1. Torrie T. Harris, Dr.P.H., MPH
Director, Office of Health Equity
KY Dept. for Public Health

2. Objectives
Define health equity and health disparities.
Define and identify social determinants of health.
Discuss the Health and Human Services Action Plan
to Reduce Racial and Ethnic Health Disparities.
 Discuss principles of the National Stakeholder
Strategy for Achieving Health Equity.
Discuss the Kentucky Office of Health Equity (OHE).
Describe OHE’s activities towards achieving health
equity as model for public health practice.

3. Definitions
Health Equity
When all people have “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.”

4. Definitions
Health Disparity
A type of difference in health that is closely linked to
social or economic disadvantage. Health disparities
negatively affect groups of people who have
systematically experienced greater social or economic
obstacles to health. These obstacles stem from
characteristics historically linked to discrimination or
exclusion such as race or ethnicity, religion,
socioeconomic status, gender, mental health, sexual
orientation, or geographic location, or cognitive,
sensory or physical ability.

5. Definitions
Health Inequality
Differences, variations, and disparities in the health
achievements of individuals and groups of people.
Health Inequity
A difference in disparity in health outcomes that is
systematic, avoidable, and unjust.

6. Social Determinants of Health
According to the World Health Organization, (WHO)
the social determinants of health are the conditions in
which people are born, grow, live, work and age,
including the health system.
These circumstances are shaped by the distribution of
money, power, and resources.

9. Addressing Health Disparities and the Affordable
Care Act (Health Reform)
 Aligned with the Affordable Care Act:
 Data Collection
Directs new Assist. Sec of Health Information to
 Set standards for data collection
 Coordinate analysis of data on health disparities with HHS
 Language Access and Cultural Competence
 Qualified health plans have appropriate communication and services
 Test models and curricula that train health professionals
 Require a study on how Medicare can reimburse health professionals
providing language services and create a 3 yr grant program to test
 Extend matching rates for states that provide language services to for Medicaid
beneficiaries not just children.
 Workforce Diversity
 Permanent advisory committee
 Increase funding and scholarships for disadvantaged students, with special
consideration to institutions with a track record of training individuals from
minority communities

10. Office of Minority Health, US Dept. of Health and
Human Services: Action Plan to Reduce Racial
and Ethnic Health Disparities
“A nation free of disparities in health and health
care.”
HHS Strategic Plan for Fiscal Year (FY) 2010-2015
Transform health care;
Strengthen the nation’s Health and Human Services
infrastructure and workforce.
Advance the health, safety, and well-being of the
American people;
Advance scientific knowledge and innovation;
Increase the efficiency, transparency, and
accountability of HHS programs.

11. HHS Initiatives to Reduce Health Disparities
Healthy People 2020
Let’s Move
Strategic Action Plan to End the Tobacco Epidemic
Efforts to Reduce Disparities in Influenza Vaccination
Interagency Working Group on Environmental
Justice

12. National Partnership for Action:
Strategies for Achieving Health Equity
Awareness: Increase significance of health disparities,
their impact on the nation, and actions necessary to
improve health outcomes.
Leadership: Strengthen and broaden leadership for
addressing health disparities at all levels.
Health and Health System Experience: Improve health
and healthcare outcomes for racial and ethnic minorities
and for underserved communities.
Cultural and Linguistic Competency: Improve
competency.
Research and Evaluation: Improve coordination and
utilization of research and evaluation outcomes.

13. A Practical Context for Change
National Partnership for Action (NPA): National
Stakeholder Strategy: promotes systematic and systemic
change that improves the overall health of the nation.
Action Plan responds to the voices of thousands of leaders
who called for actions to effectively and efficiently address
health and healthcare disparities.
Action Plan is also based on Congressional language
which called for a national strategy that is implemented
and monitored in partnership with state and local
governments, communities and the private sector.

14. KY Office of Health Equity
Established in Fall 2008
Funded by the U.S. DHHS, Office of Minority Health
and the KY Dept. for Public Health, REACH US, and
Cervical Cancer Free KY
Overarching Goals:
To eliminate health disparities among racial and ethnic
minorities, rural and low income populations in the
state of KY.
To promote health equity in the state of KY.

15. Statewide Plans to Reduce Health Disparities as of 2005
Source: National Conference of State Legislatures.The Office of Minority Health.Health
Disparities Plan, January 2009.

16. Kentucky Health Disparities: Infant Mortality
Rates* by Race; Kentucky 1993, & 2000-2006
6.3 6.3
14.1
7.16.3 6.6
6.6
5.6
7.4
15.114.714.8
11.7
10.5
13
14.1
7.6
6.86.86.87.2
5.9
6.7
8
0
2
4
6
8
10
12
14
16
1993 2000 2001 2002 2003 2004 2005 2006
Rateper1,000LiveBirths
White
African Am.
Total

17. Health Disparities in the Leading Causes of Death in
Kentucky 2005
Age-Adjusted Rate per 100,000 Population
White African-American
Heart Disease 321.5 Heart Disease 382.8
Cancer (all sites) 213.82 Cancer (all sites) 244.13
Stroke 50.0 Stroke 69.0
Diabetes 26.1 Diabetes 51.8

18. Achieving
Health Equity
KY Office of Health Equity Goals and Strategies

19. Awareness: Increase the awareness of the significance of health disparities, their impact on
the nation, and the actions necessary to improve health outcomes of racial, ethnic, and
underserved populations.
National Partnership for Action
(NPA)
KY Office of Health Equity
Healthcare Agenda KY Dept. for Public Health Strategic Planning
Partnerships •Promoting Health Equity Project
•KY Migrant Network Coalition
•National Rural Health Association
•Kentucky State University
•Human Rights Commission
•Kentucky Cancer Consortium Steering
Committee
Media •Newspaper Articles
• Television Spots
•Kentucky Entertainment Television
Communication •Racial and Ethnic Approaches to Health
(REACH) Breast and
•Cervical Cancer Project, Cervical Cancer Free KY
Project,

20. Kentucky Department for Public Health
Strategic Map: 2011- 2016
Mission: Prevent, promote and protect to improve the health and
safety of people in Kentucky.
Vision: Healthier People …. Healthier Communities.
1
2
3
4
6
5
Improve the Health
of Disparate
Populations
Implement a
Department-wide
Performance Manage-
ment System
Promote Effective
Use of Technology &
Information Exchange
Develop & Implement
A Focused Healthy
Kentuckians 2020/SHIP
Plan
Develop & Enhance
Relationships
with
Key Partners
Support Evidence-
Based and Promising
Practices
Support
Public Health
Population-Based
Practice & Research
Strengthen Internal
& External
Communications
Implement a
Culture of Customer
Service/Satisfaction
Attain and Sustain
PHAB Accreditation
Promote Best Practices
That Support Healthy
Communities &
Individuals
Cultivate a Positive
Work Environment
& a Satisfied
Workforce
Implement Sound
Financial &
Business Practices
Attract & Retain a
Competent & Diverse
Workforce
Implement a Quality
Improvement Plan
& Curriculum
P
People
Q OE
Quality
Improved
Outcomes
Efficiency &
Effectiveness
11/4/2011 Revision
Following 11-4-11
Executive Staff Meeting

23. Leadership: Strengthen and broaden leadership for addressing health disparities at all
levels.
NPA KY Office of Health Equity
Capacity Building •State Accreditation Advisory Committee
•Obtained Administrative Order to
establish Office in organization structure
•Pursing Executive Order & Legislation to
mandate funding
•Governor’s Office of Minority
Empowerment
•Foundation for a Healthy Kentucky
Funding Priorities •Secured Funding from Public Health
Commissioner $ 200k
•Regional Health Equity Council
Youth University of Kentucky, Student National
Medical Association and Multicultural
Affairs Student Office

24. Health and Health System Experience: Improve health and
healthcare outcomes for racial and ethnic minorities and for underserved communities.
NPA KY Office of Health Equity
Access to care •Health People/Healthy Kentuckians State
Coordinators
•KY Health Literacy Steering Committee
•Hispanic Diabetes Health Education
Program
•Social Determinants of Health Workgroup
Children
Older Adults
Health Communication
Education
Social and Economic Conditions

25. Cultural and Linguistic Competency: Improve cultural and linguistic
competency and the diversity of the health-related workforce.

NPA KY Office of Health Equity
Workforce •Developed Infrastructure study to assess level of
competency and compliance with the Civil Right
Acts at the local health department level.
•Developed training program to develop and
support public health practitioners at the state
and local level
•Hired a Cultural and Linguistic Competency
Coordinator
Diversity •Developed Health Equity Fellowship for MPH
students
•Mentor Preventive Medicine Residents
•Serve as Practicum Advisor
•Serve as Capstone/Dissertation Committee
Member
•Teach graduate level students Public Health
Practice and Management
Ethics and Standards, and Financing for
Interpreting and Translational Services
•Evaluating Language Access programs on the
state level
•Developing Performance Management and
Improvement project across state public health
Divisions

26. Research and Evaluation: Improve coordination and utilization of research and
evaluation outcomes
NPA KY Office of Health Equity
Data •First Comprehensive KY Minority Health Status
Report
•Sponsored and Funded BRFSS oversampling of
minority populations in KY
•Lesbian, Gay. Bisexual, Transgender Pilot Study
•Community Health Assessments
Coordination of Research •Conducted infant mortality social determinants
study with Louisville Metro Health and Wellness
and Center for Health Equity
•Practice Based Research Supplement Grant with
Robert Wood Johnson Foundation
•Hired Health Equity Epidemiologist
Knowledge Transfer •Hosted Health Equity Summit
•Tri-State Diversity Conference
•Academy Health, Health Disparities Workgroup
•Journal Publications
•Conference Presentations
•Speaking Engagements

27. Lessons Learned
Strategic Planning is key: Be a visionary !
Align goals and strategies with local, state, and national
priorities.
Collaborate and partner with those that share the same goals
and strategies.
Recruit people with a passion and interest in goals and
strategies and who can produce.
Cast away self interests and egos and remember the cause.
Integrate goals and strategies into organizational vision,
mission, and strategies.
Network, network, network.
Remember that health equity is a movement not a one-time
program.