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ADVANCING HEALTH EQUITY IN MONTEREY COUNTY
Elsa Mendoza Jimenez, MPHDirector of Health for Monterey County
March 23, 2018
MONTEREY COUNTY
2015 US Census Bureau
Population: 430,000 Ethnicity: 58% Hispanic Foreign born: 30% Undocumented: 13% Median Age: 33 years Industries: Agriculture &
Tourism Govt Health Ins: 11% Poverty: 17%
WHAT THE DATA INDICATES
• Monterey County ranks 22nd for health outcomes and 37th
for health factors among all CA counties (RWJF County Health Rankings, 2016)
• Health disparities (CHA, 2013):
• Childhood obesity• Teen birth rates• Diabetes mortality rates• Cancer screening rates• Homicide rates• Unintentional injury
• Improvements in (CHA, 2013): • Cancer incidence and mortality rates• Smoking rates• Stroke mortality rates• Heart disease mortality rates
Aging population from 2015 to 2050
DO YOU KNOW?
40%
20%10%
30%
www.communityhealthrankings.org
NOT WHAT WE THINK….
Socioeconomic Factors, 40%
Clinical Care, 20%
Physical Environment, 10%
Health Behaviors, 30%
www.communityhealthrankings.org
SOCIAL DETERMINANTS OF HEALTH
6
WHAT IS HEALTH EQUITY?
Equality is about
sameness. But this
only works if everyone starts from
the same place
Equity is about fairness. Making sure people have access to the same opportunities
HEALTH DISPARITY VS. INEQUITY
Health Disparity• A simple, qualitative
difference in health outcomes
• May lead to health inequities if social determinants of health are present
Health Inequity• Social determinants are
present and contribute to the disparity
• All health inequities are health disparities
“A difference in rates of illness, disease, or conditions among different populations.”
- UW, Robert Wood Johnson & NAACHO
“Health inequities are differences in health which are not only unnecessary and avoidable but, in
addition, are considered unfair and unjust.”
Margaret Whitehead, Dept of PH, Univ. of Liverpool
EXAMPLE OF A HEALTH DISPARITY
EXAMPLE OF A HEALTH INEQUITY
OTHER COUNTY INEQUITIES
Greenfield
Median age: 26 years
< 5: 11%
> 64: 5%
No HS diploma: 61%
Households in poverty: 18%
Life expectancy: 80 years
AAYPLL-75: 5,900/100,000
Monterey
Median age: 39 years
> 5: 5%
> 64: 15%
No HS diploma: 7%
Households in poverty: 6%
Life expectancy: 83 years
AAYPLL-75: 4,547/100,000
ACCESS TO HEALTHCARE
73%56%
75%
54%
84%89% 94% 96%
83%
97%
0%
20%
40%
60%
80%
100%
2011 2012 2013 2014 2015
Perc
ent
Hispanic/Latino White
Percent Insured
Source: California Health Interview Survey, 2016
OVERCROWDED HOUSING
Living in an overcrowded home can be harmful for the physical and mentalhealth as well as childhood development.It can also increase noiseand stress levels, leading to sleep loss.
OVERCROWDED HOUSING – GREATER SALINAS
32% of households in 93905 are overcrowded
ECONOMIC DEVELOPMENT
$28,679
$21,971
$44,123
$14,173
$26,251 $24,642
$33,010
$13,850
$23,272 $23,283 $24,753
$11,399
$-
$10,000
$20,000
$30,000
$40,000
$50,000
Race: Asian alone(includes Latino or
Hispanic)
Race: Black or AfricanAmerican alone (includes
Latino or Hispanic)
Race: White alone;Ethnicity = not Hispanic
Ethnicity: Latino orHispanic (any race)
Per Capita Income by Race/Ethnicity and Location (in 2015 dollars)
Monterey County Salinas ZIP 93905
Source: U.S. Census Bureau, 2015 American Community Survey 5-year estimates.
INDICATOR TREND
$33,864
$25,000
$22,124
$14,101
$-
$10,000
$20,000
$30,000
$40,000
2011 2012 2013 2014 2015
Per Capita Income by Race/Ethnicity within the City of Salinas
Race: White alone; Ethnicity = notHispanic
Race: Asian alone (includes Latino orHispanic)
Race: Black or African American alone(includes Latino or Hispanic)
Ethnicity: Latino or Hispanic (any race)
Source: U.S. Census Bureau, American Community Survey 5-year estimates.
CIVIC INFRASTRUCTURE INDICATOR TREND
25%22%
24%
11%9%
15%
0%
10%
20%
30%
2011-12 2012-13 2013-14
Monterey County residents who met informally with others about community problems in the past year
White(non-Hispanic)
Latino
Source: California Health Interview Survey, 2011, 2012, 2013, and 2014 data.
SOCIAL INEQUITY
Social Inequity excludes people from full and equal participation in society
Social Inequities – Root Causes of Health Inequities
EFFECT ON BODY
Increased commute
times
Housing
Segregation
Poor Air Quality
Transportation
Lack of access to stores,
jobs, services
Crime
Poor Quality Education
Stress
Stress
Stress
Stress
Stress
Stress
Stress
Stress
PUBLIC HEALTH’S WORK
Adapted from the Bay Area Regional Health Initiative (2013), Alameda County PH Dept
Our Approach to Achieving Health Equity
CommunityCapacityBuilding
InstitutionalChange
HealthEquity
Policy Change
Data and Research
WHAT IS HEALTH IN ALL POLICIES?
Recognizes that health and prevention is impacted by policies that are managed by non-health government/non-governmental entities
Strategies that improve health will also help meet the policy objectives of other agencies
Collaborative approach that integrates health considerations into policy making and program areas
Improves personal health while contributing to community wellbeing and prosperity
HiAP Task Force Report – Executive Summary pg. 4 and 5
Source: Rudolph, L., Caplan, J., Ben-Moshe, K., & Dillon, L. (2013). Health in All Policies: A Guide for State and Local Governments. Washington, DC and Oakland, CA: American Public Health Association and Public Health Institute
Aims to improve health equity by addressing social determinants of health and integrating health into decision making processes
HIAP GOALS
Ensure that decision-makers are informed about the health, equity, and sustainability consequences of various policy options
Identify confluence of the built environment, health, and prosperity can be mutually supporting
FIVE KEY ELEMENTS OF HIAP
Promotes health, equity, & environmental sustainabilitySupports inter-sector collaborationBenefits multiple partnersEngages external stakeholdersCreates structural or process change
HIAP SUPPORTS 21ST CENTURY HEALTH DEPARTMENT’S ROLE
Responds to diverse
community needs
Humanizes “unhuman”
topics
Uses health data to
prioritize non-health
policies
Broadens stakeholders
and partnerships
HIAP BECOMES PART OF MCHD’S STRATEGIC PLAN
County adopts HiAP framework
Planning, Evaluation, and Policy Unit (PEP)
gets created
HiAP manager position created for
implementation
MCHD’S STRATEGIC PLAN 2018-2022
HIAP FIT WELL INTO DEPARTMENT’S CHIP
Eradicate Health Inequities
Develop the Power of Collective Impact
Use the Social-Ecological Model
Develop Policies
Using Prevention, Partnership, and Policy
Over-arching CHIP Recommendations
CHIP EVOLUTION - IMPACT MONTEREY COUNTY
VisionTogether, a healthy, safe, thriving Monterey County
ValuesThe People of Monterey County want to live in a place where:
• Relationships, based on respect, caring, cultural sensitivity and fairness, foster connectedness and community engagement.
• Whole person approaches that include support for mind and body are available from the prenatal stage through the senior years.
• Community voices drive the design and implementation of services and policy development.
www.impactmontereycounty.org
COMMUNITY PRIORITIES
VARIOUS USERS
Strategy Maps
Service Providers
Funders
Business LeadersCommunity
Policymakers
STRATEGY MAPS
HIAP IS UPSTREAM
HIAP INVOLVES NON-TRADITIONAL PARTNERS
HIAP INVOLVES STAKEHOLDERS
Children & Families
Housing
Violence Prevention
Community Engagement
Education
Philanthropy
Business
Social Services
Nonprofits
Schools & University
DATA SHARING PLANS SUPPORTS HIAP
Future Interoperability
Social Services
Health Department
Education
Justice System
Healthcare
CBOs
Monterey County Health Department
DATA SHARING EXAMPLE
HIAP IS SUSTAINABILITY
Sustainability is meeting the needs of the present without compromising the ability of future generations to meet their own needs
HIAP IS A HEALTH COMMUNITY
a community that provides for the basic needs of all,
quality and sustainability of environment, adequate
levels of economic and social development, health and
social equity, and social relationships that are
supportive and respectful.
INSIDE-OUTSIDE STRATEGY SUPPORTED HIAP
MCHD wanted Health Elements for county and
cities
• Economic Development an opportunity to include HEALTH POLICIES in Salinas General Plan
Inside-outside strategy with CBOs from HiAP
group
• Engaged low-income and communities of color in process
• Set new standard for City community planning processes
• Worked with City to incorporate health language into policies
Engage HiAP partners in Economic Development
Element
• Trained HiAP members in intersection of economic development and health
• Non-traditional economic development partners saw their connection to plan….and ways they could contribute ideas
STRATEGIES
Health Equity Scholars Academy for Health Department staff
HiAP in county and Health Department performance measures
HiAP in county legislative platform
Health and Planning symposium and trainings
Health equity trainings with partners
Community engagement trainings
MONTEREY COUNTY HIAP COUNCILS
• Economic Dev. Element • Housing Element• Housing inequities
• Smoke-free housing • Sugar-sweetened
beverages• Safe Routes to Schools
• Active Transportation Program • Promote HiAP framework
Cent
ral
Peni
nsul
aSo
uth
Coun
ty
CITY OF SALINAS ECONOMIC DEVELOPMENT ELEMENT
Opportunity Strategy ResultsInclude health considerations in Economic Development Element of City of Salinas General Plan
HiAP training: intersection of economic dev and health
Non-traditional development partners saw the connection
Added Quality of Life section and set a new standard community planning processes
EAST SALINAS BHC EDE WORKSHOP
Discussed connection between economic
development and health Small Group Discussions:
1. Household Challenges & Solutions
2. Neighborhood Conditions
3. Future Job/Economic Opportunities
4. Neighborhood Businesses
5. Entrepreneurship
REVISED CITY ECONOMIC DEVELOPMENT FRAMEWORK
SEVERE HOUSING SHORTAGE
Opportunity Strategy Results Cities and MC
updating their General Plan housing elements.
Overcrowded, illegal, & unsafe housing
Provide direct quotes in infographics
Promote infographics demonstrating geographic needs
Provided facts to advocates Created a new
county-wide dialogue on housing needs
ACTIVE TRANSPORTATION
ResultsOpportunity Strategy$4 million grant
Improve health outcomes in low income neighborhoods in 5 cities
Address public safety
Combine parks housing, public safety, and transportation remedies
Establish community member HiAP
In progress: walkability study, walking school bus, traffic calming, bike safety, bike lanes, sidewalks
CITY OF GONZALES
Opportunities Complete Neighborhoods Access to Healthy Affordable Foods Economic Development Safety and Prevention Social Connectedness Green, Sustainable Practices
CITY OF GONZALES
1. Complete NeighborhoodsHE-1 Building Complete Neighborhoods. Promote complete and healthy communities with access to goods and services that increase the availability of resources needed to live and enjoy an active and healthy lifestyle.
HE-2 Parks and Public Spaces. Assure that all parks and public spaces are well-maintained and remain safe at all times.
HE-3 Walkability. Promote active, safe and walkable areas that are pedestrian friendly. Characteristics of a safe walkable space includes short blocks, wide-sidewalks, trees on streets and beautiful, appropriate spaces that promote physical activity and social connectedness.
CITY OF GONZALES
2. Access to Affordable Foods
HE-1 Access to Healthy Affordable Food. Increase the promotion and support for the development of complete neighborhoods that provide access to a greater range of healthy and affordable food options.
HE-2 Partnerships. Promote the development of public and private partnerships that support access to healthy foods through supporting businesses, the community and school garden projects.
CITY OF GONZALES
3. Economic Development
HE-1 Economic Development - Support the development of economically resilient systems that promote the health and wellbeing of all Gonzales residents.
HE-2 Attracting Businesses - Incentivize and encourage the opening of businesses that offer healthy foods, activities and services.
HE-3 Financial services and Financially Healthy Households - Promote financial stability and household resilience through policies and programs that promote widespread financial education in the areas of budgeting, appropriate life and health coverage, saving, and emergency funds.
OTHER HIAP OPPORTUNITIES
Add health and equity lens to County Climate Action Plan
Advance changes through Governing for Racial Equity
Conduct health impact reviews as part of project review process
Use Collective Impact method of community engagement
GOVERNING FOR RACIAL EQUITY
HEALTH DEPARTMENT’S ROLE
Trusted community engager Neutral convener Conduit to policy-makers Leveraged funding Evidence-based experts Timeliness Allocate staff and resources
Health Impact reviews with
Planning Dept
Collaboratives needing upstream
partners
Partners seeking community
engagement
LESSONS LEARNED: LOOK FOR EARLY WIN-WIN OPPORTUNITIES
HIAP CHALLENGES Helping diverse stakeholders understand their roles Keeping them engaged Obtaining consensus Ensuring that diverse perspectives and experiences are
respected and appreciated Identifying priority areas since there is so much need and
interests vary Funding to sustain the work Partners’ time constraints
HONOR RECEIVED
Winner of The Arnold X. Perkins 2017
Award for Outstanding Health Equity Practice
