Focus Area: Social Determinants of Health
Colorectal Cancer Screening Change Package
The social determinants of health focus area includes tools and resources to inform and educate about “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems.”1
- Change concepts are “general notions that are useful for developing more specific strategies for changing a process.”2
- Change ideas are evidence-based or practice-based “actionable, specific ideas or strategies.”2
- Each change idea is linked to tools and resources that can be used or adapted to improve cancer screening.
Notes
- Tools and resources with a symbol may contain some information that does not reflect the current US Preventive Services Task Force (USPSTF) recommendations for colorectal cancer screening.
- Tools and resources with a symbol are patient resources.
See a list of acronyms used in this change package.
Change Concept: Develop screening programs and jurisdictional cancer control plans and initiatives.
Tools and Resources, by Change Idea
Use social determinants of health data and tools to identify populations of focus, priority structural factors, and the living conditions to address.
- CDC — The National Environmental Public Health Tracking Network (Tracking Network)
- CDC — PLACES: Local Data for Better Health
- CDC — CDC/ATSDR Social Vulnerability Index (SVI)
- CDC and HHS Office of Minority Health — Minority Health Social Vulnerability Index
- Census Bureau — Small Area Health Insurance Estimates (SAHIE) Program (census.gov), see Health Insurance Interactive Data Tool.
- HHS Office of Minority Health — Compendium of Federal Datasets Addressing Health Disparities [PDF-4MB]
- NCI — Health Disparities Calculator (HD*Calc)
- U of M CARES (on Community Commons website) — Vulnerable Populations Footprint Tool
- U of W PHI — County Health Rankings & Roadmaps
Select a social determinants of health conceptual framework to inform program planning and advance health equity.
- Alcaraz KI, Wiedt TL, Daniels EC, Yabroff KR, Guerra CE, Wender RC, 2019 — Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy [full text available]
- AMA — Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity 2021–2023 [PDF-9MB], see AMA Equity Strategic Plan (ama-assn.org), page 18
- Eslava-Schmalbach J, Garzón-Orjuela N, Elias V, Reveiz L, Tran N, Langlois EV, 2019 — Conceptual framework of equity-focused implementation research for health programs (EquIR) [full text available]
- Frieden TR, 2010 — A Framework for Public Health Action: The Health Impact Pyramid [full text available]
- King County, Washington — 2016–2022 Equity & Social Justice Strategic Plan: The “Unhealthy Stream” Creates Inequities and “Healthy Stream” Creates Equity [infographic]
- WHO — Closing the gap in a generation: health equity through action on the social determinants of health, see Commission on Social Determinants of Health conceptual framework, page 43
- Yearby R 2020 — Structural Racism and Health Disparities: Reconfiguring the Social Determinants of Health Framework to Include the Root Cause
Develop, plan, and evaluate a screening program.
- CDC — Program Evaluation
- Eslava-Schmalbach J, Garzón-Orjuela N, Elias V, Reveiz L, Tran N, Langlois EV, 2019 — Conceptual framework of equity-focused implementation research for health programs (EquIR) [full text available]
Inform the development and content of jurisdictional cancer control plans and initiatives.
- ACS and CCCNP — Cancer Plan Tip Sheets
- AICAF, UIHI, and NCUIH — American Indian Cancer Foundation Cancer Plan 2020–2022 [PDF-456KB]
- CCSPSC — CCSPSC Champions Program [PDF-3.2MB], see Implementation Tracking Form, pages 36–38
- CCSPSC — CCSPSC Champions Program [PDF-3.2MB], see Provider Reminder Observation Form, pages 33–35
- CDC — Comprehensive Cancer Control Programs
- CDC — Decision Matrix for Program 2 of Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations funding opportunity DP22-2202: The National Comprehensive Cancer Control Program [PDF-123KB]
- CDC — Networking 2Save
- CDC — United States Cancer Statistics (USCS): Data Visualizations Tool
- CMS — Disparities Impact Statement [PDF-622KB] and Table of data sources to help identify health disparities and priority populations [PDF-119KB] [these two resources are meant to be used together]
- CPCRN — Resources and Putting Public Health Evidence in Action
- President’s Cancer Panel — Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access [PDF-14MB]
- RWJF — How Social Determinants Affect Our Health
- RWJF — Our Four Strategic Focus Areas
Change Concept: Inform policies that can support cancer screening and treatment.
Tools and Resources, by Change Idea:
Inform individuals who may be eligible for Medicaid.
- Census Bureau — SAHIE (census.gov)
- President’s Cancer Panel — Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access [PDF-14MB], page 16
Educate about benefits and options for paid leave that may improve access to cancer screening and treatment.
- CDC — Establishing Workplace Policies
- New York State Department of Health — Paid Leave: A Benefit for Employers and Employees [PDF-77KB]
- Public Health and Tobacco Policy Center — Cancer Screenings: Workplace Policies to Improve Screening Rates [PDF-3.7MB], pages 6–7
Educate about broadband access to support telehealth.
- The Brookings Institution (Tomer A, Fishbane L, Siefer A, Callahan B, 2020) — Digital prosperity: How broadband can deliver health and equity to all communities
- CDC — Public Health Law Anthologies: Telehealth and Telemedicine
- FCC and NCI — FCC-NCI Broadband Cancer Collaboration
- Rural Health Information Hub (Mead A, 2021) — Broadband in Rural America: Faster Speeds for Home and Healthcare
Change Concept: Inform about the availability of health insurance coverage.
Tools and Resources, by Change Idea:
Educate individuals on health insurance coverage for recommended cancer screenings.
- ACS — Costs and Insurance Coverage for Cancer Screening [English and Spanish]
- AGA Institute — What to Expect: Paying for Your Colonoscopy [PDF-282KB] [information sheet]
- Volpara Health (Manning K, 2020) — The Medical Necessity Letter: Advocating to Get Your Patients the Care They Need
Educate individuals about the eligibility for safety net programs that may reduce out-of-pocket costs.
- President’s Cancer Panel — Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access [PDF-14MB], page 16
Change Concept: Support employee wellness.
Tools and Resources, by Change Idea:
Promote employee screening through education and screening events or initiatives in the workplace.
References
1Centers for Disease Control and Prevention. Social Determinants of Health at CDC. Accessed December 9, 2022.
2Centers for Disease Control and Prevention. Tobacco Cessation Change Package. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.