4 wed allen 2011 hiv prevention conference

In Pursuit of Health Equity

A Broader Perspective Inclusive of the HIV/AIDS Epidemic

August 17, 2011

National HIV Prevention Conference

Atlanta, GA

Johnnie (Chip) Allen, MPHHealth Equity Coordinator

Ohio Department of Health

Presentation Goals

• Achieve a common understanding of health equity terms.

• Importance of Syndemic Orientation

• Practical considerations for Transforming Information to Action.

Health Equity Office

• Ohio Department of Health—1,300 Employees.

• 70% of all funding is from federal sources.

• Created in December 2008.

• Enterprise/Agency Coordination of all Health Equity Activities.

• Two (2) FTEs----Major emphasis on policy and implementation of innovative strategies.

What’s is the importance of a name?

• Health disparities, health inequality, health inequities, health equity, social determinants.

• Do these terms mean the same thing?

• Understanding the relation/differences in these terms are crucial for a proactive response.

“Health disparities are differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes.”

“Health inequalities, which is sometimes used interchangeably with the term health disparities, refers to summary measures of population health associated with individual- or group-specific attributes (e.g., income, education, or race/ethnicity).”

“Health inequities are a subset of health inequalities that are modifiable, associated with social disadvantage, and considered ethically unfair.”

“Health equity is when everyone has the opportunity to “attain their full health potential” and no one is “disadvantaged from achieving this potential because of their social position or other socially determined circumstance.”

Definition of Health Equity

Where does HIV/AIDS Fit within the Health Equity Discussion?

Coronary heart disease and stroke are not only leading causes of death in the United States, but also account for the largest proportion of inequality in life expectancy between whites and blacks……………

Large disparities in infant mortality rates persist. Infants born to black women are 1.5 to 3 times more likely to die than infants born to women of other races/ethnicities.

Despite overall declines in cigarette smoking, disparities in smoking rates persist among certain racial/ethnic minority groups, particularly among American Indians/Alaska Natives. Smoking rates decline significantly with increasing income and educational attainment.

Where does HIV/AIDS Fit within the Health Equity Discussion?

● Health care quality and access are suboptimal, especially for minority and low-income groups.

● Quality is improving; access and disparities are not improving.

● Urgent attention is warranted:

• Cancer screening and management of diabetes.• States in the central part of the country.• Residents of inner-city and rural areas.• Disparities in preventive services and access to care.

Root Causes of Misunderstanding

• Misunderstanding of Social Determinants of Health

• Lack of Awareness of SDoH Data-Sets

• Understanding context in which behaviors occur.

• Inexperience of combining different data-sets for 3D picture.

Overcoming Challenges in Understanding SDoH

• “Health occurs where we live, work and play” (RWJF)• What data sources should be used?

A Step in the Right Direction

• Health Equity is at the core of this plan.

• Importance of Syndemic Orientation of Health Systems.

• A syndemic orientation is defined as a way of thinking about public health work that focuses on connections among health-related problems, considers those connections when developing health policies, and aligns with other avenues of social change to ensure the conditions in which all people can be health.

A Step in the Right Direction

A Different Way of Understanding/Responding to SDOH

Atlanta, Georgia

Atlanta, Georgia2010 Pop 25+, Some High School, No Diploma

Atlanta, Georgia

2010 Pop 25+, Some High School, No DiplomaAfrican American Males Ages 15-34 years

Atlanta, Georgia


A Closer Look at SDoH in Census Block Group 13210086021

Atlanta, Georgia


• Population : 5,081• 96% Black• 1.0 White• 0.06 Asian• 0.43 Some Other Race Alone• 1.0 Two or More Races

RACE

• Hispanic Population: 155

• Mexican 89• Puerto Rican 10• Cuban 17• All Other Hispanic/Latino 39

ETHNICITY

Atlanta, Georgia


• 10% Less than 9th Grade Education• 27% Some High School, No Diploma• 52% of Households have No Vehicle.• 1,108 Families live in Poverty

• 52% Families Below Poverty with Children

Population Age 16+ Employment Status• 39% Employed• 11% Unemployed• 49% Not in Labor Force


Census Block Group 13210007001

Atlanta, Georgia2010 Pop 25+, Some High School, No Diploma

Hispanic/Latino Males Ages 15-34 yearsA Closer Look at SDoH in Census Block Group 13210074001

Atlanta, GeorgiaTarget Audience: Latino Males 15-34 Years


• 3,314 in the population• 30% White• 7% Black• 25% Asian• 24% Some Other Race• 34% Speak Spanish at Home• 18% Speak Asian/Pacific Islander Language at Home

• Pop 25 + (Latino), Population of 1,008• 56% Less than a 9th Grade Education

• 22% Some High School, No Diploma• 18 % High School of GED• 1.5 % Some College, No Degree

Atlanta, GeorgiaTarget Audience: Latino Males 15-34 Years


• Median Household Income is $33K• Average Household Size: 4• 607 live in PovertyPersons 16 + Employment Status• 60% Employed• 7% Unemployed• 32 % Not in the labor force.• 36% Work in construction.

Now you have the capacity to:

• Measure absolute and relative health disparities• Identify Data Sources• Map social determinants of health• Articulate health inequalities in new ways.

So What!

• Incorporate health equity and health disparities throughout the lifecycle of the grants process.

• Enhance a three-dimensional understanding the root causes of health disparities to develop effective interventions.

• Develop programs with respond to health disparities, health equity and the connection to social determinants.

Compelling Decision-Makers to Act on SDoH Data

Statement of Intent to Pursue Health Equity Strategies

• Explain the extent in which health disparities are manifested within the health focus of this application.

• Identify specific group(s) who experience a disproportionate burden for the disease or health condition addressed by this application.

• Identify specific (social determinants)• Statement s must be supported by data.

Actual RFP Language

Program Narrative

Problem/Need Statement

Explicitly describe segments of the target populationwho experience a disproportionate burden of the localhealth status concern (this information must correlatewith the Statement of Intent to Pursue Health EquityStrategies.)

Actual RFP Language

• Having policy statements for the pursuit of health equity is not enough!

• Must develop tools to comprehensively monitor and evaluate a response to Health Disparities and Health Inequities.

• Need political capital to do the first two statements.

Program Management Using SPES

• Consistent processes and workflow with user customization.

• Continuous improvement of project effectiveness due to quality management features

• Sharing of Project success stories and lessons learned supports a continuous learning organization

• Management by fact – All levels see same real-time view of project status

• Data model and security roles allow information sharing that is controlled by each organization.

• S.M.A.R.T objectives and results provide quantitative measures of success

• Crystal Reports allows ad hoc reports across projects

• GIS identifies location of activities within legislative districts

BHPRR

ODH

CVH TOB

Bureau I

Division A

Program Y

Project 1

Project 4

Project 3Project 6

Project 5

Bureau II

Program X

Project 2

Dept. X

Prevention

OH

External User

Internal UserProgram Supervisor /ConsultantLocal Project Manager

Roles

Example Organization withUser-Defined Roles

Thank you for listening!

Health & Medicine

4 wed allen 2011 hiv prevention conference