Health Disparities and Community Engagement August 8, 2012

Pathways to Respecting American Indian Civil Rights Conference

Deanna J. Butler, Office of Health Disparities Colorado Department of Public Health and Environment

Office of Health Disparities

Today’s Session Information includes…

Federal and State strategies to address Health Equity and Environmental Justice

Health Disparities Overview

Community Engagement

Colorado’s Racial and Ethnic Communities and Coordinated Efforts

Shared Learning

Office of Health Disparities

Shared Public and Environmental Health Responsibilities

The economic environment the United States has increased underserved public health customers. Existing health disparities are now at risk of increase. The strain on the healthcare system is expensive to all. The Patient Protection and Affordable Care Act (PPACA) of 2010 is meant to address some of these issues

Office of Health Disparities

Health Equity - Definitionhttp://www.vdh.state.va.us/healthpolicy/healthequity/definitions.htm

Health equity is achieving the highest level of health for all people. Health equity entails focused societal efforts to address avoidable inequalities by equalizing the conditions for health for all groups, especially for those who have experienced socioeconomic disadvantage or historical injustices.

Office of Health Disparities

Addressing Health Equity Office of Minority Health, Department of Health and Human Services (DHHS)http://minorityhealth.hhs.gov/npa/

National Partnership for Action (NPA) Goals for Health Equity

1. AWARENESS Increase awareness of the significance of health disparities…*Healthcare Agenda

2. LEADERSHIP Strengthen and broaden leadership for addressing

health disparities…*Capacity Building

3. HEALTH SYSTEM AND LIFE EXPERIENCE Improve health & healthcare outcomes for racial, ethnic, and underserved…

*Access to Care

4. CULTURAL & LINGUISTIC COMPETENCY Improve cultural and linguistic competency and the diversity…*Workforce *Diversity

5. DATA, RESEARCH, AND EVALUATION Improve data availability,

and coordination…Strategy - *Data

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HP2020http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39

Social Determinants of Health

The idea that…health starts in our homes, schools, workplaces, neighborhoods, and communities.

The idea that…taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health.

Office of Health Disparities

HP2020

Social Determinants of Health

Health is determined in part by access to social and economic opportunities, and resources available in our homes, neighborhoods, and communities,

(i.e. the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships).

The environmental conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.

Office of Health Disparities

Environmental Justice – DefinitionDepartment of Health and Human Serviceshttp://www.hhs.gov/environmentaljustice/http://www.epa.gov/environmentaljustice/

Environmental justice has been defined as the pursuit of equal justice and equal protection under the law for all environmental statutes and regulations without discrimination based on race, ethnicity, and/or socioeconomic status. This concept applies to governmental actions at all levels -- local, state and federal -- as well as private industry activities

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EJ Focuses-The fair treatment and meaningful involvement of all people

regardless of race, color, national origin, educational level, or income when implementing enforcement of environmental laws.

-Seeks to ensure that minority and low-income communities have access to public information relating to human health and environmental planning, regulations and enforcement.

- A New DHHS Strategy for EJ is coming to focus on: Policy Development and Dissemination Education and Training Research and Data Collection, Analysis and Utilization; and

Services

Office of Health Disparities

Health Disparities

Office of Health Disparities

Health Disparities Definition

Persistent differences in health outcomes (i.e. disease, disability, and death) across many areas of health over time:

Maternal and Child Health Indicators Infectious Disease Intentional and Unintentional Injury Chronic Disease Life Expectancy

Office of Health Disparities

Types of Health Disparities

1. Health status

2. Health Care

a. Access to care

b. Quality of care

Office of Health Disparities

Types of Health Disparities

1. Health status

2. Health Care

a. Access to care

b. Quality of care

Office of Health Disparities

• Use Colorado Department of Public Health and Environment’s Data Resources…

Office of Health Disparities www.cdphe.state.co.us/ohd

Prevention Services Division Center for Health and Environmental

Information and Statistics

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Social Determinants of Health / Health Equity Model

Public Health Role in Addressing the Social Determinants of Healthhttp://sustainablecolorado.org/wp-content/uploads/2011/05/HealthEquityModel_CDPHE.pdf

Advocating for and defining public policy to achieve health equity

Coordinated interagency efforts

Creating supportive environments to enable change

Data collection, monitoring and surveillance

Population based interventions to address individual factors

Community engagement and capacity building

Social Determinants of Health

Source: Healthy People 2010

Policies and Interventions

Access to Quality Health Care

Physical Social Environment Individual Environment

Behavior

Biology

Office of Health Disparities

Social Determinants (Disparities) of Health Examples

Income and social status Social Support Network Education and Literacy Social Environments Physical Environments Personal Health Practices Health Services (Access and Quality) Mental Health Biology and genetic endowment Gender Culture

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Social Determinants (Disparities) of Health Examples

Colorado Winnable Battle - Obesity

American Indian, Native Alaskan Population

Neither overweight or obese - 27.8%

Overweight - 39.5%

 Obese - 32.7%

 

Office of Health Disparities

Community Partnership

Office of Health Disparities

Community participation is ESSENTIAL to:

develop and implement programs successfully change policies improve systems at the local and state level

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What exactly is Community Partnership?

Community Partnership is:

Seeking and establishing relationships.

The process of outreach to citizens of a community as a means of validating their significance and benefiting from their contributions.

Source: Center for Policy, Planning, and Performancehttp://www.effective.org/programs/consulting/consulting_citizen.html

Office of Health Disparities

Community Engagement

Trust Building a culture of collaboration with communities that is

based on trust. Involve trusted community organizations

Negative impact of historical events on both a national scale and through local experiences.

Establish and communicate principles of respect for the community.

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Community Engagement

Needs Knowledge that disparities exist Knowledge and tools for beginning the long process,

including health and capacity-building resources. Partnerships to assess disparities and address priority

concerns Tools to ‘undo’ health disparities.

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Focus on Causes

Assessing and focusing on underlying causes of poor community health and implementing solutions designed to remain embedded in the community’s infrastructure.

Source: Health Canada, “Health and Environment: Critical Pathways,” Health Policy Research Bulletin, Issue 04, October 2002, p. 3.

Office of Health Disparities

Other Ways to Engage Communities

Design health initiatives that acknowledge unique historical and cultural context of the racial and ethnic community.

Support Community Leaders to act as catalysts for health change.

Develop a collective outlook and shared interest.

Foster optimism, hope, and vision for a healthier future.

Involve trusted community organizations(Building a culture of collaboration with communities that is based on trust).

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Other Ways to Engage Communities Con’t.

Plan long-lasting and self-sustaining community activities programming.

Include: Long-term Problems Contributing Factors Strategies and Practices Outcomes and Impacts Long-term Objectives and Goals

Office of Health Disparities

Other Ways to Engage Communities Con’t.

Consider varied levels of engagement:

Individual – knowledge and skills

Environmental – physical, social, and economic circumstances

Community – values, assets and involvement

Systems – resources, coordination, leadership, commitment, user-center design, science and knowledge

Office of Health Disparities

Racial and Ethnic Populations

Members of racial and ethnic minority groups are also overrepresented among the 56 million people in America who have inadequate access to a primary care physician. Minority children are also less likely than non-Hispanic White children to have a usual source of care.

(Department of Health and Human Services), http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

)

Colorado’s Racial and Ethnic Populations

71.00%

19.40%

4.50%

3.40% 1.70%

White Latino/Hispanic Black/African Amer-ican Asian/Pacific Islander Indian/Native Amer-ican

Office of Health Disparities

American Indians in Colorado

The Office of Health Disparities partners with the Denver Indian Health and Family Services, Inc., the Colorado Commission on Indian Affairs, and many other key leaders to address health and wellness in Colorado’s American Indian communities.

Office of Health Disparities

Hispanics/Latinos in Colorado

The Office of Health Disparities partners with the Unidos Por la Salud-United for Health (Unidos) to maximize Latino health and reduce disparities by accelerating strategic partnership in advocacy, leadership, best practices, and research.

Office of Health Disparities

African Americans/Blacks in Colorado

The Office of Health Disparities partners with the Colorado Black Health Collaborative, and many other key leaders to address health and wellness in Colorado’s Black/ African American communities, and provide community health forums.

Office of Health Disparities

Asian American/Pacific Islander in Colorado

Current Events

The Office of Health Disparities partners with Asian community leaders and stakeholders to coordinate and activate health participation and address health and wellness in Colorado’s Asian/Pacific Islander communities.

Office of Health Disparities

Federal and State health Equity Resources

Office of Minority Health / National Partnership for Action to End Health Disparities (NPA), Office of Minority Health

http://minorityhealth.hhs.gov/npa/

Interagency Health Disparities Leadership Council, Colorado Department of Public Health and Environment

http://www.cdphe.state.co.us/ohd/ialc.html

Patient Protection and Affordable Care Act (PPACA) of 2010

http://www.jlbghealth.com/blog/archives/522-Patient-Protection-and-Affordable-Care-Act-PPACA-guidelines-effective-September-23rd,-2010.html

Office of Health Disparities

Federal and State health Equity Resources Con’t. Title VI of the Civil Rights Act of 1964,

http://www.justice.gov/crt/about/cor/coord/titlevistat.php Executive Order 13166  US Department of Health and Human Services - Developing a Self-Assessment Tool for Culturally

     and Linguistically Appropriate Services in Local Public Health Agencies: Final Report 2003  US Department of Health and Human Services, Office of Minority Health. National Standards for

     Culturally and Linguistically Appropriate Services in Health Care. March 2001. Washington, D.C. Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services

     in Health Care. DHHS. March 2001. (PowerPoint slideshow provided by Christina Harlan) National Census Bureau. American Fact Finder - 2000 A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations.  

     The Office of Minority Health has sponsored the development of A Patient-Centered Guide to     Implementing Language Access Services in Healthcare Organizations guide to help healthcare     organizations implement effective LAS to meet the needs of their limited English proficient (LEP)     patients, thereby increasing their access to health care.

National Standards of Practice for Interpreters in Health Care.   This introduction to the National     Standards of Practice for Interpreters in Health Care explains the context in which standards      were developed, the process of development, and suggests ways in which standards can be used.

US Department of Health and Human Services - Office for Civil Rights Website of the Federal Interagency Working group on Limited English Proficiency

Office of Health Disparities

Shared Learning

Open Sharing and Final Thoughts

Office of Health Disparities

Contact Information

Director: Mauricio Palacio

HD Specialist / Program Evaluator: Deanna Butler

Language Service Coorindator: Maria Carreon Ayers

Contract Monitor: Kim Phi

Health Equity Coordinator: Lorena Zimmer

HD Program Coordinator: Barbara Quintana

www.cdphe.state.co.us/ohd

Thank You!

Office of Health Disparities