A Framework for Educating Health Professionals to Address the Social Determinants of Health (2016) / Chapter Skim
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4 Social Determinants of Health: A Framework for Educating Health Professionals
4 Social Determinants of Health: A Framework for Educating Health Professionals
Pages 69-108
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From page 69... ...
Rather, there is a need for a holistic, consistent, coherent structure aligning education, health, and other sectors in partnership with communities. To help meet this need, the committee developed a framework for strengthening the education of health professionals to impart better understanding the social determinants of health across the learning continuum.
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From page 70... ...
Elements of a Unifying Framework Chapter 3 presents a number of prior frameworks salient to understanding and acting on the social determinants of health. Each has particular strengths that, when combined, fulfill the committee's vision for better aligning different sectors in educating health professionals to address the social determinants of health in partnership with communities.
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From page 71... ...
These partnerships entail close working relationships among policy makers, educators, health professionals, community organizations, nonhealth professionals, and community members. Health professionals who are educated under what Frenk and colleagues (2010)
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, the committee developed a unifying framework for educating health professionals to address the social determinants of health (see Figure 4-1)
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Box 4-1 lists components of that education, which are discussed below. BOX 4-1 Components of the Education Domain Experiential learning • Applied learning • Community engagement • Performance assessment Collaborative learning • Problem/project-based learning • Student engagement • Critical thinking Integrated curriculum • Interprofessional • Cross-sectoral • Longitudinally organized Continuing professional development • Faculty development • Interprofessional workplace learning
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From page 74... ...
. Given the lack of oversight and accountability in volunteer activities, the value to the community of purely altruistic activities by students and culturally unaware health professionals is suspect, and such activities may even be counterproductive (Caldron et al., 2015)
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. Performance Assessment Performance assessment of the competency of health professionals, students, and trainees in addressing the social determinants of health entails demonstrating competencies articulated for transformative learning.
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. As such, project-based learning can be considered a useful tool for educating health professionals in addressing the social determinants of health in and with communities.
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, and allows learning objectives to build o and increase in complexity as students advance in their professional development and maturity. In a review of the literature using the BEME (Best Evidence Medical and Health Professional Education)
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Recommendation Introducing any of the components discussed above into health professional education would represent a move toward transformative learning, but for maximal impact, the committee makes the following recommendation: Recommendation 1: Health professional educators should use the framework presented in this report as a guide for creating lifelong learners who appreciate the value of relationships and collaborations for understanding and addressing community-identified needs and for strengthening community assets. Implementing the committee's framework would enable health professional students, trainees, educators, practitioners, researchers, and policy makers to understand the social determinants of health.
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From page 79... ...
Through shifts in power from health professionals to community members and organizations, the community shares responsibility for developing strategies for the creation of learning opportunities that can advance health equity based on community priorities. Box 4-2 outlines the three identified domain components that are essential for partnerships with communities.
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From page 80... ...
Learning how to educate and learning how to listen are equally important for health professionals, students, and trainees if they are to work effectively in and with communities. Community Assets An often-cited study by McKnight and Kretzmann (1990)
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From page 81... ...
The combination of shared knowledge and a desire for action is the engine for social change that improves community health and reduces health disparities. Numerous groups around the world have used community-based participatory research to build community trust in research aimed at improving health, equity, and quality of life in communities (Abdulrahim et
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Within formal structures are informal social networks formed among families, neighborhoods, and populations that share unique characteristics. These informal support systems hold potential solutions to better meeting the needs of community members.
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From page 83... ...
. One way to ensure that research reflects community priorities while further enhancing the education of health professionals in the social determinants of health is by conducting health impact assessments (HIAs)
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From page 84... ...
Homophily has been shown to impact people's choices of whom to marry and befriend, as well as whom health professionals interact with at work, who collaborates on scientific research and publication, and who is hired (Freeman and Huang, 2014; Mascia et al., 2015; Maume, 2011; McPherson et al., 2001)
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From page 85... ...
. Health professional schools are charged with the responsibility of preparing a competent health workforce that can meet the needs of a rapidly changing, racially and ethnically diverse population.
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From page 86... ...
Candidates for student, trainee, and faculty positions will ideally be recruited from the local community and will represent the population to be served. In pursuit of this ideal, the committee puts forth the following recommendation: Recommendation 2: To prepare health professionals to take action on the social determinants of health in, with, and across communities, health professional and educational associations and organizations at the global, regional, and national levels should apply the concepts embodied in the framework in partnering with communities to increase the inclusivity and diversity of the health professional student body and faculty.
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From page 87... ...
BOX 4-4 Components of the Organization Domain Vision for and commitment to education in the social determinants of health • Policies, strategies, and program reviews • Resources • Infrastructure • Promotion/career pathways Supportive organizational environment • Transformative learning • Dissemination of pedagogical research • Faculty development/continuing professional development
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From page 88... ...
Resources Often through research and grant-funded projects, health professional schools bring to bear financial resources for building partnerships between university and community organizations. The University of British olumbia C provides multiple examples of context-specific work undertaken in partnership with community organizations (UBC, n.d.)
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From page 89... ...
. Supportive Organizational Environment Academic institutions that support transformative learning environments take advantage of networking opportunities and partnerships for educating students, trainees, and health professionals (Frenk et al., 2010)
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Therefore, in response to the calls for action from signatories of the Rio Declaration, as well as many individual health professionals and their representative professional and educational organizations, the committee makes the following recommendation:
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From page 91... ...
draws on multiple sources to show how strengthening health professional education to address the social determinants of health can produce a competent health workforce able to partner with communities and other sectors to improve the socioeconomic and political conditions that lead to health inequity and diminish health and well-being (Frenk et al., 2010; HHS, 2010; Solar and Irwin, 2010; Sousa et al., 2013; WHO, 2006, 2008b, 2011b)
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FIGURE 4-2 Conceptual model for strengthening health professional education in the social determinants of health. NOTE: SDH = social determinants of health.
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From page 93... ...
To the left of the framework is the population/future health workforce, which forms the pipeline for the education and production of future health professionals. Through the transformative learning approach described in the framework, health professionals, students, and trainees learn how to establish equal partnerships with communities, other sectors, and other professions for better understanding of and action on the social determinants of health.
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From page 94... ...
. MOVING FORWARD There are many challenges to educating health professionals to under stand and act upon the social determinants of health in and with communities.
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From page 95... ...
Finding faculty who understand and can offer effective learning opportunities that demonstrate how the social determinants of health impact individuals, populations, and communities poses an additional challenge. Despite these challenges, the potential financial, social, and political returns from such an investment in education are great.
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From page 96... ...
Support from multiple stakeholders at all levels will be necessary for these benefits to be realized. Garnering that support will require reaching beyond traditional health professional education pedagogy and silos and engaging new players, such as community health workers and other trusted members of the community, in equal partnership to address community concerns while educating health professionals (Johnson et al., 2012; Torres et al., 2014)
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From page 97... ...
In closing, the committee reiterates that passive learning is not sufficient to fully develop the competencies needed by health professionals to understand and address the social determinants of health. To impact health equity, health professionals need to translate knowledge to action, which requires more than accruing knowledge.
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From page 98... ...
2006. Sustaining civic engagement: Faculty development, roles, and rewards.
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2002. Council resolution of 27 June 2002 on lifelong learning.
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2010. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world.
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2014. Advancing efforts to achieve health equity: Equity metrics for health impact assess ment practice.
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2014. Examining the intersections b etween continuing education, interprofessional education and workplace learning.
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Academic Medicine 87(3)
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2014. Report on the 2014 confer ence on transformative learning for health equity: Prince Mahidol Award Conference 2014.
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2014. The training for health equity network evaluation framework: A pilot study at five health professional schools.
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2014. Improving health equity: The promising role of community health workers in Canada.
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From page 107... ...
2014. Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing.
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