Appendix D

Results from a University of Michigan Survey Regarding Priorities for Population Health Research

September 22, 2015
(N = 110 respondents)

EXAMPLE SURVEY RESULTS
RESEARCH AREA 1
ROOT CAUSES OF PROBLEMS, IMPLICATIONS
FOR POPULATIONS/COMMUNITIES

Social Determinants—General Research Questions

• Does poverty affect children from different racial/ethnic groups differently in terms of health outcomes?
• Determinants of improvement in self-reported health
• What percent of non–health care investments accrue to health outcomes, so that a true health budget can be established?
• Research linking multiple social priorities and illustrating alignment
• Identifying the key levers among the social determinants of health that would trigger ripple effects in eliminating inequalities in multiple systems that contribute to health inequalities

Socioeconomic Determinants—Income, Education, Housing

• Deeper understanding between the intersection of health and wealth
• The role of mass incarceration in health disparities in the United States

• As a society, where can we get better return on investment: education or plain wages increases?
• Understanding causality with relationship to the protective influence of education on health
• Role of educational interventions during K–12 on health disparities
• The effects of housing on anything

Racism, Segregation, and Immigration

• How does historic racism (structural and individual) affect population health?
• Effects of structural racism on health outcomes
• How segregation produces health disparities
• Increased understanding of factors affecting health among immigrants and the variability of these factors across immigrant populations
• How does discrimination against immigrants affect physical and mental health?

Early Childhood and Family

• Increased understanding of childhood adverse childhood experiences and risk for mental and cardiovascular risk in adulthood
• Increased understanding of how to mitigate the effect of childhood trauma on morbid obesity in adult women
• Why do youth born into similar low social and economic circumstances have very different life outcomes?
• Does poor nutrition early in life have an irreversible effect on brain and neurodevelopment?
• What is the effect of depression in mothers on the healthy social and emotional development of their children?

Food and Obesity

• Evidence of multilevel determinants of obesity and diabetes
• Would reducing obesity reduce the number of older Americans with multiple chronic conditions and their health care costs?
• Does elimination of food and beverage marketing to children affect food preference?
• Seasonal fluctuations in food insecurity
• Causal link between healthy food access and high school graduation

• Relationship of the availability of healthy food and vegetables to lower socioeconomic neighborhoods to health status

Social and Psychological Factors

• Interaction between long-term environmental exposure (e.g., indoor air quality) and stress
• How does stigma (race/ethnicity, sexual orientation, socioeconomic status) affect health?
• How to reverse hopelessness in impoverished communities
• How does the experience of cultural isolation and depression affect health disparities in a population?
• Better understanding of the role of inequity in making people feel more and more impoverished even when absolute income and wealth are rising
• Increased understanding of the role of social cohesion in mental health conditions

Community, Neighborhood, and Contextual Factors

• How does geography affect population health apart from other variables such as income and education?
• The role of the built environment in urban areas in health and illness
• A stronger body of evidence around the contributions of neighborhood conditions to health, as opposed to individual or households attributes
• How does urban living contribute to the rise of type 2 diabetes?
• The role of community organizing in advancing health equity
• What evidence exists regarding the effect of community health assessments and improvement plans and their effect on the needs and inequities experienced by subpopulations within communities?

Health Risk Behaviors

• How can behaviors be reinforced or changed when the individual is in a family or living setting that does not support change?
• How can employers effectively motivate employees in taking charge of their own health through exercise, better nutrition, and other habits?
• Aspects of behavioral economics most relevant to burden of health disease in a population
• How should public health and health care respond to e-cigarettes?

• What are the major drivers of the epidemic of opioid addiction in the United States?
• The epidemiology and causal models of the growing trend of substance abuse in all segments of communities

Communications and Public Opinion

• How to craft messages tailored to different cultural groups
• What particular element of population health motivates audiences with a range of political views the most regarding spending and policy action?
• Why are some groups opposed to family planning?
• Do changes in public opinion about public policy strategies affect policy action?
• Understanding how to overcome public misunderstanding of vaccines and vaccine research

Physiology and Genetics

• Effects of social conditions on gene expression and health
• Endocrine-disrupting chemicals and differential exposure

Health Care and Health Care Reform

• What are the potential negative consequences of reforming the health care delivery system?
• Increased understanding of barriers to prevention of disease and management of health
• How social determinants and clinical interventions interact to shape disparities in health
• Understanding how small primary care practices can achieve high levels of performance in a value-based context
• Increased understanding of what does and does not work in terms of wellness program lifestyle interventions
• How can payment for health care and social services be best integrated to improve patient outcomes?

Public Health Systems and Cross-Sector Collaboration

• What are the workforce skills and gaps needed for local health departments to effectively address population health?

• What are the best ways for local and state public health agencies to collaborate with such nongovernmental organizations as businesses, faith-based groups, and nonprofit organizations?
• How does the integration of health care, public health, behavioral health, housing, and human services lead to better outcomes in overall health and social well-being?
• Modeling the health and economic benefits of clinical medicine and public health integration
• Increased understanding of the use of similar metrics by health departments and health systems in measuring population health improvement

Other

• The role of climate change in producing or maintaining health disparities
• Calculation of health-adjusted life expectancy
• What technologies are more adoptable by young people?

EXAMPLE SURVEY RESULTS
RESEARCH AREA 2
INTERVENTIONS AND POLICY ACTION

Effect of General Types of Interventions

• High-value policies and/or interventions that have been proven to reduce inequities
• What can employers do to reduce health inequities?
• How to reduce racism and other forms of social stigmatization in the larger culture
• How to shift wealth distribution to eliminate poverty
• The effect of economic and education policies on health in the short and long term
• Research aimed at improving school performance for inner-city youth
• How to increase purchasing demand for healthy foods in low-income communities
• How can behavioral economics be leveraged to foster uptake of efficacious, health-promoting, and economically advantageous (to individuals) choices?

Effect of Specific Interventions

• What is the net effect on health of policies to increase physical activity, such as bicycle lanes and city bike programs?
• Which poverty reduction efforts actually work to reduce poverty and improve health?
• Effect of living wage laws
• Enforcement of housing codes: effects on childhood asthma and lead poisoning
• The effect of availability of affordable housing on public health
• Elements of wellness programs that actually have sustained impact on health status
• What is the effect of very low cost but high-quality, high-speed broadband on health in a very low income population?
• Interventions to increase the use of long-acting reversible contraceptives
• What are effective early interventions to address newly diagnosed mental illness?
• Effect of Medicaid expansion on health access for reentry population (criminal justice involved)
• How can we increase medication adherence through community support?
• Policies to mitigate overprescription of opioid painkillers

Effect of Interventions Related to Obesity, Food, Nutrition, and Physical Activity

• The effect of a tax on sugar-sweetened beverages on obesity in different sociodemographic groups
• How to establish an incentive structure for government to use to attract markets to food deserts
• Use of built environment and health in all policies approaches to improve physical activity and reduce obesity
• How to use schools and other social institutions to help improve children’s eating behavior
• Programming during the school day that increases physical activity among youth

Interventions for Specific Sociodemographic Groups and Populations

• How to tailor interventions to different cultural groups
• What interventions actually work to improve education for African Americans living in poverty?

• What sexual health education programs work best with Hispanic youth living in a border city?
• Further examination of the Hispanic paradox¹ and how that can be applied to other immigrant groups in supportive services
• Identifying effective approaches and models for engaging lower-income men in health promotion and disease prevention activities
• Identifying more effective ways for ethnic organizations to truly communicate and partner with mainstream organizations
• Public health organizations whose messaging and approach is not resonating with both ethnic community
• Best practices or evidence-based interventions to reach people in the beginning of a chronic condition

Communities, System-Level Interventions, and Cross-Sector Collaborations

• Do policy, system, and environment changes or interventions for various health issues (e.g., obesity, tobacco) at a community level result in improved health?
• What effect has the “health in all policies” approach had on health?
• Social and environmental interventions to promote health behavior (e.g., diet, physical activity, smoking)
• What are the best ways to build community connectedness?
• What are the best ways for local and state public health to collaborate with nongovernmental organizations (NGOs)?
• What community health worker models (e.g., clinic based, NGO based, housing based) are most effective?
• How are hierarchical organizations best encouraged to engage in collaborative leadership with their local communities?

Cost-Effectiveness and Return on Investment Research

• What are the most cost-effective community change strategies?
• What is the cost-effectiveness of interventions involving efforts outside of the health care delivery system, and how generalizable are results from one initiative to another?
• Cost-effectiveness of school-based interventions
• Cost-effectiveness of workplace health interventions

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¹ The epidemiologic finding that Hispanic and Latino Americans tend to have health outcomes that paradoxically are comparable to, or in some cases better than, those of their U.S. white counterparts, even though Hispanics have lower average income and education (Franzini et al., 2001).

• Cost-effectiveness of permanent supportive housing for chronically homeless persons
• Cost-effectiveness of integrating physical and mental health services

Evaluation Research Regarding Interventions That Involve Health Care and the Health Care System

• Effect of community navigators in the health care system
• What is the effect of an information system designed to e-prescribe community resources for self-care and disease management on health and economic vitality of a community?
• Effect of high-deductible plans on health inequities
• What are the best practices for getting hospitals to align their community benefit requirements within a community’s population health plan?
• What is the effect on health outcomes from integrating behavioral health and general primary care?

Public Health Systems

• Meta-analysis of studies of other sectors (transportation, economic development, housing, etc.) to explore
• How is public health viewed?
• Determine strategies for strengthening partnership efforts
• What are ways that local public health can be more effective partners with external partners?
• What are effective budgeting strategies to support a health in all policies approach?

EXAMPLE SURVEY RESULTS
RESEARCH AREA 3
HOW TO IMPROVE RESEARCH TRANSLATION AND ITS EFFECTS

Research Dissemination to Policy Makers, Clinicians, and Other Practitioners

• What approaches to adoption and spread of evidence-based practices are most successful?
• Effective ways to scale and replicate effective interventions that address social determinants
• How credible are models or modeling to governmental policy makers?

• Effectiveness of various methods to disseminate research evidence to policy makers
• How is research that goes against conventional wisdom or strongly held assumptions best communicated to policy makers and their staff?
• What impactful policies addressing population health would have bipartisan support; what coalitions would need to be built?
• How can health system efforts on addressing social needs be made sustainable when there is so much else to do in health care?
• What elements of research are most useful to community advocacy efforts?

Public Communication, Media, and Increasing Awareness of Issues and Solutions

• What are the best communication strategies in describing population health to the public, policy makers, and payers?
• How do we best translate the effect of the social determinants of health on overall population health?
• What role does—or how effective is—the entertainment media play in bringing research messages to the general public?
• How to integrate health information into social media
• How can we tell the story of disadvantaged populations to policy makers and the general public in ways that would build empathy and political will to support the needed change?
• Most compelling language and messages to build buy-in for specific population health improvement approaches to audiences across a range of political viewpoints
• Best practices for communicating with the full spectrum of policy makers about health equity issues
• How do community-based organizations gain access to information systems and data that they can contribute and apply to demonstrate impact or to inform practice change?

How to Raise Awareness and Motivate Action

• How do all of us better distinguish between science and the values that may drive alternative responses to that science?
• How do you raise awareness about homelessness and inspire compassion and understanding?
• How can research findings be communicated more effectively in terms that get the attention of practitioners?

Identifying and Communicating Best Practices

• Best practice for providing health care to returning incarcerated persons
• Model policies for school districts on sexual health education
• Best practices for youth engagement, especially youth of color, so they can become the leaders of tomorrow
• Best practices or synthesis of evidence about employer-based wellness initiatives
• Best practices for reducing impact of treatment cascade for HIV/ AIDS

Research Funding and Priority Setting

• Best practices for getting funders to discontinue interventions or programs that research demonstrates are not effective
• Effective and acceptable means for transferring funding to prevention activities
• How does policy and translation of research factor into health policy research?
• What would be the effect of policy requiring recipients of grants and philanthropy to receive sufficient funding for information system infrastructure, including hardware, software, and high-speed Internet access?
• Funding for multisector collaborative studies

Research Methods and Approaches

• Can we establish better low-cost longitudinal studies to really measure policy and program effect?
• How do we make research results actionable?
• Alternatives to institutional review boards for public health investigations or evaluations that are not considered research
• Identifying how best to use data to inform local and state health policy making
• Best practices for displaying information

Academic Challenges to Research Translation

• How can academics engage in translational research when those activities are inconsistent with tenure and promotion?
• How to incentivize universities to better encourage knowledge exchange

• How to incentivize implementation of evidence-based practices while also balancing the need for innovation
• How to raise the profile of “grey literature,” which is significantly more accessible than peer-reviewed literature—and likely more relevant

Evidence-Based Medicine

• What are the root causes of community variations in the use of evidence-based medicine?
• How to create meaningful continuity of care in primary care when physicians are reluctant to take on the responsibility
• Definition and rationale for primary prevention strategies as integrated into new payment reform systems
• Communicating changes in guidelines for clinical preventive services to increase uptake of the guidelines by health care providers
• Does the makeup of the board deciding on how to use hospital community benefits affect the types of uses of community benefits?

Prepared by Paula Lantz, Ph.D., Professor and Associate Dean for Academic Affairs, Gerald R. Ford School of Public Policy, University of Michigan.

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