A plenary presentation by Jim Bloyd, MPH, Regional Health officer at the Cook County (Illinois, USA) Department of Public Health, was made Tuesday April 12, 2016, at the National Leadership Academy, "Strengthening the Capacity of Public Health Departments to Advance Health Equity," at the CDC Tom Harkin Global Communications Center, Atlanta, Georgia. The presentation describes the Chicago-area context in which policy is considered, the importance of adopting a causal framework for policy action to eliminate health inequities, actions taken by the Cook County Department of Public Health through its planning and assessment process, and the role of the Collaborative for Health Equity Cook County. The plenary topic, "Best Practices for Developing Policies to Address Social Determinants of Health," was addressed by a panel moderated by Leandris Liburd, Director, Office of Minority Health and Health Equity at the Centers for Disease Control and Prevention. The CDC hosted the National Leadership Academy on Health Equity, a two-day meeting April 11-12, 2016. The Association of State and Territorial Health Officials (ASTHO), the National Association of State Offices of Minority Health (NASOMH), and the National Association of County and City Health Officials (NACCHO) invited participants. At the conclusion of the National Leadership Academy on Health Equity a final report will be developed highlighting action steps, opportunities, challenges and lessons learned fro participants at the leadership academy. Participants' input during breakout sessions will play a critical role in defining the substance of the report. A twitter hashtag #CDCHealthEquity was created by participants during the meeting.

1. Policy Development to Tackle
Structural Origins of Health Inequi=es:
Thoughts On Best Prac=ces
Jim Bloyd, MPH
Regional Health Officer, Cook County
Department of Public Health
Strengthening the Capacity of Public Health
Departments to Advance Health Equity
April 12, 2016
CDC Tom Harkin Global Communica=ons Center,
Atlanta, Georgia

2. Outline
• Cook County (Illinois) Context
• What is our causal framework: ‘nothing as
prac=cal as a good theory….’
• ‘best prac=ce’ thoughts on policy to tackle
health inequi=es
Cook County Department of Public Health 3

3. US Federal Government created
wealth for white people 1930’s…
Records of the Federal Home Loan Bank Board [FHLBB]. (n.d.). [Web page]. Retrieved
from h]p://www.archives.gov/research/guide-fed-records/groups/195.html#195.

4. Home equity stripping of Black and
Brown neighborhoods today…
Cook County Department of Public Health 5
Source: County of Cook, Illinois v
Wells Fargo Case No: 14-cv-9548
(Filed November 2014)

5. 6
Map of Child Opportunity in Cook
County (Source: Diversitydatakids.org)
Children in Cook County grow up in
neighborhoods with stark, unfair
differences in opportunity for healthy
development. Na=onally, 40% of Black
and 32% of Hispanic children live in
very low-opportunity neighborhoods
compared to 9% of White children.
(Acevedo-Garcia, etal 2015)

6. Cook County Department of Public Health 7
Source: Center for Tax and Budget Accountability. (2015) h]p://bit.ly/1qB3qeA

7. Poor Black children exposed to
neighborhood poverty metro Chicago
Cook County Department of Public Health 8
Source: Children Lei Behind (2007) h]p://diversitydata.sph.harvard.edu

8. Poor La=no children exposed to
neighborhood poverty metro Chicago
Cook County Department of Public Health 9
Source: Children Lei Behind (2007) h]p://diversitydata.sph.harvard.edu

9. #16Shots #LaQuanMcDonald
Cook County Department of Public Health 10

10. Cook County Department of Public Health 11

11. 12.24.2016 #BlackChristmas Mag Mile
Chicago Protest
Cook County Department of Public Health 12

12. Our views inform policy and strategy:
Graham’s simplified model
Cook County Department of Public Health 13
Source: Graham, H. (2007) Unequal lives: Health and socioeconomic inequaliHes.

13. We have repeatedly referred to Hilary
Graham’s warning about the tendency to
conflate the social determinants of health
and the social processes that shape these
determinants’ unequal distribution, by
lumping the two phenomena together under
a single label. Maintaining the distinction is
more than a matter of precision in language.
As Graham argues, blurring these concepts
may lead to seriously misguided policy
choices.
[emphasis added]
Source: Solar & Irwin (2010) p.47
Cook County Department of Public Health 14

14. Our views inform policy and strategy:
WHO Conceptual Framework
Cook County Department of Public Health 15
Source: Solar & Irwin (2010) A conceptual framework for acHon on the social
determinants of health..

15. Public health values & ethics should
guide policy development
• Social Jus=ce
• Health is a Human Right & “humans have a
right to the resources necessary for health”(p2
Principles of the Ethical PracHce of Public Health)
• Addressing fundamental & systemic causes of
health “is more truly preven=ve” (PH Leadership Society
2002 p6)
• CCDPH Mission: “…to achieve heath equity”
• CCDPH WePLAN2020 priority-Health inequity
Cook County Department of Public Health 16

16. Structural Racism: WePLAN2020
Priority
Cook County Department of Public Health 17
www.cookcountypublichealth.org
h]p://www.cookcountypublichealth.org/about/weplan-feedback
WePLAN2020 Forces of Change Assessment h]p://bit.ly/1V5sKWR
Health Issue Priori=za=on Process Summary h]p://bit.ly/1VEKWF6

17. CCDPH @CookCoHealth
Tell us if housing, health svcs,
jobs, schools, transportation
& recreation support healthy
living in your community.
http://ow.ly/RNBrE
June-October, 2015: Forces of Change Assessment
June-October: Community Themes & Strengths Assessment
September 1: Local Public Health System Assessment Mee=ng
June-October: Community Health Status Assessment
October 2015-January 2016: Community Partner & Strategy
Mee=ngs
Cook County Department of Public Health 18
4 MAPP assessments planned by CCDPH
staff commi]ees

18. Framework
used in the
CCDPH
Forces of
Change
Focus
Groups
Cook County Department of Public Health 19

19. Cook County DPH
jurisdic=on is four
Districts
4 Focus groups/
loca=ons
26 people/ mul=-
sector
City of Chicago-
(Grey)
Cook County Department of Public Health 20

20. Ques=ons
used in the
CCDPH Forces
of Change
Focus Groups
Cook County Department of Public Health 21

21. Cook County Department of Public Health 22
‘Pa]erns ’ Results

22. Cook County Department of Public Health 23
‘Power/ Interests ’ Results

23. Iden=fy & confront systems of
privilege, dominance
You don't even have to be aware of it to receive
the benefit. And the thing that's really slick
about whiteness, if you will, is that most of the
benefits can be obtained without ever doing
anything personally.
john powell
Source: Interview with john a. powell edited transcript (2003) California Newsreel
Cook County Department of Public Health 24

24. Cook County Department of Public Health 25
CHECookCounty.org
@CHECookCounty

25. Power, after all, is the heart of the matter—and
the science of health inequities can no more
shy away from this question than can physicists
ignore gravity or physicians ignore pain.
Jason Beckfield & Nancy Krieger
Source: Epidemiologic Reviews, 31, 152-77 (2009) p. 169
Cook County Department of Public Health 26

26. Thank you
Cook County Department of Public Health 27
Jim Bloyd, MPH
Regional Health Officer
Cook County Department of Public Health
15900 S. Cicero Avenue
Oak Forest, Illinois 60452
jbloyd@cookcountyhhs.org
708-633-8314
Acknowledgements:
• Focus Group Par=cipants
• Deya Greer, MA, Na=onal Associa=on of
County & City Health Officials
• Tiffany Huang, MPH, Na=onal Associa=on of
County & City Health Officials
• Joseph Zanoni, PhD, University of Illinois at
Chicago, School of Public Health