Social Determinants of Health and Policy Priorities: Findings From Oregon Statewide Policy Delphi Survey

Purpose: Based upon the frame of social determinants of health (WHO, 2013), the Health Authority, Office of Equity and Inclusion (OEI) used a modified policy delphi-survey method (Rayens & Hahn, 2000) to identify health-related policy priorities in Oregon. The survey findings seek to inform strategic policy decisions and actions within state and local government agencies, legislative initiatives, and community coalition building activities which will advance health equity statewide. This presentation reports 13 health-related policy areas and priorities, and 67 sub-policy items identified by statewide stakeholders. The differences between priorities identified by sub-communities are addressed.

Methods: The OEI and its community partners held eight health equity policy forums statewide in 2012 to better understand: (a) How communities define health, (b) What their community strengths and challenges are, and (c) What policy ideas they have to advance health equity statewide. The OEI requested applications to fulfill two key components of the survey: Policy Platform Development Panel (PPDP) and Community Analysis Team (CAT). The OEI received 180 applications for the PPDP and invited 50 applicants. Special attention was paid to include representatives of communities experiencing health disparities. The CAT was formed from diverse communities to monitor/advise the survey process. Based upon what OEI learned from the policy forums, 13 health-related policy areas and relevant 67 sub-policy items were developed. Three sequential surveys were conducted with the PPDP in 2013 to identify top priorities, as well as untapped concerns. Preceding survey findings informed the CAT’s design of subsequent questionnaires, based upon panelist responses to the previous questions.  These findings were also given to panelists to help them make informed decisions on the follow-up surveys.

Results: Findings show policy priorities among “mainstream” communities (age 25-64, non-immigrant community, English only speaking, non-LGBTQ, and living in metropolitan area) were very similar while several sub-communities clearly identified different priorities. Access to health/dental/mental health services for all individuals was the top priority among all communities; overall, access to physical activity and recreation related items were ranked low. Ensure affordable and safe housing was the second among most communities except people with disabilities (6^th) and transgender (11^th) community. There were  some differences between racial/ethnic groups, like Pacific Islanders and Whites who ranked community engagement with government/health institutions as their fourth compared to sixth-ninth among other groups; education opportunities was ranked at second among Asian and Hispanic communities.  Removing legal residency requirements to obtain driver’s license item was one of the lowest priorities cross all communities except Black (5^th), and Spanish-speaking communities (2^nd). The access to healthy foods item was the second priority among panelists living in rural compared to sixth among all panelists. 

Conclustions: The policy delphi-survey method was useful to engage stakeholders from various communities in building consensus and identifying divergence of opinion. The findings highlight the importance of developing comprehensive policy options across government/private organizations and communities who are working on social determinant of health and equity issues. Face-to-face interview methods with particular communities may enhance in-depth understanding of different policy priorities and concerns identified by the delphi-survey.