A FRAMEWORK FOR
TO ADDRESS THE
Committee on Educating Health Professionals to Address the
Social Determinants of Health
Board on Global Health
Institute of Medicine
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS500 Fifth Street, NWWashington, DC 20001
This study was supported by contracts between the National Academy of Sciences and the Academic Collaborative for Integrative Health, the Academy of Nutrition and Dietetics, the Accreditation Council for Graduate Medical Education, the Aetna Foundation, the Alliance for Continuing Education in the Health Professions, the American Academy of Family Physicians, the American Academy of Nursing, the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Board of Family Medicine, the American Board of Internal Medicine, the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists/American Board of Obstetrics and Gynecology, the American Council of Academic Physical Therapy, the American Dental Education Association, the American Medical Association, the American Occupational Therapy Association, the American Psychological Association, the American Society for Nutrition, the American Speech–Language–Hearing Association, the Association of American Medical Colleges, the Association of American Veterinary Medical Colleges, the Association of Schools and Colleges of Optometry, the Association of Schools and Programs of Public Health, the Association of Schools of the Allied Health Professions, the Council of Academic Programs in Communication Sciences and Disorders, the Council on Social Work Education, Ghent University, Health Resources and Services Administration, the Jonas Center for Nursing and Veterans Healthcare, the Josiah Macy Jr. Foundation, Kaiser Permanente, the National Academies of Practice, the National Association of Social Workers, the National Board for Certified Counselors, Inc. and Affiliates, the National Board of Medical Examiners, the National League for Nursing, the Office of Academic Affiliations—Veterans Health Administration, the Organization for Associate Degree Nursing, the Physician Assistant Education Association, the Robert Wood Johnson Foundation, the Society for Simulation in Healthcare, Training for Health Equity Network, the Uniformed Services University of the Health Sciences, and the University of Toronto. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-39262-4
International Standard Book Number-10: 0-309-39262-4
Digital Object Identifier: 10.17226/21923
Library of Congress Control Number: 2016955391
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Copyright 2016 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. A framework for educating health professionals to address the social determinants of health. Washington, DC: The National Academies Press. doi: 10.17226/21923.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.
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COMMITTEE ON EDUCATING HEALTH PROFSSIONALS TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH
SANDRA D. LANE (Chair), Laura J. and L. Douglas Meredith Professor of Public Health and Anthropology, Syracuse University
JORGE DELVA, Professor and Associate Dean, University of Michigan School of Social Work
JULIAN FISHER, Research Associate, Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig Institute of Technology, and Hannover Medical School
BIANCA FROGNER, Associate Professor and Director, Center for Health Workforce Studies, Department of Family Medicine, University of Washington School of Medicine
CARA V. JAMES, Director, Office of Minority Health, Centers for Medicare & Medicaid Services
MALUAL MABUR, Health Promotion Specialist and Community Health Outreach Worker, City of Portland, Maine; Student, University of New England
LAURA MAGAÑA VALLADARES, Academic Dean, National Institute of Public Health, Mexico
SPERO M. MANSON, Distinguished Professor and Director, Centers for American Indian & Alaska Native Health, University of Colorado Denver
ADEWALE TROUTMAN, Associate Dean for Health Equity and Community Engagement, University of South Florida
ANTONIA M. VILLARRUEL, Professor and Margaret Bond Simon Dean of Nursing, University of Pennsylvania School of Nursing
SUSAN SCRIMSHAW, President, The Sage Colleges
SARA WILLEMS, Professor, Inequity in Health Care, Ghent University
KAREN ANDERSON, Senior Program Officer, Institute of Medicine
RONA BRIERE, Consultant Editor
National Academies of Sciences, Engineering, and Medicine Staff
PATRICIA A. CUFF, Senior Program Officer
MEGAN M. PEREZ, Research Associate
BRIDGET CALLAGHAN, Research Assistant
DANIEL BEARSS, National Academies Research Center Researcher
REBECCA MORGAN, National Academies Research Center Researcher
CHRISTIE BELL, Financial Officer (until September 2015)
FAYE HILLMAN, Financial Associate (from September 2015)
PATRICK W. KELLEY, Senior Board Director, Board on Global Health
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
RAPHAEL BOSTIC, University of Southern California School of Public Policy
ANDREIA BRUNO, International Pharmaceutical Federation
FRANCISCO EDUARDO DE CAMPOS, National Open University for the Unified Health System
FERNANDO A. GUERRA, University of Texas Health Science Center, San Antonio, Texas
CAMARA PHYLLIS JONES, Morehouse School of Medicine
ARTHUR KAUFMAN, University of New Mexico School of Medicine
PAULA LANTZ, University of Michigan School of Public Policy
NANDI A. MARSHALL, Armstrong State University Department of Health Sciences
DAVID T. TAKEUCHI, Boston College School of Social Work
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by KATHLEEN DRACUP, University of California, San Francisco, and SUSAN J. CURRY, University of Iowa. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Boxes and Figures
Community-based education “consists of learning activities that use the community extensively as a learning environment” (WHO, 1987, p. 8).
Community-engaged learning is an educational process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them; in making decisions about factors that affect their lives; in formulating and implementing policies; in planning, developing and delivering services; and in taking action to active change (adapted from WHO, 2002).
Community Oriented Primary Care integrates clinical medicine with public health at the community level and is directed to the epidemiologically defined health needs of the population under care (TUFH, 2000).
Continuing professional development “aims to enhance knowledge and improve performance leading to quality outcomes” (WHO, 2008a).
Equity is “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically” (WHO, 2016a).
1 Note that this glossary includes only terms that appear in the report. The committee recognizes that many definitions for these terms exist and that some definitions evolve over time.
Experiential learning involves concrete experiences, reflective observation, abstract conceptualization, and application of knowledge (Kolb, 1984).
Framework is “the ideas, information, and principles that form the structure of an organization or plan” (Cambridge University Press, 2016a).
Health disparities are health outcomes seen to a greater or lesser extent between populations of differing race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location (HHS, 2016).
Health impact assessment is a combination of procedures, methods, and tools by which a policy, program, product, or service may be judged concerning its effects on the health of the population (WHO, 1998).
Health in all policies is a policy or reform designed to “secure healthier communities, by integrating public health actions with primary care and by pursuing healthy public policies across sectors” (WHO, 2008b, 2011).
Health inequities “involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. They also entail a failure to avoid or overcome inequalities that infringe on fairness and human rights norms” (WHO, 2016a).
Health professionals “are the service providers who link people to technology, information, and knowledge. They are also caregivers, communicators and educators, team members, managers, leaders, and policy makers” (Frenk et al., 2010).
Interprofessional education “occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (WHO, 2010).
Lifelong learning is a continuum of learning throughout the life course aimed at “improving knowledge, skills, and competences within a personal, civic, social, and/or employment-related perspective” (The Council of the European Union, 2002).
Model is “something built or drawn especially to show how something much larger would look” (Cambridge University Press, 2016b).
Problem-based learning is a way of delivering a curriculum in order to develop problem solving skills as well as assisting learners with the acquisition of necessary knowledge and skills. Students work cooperatively in groups
to seek solutions to real-world problems, set to engage students’ curiosity and initiate learning the subject matter (WHO, 2008a).
Social determinants of health are “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 social determinates of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries” (WHO, 2016b).
Transformative learning is education that emphasizes searching, analysis, and synthesis of information for decision making; achieving core competencies for effective teamwork in health systems; and creative adaptation of global resources to address local priorities (Frenk et al., 2010).
Cambridge University Press. 2016a. Framework. http://dictionary.cambridge.org/us/dictionary/english/framework (accessed February 2, 2016).
Cambridge University Press. 2016b. Model. http://dictionary.cambridge.org/us/dictionary/english/model (accessed February 2, 2016).
The Council of the European Union. 2002. Council resolution of 27 June 2002 on lifelong learning. Official Journal of the European Communities C 163/161-C 163/163.
Frenk, J., L. Chen, Z. A. Bhutta, J. Cohen, N. Crisp, T. Evans, H. Fineberg, P. Garcia, Y. Ke, P. Kelley, B. Kistnasamy, A. Meleis, D. Naylor, A. Pablos-Mendez, S. Reddy, S. Scrimshaw, J. Sepulveda, D. Serwadda, and H. Zurayk. 2010. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet 376(9756):1923-1958.
HHS (U.S. Department of Health and Human Services). 2016. Healthypeople.gov: Disparities. http://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities (accessed January 28, 2016).
Kolb, D. A. 1984. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.
TUFH (Towards Unity for Health). 2000. Towards Unity for Health: Coordinating changes in health services and health professions practice and education. Geneva, Switzerland: WHO.
WHO (World Health Organization). 1987. Community-based education of health personnel. Report of a WHO study group. WHO technical report series 746. Geneva, Switzerland: WHO.
WHO. 1998. Health promotion glossary. Geneva, Switzerland: WHO.
WHO. 2002. Community participation in local health and sustainability development: Approaches and techniques. Copenhagen, Denmark: WHO.
WHO. 2008a. Interprofessional education and collaborative practice glossary. http://caipe.org.uk/silo/files/who-interprofessional-education-and-collaborative-practice-iecpglossary.doc (accessed September 22, 2016).
WHO. 2008b. The world health report 2008. Primary health care: Now more than ever. Geneva, Switzerland: WHO.
WHO. 2010. Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: WHO.
WHO. 2011. Health systems strengthening glossary. http://www.who.int/healthsystems/hss_glossary/en (accessed September 22, 2016.
WHO. 2016a. Health systems: Equity. http://www.who.int/healthsystems/topics/equity/en (accessed February 2, 2016).
WHO. 2016b. Social determinants of health. http://www.who.int/topics/social_determinants/ en (accessed February 2, 2016).
The committee recognizes the efforts of several individuals whose contributions fostered discussion, enhanced the report’s quality, and provided expert advice and opinions to inform the committee. With gratitude for their willingness to speak at the Open Session meeting on September 15, 2015, the committee members would like to thank: David Brown, Joanna Cain, Brigit Carter, Elizabeth Doerr, Kira Fortune, Pedro J. Greer, Lillian Holloway, Onelia Lage, Pierre LaRamée, Angelo McClain, Susan Scrimshaw, Sara Willems, and Shanita Williams.
The committee offers great appreciation for the consultants to the committee: Susan Scrimshaw, co-chair of the Global Forum on Innovation in Health Professional Education, and Sara Willems, author of the paper presented in Appendix A of the report; Karen Anderson, National Academies of Sciences, Engineering, and Medicine staff consultant; and Rona Briere, consultant editor.
The committee members would like to acknowledge the hard work of the study staff. Special appreciation goes to Patricia Cuff, study director, for her tireless efforts, keen dedication to the study, and adept skills. The committee also thanks Megan Perez, research associate; Bridget Callaghan, research assistant; and Patrick Kelley, board director of the Board on Global Health. In addition, the committee is grateful to the Academies Research Center, in particular Daniel Bearss and Rebecca Morgan, for conducting the literature review that provided the basis for Appendix A of the report.
Finally, the committee acknowledges its appreciation to the sponsors of this study; without their financial support, this study would not have been possible.
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