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Manuel Franco MD, PhD
University of Alcala, Madrid, Spain
Achieving health equity through
place-based interventions
Establishing partnerships with local
authorities and community members:
Heart Healthy Hoods study,
the case of Madrid
http://hhhproject.eu
Egalitarian cities, healthier cities
healthier residents
Life expectancy in high income
neighborhood: 85 years
Life expectancy in low income
neighborhood: 66 years
Baltimore life expectancy gap
by neighbohoods: 18 years
http://hhhproject.eu
Egalitarian cities, healthier cities
healthier residents
Life expectancy in high income
neighborhood: 85 years
Life expectancy in low income
neighborhood: 78 years
Madrid life expectancy gap
by neighbohoods: 7 years
Social and Physical Urban
Environment and CV Health:
The Much Needed
Population Approach
Manuel Franco MD, PhD
For the HHH investigators
http://hhhproject.eu
ERC Starting Grants
FUNDING 1.5 million € for 5 years
OBJECTIVE To encourage independent careers of excellent
investigators providing enough support in the critical
moment (starting to develop their own team).
ELEGIBILITY PI must have a PhD degree in the last 2 to 7 years.
Available to non-EU researchers.
REQUISITES At least one relevant publication without his/her
thesis advisor
At least 50% effort
PROFILE High potential, project with potential social
Impact in Europe.
Presenter’s Name
Date
Physical
Environment
Social
Environment
SOCIAL
EPIDEMIOLOGY
Studies social determinants of disease
Methodologies from Social Sciences and Public Health
Focus on population preventive approach
Addresses growing social inequalities in health
First cause of death in Europe (47% of all deaths in 2010)
Increasing prevalence (50 mill. patients in 2009 in Europe)
Rising social and economic costs (196 billion € in 2009)
Traditional medical preventive approaches are individual
Cardiovascular
Health
Presenter’s Name
Date
Physical
Environment
Social
Environment
Cardiovascular
Health
HEART
HEALTHY
HOODS
Obesity
Physical
Activity
Diet
Alcohol
Physical Activity
Environment
Food
Environment
CVD
Smoking
Tobacco
Environment
Social and Physical
Environment
Individual
Cardiovascular Health
Alcohol
Environment
NeighborhoodSocioeconomicStatus
Unemployment–Education–Poverty
ImmigrationComposition
IndividualSocioeconomicStatus
Occupation–Income–Education
Gender–Immigration
Heart Healthy Hoods Study
Main Goal
http://hhhproject.eu
To study the impact of the
social and physical environment in terms of
tobacco, alcohol, food and physical activity
on residents cardiovascular health
Heart Healthy Hoods
Overall Objectives
http://hhhproject.eu
1. To include a qualitative approach to understand
the context and meanings of the urban
environment in relation to cardiovascular health
1. To develop measurements to characterize the
social and physical urban environments in a
systematic and accurate fashion
Heart Healthy Hoods
Secondary Objectives
http://hhhproject.eu
3. To compare the relation between the urban
environment and cardiovascular health in the
United States with this relation in Europe
(ICUH Julia Diez, Sunday 15:15 CS 8.5)
4. To evaluate naturally occurring changes (natural
experiments) such as public policy interventions
occurring during the time of the study modifying the
urban environment
Heart Healthy Hoods
Secondary Objectives
http://hhhproject.eu
To provide scientific evidence to the general
population, researchers and policy makers to
intervene at the population level to prevent the
first cause of death in Europe
HHH overarching objective:
Policy and research implications
http://hhhproject.eu
Mejorar la ciudad
Mejorar nuestra salud
21 Districts
128 Neighborhoods
2412 Census Units
3,2 Mill. Residents
Access to the
Integrated Primary
Care Health System
Database
1,4 million residents
40-75 ys. old
HHH Pilot Study
(ICUH Usama Bilal, Sunday 15:15 CS 8.2)
http://hhhproject.eu
HHH Pilot Study Area
http://hhhproject.eu
Gilles-Corti et al. Journal of Public Health Policy 2015 Vol. 36, 2, 231–243
Translating urban health research
into policy and practice
DISSEMINATION STRATEGY
DISSEMINATION STRATEGY
NON-POLICY-RELEVANT Research
RESEARCH METHODSRESEARCH QUESTION
POLICY-RELEVANT Research
RESEARCH METHODS
POLICY RELEVANT
RESEARCH QUESTION
Giles-Corti et al
http://hhhproject.euUntil relatively recently, few active living researchers from the health
DISSEMINATION STRATEGY
DISSEMINATION STRATEGYRESEARCH METHODSRESEARCH QUESTION
ADVOCACY POLICY
POLICY-RELEVANT Research
RESEARCH METHODS
POLICY RELEVANT
RESEARCH QUESTION
Figure 1: Processes, partners, and strategies that differentiate non-policy-relevant and policy-
relevant research.Gilles-Corti et al. Journal of Public Health Policy 2015 Vol. 36, 2, 231–243
Translating urban health research
into policy and practice
http://hhhproject.eu
Establishing partnerships with local authorities:
Primary Health Care Research Unit Madrid State Gov.
• For conducting the HHH cohort study
• For analyzing Electronic Health Records
Public Health Research Unit Madrid State Gov.
• For analyzing SES Madrid data
• For analyzing Madrid Health surveillance data
Heart Healthy Hoods
Manuel Franco MD, PhD
University of Alcala, Madrid, Spain
Achieving health equity through
place-based interventions
Establishing partnerships with
community members: Photovoice
project in Villaverde, Madrid
http://hhhproject.eu
Main objective
To conduct a participatory photovoice project
with residents of a low-income urban area to
understand environmental and social
characteristics of the local food environment
influencing residents diets.
http://hhhproject.eu
Setting Two neighborhoods of a
low-income area in Madrid (Spain).
Participants
- 24 residents (31-72 years old).
- A group of women and another
one of men per neighborhood.
Procedure
- A total of 163 pictures of their
local food environment
- Groups met at least for 5 sessions
two months
Photovoice Food Environment:
Methods
http://hhhproject.eu
Photovoice Food Environment:
Participants´Analysis
- Each one chose their best photograph
- Participants defined the meaning of
their photographs and discussed them
critically
- Participants identified 31 emerging
themes
http://hhhproject.eu
31 final themes of the four
groups were finally merged
into 5 main themes:
o Eating in moderation
o Cultural diversity
o Food retailers
o Socialization
o Economic crisis and poverty
Photovoice Food Environment:
Results
http://hhhproject.eu
Theme 1: Eating in moderation
http://hhhproject.eu
Theme 2: Cultural diversity
http://hhhproject.eu
Theme 3: Food retailers
http://hhhproject.eu
Theme 4: Socialization
http://hhhproject.eu
Theme 5: Economic crisis
and poverty
http://hhhproject.eu
Process: overview
http://hhhproject.eu
Disseminating results and
reaching policy makers
Citizen Science Meeting Photography exhibit
• Residents participated in dissemination strategies raising
awareness and promoting social action: Photobook, Video,
Scietific and cultural meetings, Media collaboration
• Participants generated 11 policy recommendations

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Achieving Health Equity through Place Based Interventions. Establishing partnerships with local authorities and community members: Heart Healthy Hoods study, the case of Madrid

  • 1. Manuel Franco MD, PhD University of Alcala, Madrid, Spain Achieving health equity through place-based interventions Establishing partnerships with local authorities and community members: Heart Healthy Hoods study, the case of Madrid
  • 2. http://hhhproject.eu Egalitarian cities, healthier cities healthier residents Life expectancy in high income neighborhood: 85 years Life expectancy in low income neighborhood: 66 years Baltimore life expectancy gap by neighbohoods: 18 years
  • 3. http://hhhproject.eu Egalitarian cities, healthier cities healthier residents Life expectancy in high income neighborhood: 85 years Life expectancy in low income neighborhood: 78 years Madrid life expectancy gap by neighbohoods: 7 years
  • 4. Social and Physical Urban Environment and CV Health: The Much Needed Population Approach Manuel Franco MD, PhD For the HHH investigators
  • 6. ERC Starting Grants FUNDING 1.5 million € for 5 years OBJECTIVE To encourage independent careers of excellent investigators providing enough support in the critical moment (starting to develop their own team). ELEGIBILITY PI must have a PhD degree in the last 2 to 7 years. Available to non-EU researchers. REQUISITES At least one relevant publication without his/her thesis advisor At least 50% effort PROFILE High potential, project with potential social Impact in Europe.
  • 7. Presenter’s Name Date Physical Environment Social Environment SOCIAL EPIDEMIOLOGY Studies social determinants of disease Methodologies from Social Sciences and Public Health Focus on population preventive approach Addresses growing social inequalities in health First cause of death in Europe (47% of all deaths in 2010) Increasing prevalence (50 mill. patients in 2009 in Europe) Rising social and economic costs (196 billion € in 2009) Traditional medical preventive approaches are individual Cardiovascular Health
  • 8. Presenter’s Name Date Physical Environment Social Environment Cardiovascular Health HEART HEALTHY HOODS Obesity Physical Activity Diet Alcohol Physical Activity Environment Food Environment CVD Smoking Tobacco Environment Social and Physical Environment Individual Cardiovascular Health Alcohol Environment NeighborhoodSocioeconomicStatus Unemployment–Education–Poverty ImmigrationComposition IndividualSocioeconomicStatus Occupation–Income–Education Gender–Immigration Heart Healthy Hoods Study Main Goal
  • 9. http://hhhproject.eu To study the impact of the social and physical environment in terms of tobacco, alcohol, food and physical activity on residents cardiovascular health Heart Healthy Hoods Overall Objectives
  • 10. http://hhhproject.eu 1. To include a qualitative approach to understand the context and meanings of the urban environment in relation to cardiovascular health 1. To develop measurements to characterize the social and physical urban environments in a systematic and accurate fashion Heart Healthy Hoods Secondary Objectives
  • 11. http://hhhproject.eu 3. To compare the relation between the urban environment and cardiovascular health in the United States with this relation in Europe (ICUH Julia Diez, Sunday 15:15 CS 8.5) 4. To evaluate naturally occurring changes (natural experiments) such as public policy interventions occurring during the time of the study modifying the urban environment Heart Healthy Hoods Secondary Objectives
  • 12. http://hhhproject.eu To provide scientific evidence to the general population, researchers and policy makers to intervene at the population level to prevent the first cause of death in Europe HHH overarching objective: Policy and research implications
  • 13. http://hhhproject.eu Mejorar la ciudad Mejorar nuestra salud 21 Districts 128 Neighborhoods 2412 Census Units 3,2 Mill. Residents Access to the Integrated Primary Care Health System Database 1,4 million residents 40-75 ys. old
  • 14. HHH Pilot Study (ICUH Usama Bilal, Sunday 15:15 CS 8.2)
  • 16. http://hhhproject.eu Gilles-Corti et al. Journal of Public Health Policy 2015 Vol. 36, 2, 231–243 Translating urban health research into policy and practice DISSEMINATION STRATEGY DISSEMINATION STRATEGY NON-POLICY-RELEVANT Research RESEARCH METHODSRESEARCH QUESTION POLICY-RELEVANT Research RESEARCH METHODS POLICY RELEVANT RESEARCH QUESTION Giles-Corti et al
  • 17. http://hhhproject.euUntil relatively recently, few active living researchers from the health DISSEMINATION STRATEGY DISSEMINATION STRATEGYRESEARCH METHODSRESEARCH QUESTION ADVOCACY POLICY POLICY-RELEVANT Research RESEARCH METHODS POLICY RELEVANT RESEARCH QUESTION Figure 1: Processes, partners, and strategies that differentiate non-policy-relevant and policy- relevant research.Gilles-Corti et al. Journal of Public Health Policy 2015 Vol. 36, 2, 231–243 Translating urban health research into policy and practice
  • 18. http://hhhproject.eu Establishing partnerships with local authorities: Primary Health Care Research Unit Madrid State Gov. • For conducting the HHH cohort study • For analyzing Electronic Health Records Public Health Research Unit Madrid State Gov. • For analyzing SES Madrid data • For analyzing Madrid Health surveillance data Heart Healthy Hoods
  • 19. Manuel Franco MD, PhD University of Alcala, Madrid, Spain Achieving health equity through place-based interventions Establishing partnerships with community members: Photovoice project in Villaverde, Madrid
  • 20. http://hhhproject.eu Main objective To conduct a participatory photovoice project with residents of a low-income urban area to understand environmental and social characteristics of the local food environment influencing residents diets.
  • 21. http://hhhproject.eu Setting Two neighborhoods of a low-income area in Madrid (Spain). Participants - 24 residents (31-72 years old). - A group of women and another one of men per neighborhood. Procedure - A total of 163 pictures of their local food environment - Groups met at least for 5 sessions two months Photovoice Food Environment: Methods
  • 22. http://hhhproject.eu Photovoice Food Environment: Participants´Analysis - Each one chose their best photograph - Participants defined the meaning of their photographs and discussed them critically - Participants identified 31 emerging themes
  • 23. http://hhhproject.eu 31 final themes of the four groups were finally merged into 5 main themes: o Eating in moderation o Cultural diversity o Food retailers o Socialization o Economic crisis and poverty Photovoice Food Environment: Results
  • 30. http://hhhproject.eu Disseminating results and reaching policy makers Citizen Science Meeting Photography exhibit • Residents participated in dissemination strategies raising awareness and promoting social action: Photobook, Video, Scietific and cultural meetings, Media collaboration • Participants generated 11 policy recommendations

Editor's Notes

  1. Achieving health equity through place-based interventions   Populations living in socially disadvantaged areas often defined as low socio-economic status, high social exclusion, poor physical environments, and increasing crime rates, tend to have poorer physical and mental health outcomes. Therefore, place-based interventions can offer different solutions to address the health inequities faced by these populations through positive impacts on various social determinants of health. In this session, four international researchers have joined to describe the different perspectives involved to achieve health equity through place-based interventions.   Dr. Hortensia Amaro will provide an introduction to place-based interventions and their impacts on health while discussing the importance of moving upstream when developing interventions in order to address health equity.   Dr. Julie Clark provides an urban planning perspective by discussing the use of mixed-methods to study placed-based interventions like urban regeneration and mega-events in Glasgow, and their health impacts across neighborhoods.   Dr. Manuel Franco will discuss the importance of establishing partnerships and working with community members when designing interventions. He draws on a photovoice project used to better understand the food environment of a low-income area of Madrid in order to help develop interventions and policies to address the scarce food outlets in these areas.   Dr. Roshanak Mehdipanah will conclude the session by discussing some of the theories associated with place-based interventions and their impacts on health equity. This will include a closer look at the mechanisms involved and the concept of ‘place-bound’ populations described by the frequency or degree of interaction an individual has with their neighborhood.  
  2. el logo arriba y abajo queda repetido. Propongo quitar la chapa y centrar el título
  3. Preguntas al publico !! Madrid es una ciudad de barrios, cual es tu barrio? Qué caracteristicas tiene tu barrio que se relacionen con tu salud?
  4. Te propongo cambiar le orden de las diapos 6 y 7 --> introducir primero CV health y social epidemiology para despues presentar la 7 para ver como se relacionan una con la otra. La 7 sirve para introducir el marco conceptual...la 6 más bien como justificaicón del estudio
  5. Hacer un poco más pequeña la imagen para dejar márgenes Repasar animacion! Porque al final sale el titulo de la diapo...valorar si el tñitulo sale desde el principio
  6. porque el segundo punto en cursiva? uniformizar el fomrato (letra/tamañao de las diapos) --> las diapos de objetivos tienen letra diferente creo que le segundo objetivo más que un objetivo en si podría ponerse com un apartado al final de Public Health // POlicy implication of the study
  7. using a qualitative approach
  8. whats that? titulo...
  9. Achieving health equity through place-based interventions   Populations living in socially disadvantaged areas often defined as low socio-economic status, high social exclusion, poor physical environments, and increasing crime rates, tend to have poorer physical and mental health outcomes. Therefore, place-based interventions can offer different solutions to address the health inequities faced by these populations through positive impacts on various social determinants of health. In this session, four international researchers have joined to describe the different perspectives involved to achieve health equity through place-based interventions.   Dr. Hortensia Amaro will provide an introduction to place-based interventions and their impacts on health while discussing the importance of moving upstream when developing interventions in order to address health equity.   Dr. Julie Clark provides an urban planning perspective by discussing the use of mixed-methods to study placed-based interventions like urban regeneration and mega-events in Glasgow, and their health impacts across neighborhoods.   Dr. Manuel Franco will discuss the importance of establishing partnerships and working with community members when designing interventions. He draws on a photovoice project used to better understand the food environment of a low-income area of Madrid in order to help develop interventions and policies to address the scarce food outlets in these areas.   Dr. Roshanak Mehdipanah will conclude the session by discussing some of the theories associated with place-based interventions and their impacts on health equity. This will include a closer look at the mechanisms involved and the concept of ‘place-bound’ populations described by the frequency or degree of interaction an individual has with their neighborhood.  
  10. Importancia del equeño comercio vs supermarkets: Beterr in quality, more fresh and a much better customer service Supermarkets offer greater variety but characterized by fraudulent and unhealthy marketing Local food retailers should be supported not just by local adminstrators but by local residents
  11. Manuel, si quieres modificar esta imagen, la tienes en la siguiente diapo que está oculta. Lo importante que yo diría aquí: En base a los resultados obtenidos en el Photovoice se han generado unas recomendaciones (etapa 4) y actualmente estamos trabajando en la etapa 5 y 6 con la idea de que se llegue a una etapa 7, que ya depende de los políticos. Los participantes (community) han estado involucrados en el proceso de manera activa desde etapas tempranas. Los políticos no serán “únicamente” informados con nuestro proyecto, si no que se les ha involucrado de manera activa en la difusión (Ayuntamiento, expo, fotolibro)