GOAL 1: MAKE DATA ABOUT HEALTH DISPARITIES INCLUDING ... · advance health equity Potential champions Grass root support, particularly among those disproportionately facing health

GOAL 1: MAKE DATA ABOUT HEALTH DISPARITIES, INCLUDING COMMUNITY CONDITIONS, READILY AVAILABLE TO COMMUNITY LEADERS FOR DECISION-MAKING.

Strategy 1: Develop agreement on key data elements that will reflect health disparities, including community conditions, in Arlington. Strategy 2: Develop, maintain and make available an inventory of existing and relevant data on disparities, including community conditions, in Arlington. • Agree upon data sources and standards • Develop tool to display data • Collect and store data from designated sources • Develop and implement process to maintain current inventory

1. What does the Lack of Data about Disparities in Community Conditions mean? Data about disparities in Arlington is available but decisions are needed on:

• Which data will improve decision-making about community conditions • Which data are available now or readily acquired • Which available data are compliant with established data standards and practices • Which data is available at the Arlington County census tract, neighborhood, or other local population level

There is a lot of data available about disparities in community conditions, including in Arlington. Community condition data includes but is not limited to economic, environmental, education, and safety and security data.

However, this data about disparate community conditions specific to Arlington is not readily available to leaders of Arlington institutions (government, and profit and not-for-profit) responsible for creating community conditions.

And yet we know that these conditions greatly influence the health of populations.

Data characteristics desired for this project should be as specific to Arlington as possible. That is, using data at the census tract when available or using appropriate techniques to use the best Arlington, regional, state, or national data and apply it to Arlington at the census tract level. 2. Why is the Lack of Data about Disparities important to health equity? Lack of data about disparities at the fingertips of leaders prevents them from incorporating information about disparities in community conditions in their decision making.

Data about disparities in community conditions allows leaders the opportunity to incorporate this information into their decision making. This allows for more equitable decisions, which ultimately creates the community conditions for health equity.

This data enables leaders to:

• Better talk about the issue, tell the story behind their decision making • Invite cross-sector collaboration to solve problems due to disparate community conditions.

November 14, 2018 D2027 Steering Committee Meeting

Page 3 of 25

3. Who needs to collaborate/coordinate on the Lack of Data about Disparities?

STAKEHOLDER Organization Organizational Assets

Readiness/ Commitment Notes

Arlington County Government (e.g., police, fire, human services, parks and recreation)

Data by zip code or census tract

Virginia Hospital Center Data by zip code or census tract

Coalitions (e.g, CPN, BOP, PCYF, other) Data by zip code or census tract

VCU/NVHF Data by zip code or census tract

Arlington Public Schools Data by zip code or census tract

4. What are the opportunities for Arlington from D2027 addressing the Lack of Data about Disparities? • Meaningful data about disparities can help increase awareness, encourage collaboration, and improve access to

services • Data about disparities will help us set goals and monitor progress 5. What are the challenges ahead for Arlington from D2027 addressing the Lack of Data about Disparities? • Lack of data about disparities impedes our ability to achieve our goal: “To increase health equity through systems

change by 2027.” • Lack of data about disparities increases the risk of making incorrect assumptions and ineffective decisions 6. How does addressing the Lack of Data about Disparities contribute to success with other issues in the D2027

Health Equity Action Plan?

7. Strategies and Success for Addressing the Lack of Data about Disparities

Strategy Agreement on key data points


Page 4 of 25

Timeframe Fully implementable within:

2 years (short-term) 5 years (intermediate) 10 years (long-term)

What Success Looks Like

1) Identify data points desired,

2) Identify source institutions with desired data, and

3) Work with source institutions to obtain access to data.

Resources Available Determined by stakeholders listed in Section 3., including data by zip code or census tract

Resources Needed Determined by stakeholders listed in Section 3.

Contextual Factors/ Forces Supporting

Moving Forward

Growing interest in health equity within and external to Arlington.

Contextual Factors/ Forces Hindering Moving Forward

• too much data • lack of agreement on which data elements to focus on • federal government changes to census data available locally, possible elimination

Initial Steps: How would you start

this work?

Setting up team with data expertise to assess data strengths and maintain data standards.

NOTES:

D2027 member(s) drafting this strategy: Reuben Varghese, Debby Taylor, Pat Mathews, Mike Collins, Anne Vor der Bruegge, Laura Newton

Strategy Compiling a data Inventory / library of assessments




Page 5 of 25


- Data is shared - Available in multiple useful formats - Judicial, priority focused list

Resources Available

- Dashboard - MAP - Norther VA health foundation census track - YRBS - Affordable Housing Master Plan - Phoenix house data - Police, Fire

Resources Needed - Decision about what degree of granularity / statistical significance


Moving Forward


- So much data - Needs to be Arlington specific - Uniform definitions


this work? - Setting up a central group to compile the different data inventories

NOTES:



Page 6 of 25

Strategy Investigate and share data about where these efforts are working elsewhere




- Have an idea of how others have worked with health disparities - Benchmark

Resources Available - Kings county - CA Endowment

Resources Needed


Moving Forward


- Time / resources


this work? - Contact these organizations

NOTES:



Page 7 of 25

GOAL 2: BUILD AWARENESS, RESPONSIBILITY AND ENGAGEMENT TO PROMOTE HEALTH EQUITY

Strategy 1: Provide guidance about the essential questions that each stakeholder organization should be asking to promote health in all policy and practices Strategy 2: Develop and disseminate coordinated messages about health equity and how to engage in meaningful ways to improve health equity

1. What does awareness, responsibility, and engagement mean? Awareness means key individual and organizational D2027 stakeholders understand: 1) all communities in Arlington – regardless of race, ethnicity, socio-economic status, or other demographic characteristics – can fully participate in opportunities to achieve optimal health throughout their lives; 2) A multi-sectoral approach focused on creating equity among vulnerable and disadvantaged groups could address avoidable differences contributing to the disproportionate risk for poor health outcomes and lower life expectancy too many of our communities in Arlington with lower socio-economic status or a higher concentration of racial/ethnicity minorities face; and 3) Our County can create and promote equity in all organizational policies, programmatic approaches, and resource allocation to eliminate barriers to and foster full participation in opportunities for all Arlington communities to achieve optimal health throughout their lives.

Responsibility means all key individual and organizational D2027 stakeholders have a duty to act independently and ideally as part of a collaborative D2027 group to create and promote equity in all organizational policies, programmatic approaches, and resource allocation to eliminate barriers to and foster full participation in opportunities for all Arlington communities to achieve optimal health throughout their lives.

Engagement means all key individual and organizational D2027 stakeholders take part in independent and ideally collective dynamic processes to address to create and promote equity in all organizational policies, programmatic approaches, and resource allocation to eliminate barriers to and foster full participation in opportunities for all Arlington communities to achieve optimal health throughout their lives.

2. Why are building awareness, responsibility and engagement important to promoting health equity? Building awareness is foundational to building responsibility and engagement since knowledge is power only if people are able to access it, understand it, and apply it. Responsibility is critical to ensuring all key individual and organizational D2027 stakeholders feel a sense of duty and ownership in each of the independent and/or collective ways he/she or they can contribute towards creating and promoting equity in all organizational policies, programmatic approaches, and resource allocation to eliminate barriers to and foster full participation in opportunities for all Arlington communities to achieve optimal health throughout their lives. Engagement is empowering and has the potential to advance D2027 goals and strategies by helping to facilitate the development of more contextually driven goals and strategies, increase buy-in for the goals and strategies put forth, and, ultimately, lead to more meaningful change. Collective impact is a framework to help meaningfully engage key individual and organizational entities in efforts to tackle complex social


Page 8 of 25

problems such as promoting health equity. As described by Kania & Kramer in 2011, collective impact is made up of the following five elements: “1) all participants have a common agenda for change including a shared understanding of the problem and a joint approach to solving it through agreed upon actions; 2) Collecting data and measuring results consistently across all the participants ensures shared measurement for alignment and accountability; 3) A plan of action that outlines and coordinated mutually reinforcing activities for each participant; 4) Open and continuous communication is needed across the many players to build trust, assure mutual objectives, and create common motivation; and 5) A backbone organization(s) with staff and specific set of skills to serve the entire initiative and coordinate participating organizations and agencies.”1 Put simply, D2027 should strive for goals and strategies that recognize the value the importance of the expression “nothing about us without us.” 3. Who are the key individual and organizational stakeholders for building awareness, responsibility, and

engagement around promoting health equity?

Stakeholder(s) Individual or Organizational Asset(s)


D2027 stakeholders including local public health system (LPHS)

Demonstrated willingness to be engaged as evidenced by participation thus far but efforts should be made to assess individual and organizational assets more thoroughly by each participating entity describing their work in this area thus far and sharing their short and long term goals to contribute towards D2027 goals and strategies

Strong commitment to issue

D2027 is made up of key NGOs and social service safety net providers but efforts should be made to map all key individual and organizational stakeholders and assess completeness

Elected officials

Leadership Awaiting D2027 recommendations/contending with budgetary limitations FY19

Government officials

Leadership Many departments already involved in D2027/contending with budgetary limitations FY19

Business community

Knowledge/skill on how to communicate

Potential champions Diverse, dispersed community

Civic Federation Direct link to community leaders Potential champions

County Council of PTAs

Direct link to parents Potential champions

Faith community

Leadership, trusted source in the community, tend to advance social justice issues, and direct link to community members

Potential champions


Page 9 of 25

Stakeholder(s) Individual or Organizational Asset(s)


All residents*

Vote, most affected and knowledgeable about needs to advance health equity

Potential champions Grass root support, particularly among those disproportionately facing health disparities but also those in privileged positions to foster equity

4. What results if we do not build awareness, responsibility and engagement to promote health equity by

2027? Failing to build genuine awareness, individual and/or shared responsibility, and meaningful engagement can contribute to inequities persisting and even getting worse. Some could view disinformation as an abuse of power and a lack of transparency.

5. How does building awareness, responsibility, and engagement contribute to the other goals and strategies put forth in the D2027 Health Equity Action Plan?

Awareness is a foundational component to instilling a sense of individual and/or shared responsibility and both are critical to ensuring effective engagement in the multi-sectoral approach put forth to create and promote equity in all organizational policies, programmatic approaches, and resource allocation to eliminate barriers to and foster full participation in opportunities for all Arlington communities to achieve optimal health throughout their lives.

6. Strategies for Building Awareness, Responsibility and Engagement

Strategy

Develop and Disseminate Health Equity Improvement Plan Partner Guidance D2027 will strategically and systematically develop and disseminate guidance such as essential questions among D2027 individual and organizational stakeholders on how each can individually and collectively create and promote equity in organizational policies, programmatic approaches, and resource allocation to eliminate barriers to and foster full participation in opportunities for all Arlington communities to achieve optimal health throughout their lives.

Timeframe Fully implementable within: Operational definition by first quarter of Year 1; ongoing implementation 2 years (short-term) 5 years (intermediate) 10 years (long-term)


• D2027 stakeholders including local public health system are strategically and systematically using the essential questions or other emerging D2027 guidance when developing new or updating existing organizational policies, programmatic approaches, and resource allocation.

• New D2027 stakeholders are actively recruited and provided technical assistance on using the essential questions or other emerging D2027 guidance when developing new or updating existing organizational policies, programmatic approaches, and resource allocation.

• Participating individuals and organizations are actively disseminating their efforts to individually and collectively create and promote equity in organizational policies, programmatic approaches, and resource allocation to


Page 10 of 25

eliminate barriers to and foster full participation in opportunities for all Arlington communities to achieve optimal health throughout their lives.

• D2027 regularly convenes to: assess and, if needed, add to or amend Health Equity Improvement Plan Partner guidance; evaluate disseminate efforts to date and discuss any remaining gaps and opportunities for existing or new partners; and highlights what’s working including awarding individual and organizational efforts to promote health equity using the essential questions.

Resources Available

A draft of the essential questions for D2027 individual and organizations to consider that was informed by similar efforts to assess equity of a policy, program, practice, or resource allocation.

Resources Needed

Coordinator with dedicated time to develop and disseminate Health Equity Improvement Plan Partner Guidance including: • Managing the draft refinement and revision process over time, • Recruiting existing and new partners to use the essential questions when

developing new or updating existing organizational policies, programmatic approaches, and resource allocation,

• Providing technical assistance, • Monitoring implementation and progress for participating and new D2027

stakeholders, • Developing best practices based on D2027 participants experiences to date, and • Highlighting individual and organizational efforts to use the essential questions.

Contextual Factors/ Forces

Supporting Moving Forward

There is community momentum on the issue of equity, including Community Progress Network, Childcare Initiative, and the new language the School Board adopted on equity.


Hindering Moving Forward

• There is a lack of understanding about the issue • Some people will start by focusing on the costs • There will be a need to translate into other languages • Lack of County metric to examine short and long term return on investment

Initial Steps: How would you start this work?

• Use the Arlington zip code disparity exercise in initial efforts to build awareness about health disparities in our County

• Develop guidance such as essential questions • Recruit current D2027 stakeholders to use essential questions to assess a new or

existing organizational policy, programmatic approach, and/or resource allocation and to share their experience with this application(s).

• Monitor supporting and hindering factors moving forward D2027 stakeholders use of the essential questions or other technical assistance to help promote their individual and/or collective efforts to promote health equity.

Strategy

Develop and Disseminate Coordinated Messages about Health Equity in Our County and Meaningful Ways to Engage in Advancing D2027 Goals and Strategies D2027 will facilitate the development and use of coordinated messages tailored to targeted audiences across various communication mediums and modes. This could include: disparities exist, they matter, they are not OK, and D2027 offers practical guidance on meaningful ways individuals and organizations can individually and/or collectively help promote health equity.


Page 11 of 25

Timeframe Fully implementable within: Recruit professional to help develop messages and test them within 2 years; ongoing implementation 2 years (short-term) 5 years (intermediate) 10 years (long-term)


• All Arlington residents are aware of health equity and ways to engage in accelerating D2027 goals and strategies. And, over time, health equity is incorporated into how individuals and organizations approach policy, practice, programmatic, and resource allocation.

• We are measuring and monitoring changes in awareness, responsibility, and engagement.

• D2027 stakeholders are using coordinated messages and outreach as reflected by presentations among key audiences and use of diverse and effective communication mediums and modes.

• New stakeholders are approaching D2027 to partner.

Resources Available

Existing materials from other communities, along with established and trusted venues to communicate with key D2027 stakeholders.

Resources Needed

• Professional communications expertise (may require financial resources) to develop coordinated messages and communications plan

• Coordinator to help monitor development, implementation, evaluation, and dissemination of communication plan and monitor engagement by targeted audiences over time, using qualitative and quantitative data to assess


Supporting Moving Forward

Have a message (disparities exist, they matter, they are not OK) and we’ll hopefully articulate meaningful ways to engage on accelerating progress on D2027 recommendations by key stakeholder groups to help provide ideas for messages around engagement.


Hindering Moving Forward

Lack of understanding about the issue and meaningful ways to engage and some people may choose not to believe or meaningfully engage.

Initial Steps: How would you start this work?

• Identify and prioritize audience(s) informed by general categories laid out in question 3; that is, be more specific with identifying and prioritizing targeted audiences for coordinated messages

• Tailor message(s) and communication medium(s) and mode(s) used to reach audience and evaluate reach and impact

• Identify and fund a coordinator with dedicated time to manage process, recruit, provide technical assistance, and monitor implementation and progress for participating and new D2027 stakeholders

Drafting Team: Katherine Garcia, Sheila Fleischhacker (Co-Chair), Tricia Rodgers, Aisha Salazar (Co-Chair), and Wayne Vincent

1 https://www.collaborationforimpact.com/collective-impact/


Page 12 of 25

GOAL 3: EMBRACE A CULTURE OF COLLABORATION AND COORDINATION TO IMPROVE HEALTH EQUITY.

Strategy 1: Establish an entity of key stakeholders to work together to improve health equity over the next decade through systems change by building awareness, access to resources, and data about health disparities. This organization will drive implementation, accountability, and sustainability efforts as we move forward. Strategy 2: Empower all partners to make changes to how we do business within and across sectors to improve health equity. An example might be to imbed the work of health equity into each agency/organization. We want to think through the small changes we can start making today (cultural hacks) to increase collaboration and coordination efforts.

1. What does Collaboration/Coordination mean? Often the words collaboration, coordination, and cooperation are used to describe effective teamwork. But they are not the same, and when we use these words interchangeably, we dilute their meaning and diminish the potential for creating powerful, collaborative workplaces.

• Collaboration is working together to create something new in support of a shared vision. The key points are that a) it is not through individual effort, b) something new is created, and c) that the glue is the shared vision.

• Coordination is sharing information and resources so that each party can accomplish their part in support of a mutual objective. It is about teamwork in implementation. Not creating something new.

• Cooperation is important in networks where individuals exchange relevant information and resources in support of each other’s goals, rather than a shared goal. Something new may be achieved as a result, but it arises from the individual, not from a collective team effort.

All three of these are important. All three are aspects of teamwork. But they are not the same! In a network environment, where there is not interdependence, collaboration is not essential to the creative process. Through cooperative sharing of information and resources, creativity emerges through individuals and is hopefully recognized and supported. However, in an interdependent network such as Destination 2027, collaboration is the bedrock of creative solutions and innovation. Focus for D2027 work is on population-based work. It’s important that the leaders of D2027 demonstrate collaborative behavior 2. Why is Collaboration/Coordination important to health equity? There are a diverse set of sectors that influence social determinants of health and if they are not well coordinated, aligned, and able to pivot toward solutions to population health barriers it will not be effective or sustainable as a systems approach in improving health equity. Creating an integrated sole purpose network of services with a unified,


Page 13 of 25

measurable vision and strategy is the only way to achieving a sustainable model for the future. Existing coordination will only maintain status quo and potentially degrade services as resources are more constrained. Collaboration results in agreement on and commitment to shared vision – revisited & recommitted periodically to sustain health equity improvements. Collaboration supports a more effective, efficient use of resources. Through collaboration, partners are better positioned to identify gaps and reduce duplication. It has been demonstrated that solutions developed with diverse perspectives result in better products. Collaboration provides an opportunity to learn from others, including identification of best practices, first hand experiences, lessons learned, and a deeper sense of individual priorities.


Page 14 of 25

3. Who needs to collaborate/coordinate on the Lack of Collaboration/Coordination?

STAKEHOLDER Organization Organizational Assets Readiness/ Commitment Notes

NGO’s

Government entities (fed, state & local)

Washington Council of Governments (COG), Other local jurisdictions, National Association of Counties (NACo), National Association of City and County Health Officials (NACCHO) all have perspectives to share.

APS, PTA

Community trust Schools are cohesion to many communities/neighborhoods Data Regular communications to community in diverse languages

NOVA Subject matter expertise Staffing Methods/Procedures

Marymount Subject matter expertise Staffing Methods/Procedures

Virginia Tech Subject matter expertise Staffing Methods/Procedures

Experience and interest supporting Partnership opportunities

Private sector –Nestle, Chambers of Commerce, VHC, (maybe Amazon in future)

Money resources to invest locally;

how do these businesses apply equity and systems to their policies/benefits, admin leave for flu shot, for example

Faith Communities – VOICE, Our Lady of Peace, UUCA, St Mary’s Episcopal, Presbytarian House, Mt Olive and Macedonia

Potential interfaith council on health

Parts to build an interfaith council on health to better fill needs in Arl

ANNE (Arl Network of News Email), Nextdoor, Senior Villages (Arl Senior Village)

Communications - Social Media Outreach

APAH Working trust - relationship with communities

Actively working on many county efforts related to health equity (Bridges out of Poverty, Childcare Initiative, D2027, and Digital Equity initiative at Arlington Mill).

Recognition that health and housing are connected to effecting outcomes. Actively working on a Digital Equity initiative at Arlington Mill.


Page 15 of 25


Arlington Community Foundation (NonProfit Center)

Asset Map from Columbia Pike Project Working trust - relationship with communities

Actively working on many county efforts related to health equity (Bridges out of Poverty, Childcare Initiative, D2027).

1

Arlington County Government (including public safety partners – fire, police, EMS)

Actively working on many county efforts related to health equity (Bridges out of Poverty, Childcare Initiative, D2027).

ACPHD

Equity Lens Equity Toolkits D2027 Population Health Data


Recognition that health and housing are connected to effecting outcomes. Actively working on a Digital Equity initiative at Arlington Mill.

Parks & Rec Established relationship with communities, community centers


DHS (CPS, EID)

Actively working on many county efforts related to health equity (Bridges Out of Poverty, Childcare Initiative, D2027, and Digital Equity initiative at Arlington Mill).

DTS

ConnectArlington SME in applying systems-based approach Technology

Digital Equity initiative at Arlington Mill Actively interested in supporting health equity efforts

ConnectArlington, a fiber backbone to be used for public good, an innovation perspective, experienced data team.

DES

Serves all residents Transportation Informs land use planning in County

Housing

Clubs, rotary, lions, etc If all coordinated together they could better align their resources more effectively


Page 16 of 25

4. What are the opportunities for Arlington from D2027 addressing the Lack of Collaboration/Coordination? Through achieving true collaboration, Arlington has the opportunity to gain: • Effective, efficient use of resources • Identification of any current duplication, gaps • Experience and insights from others • Identification of best practices, what’s working • Agreement on, commitment to, and reinforcement of a shared vision – revisit & recommit periodically

5. What are the challenges ahead for Arlington from D2027 addressing the Lack of Collaboration/Coordination? • Currently may have ineffective, inefficient use of resources • Current efforts could be duplicative, produce gaps • Hard to identify and share best practices, know what’s working • Lacking agreement on and commitment to shared vision 6. How does addressing the Lack of Collaboration/Coordination contribute to success with other issues in the D2027

Health Equity Action Plan?

Working together takes practice and reinforcement. By continually approaching the efforts with a collaboration mindset, the stated goals of the Destination 2027 are fortified, the relationships between the multiple parties are strengthened, and the expertise necessary to support the other issues is tapped. A backbone organization to collaborate, coordinate, and cooperate is critical to the success of the implementation of all the strategies proposed in Destination 2027 - awareness and engagement, data on health disparities, and for access and resources - to achieve health equity in Arlington.

7. Strategies and Success for Addressing the Lack of Collaboration/Coordination

Strategy

Establish an entity to serve as the convener of key stakeholders working together to improve health equity over the next decade through systems change by building awareness, access/resources, and data about health disparities. Identify a “backbone” organization to guide the process of a county wide strategic plan around health equity - work toward shared vision; A place to “keep it all together & moving forward” with a “Quarterback” – Use existing structures, align with people already there – Arlington Non-Profit center (Arlington Community Foundation) can be quarterback (other possible options are CPN, Bridges Out of Poverty). Convener is trusted agent in community, and can serve as fiscal agent. Entity needs to be in a position to lead the change needed to achieve the vision, have affinity in health equity, and should have effective marketing, communication (knows how to communicate, builds trust, timely, etc), enable a living directory to maintain up to date information on community assets in Arlington (Aunt Bertha, CPN inventory, others); networkers- convene expertise to pivot to an issue; supporting universal screening/intake tool/referral to enable “no wrong door” ; systems thinkers (expertise/roles) that can recognize and apply system solutions to the opportunities and challenges facing health equity

Timeframe

Fully implementable within:

2 years (short-term) 5 years (intermediate) 10 years (long-term) Within 2yrs- get QB/convener (non-profit ctr, bridges, CPN, etc.)


Page 17 of 25


This entity will serve as the convening entity to achieve shared vision to improve health equity over the next decade through systems change by building awareness, access/resources, and data about health disparities. Could look like an Office of Planning & Evaluation/Population Health at County Manager’s office level (from “Lack of Data” discussion) in the government setting

Could establish an advisory board to include APS and County Impact on health equity is demonstrated statistically (with data), to communicate what impact the backbone organization efforts has had on health equity within Arlington. Outcomes include entity improving health equity, through effective marketing, communication (knows how to communicate, builds trust, timely, etc), Supports a living directory to maintain up to date information on community assets in Arlington (Aunt Bertha, CPN inventory, others); Effective network that convene expertise to pivot to an issue; supporting universal screening/intake tool/referral to enable “no wrong door” ; systems thinkers (expertise/roles) that can recognize and apply system solutions to the opportunities and challenges facing health equity

Resources Available

Networks exists (COG, NACo), universal intake, Aunt Bertha and other similar resource directories, Destination 2027 efforts/partners (LPHS); community report, assessments from D2027, regional assessment efforts; pockets of strong collaboration among non-profits (that can be expanded upon/strengthened, platforms that provide tools to support creating connections, VHC Community vision report

Resources Needed Bridging knowledge among/across partners/entities involved (commitments) MOUs MOAs etc. to formalize these collaborations and adapt with evolving needs (technologies included); build community engagement (awareness/engagement) for buy in to this effort


Moving Forward

Commitment from govt/nonprofit to move into health equity; financial drivers from health providers and payers recognizing that 25% of health care costs are currently covered by nonprofits (Gartner).


Time, resources, human resources, energy to be built in community around health equity


this work?

Criteria needed to be quarterback- who has these skills/capacity – draft and circulate RFA- requests / public announcements? – who makes selection of entity? When

NOTES: Wish we could have other groups to share ideas and build on each other…

D2027 member(s) drafting this strategy: Kimberly Durand, Rachel Lynch, Cheryl E. Johnson, Diane Kresh, Lauren Brooks, Holly Hartell


Page 18 of 25

Strategy

Make changes to how we do business (in relation to shared D2027 vision, e.g., changes in policies & procedures to reflect D2027 work); including using existing structures differently (e.g., health in all policy)

Most offices have to consider communications in all aspects of the work they do. Some have a communications plan; others have communications coordinators. We recommend a strategy of each dept./agency have a health plan/coordinator. Ensure inclusion with departmental and agency goals and objectives. It will require an active effort to align with others to support a single, measurable vision and strategy.




All decisions based on and support the Destination 2027 vision Communicate effectively & routinely on the Health Equity Action plan priorities

Resources Available Existing best practices in systems change, HIAPs framework to inform this work Review other health equity action plans for resources to support this work.

Resources Needed Dedicated role in organization to identify any potential impacts on health equity in line of business, policies, procedures, and strategic plans/workplans; leadership buy in to approach, including a governance framework to delineate roles, responsibilities, and expectations for all partners;


Moving Forward

Other localities have accomplished restructuring work to improve health equity (list other locales – Seattle King County, LA County, etc.) Arlington County Government vision, APS Strategic Plan (Equity, Whole Child Initiative) Rising health care costs make the current model of care untenable.


The lack of knowledge and/or understanding among our diverse sectors on how they each and collectively impact health equity and affect each other (SDOT, SDOH); The need to instill a cultural shift on how to work together Structures not in place to build better collaboration on health equity Growth in gentrification of Arlington Resistance to change and a natural desire to protect silos creates a significant risk to progress and must be addressed throughout the effort of collaboration.


this work?

Think through small cultural hacks that can influence and build on changes needed to redesign/reframe… Governance document to articulate how to do this Build on successful partnering and build out (partner ACG with APS on changing business to improve health equity and grow out – instead of all at start – incrementally build out…) Social infrastructures drive culture- libraries, community centers, to build a social infrastructure… to build awareness and understanding (Paralysis of the People)

NOTES: D2027 member(s) drafting this strategy: Kimberly Durand, Rachel Lynch, Cheryl E. Johnson, Diane Kresh, Lauren Brooks, Holly Hartell


Page 19 of 25

GOAL 4: EXPAND ACCESS TO THE RESOURCES AND OPPORTUNITIES NEEDED FOR OPTIMAL HEALTH AND WELLBEING.

Strategy 1: Establish a shared vision and commitment to health equity through a County Board policy with a goal of improving health equity, working with stakeholders throughout Arlington County. Strategy 2: Create an entity, either within or outside of County Government, to implement the policy countywide.

1. What does the Lack of Access/Resources mean? Lack of Access/Resources means that not all populations have the same access to the resources and opportunities needed to achieve positive health outcomes. The resources needed include not only equitable access to health and medical care but also access to affordable (but not substandard) housing, transportation, food, childcare, education, financial services, among others. The lack of access to these resources includes the lack of knowledge about where and/or how to access these services. 2. Why is the Lack of Access/Resources important to health equity? It is important because barriers to positive health outcomes impose on governments, hospitals, businesses, and all of us, as tax payers, significant costs both monetarily and in loss of productivity. For the individual and for families the costs are even higher - children do not grow to their potential, adults are strained by multiple demands on their time and resources as they try to prosper, and the elderly struggle to remain in their homes and find appropriate care. In order to expand access to affordable housing, health care, and the other resources and opportunities needed for optimal health and wellbeing, the community must have a shared vision and commitment to health equity. This shared vision and commitment can be expressed through a County health equity policy. To implement the policy countywide, an entity (either within or outside of Arlington County Government) should be created to move this work forward, to monitor progress, and to provide accountability and transparency. Progress toward expanding access needs to be monitored. 3. Who needs to collaborate/coordinate on the Lack of Access/Resources?


Page 20 of 25


Elected Officials

Power, engaged, broad influence, can build on the child care equity plan; can adopt a health equity policy

TBD

County Government and its agencies

Can implement the County health equity policy throughout County government; can build trust/relationships with the community

Good All County Government departments/agencies have a role to play – can consider how their programs and practices can promote health equity

Arlington Public Schools

Already have equity in their mission and vision; strategic plan includes wellness; surveys indicate community trusts/feels safe at APS

TBD More opportunity for APS to collaborate with Arlington County Government and non-profits on wellness

Civic & Community organizations

Community engagement and broader reach to citizens

TBD

Businesses/BIDs/Professional Organizations

Good data; can play a role regarding the health/opportunities for health for all of their employees

TBD

Non-Profits & NGO

Have financial and human resources, expertise, relationships in the community

TBD County Government could better leverage the resources of the non-profits to improve health equity in a cost-effective way

Faith-based organizations Have relationships/trust in community

TBD

Other Government Ft. Myer; Metropolitan Washington Airports Authority; Pentagon

TBD Consider roles these play in the community

Educational Institutions Data gathering/analysis

Virginia Hospital Center A valuable resource for the community

What additional assets can the hospital bring to the community


Page 21 of 25

4. What are the opportunities for Arlington from D2027 addressing the Lack of Access/Resources?

Arlington County has a generous, socially aware population with a strong social conscience that has a history of striving for equal access. If successful, this process will set the direction for numerous stakeholders to follow in the years to 2027. 5. What are the challenges ahead for Arlington from D2027 addressing the Lack of

Access/Resources?

The potential costs are considerable such that no action is taken. Even when an investment is made, it is the difficult to demonstrate a clear connection, in the near term, to a future financial return on the investment, or other measure of success. Metrics should be developed to demonstrate the return on investment of addressing health equity. The most important challenge is in bringing all these stakeholders together in an effective and efficient manner to develop a strategic plan to achieve success. 6. How does addressing the Lack of Access/Resources contribute to success with other issues in the

D2027 Health Equity Action Plan?

Addressing the lack of access/resources by the County adopting a health equity policy supports the success of the other issues in the D2027 Health Equity Action Plan by including all of the issues in that policy. Creating an entity to implement the policy will provide the structure needed to implement the strategies that Destination 2027 has identified for data, awareness/engagement, and collaboration.


Page 22 of 25

7. Strategies and Success for Addressing the Lack of Access/Resource

Strategy 1

Strategy 1: The County Board adopts a health equity policy with the following elements: Reason for the Policy: Disparities exist, they matter, they are not OK; a shared vision and commitment are needed to make progress. Goal of the Policy: Improve health equity, which exists when everyone has access to the conditions needed for optimal health and wellbeing, working with stakeholders throughout Arlington County. Context: The Policy is consistent with the County vision and the County’s Human Rights Ordinance, which provides that it is in the interest of the County that each citizen is provided “equal opportunity to participate in the benefits, rights, and privileges of community life.” Foundational Practices:

• Make data about health disparities, including community conditions, readily available to community leaders for decision-making;

• Build awareness, responsibility and engagement to promote health equity; • Embrace a culture of collaboration and coordination to improve health

equity; and • Expand access to the resources and opportunities needed for optimal health

and wellbeing.

Strategy 2

Strategy 2: Establish an entity, either within or outside of County Government, to implement the policy countywide. Consistent with the Destination 2027 goals and strategies, the entity would:

• Develop agreement on key data elements that will reflect health disparities, including community conditions, in Arlington (data);

• Develop, maintain and make available an inventory of existing and relevant data on health disparities, and community condition, in Arlington (data);

• Provide guidance about the essential questions that each stakeholder organization should be asking to promote health in all policy and practices (awareness and engagement);

• Develop and disseminate coordinated messages about health equity and how to engage in meaningful ways to improve health equity (awareness and engagement);

• Convene key stakeholders to work together to improve health equity over the next decade through systems change by building awareness, access to resources, and data about health disparities (collaboration and coordination);

• Empower all partners to make changes to how we do business within and across sectors to improve health equity (collaboration and coordination);

• Monitor progress on expanding access to the resources and opportunities needed for optimal health and wellbeing and make recommendations for changes to expand access (access);

• Develop metrics to demonstrate return on investment of addressing health equity;

• Engage the community in its work;


Page 23 of 25

• Report annually to the County Board on its work, on progress in meeting the strategic plan goals, and on best practices/successes in including health equity in all policies and practices; and

• Be inclusive and representative of Arlington County in its membership.



What Success

Looks Like The Board adopting the policy and an entity being created to implement the policy.

Resources Available

Engaged people who can sell this to the board, momentum in this work within the county and APS, we already have staff support and board liaisons

Resources Needed

A team to draft the policy, based on the proposed policy elements included here; time; meeting space; effective lobbyists

Contextual Factors/

Forces Supporting

Low cost, similar work has been done in APS; fact that County has policies on many areas, but not one on health equity. This policy is consistent with work being done around equity involving the child care initiative; by the Arts Commission on cultural equity; with the Housing Conservation Plan to implement the Affordable Housing Master Plan; and by the County Manager and Council of Governments on equity.


Page 24 of 25

Moving Forward

Contextual Factors/

Forces Hindering

Moving Forward

Concern about creating a new policy and another entity.

Initial Steps:

How would you start

this work?

Draft the policy based on the initial work done here; start a conversation with Board members, County Manager, others to start to build support.

NOTES:

D2027 member(s) drafting this strategy: Charlie Meng, Cindy Richmond, Natasha Alfonso Ahmed, Patrick Brennan, Mike Gowen, Abby Raphael


Page 25 of 25

Documents

GOAL 1: MAKE DATA ABOUT HEALTH DISPARITIES INCLUDING ... · advance health equity Potential champions Grass root support, particularly among those disproportionately facing health