Holly Avey, Elizabeth Fuller, Jane Branscomb, et al. “Using a Health in All Policies Approach to Address Social Determinants of Sexually Transmitted Disease Inequities in the Context of Community Change and Redevelopment.” Public Health Reports, Supplement 3 (2013).
This study used a ‘Health in All Policies’ (HiAP) framework to investigate ways in which sexual health can be improved, and sexually transmitted disease (STD) prevalence can be reduced, in vulnerable communities surrounding the Fort McPherson Army base located in Atlanta, Georgia. The HiAP framework is a method for examining public health issues “that strengthens the link between health and policies from other sectors such as housing, transportation, education, employment, and land use to create an environment that enables people to lead healthy lives” and utilizes a collaborative approach across multiple sectors to address these health issues. Communities in this area experience some of the highest incidences of chlamydia, gonorrhea, and syphilis in the Atlanta area, as well as the second highest rate of home foreclosures in the nation.
The researchers conducted a literature review to explore the social determinants of STD inequities and the roles other factors could play in impacting these inequities. They focused on five key factors: education, employment, drug and alcohol marketing, male incarceration, and social capital (that is, levels of trust and mutual assistance among community residents). The researchers also assessed existing quantitative data on social determinants of STDs, conducted interviews with key informants to identify potential policy opportunities, and used a community-based participatory research technique called Photovoice to involve community residents in addressing the problems related to each of the five factors they studied.
Education: Schools located near the Fort McPherson area had graduation rates ranging from 64% to 81%, with data from a previous study indicating that school-funding equity in Georgia ranged from a C- to a C+.
Employment: Census tracts surrounding the Fort McPherson base had a deficit of jobs relative to residents; community members worried that the closing of the base would lead to further economic hardship for small businesses in the area.
Male incarceration: The communities surrounding Fort McPherson had the highest concentrations in Atlanta of male residents on parole, with a quarter of their offenses being nonviolent and drug-related.
- STD rates: Higher rates correlated with neighborhoods that had lower graduation rates and school funding, higher unemployment, and higher male incarceration.
Sexual health problems such as STDs do not exist in a vacuum. Some opponents of comprehensive sexuality education blame individual moral failings for STDs, unintended pregnancies, intimate partner violence, and other concerns affecting sexual well being. In contrast, as this article demonstrates, social determinants – factors in the social, economic, and political context - often determine what sexual health problems exist in a given community, who in the community will be most affected, and what resources are available to address (and hopefully prevent) those problems. The authors have provided a comprehensive and innovative approach to addressing STD inequities in the Fort McPherson area. For each of the five social determinants (education, employment, drug and alcohol marketing, male incarceration, and social capital), with input from local residents, they identified opportunities to change public policy and involve community members in implementing solutions. Some of the resulting recommendations and action steps included 1) increasing the ratio of social workers to students based on school population needs; 2) implementing ‘community hire agreements’ to encourage new businesses to hire locally; 3) boosting enforcement of city codes such as those which address environmental contaminants; 4) increasing community access to addiction and mental health treatment resources; and 5) developing joint-use agreements for community meeting spaces so that multiple community groups can use the same location.
With this multi-dimensional approach to address what may seem like an overwhelming list of social problems, the HiAP framework works to “specifically [target] policy opportunities in sectors outside of health with a solutions-focused lens, concentrating on fundamental causes.” The researchers and their community allies in Atlanta have demonstrated that a sustainable reduction in STD rates requires more than testing and treatment. It requires a comprehensive approach to social determinants that include jobs, education, and affordable housing.
Avey, H., Fuller, E., Branscomb, J., Cheung, K., Reed, P. J., Wong, N., Henderson, M., & Williams, S. (2013). Using a health in all policies approach to address social determinants of sexually transmitted disease inequities in the context of community change and redevelopment. Public Health Reports, 128(3), 77-86. Accessed October 28, 2013, at http://www.publichealthreports.org/issuecontents.cfm?Volume=128&Issue=9.