TRANSFORMING SERVICES TO ADDRESS HEALTH ...Public policy can influence social determinants of health and can lead to negative or positive health outcomes. Improving the quality of

TRANSFORMING SERVICES TO TRANSFORMING SERVICES TO

ADDRESS HEALTH DISPARITIESADDRESS HEALTH DISPARITIES

Dr. Kim Turner, Deputy Director

Health & Human Services

July 30, 2009

A LOCAL EXPERIENCE IN FULTON COUNTY, GEORGIA



�� County services are being integrated to better County services are being integrated to better

address the causes of health disparities. address the causes of health disparities.

�� Common GroundCommon Ground in Fulton County, Georgia: in Fulton County, Georgia:

Transforming Services to Address Health Transforming Services to Address Health

DisparitiesDisparities



�� Prevention ProgramsPrevention Programs

�� Targeting areas of greatest needTargeting areas of greatest need

�� Indigent Care StudyIndigent Care Study

�� CollaborationsCollaborations



�� Eliminating Disparities and Closing the GapEliminating Disparities and Closing the Gap

�� Prioritizing Programmatic InitiativesPrioritizing Programmatic Initiatives

�� Focusing Resources Based on PlanningFocusing Resources Based on Planning



Health Outcome Health Outcome

CategoryCategory

Whole Whole

County Rate County Rate

or Measureor Measure

AfricanAfrican--

American or American or

Black Rate in Black Rate in

CountyCounty

County County

GradeGrade

% Below Poverty% Below Poverty 15.7%15.7% 26.5%26.5% DD

Employment (adult Employment (adult unemployment)unemployment)

8.9%8.9% 13.113.1 FF

YPLLYPLL--75 Rate 75 Rate (Life years Lost)(Life years Lost)

4,5144,514 3,4273,427 FF



Health Outcome Health Outcome

CategoryCategory

Whole County Whole County

Rate or Rate or

MeasureMeasure

AfricanAfrican--American American

or Black Rate in or Black Rate in

CountyCounty

County County

GradeGrade

Preventable Preventable Emergency Dept. Emergency Dept.

VisitsVisits5,901.65,901.6 29,390.529,390.5 DD

Mental HealthMental Health

Emergency Dept Emergency Dept VisitsVisits

960.4960.4 2,212.82,212.8 CC

Low Birth WeightLow Birth Weight 7%7% 14.614.6 D+D+

TRANSFORMING SERVICES TO ADDRESS HEALTH DISPARITIESTRANSFORMING SERVICES TO ADDRESS HEALTH DISPARITIES

Examples

of SDH

�� Condition of the Built Environment Condition of the Built Environment

�� Housing & Physical living conditionsHousing & Physical living conditions

�� Access to TransportationAccess to Transportation

�� Access to Health CareAccess to Health Care

�� Policies and laws in placePolicies and laws in place

�� Education LevelEducation Level

�� Socioeconomic status of the communitySocioeconomic status of the community

�� Crime levelsCrime levels

Social determinants of health (SDH) are essential factors and resources in

the social environment that contribute to or detract from the health of

individuals and communities.

This phenomenon has long been accepted by scientists, practitioners

and policy makers. inequitable distribution of the SDH in question

which has a significant influence on persistent health disparities in our

most underserved communities.

TRANSFORMING SERVICES TO ADDRESS HEALTH TRANSFORMING SERVICES TO ADDRESS HEALTH DISPARITIESDISPARITIES

HEALTH DISPARITIES


HEALTH DISPARITIES

HEALTH DISPARITIES

Health

Status

�� 2008 Georgia Department of Community Health report entitled 2008 Georgia Department of Community Health report entitled

Health Disparities Report 2008: A CountyHealth Disparities Report 2008: A County--Level Look at Health Level Look at Health

Outcomes for Minorities in Georgia. Outcomes for Minorities in Georgia.

�� Fulton County received an overall failing grade for health Fulton County received an overall failing grade for health

outcomes and health inequity for “extremely poor outcomes outcomes and health inequity for “extremely poor outcomes

and/or extremely severe racial inequality”. and/or extremely severe racial inequality”.

�� This is a result of a long history of the environmental and social This is a result of a long history of the environmental and social

conditions that have affected the health status of Fulton County. conditions that have affected the health status of Fulton County.

�� Over the years support has been provided to people through Over the years support has been provided to people through

social and health programssocial and health programs

�� People are suffering from poor health conditions and diseases People are suffering from poor health conditions and diseases

that are preventable because of inequity in the system. that are preventable because of inequity in the system.

�� Fulton County government has acted to address social Fulton County government has acted to address social

determinates of health to affect health disparities. determinates of health to affect health disparities.



CHALLENGE AND RESPONSECHALLENGE AND RESPONSE

Zachary Williams, County Manager

Fulton County Government

July 30, 2009

A LOCAL EXPERIENCE IN FULTON COUNTY, GEORGIA

�� The conditions in which people live have an impact The conditions in which people live have an impact on individual and community health status. on individual and community health status.

�� Policy drives the conditions in which people live and Policy drives the conditions in which people live and work. work.

�� In order to affect the health status of the residents of In order to affect the health status of the residents of Fulton County on a large scale and over the long Fulton County on a large scale and over the long term, government must shift the way it conducts term, government must shift the way it conducts business and provides services by creating and business and provides services by creating and implementing policies that address the social implementing policies that address the social determinants of healthdeterminants of health


CHALLENGE AND RESPONSE

�� Public policy can influence social determinants of health and can Public policy can influence social determinants of health and can

lead to negative or positive health outcomes. lead to negative or positive health outcomes.

�� Improving the quality of public services, the community Improving the quality of public services, the community

infrastructure, and the socioinfrastructure, and the socio--economic conditions in which economic conditions in which

people live can also improve health. people live can also improve health.

�� Modifying service delivery through the lens of the Social Modifying service delivery through the lens of the Social

Determinants of Health is a new perspective for conducting Determinants of Health is a new perspective for conducting

government. government.

�� The economic viability and health status of a community are The economic viability and health status of a community are

intertwined. intertwined.

POLICY CHANGE

Alameda County Health Disparities Report 2002



�� Environmental attributes of a community such as walking Environmental attributes of a community such as walking

trails, parks and recreation are essential elements that have a trails, parks and recreation are essential elements that have a

major impact on resident’s health problems such as obesity, major impact on resident’s health problems such as obesity,

hypertension, diabetes, cardiohypertension, diabetes, cardio--vascular disease and others. vascular disease and others.

�� Public policy must address “social exclusion”, defined as “the Public policy must address “social exclusion”, defined as “the

economic hardship of relative economic poverty and includes economic hardship of relative economic poverty and includes

the process of marginalizationthe process of marginalization--how groups come to be how groups come to be

excluded and marginalized from various aspects of social and excluded and marginalized from various aspects of social and

community life”. community life”.

�� Public policy must support the survival of residents and their Public policy must support the survival of residents and their

communities and should be created through empowering communities and should be created through empowering

communities to drive the process. communities to drive the process.



POLICY CHANGE

Alameda County Health Disparities Report 2002

COMMON GROUND INITIATIVECreating Equity through Public Policy and Community Engagement

� Intended to create more collaborative

approaches to service delivery among

Human Services Departments.

� Concept has evolved into a much

larger, long term, County-level

strategic initiative to address the

Social Determinants of Health.

� One of the first in the nation.



�� Fulton County Health and Human Services Agencies Fulton County Health and Human Services Agencies began to research actions to optimize service delivery began to research actions to optimize service delivery among Departments within the Fulton County among Departments within the Fulton County Government. Government.

�� The task evolved into a much larger strategic initiative to The task evolved into a much larger strategic initiative to develop a systemdevelop a system--wide approach to address Social wide approach to address Social Determinants of Health. Determinants of Health.

�� August, 2008 the Health and Human Services Agencies August, 2008 the Health and Human Services Agencies were charged with developing a proposal to address were charged with developing a proposal to address inequities with regard to racial, ethnic and other inequities with regard to racial, ethnic and other socioeconomic disparities and their impact on health socioeconomic disparities and their impact on health status. status.

�� The agencies identified opportunities for further The agencies identified opportunities for further partnerships and collaborated on opportunities to create partnerships and collaborated on opportunities to create new programs and policies to address local inequities. new programs and policies to address local inequities.

�� The effort has evolved into the current initiative entitled The effort has evolved into the current initiative entitled Common Ground: Creating Equity through Public Policy Common Ground: Creating Equity through Public Policy

and Community Engagement. and Community Engagement.

COMMON GROUND INITIATIVEGovernmental AgenciesGovernmental Agencies

Elected Officials/ Policy MakersElected Officials/ Policy Makers

Economic and Community Economic and Community

DevelopmentDevelopment

Family and Children ServicesFamily and Children Services

General ServicesGeneral Services

Public WorksPublic Works

Arts CouncilArts Council

LibraryLibrary

Police DepartmentPolice Department

Housing and Community Housing and Community

DevelopmentDevelopment

Code EnforcementCode Enforcement

Parks and RecreationParks and Recreation

Cooperative ExtensionCooperative Extension

Public HealthPublic Health

Behavioral HealthBehavioral Health

Human ServicesHuman Services



�� Serving AtServing At--Risk Teens (START) System of CareRisk Teens (START) System of Care

�� Oak Hill System of Care for Youth and FamiliesOak Hill System of Care for Youth and Families

�� North and South Fulton Community CentersNorth and South Fulton Community Centers

�� Neighborhood Union Primary Care PartnershipNeighborhood Union Primary Care Partnership

�� Intergenerational Communities Intergenerational Communities

�� Primary Care Lite ClinicPrimary Care Lite Clinic

COMMON GROUND TARGETED OPPORTUNITIES



Access

to Care

�� $424,400 approved in FY2009$424,400 approved in FY2009

�� Oak Hill Adolescent and Family Program serves Oak Hill Adolescent and Family Program serves

is a “oneis a “one--stop shop” resource to enhance access stop shop” resource to enhance access

and coordination of treatment services to the and coordination of treatment services to the

target population of children and families who target population of children and families who

present for servicespresent for services

�� 374 youth ages 7374 youth ages 7--21 and 20 youth ages 021 and 20 youth ages 0--6 have 6 have

received carereceived care

Oak Hill Center – System of Care



� $ 3.2 Million Renovation Project

� Neighborhood Union - Common Ground project

� The project seeks to couple traditional public

health, mental health and human services with

primary care services, in addition to other county

services that are scheduled to be integrated

� Multidiscipline Service Centers to address the

mounting need for adequate, accessible health

care for the underserved living in surrounding

communities

Access

to Care

Multi-discipline Service Center – System of Care



�� Fulton County is engaging a wide array of Fulton County is engaging a wide array of

organizations to address the disparities issues organizations to address the disparities issues

�� All sectors of County government and as well as All sectors of County government and as well as

other stakeholders must be involved other stakeholders must be involved

�� Partnering with multiple segments of the community Partnering with multiple segments of the community

in order to sustain the processin order to sustain the process



COLLABORATIVE PARTNERSHIPS

�� The Atlanta Regional Commission The Atlanta Regional Commission

�� United Way United Way

�� MARTA MARTA

�� CommunityCommunity--based Organizations based Organizations

�� FaithFaith--based Organizations based Organizations

�� Neighborhood Planning UnitsNeighborhood Planning Units

�� Local Businesses Local Businesses

�� Institutions of higher educationInstitutions of higher education-- Morehouse and Emory Morehouse and Emory

�� School BoardsSchool Boards

�� Municipalities and other government agenciesMunicipalities and other government agencies



COLLABORATIVE PARTNERS

�� The movement to address the social determinants of health The movement to address the social determinants of health in Fulton County was founded upon an interdepartmental in Fulton County was founded upon an interdepartmental collaboration with current and future community collaboration with current and future community partnerships.partnerships.

�� By forging solid relationships with other Fulton County By forging solid relationships with other Fulton County agencies, businesses and community representatives, Fulton agencies, businesses and community representatives, Fulton County is utilizing its assets more effectively to combat County is utilizing its assets more effectively to combat poverty, housing inadequacies, environmental stressors and poverty, housing inadequacies, environmental stressors and other social determinants of health that affect our other social determinants of health that affect our communities communities



THANK YOU

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TRANSFORMING SERVICES TO ADDRESS HEALTH ...Public policy can influence social determinants of health and can lead to negative or positive health outcomes. Improving the quality of