Causal Pathway Mapping
Context
A causal pathway is the first step in organizing an intervention to address a public health issue. Think of a public health issue you want to address through a behavioral intervention. Throughout this course, we will work to address the public health issue within a specific population. Take a look back at Week 2 and review your discussion feedback as well as the "assignment preparation" module. The public health issue you select will be the same topic you address throughout the assignments this term.
A causal pathway is the outline to identifying the determinants of health of your selected public health issue. Use what you have learned from your studies material to "map" a path FROM the Structural Determinants of Health (SDOH) to a health outcome THROUGH the intermediary determinants of health for the public health issue you have selected.
Instructions
The SDOH Framework is outlined on page 25 of your textbook. Construct a “flowchart” (an example is provided below) and a narrative describing the pathway of your flowchart. It is highly encouraged to use PowerPoint to construct your map and use the “Notes” portion below to write the narrative describing the pathway. Please be aware that your ‘notes’ will not be visible in the ‘preview’ of the assignment during the submission process. The instructor will download the PPT file and view the notes on the download.
Your pathway should include at least one complete path from a structural determinant to the health outcome (i.e., there should not be any “gaps” in the connections between the mediating constructs in your illustration or narrative) and the points marked on your map for potential interventions.
Mark the “points of potential public health interventions” on your pathway with a star. You should have at least two points of intervention (one will be used as potential interventions to develop on later assignments). Provide a narrative (in the notes section under the slide) identifying and discussing each of the constructs in your model along with potential interventions that could be utilized to change the points you identified.
Points will be deducted for lack of correspondence between the structural determinants, the intermediary determinants and the health behavior and outcome, and for unprofessional presentation of your exercise (i.e., poor organization in your writing, misspelling, etc.). You do not need to cite literature or provide references in this exercise.
It may be helpful to review the Causal Pathway Example [PPTX] before beginning work on your assignment.
Your submission will be assessed on the following criteria:
- Create a pathway from the structural determinants to the selected health outcome.
- Make sure the pathway clearly flows through the structural and intermediary determinants. Please note the structural determinants begin with a policy, governance, etc. as outlined in the SDOH Framework in your book on page 25.
- Identify two points of intervention on the causal pathway.
- Why are the points of intervention you identified relevant?
- How do these points of intervention have the potential to have positive impacts?
- Describe the connection between the constructs of the causal pathway and the health outcome(s).
- Are the connections clear and easy to follow for someone else?
- Are the constructs clearly explained?
- Convey purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.
Please note the following when submitting your assignment:
The file must be a PPT or PPTX file of your presentation. You cannot upload slides from google slides or any other cloud-based service. You must upload as a PowerPoint file for the notes to be visible to the instructor when downloaded.
The Public Health Masters Program Library GuideLinks to an external site. and Writing CenterLinks to an external site. may also be helpful resources.
Topic pregnant women in low-income communities as a vulnerable healthcare population
Reducing the School to Prison Pipeline in People of Color in Hamilton County, OH
Structural Determinants
Intermediary Determinants
Outcome
Higher Rates of School Suspensions in Hamilton County
A. Zero-Tolerance Policy in Schools
B. Quality of Education
C. Higher impact on students of color.
D. Lower SES
E. Biological Factors: Elevated Stress & Cortisol levels
F. Behavior Factors: Mental Health
G. Psychosocial Factors: Discrimination
I. Psychosocial Factors: Social exclusion
H. Access to Healthcare
Hamilton County in Ohio currently has the highest suspension rates in the state. The state average is approximately 11.2% of students will experience a suspension while students in three Hamilton County schools see approximately 50% of students experiencing a suspension each year (Ohio Board of Education, 2017). Current research shows students experiencing suspensions are more likely to enter the prison system after the age of 18 (Basford, L., Lewis, J., Trout, M., 2021; Bacher-Hicks, A. et al., 2021).
Zero-tolerance policy in schools was designed to reduce the use of illicit drugs and presence of deadly weapons in the school. This policy allowed schools to utilize law enforcement as punishment and allowed for suspension and expulsion. This policy has been shown to disproportionately impact students of color- C.
Quality of Education is directly impacted by funding provided by tax dollars and state resources. In addition to the funding, students who experience suspensions and expulsions are missing out on valuable instruction which puts students at an academic disadvantage.
Disproportionate impact on Black and Brown students- Several constructs disproportionately impact students of color including: zero tolerance policy, discrimination, social exclusion, and lower SES.
Lower SES- SES includes education, employment and income. Approximately 16.2% of Hamilton county residents are living in poverty- which is higher than the state average of 14.2% (Ohio Poverty report, 2020). The Zero-tolerance policy in the school is leading to a lower overall quality of education for students of color which directly impacts the students ability to attend a college/university and directly impacts the future earnings which leads to elevated stress levels, lower mental health, & decreased access to healthcare.
Elevated Stress- Chronic stress leads to elevated cortisol levels. Overtime, elevated levels of cortisol can lead to obesity, heart disease, and increased risk of various cancers. A lower SES can cause stress due to a lack of necessities (or worry about the lack) such as food, shelter, and safety.
Mental health concerns such as depression, anxiety and/or psychological disorders are often left untreated in youth due to a lack recognition. Often these behaviors present as distress but are seen as “troubled youth” and are expelled or suspended from school instead of treated. The lack of access to health care, discrimination in the schools and/or health care system are impact these issues.
Discrimination- People of color experience racism in both policy enforcement, healthcare, and in the workforce. These leads to increase stress, anxiety, and social exclusion.
Social exclusion is tied to discrimination. Social capital leads to the amount of influence and individual has over their community, behavior, and outcomes. Social exclusion is often experienced by individuals labeled as ‘troubled’. A lack of social support leads to higher levels of high-risk behaviors, depression, and other mental health concerns.
Potential Intervention Points:
A. Zero-tolerance policy: potential interventions include education programs for school administrators. (Topics include: trauma informed care for principals and trauma informed pedagogy for teachers).
E. Biological Factors- Elevated Stress: Include socio-emotional learning in school programs for students
I. Social Exclusion: Work with community leaders to provide mentorship for students in schools. Utilize existing programs (such as Boys and Girls Club) or meet with mentors to work directly in the schools.
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