In Pursuit of Health EquityA Broader Perspective Inclusive of the HIV/AIDS Epidemic August 17, 2011 National HIV Prevention Conference Atlanta, GA Johnnie (Chip) Allen, MPH Health 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 theirdeterminants between segments of the population, as defined bysocial, demographic, environmental, and geographic attributes.”“Health inequalities, which is sometimes used interchangeablywith the term health disparities, refers to summary measures ofpopulation health associated with individual- or group-specificattributes (e.g., income, education, or race/ethnicity).”“Health inequities are a subset of health inequalities that aremodifiable, associated with social disadvantage, and consideredethically unfair.”
Definition of Health Equity“Health equity is when everyone has the opportunity to “attaintheir full health potential” and no one is “disadvantaged fromachieving this potential because of their social position or othersocially determined circumstance.”
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……………Despite overall declines in cigarette smoking, disparities insmoking rates persist among certain racial/ethnic minority groups,Large disparities in infant mortality rates persist. Infants born toparticularly among American Indians/Alaska Natives. Smokingblack women are 1.5 to 3 times more likely to die than infants bornrates decline significantly with increasing income and educationalto women of other races/ethnicities.attainment.
Where does HIV/AIDS Fit within the Health Equity Discussion?● Health care quality and access are suboptimal, especiallyfor minority and low-income groups.● Quality is improving; access and disparities are notimproving.● 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 Different Way of Understanding/Responding to SDOH Atlanta, Georgia
Atlanta, Georgia2010 Pop 25+, Some High School, No Diploma
Atlanta, Georgia2010 Pop 25+, Some High School, No Diploma African American Males Ages 15-34 years
Atlanta, Georgia 2010 Pop 25+, Some High School, No Diploma African American Males Ages 15-34 yearsA Closer Look at SDoH in Census Block Group 13210086021
Atlanta, Georgia A Closer Look at SDoH in Census Block Group 13210086021 RACE ETHNICITY• Population : 5,081 • Hispanic Population: 155• 96% Black• 1.0 White • Mexican 89• 0.06 Asian • Puerto Rican 10• 0.43 Some Other Race Alone • Cuban 17• 1.0 Two or More Races • All Other Hispanic/Latino 39
Atlanta, Georgia A Closer Look at SDoH in Census Block Group 13210086021• 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
2010 Pop 25+, Some High School, No Diploma African American Males Ages 15-34 years Census Block Group 13210007001
Atlanta, Georgia 2010 Pop 25+, Some High School, No Diploma Hispanic/Latino Males Ages 15-34 yearsA Closer Look at SDoH in Census Block Group 13210074001
Atlanta, Georgia Target Audience: Latino Males 15-34 Years A Closer Look at SDoH in Census Block Group 131210074001• 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, Georgia Target Audience: Latino Males 15-34 Years A Closer Look at SDoH in Census Block Group 131210074001• 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!
Compelling Decision-Makers to Act on SDoH Data • 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.
Actual RFP Language 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.
Program Narrative Problem/Need Statement Actual RFP LanguageExplicitly 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.)
• 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 Roles External User Example Organization with • Consistent processes and workflow with Internal User User-Defined Roles user customization. Program • Continuous improvement of project Supervisor / OH effectiveness due to quality management Consultant features Local Project • Sharing of Project success stories and Manager lessons learned supports a continuous learning organization Dept. X ODH • Management by fact – All levels see same real-time view of project status Division A Prevention • Data model and security roles allow information sharing that is controlled by each organization. • S.M.A.R.T objectives and results provide Bureau I Bureau II BHPRR quantitative measures of success • Crystal Reports allows ad hoc reports across projectsProgram X Program Y • GIS identifies location of activities within CVH TOB legislative districtsProject 1 Project 2 Project 3 Project 5 Project 4 Project 6