This teaching case study examines psychological trauma in a community context and the relevance, both positive and negative, of social determinants of health. Healthy People 2020 views people residing in communities with large-scale psychological trauma as an emerging issue in mental health and mental health disorders (Healthy People, 2016). The case study, which focuses on Newark, New Jersey, addresses three of the five key determinants of health: social and community context, health and health care, and neighborhood and built environment. The three key determinants are addressed using psychological trauma as an exemplar in the context of trauma-informed systems. The social and community context is addressed using concepts of social cohesion, civic participation, and discrimination. Access to health and health care are addressed with discussion of access to mental health and primary care services, health literacy, and the medical home model. Neighborhood and built environment are viewed through the lens of available government and NGO programs and resources to improve the physical environment with a focus on quality of housing, crime and violence, and environmental conditions. Upstream interventions designed to improve mental health and well-being that support trauma-informed systems are analyzed. The use of Newark as the case study setting allows a real-life exploration of each of these three key determinants of health.

This case study has four sections – introduction, case study, side bar, and vignettes. Learners should work through the case, access appropriate resources, and work in a team for successful completion.

This module will present two unfolding case studies based on real-world, actual events. The cases will require participants to review videos embedded into three modules and a summary module:
Introduction to Concepts of Social Determinant of Health and Seeking Racial Equity 
Case Study on Health and Healthcare Context - Greensboro Health Disparities Collaborative (GHDC)​   
Case Study on Social and Community Context - Renaissance Community Cooperative (RCC)
Summary (Optional)

The learning objectives for the modules are related to achieving the Healthy People 2020 Social Determinants of Health Objectives – specifically the (1) Health and Healthcare Context, and (2) Social and Community Context.   

This multimedia module includes three clinical case videos demonstrating a variety of geriatric patient circumstances. Participants will view each case with attention to the medical care provided, as well as the impact of the social determinants of health (SDOH) in each scenario. The provider, in each case, models how to integrate the SDOH into the care plan to optimize the patient’s health and functionality.

Facilitators who utilize this module will develop panels from local community and state agencies to follow each case. The panels serve to deepen the learning experience through discussion and linking the participants to local experts. This strengthens the participant’s ability to apply lessons learned from this module in the clinical community contexts they serve.

The learning objectives for this module are directly related to Healthy People 2020 with the core SDOH categories including: economic stability; social and community context; health and healthcare; neighborhood and built environment; and environmental conditions. 

This case summarizes the toxic water crisis in Flint, Michigan between 2011 and the end of 2016, which followed the decision to switch the city’s public water supply from Lake Huron to the more corrosive Flint River. It outlines the factors that led to the initial government decision, and the social, economic, health, and policy consequences that followed. The case highlights the role of citizens, scientists, and activists in raising public awareness of the crisis and the toxic long-term effects of lead poisoning on affected children. It also illustrates the challenges and questions such a crisis poses for other communities in the United States and globally.

The case is accompanied by an instructor’s note, role play exercise, and discussion guide with an accompanying teaching graphic.

Beginning in 2013, Humana Inc., headquartered in Louisville, Kentucky, pursued a major organizational transformation, from being an insurance company focused on paying claims to becoming a health and well-being company focused on improving the health of its beneficiaries. The company set a “Bold Goal” of improving the health of the communities it served by 20% by 2020. To achieve this new goal, Humana undertook a multiyear redesign and investment of people, processes, and products in order to gain the trust of consumers and providers, and to partner with communities to improve health. The case focuses on community initiatives, where Humana was developing its new role as “convener of conversations,” providing leadership infrastructure and partial funding to spark community planning with a wide range of stakeholders and to design and monitor interventions that were tailored to local health improvement. At the same time, Humana remained a publicly-held corporation accountable to its shareholders for revenue growth and financial return. The case protagonist, Andrew Renda, MD, MPH, Director, Bold Goal Measurement, must design and implement a business plan, including leading and lagging performance metrics, that would measure Humana’s progress toward its Bold Goal in ways that supported continued investment in community health improvement in Humana’s local markets, while satisfying its traditional business constituents.

This case can be used in courses on strategy, community health improvement, the corporate role in public health, and other courses exploring the intersection of business and society. It also offers a rich opportunity to explore the research design and measurement challenges associated with evaluating the impact of public health interventions on local communities.

In February 2015, technical staff reviewed the results from a jointly conducted study on malaria control. This study had major implications for malaria in Zambia—and elsewhere. The preliminary analysis strongly suggested that the study’s Mass Drug Administration (MDA) strategy was reducing the incidence of malaria disease. In addition, MDA seemed to be driving down the infection reservoir among asymptomatic people in the study area of the Southern Province of Zambia. Further analysis with mathematical models indicated that if the intervention was sustained so current trends continued, then the MDA strategy would make it possible to eliminate malaria in the Southern Province. 

If malaria could be eliminated in one region of Zambia, that would provide new evidence and motivation to work towards elimination throughout the country, an ambitious goal. But it would not be easy to move from conducting one technical study in a single region to creating a national strategy for malaria elimination. The scientists realized that their new data and analyses—of malaria infections, mosquito populations, and community health worker activities—were not enough. A national malaria elimination effort would require mobilizing many partners, national and local leaders, and community members, and convincing them to get on board with this new approach. 

• “Everybody’s Business": Mobilizing Citizens During Liberia’s Ebola Outbreak, 2014–2015
• All Hands on Deck: The US Response to West Africa’s Ebola Crisis, 2014-2015
• Chasing an Epidemic: Coordinating Liberia’s Response to Ebola, 2014–2015
• Filling Skill Gaps: Mobilizing Human Resources in the Fight Against Ebola, 2014-2015
• Offering a Lifeline: Delivering Critical Supplies to Ebola-Affected Communities in Liberia, 2014-2015
• The Hunt for Ebola: Building a Disease Surveillance System in Liberia, 2014–2015