conversation
Please continue to discuss this topic on
Health Equity Clicks: Community
http://nccdh.ca/community/post/webin
ar-intersectoral-action-for-health-
equity
Login with your Health Equity Clicks: Community username and
password or register if you aren’t a member yet.

31. Evaluation
Please check your email and complete the
evaluation survey for this webinar
If you did not receive an email with a link to the
survey, please e-mail Jennifer McGugan:
mcgugj@mcmaster.ca
Thank you for your participation!