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The social determinants of health include: social context, education, economic stability, health and health care, and neighborhood and built environment. One of our goals for this practicum was to create an opioid campaign on the opioid epidemic that could be used and distributed by the Johnston County Health Department (R1).

When brainstorming for our campaign it was important to keep in mind the riskscape that leads to opioid addiction. Is it a moral, disease, spiritual, biopsychological issue? Addiction is disease, but what starts it? Is it the push of overprescribing by big pharma or misleading information about the drugs? Drug use is precipitated by culture, social context, built environment, even education levels and economic stability. The addiction is interacting with realities of bodies and psyches to create public health crisis, proving why it is vital that campaigns and efforts to stop the opioid epidemic are centered around an individual’s social determinants of health and not the superficial stigma’s that exist.

In rural communities there is geographic isolation, decreased economic stability, lower levels of education, and unique cultures that do not occur in urban communities. All these factors are risk factors for opioid addiction. Being that Johnston County is in a rural county it was important to consider all the barriers the community members face when facing this problem. We wanted to create an opioid campaign that reached individuals at all levels and sectors as well as gave various messages in order to tackle some of the social determinants of health. For our first leg of the campaign we made a poster to be distributed around the county, such as in doctor’s offices, grocery stores, bus stops, etc. We figured this would be the option that could target a variety of populations from high to low income, white to African American, and highly to uneducated because of the placement. We also chose this idea as a way to succeed in rural areas because a lot of the community members may not have cable, radio, or internet to hear ads or campaigns. Our poster featured an hourglass that talked about time running out. This message is important because a lot of addicts know they have a problem and want to stop but can’t. Hopefully with the visual representation it becomes a little clearer and a message is sent. The next part of our campaign was developing a newspaper article. Again, we liked the idea of print media for the fact that some community members, especially those addicted to opioids, won’t have cable, radio or internet. Our newspaper article took a different approach to the problem, it focused on preventative and treatment measures. There were the symptoms of an overdose, locations to access Narcan and how to administer it. This part of the campaign took into account that while people want to change and stop their addiction, it usually takes multiple attempts, however, in any case they should be prepared to deal with overdoses so that lives can be saved. Finally, the last part of our campaign included combining everything we have written and created onto Johnston County Health Department’s website in its own new section. This part was unique in that it was the only one that included technology. But it can now be accessed at anytime from anywhere with internet. An individual with questions about where to get Narcan locally doesn’t have to look to the newspaper (that they have to buy) or refer to the resource guide but can go directly to the correct information on the website.

           Throughout the different activities we have done as a practicum group with Johnston County Health Department, we have learned the barriers and challenges the community members face when it comes to accessing resources and health care. Based on the knowledge we have gained, it becomes apparent the need to advocate for political, social, or economic policies and programs that will improve health in diverse populations (F14).

           One of our first tasks was to make a resource guide for the county. While putting this resource guide together, it was interesting to see the resources that were and needed to be included for the community members, ones that don’t seem obvious. The resource guide is split into the following categories: childcare, clothing, domestic violence, education / training, employment, financial assistance, local / county government, medical services, mental health, substance abuse, nutrition, food assistance, rent / utility / housing, support groups, transportation, veterans, and youth services. While some of these services seem necessary and common to include in a resource guide, there are others that we had to include that would not be thought of, unless you’re in that vulnerable situation. Without the experience and challenges of being under resourced and under served in a rural area, you wouldn’t think to add clothing, food assistance, or transportation services. Seeing these resources and services that people are looking for every day, it’s clear to see policies and programs have to be put in place to start making changes to improve health in these rural diverse populations.

           Another task we did as a practicum group was perform listening sessions to be able to produce a health assessment for the county. These listening sessions consisted of talking to community members of Johnston County and asking their opinions on the health concerns, reasons, and changes happening in the community. This experience was very insightful because we got to hear first-hand what the community members thought were the problems, instead of the people in charge and making the changes. This is important because by knowing their opinions and what problems actually persist in the community, more accurate and beneficial changes can be made, that will actually make a difference with the individuals in the community. Moreover, that is the point of the Johnston County Health Assessment. They want to hear the opinions from the individuals that live, work and play in the community so that the policies and programs they start to develop will be ones that the community members need, want and will utilize. From doing the listening sessions we learned that the community members want cheaper gym memberships, more community activities, the developments of community gardens, and more affordable healthy foods, just to name a few. With the help of the community members and the output they gave us, it makes it easy to now implement programs and create policies to improve these challenges. Additionally, the individuals gave us ideas and what they think could change these problems. Some examples include lowering the price for gym memberships to induce more exercising, create more activities around the community for them to get involved in, and / or cultivate a community garden. With the help of these listening sessions and the health assessment, it’s easy to see how Johnston County is now able to advocate for political, social or economic policies and programs that will improve the health in this community.