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Advancing Health
Equity through the
PHAB Standards
May 31, 2017
Welcome and Introduction
Learning Outcomes
• Explore specific PHAB Standards and Measures
which address collaborative efforts to advance health
equity
• Describe multiple ways in which health departments
collaborate with community partners to promote
health equity and a culture of health
• Discuss resources that support health equity work
• Identify strategies currently being implemented
through accredited health departments to advance
health equity in the populations they serve
Presenters
Shirley Orr, MHS, APRN, NEA-BC
PHAB Consultant
April Harris, MPH, CHES
Accreditation Specialist, PHAB
Sheila Masteller, RN, MS
Director, Community and Family Services, Spokane Regional Health District
Kelley Vivian
Development and Strategic Initiatives Officer, El Paso County Public Health
Dr. Wilma Wooten, MD, MPH
Public Health Officer, County of San Diego Health and Human Services Agency
Webinar Format
• Presentation and discussion
• During the presentation, enter your questions
into question box on the control panel to the
right of your computer screen
• Questions will be addressed in the discussion
period following the presentations
Health Equity in the PHAB
Standards and Measures
April Harris
PHAB
Frameworks and Tools to Support Health
Equity Work
Shirley Orr
PHAB Consultant
Building a Culture of Health
Value on health
interdependence
Value on well-being
Public discussion on
health promotion and
well-being
Sense of community
Social support
Voter participation
Volunteer engagement
MAKING HEALTH
A SHARED VALUE
1
ACTION
AREA
MINDSET AND
EXPECTATIONS
SENSE OF
COMMUNITY
CIVIC
ENGAGEMENT
DRIVERS
STTI Leadership Connection, September 19, 2016, Susan B. Hassmiller
FOSTERING CROSS-SECTOR
COLLABORATION TO
IMPROVE WELL-BEING1
ACTION AREA
NUMBER
AND QUALITY
OF PARTNERSHIPS
INVESTMENT IN
CROSS-SECTOR
COLLABORATION
POLICIES
THAT SUPPORT
COLLABORATION
DRIVERS
2
Local healthdepartment collaboration
Opportunities to improve health for youth at schools
Business supportfor workplace health
promotion andCulture of Health
U.S. corporate giving
Federal allocations forhealth investments
related to nutrition andindoor and outdoor
physical activity
Community relationsand policing
Youth exposure to advertisingfor healthy and unhealthy
food and beverage products
Climate adaptation and mitigation
Health in all policies(support for working families)
STTI Leadership Connection, September 19, 2016, Susan B. Hassmiller
CREATING HEALTHIER,
MORE EQUITABLE
COMMUNITIES
ACTION AREA
BUILT ENVIRONMENT/
PHYSICAL CONDITIONS
SOCIAL AND
ECONOMIC
ENVIRONMENT
POLICY AND
GOVERNANCE
DRIVERS
3
Housing affordability
Access to healthy foods
Youth safety
Residential segregation
Early childhoodeducation
Public libraries
Complete Streets policies
Air quality
STTI Leadership Connection, September 19, 2016, Susan B. Hassmiller
STRENGTHENING
INTEGRATION OF HEALTH
SERVICES AND SYSTEMS
ACTION AREA
ACCESS
CONSUMER
EXPERIENCE AND
QUALITY
BALANCE AND
INTEGRATION
DRIVERS
4
Access to public health
Access to stablehealth insurance
Access to mentalhealth services
Routine dental care
Consumer experience
Population coveredby an AccountableCare Organization
Electronic medicalrecord linkages
Hospital partnerships
Practice laws fornurse practitioners
Social spending relativeto health expenditure
STTI Leadership Connection, September 19, 2016, Susan B. Hassmiller
IMPROVED POPULATION
HEALTH, WELL-BEING
AND EQUITY
ENHANCED
INDIVIDUAL AND
COMMUNITY
WELL-BEING
MANAGED CHRONIC
DISEASE AND
REDUCED TOXIC
STRESS
REDUCED
HEALTH CARE COSTS
OUTCOME AREA
OUTCOME
Well-being rating
Caregiving burden
Adverse child experiences
Disability associatedwith chronic conditions
Family health care cost
Potentially preventable hospitalization rates
Annual end-of-lifecare expenditures
Health EquityResources
from Other National
Partners
https://www.apha.org/topics-and-issues/health-equity
https://www.cdc.gov/healthequity/
http://www.naccho.org/programs/public-health-infrastructure/health-equity?p=roots
Spokane Regional
Health District
Sheila Masteller
Spokane, Washington
Addressing health inequity with data and stories
STRATEGIC PLAN GOAL 3
Division or Program Name Goes Here
Strategy: Increase education and awareness of inequity within the agency and in the community.
•Action: Provide ongoing education to staff about inequities and cultural competencies.
•Action: Develop a comprehensive community education and awareness plan.
STRATEGIC PLAN GOAL 3
Division or Program Name Goes Here
Strategy: Identify and promote policies that address inequities.
•Action: Encourage the adoption of policies to address inequities by promoting a health-in-all-policies perspective and the use of health and equity impact analysis tools.
STRATEGIC PLAN GOAL 3
Division or Program Name Goes Here
Strategy: Strategically address inequities.
•Action: Identify opportunities to engage with other sectors and build collaborations to address inequities
KRESGE EMERGING LEADERS
Focus for the Spokane Regional Health District team is health equity, first internally and then with community and partners.
Division or Program Name Goes Here
Data Center Reports
Odds Against Tomorrow: Health Inequities in Spokane County 2012Missing the Foundation: Understanding Homelessness in Spokane County 2015Spokane Counts 2015Spokane Counts Executive Summary 2015 , 2013 , 2011 , 2009 , 2007 , 2005Spokane County Demographics 2013 , 2011 , 2008 , 2007Leading Causes of Death 2014 , 2013 , 2012 , 2011 , 2010 , 2009 , 2008 , 2007 , 2006 , 2005Gun Violence in Spokane County 2013Linking Transportation Planning and Health Outcomes 2014Paid Sick Leave in Spokane 2015Violence Against Children 2015Demographics & Social Characteristics 2015
Life expectancy among females in Spokane County is approximately 19 years between the neighborhood with the highest life expectancy, Browne's Addition (86.49), and the neighborhoodwith the lowest life expectancy, Riverside (67.79).
Among males in Spokane County, the gap in life expectancy is approximately 17 years between the neighborhood with the highest life expectancy, Southgate (82.34), and the neighborhood with the lowest life expectancy, Riverside (65.65).
Division or Program Name Goes Here
Priority Spokane worked to improve health by improving educational outcomes. Data collected created an early warning system, demonstrated 20% increase in on-time graduation and we also gathered unexpected data.
Priority Spokane is currently working with multiple community partners to reduce homelessness for children going to our schools.
We believe that the approximately 3000 homeless students in our county is not acceptable and that we as a community must address this shortcoming.
As an example:
The poorest individuals in Spokane Countywere the only ones earning less after eight years.
We work to be the mirror to our community. . . “This is what we are.”
And to be a means to look at our collective conscience. . . Is this okay?
El Paso County
Public Health
Kelley Vivian
Incorporating Health Equity in the Community Health Assessment and
Improvement Plan
El Paso County Public Health
• Mission
Our mission is to promote and protect public health and environmental quality across El Paso County through people, prevention and partnerships.
• Vision
Our vision is for all El Paso County residents to live in thriving communities where every person has the opportunity to achieve optimal health
Health Equity Lens for Decision-making
• Help partners understand the impact of social systems on health outcomes
• Create intention in improvement planning activities and goals
• Align with local, state, and national efforts
CHA/CHIP Process
• Discussed impact of social determinants of health (2-3 months). Gathered qualitative data from partners.
• Reviewed socioeconomic data for community and mapped
• Shared stratified health data by race/ethnicity. Gender, income level, education level
• Prioritized goal areas using health equity as lens
• Created CHIP goals with health equity emphasis
Source: Colorado Department of Public Health and the Environment
Health Equality vs. Health Equity
*American Public Health Association, https://www.apha.org/topics-and-issues/health-equity
Health Equality vs. Health Equity
*Matt Kinshella, 2016 Equity Illustrated Design Contest
94
115
83
83
24
85
25
0 5 102.5 Miles
Percent PopulationLiving Below Poverty
Data Not Available
Incorporated Cities
U.S. Military Installation
1 - 5%
6 - 10%
11 - 20%
21 - 30%
31 - 46%
Percent HouseholdsReceiving SNAP
0.2 - 1.0
0.2 - 1.0
2.1 - 3.0
3.1 - 4.3
Source: U.S. Census Bureau. 2010-2014 ACS.
Poverty and Supplemental Nutrition
94
115
83
83
24
85
25
0 5 102.5 Miles
Percent SingleParent Families
Data Not Available
Incorporated Cities
U.S. Military Installation
5 - 10%
11 - 20%
21 - 30%
31 - 40%
41 - 59%
Source: U.S. Census Bureau. 2010-2014 ACS.
Single Parent Families
94
115
83
83
24
85
25
0 5 102.5 Miles
Percent HispanicPopulation
Incorporated Cities
U.S. Military Installation
2 - 10%
11 - 15%
16 - 20%
21 - 35%
36 - 51%
Source: U.S. Census Bureau. 2010
Hispanic Population
94
115
83
83
24
85
25
0 5 102.5 Miles
Social VulnerabilityIndex (2010 CDC)
Incorporated Cities
U.S. Military Installation
Lowest vulnerability
Highest vulnerability
Source: CDC, Social Vulnerability Index, 2010
Social Vulnerability Index
Life Expectancy
Mental Health and Substance Abuse
25.8%
17.1%18.8%
11.0%
25.2%
15.4%
19.4%
10.7%
1 - 7 Days 8+ Days 1 - 7 Days 8+ Days
Female Male
Percent of Adults Aged 18+ Years Reporting >1 Day of Poor Mental Health in Past 30 Days, By Sex: A Comparison Between El Paso
County & Colorado, 2013 - 2014(Source: Behavioral Risk Factors Surveillance System, CDPHE)
El Paso County Colorado
Source: BRFSS
Obesity
0
5
10
15
20
25
30
35
40
45
50
Fem
ale
Mal
e
< H
S
HS
Gra
du
ate
Som
e C
olle
ge o
rm
ore
<$2
5,0
00
$2
5,0
00 -
49
,99
9
$5
0,0
00+
Wh
ite
His
pan
ic
Bla
ck
Oth
er
Gender Education Income Race/Ethnicity
Per
cen
t
Proportion of adults aged 18+ obese, by race/ethnicity, income, and education, El Paso County 2013-2014
Obesity
Sources: Pregnancy Risk Assessment Monitoring System (PRAMS); Healthy People 2020 Objective MICH-21.1
InitiatedBreastfeeding
4 weeks or less 5 - 8 weeks 9 or moreweeks
80.2%
39.4%
2.5%
58.1%
92.8%
13.7%8.2%
78.0%
New Mothers Who Breastfed Their Infants By Duration and WIC Participation, El Paso County, 2014
(Source: Pregnancy Risk Assessment Monitoring Systems (PRAMS))
WICParticipant
Non-WICParticipant
Oral Health
Source: Colorado Oral Health Survey 2011-2012 School Year
* The proportion of children who qualify for free or reduced lunch is an indicator of overall socioeconomic status at the school level. Therefore, the SES is not a direct reflection of the individual students.
0
10
20
30
40
50
60
70
High Middle Low
Socioeconomic status
Untreated dental decay
Use of dental sealants
Caries experience
Oral health of third grade children, by socioeconomic status*, Colorado 2011-2012
Tobacco
Source: CDPHE Health Statistics Section. 2013-2014 BRFSS.
0
5
10
15
20
25
30
35
40
45
50
Female Male < HS HSGraduate
SomeCollege or
more
<$25,000 $25,000 -49,999
$50,000+ White Hispanic Black Other
Gender Education Income Race/Ethnicity
Per
cen
t
Prevalence of current adult smokers aged 18+, by sex, age, income, and education, El Paso County 2013-2014
Prioritization Process
Health equity is achievedwhen every person has theopportunity to attain his or herfull health potential and no one is disadvantaged from achieving this potential based upon socially determined circumstances.
• Based on burden of disease and impact of health inequities across our community: Rank to what degree each of these issues should be a focus area.
The question The filter
Should not be a focus area at
this time
Very strong consideration as focus area
Some consideration as a focus area
Average Scores by Focus Area and Health Inequity Severity
Very Strong Consideration
Should not beConsidered
Some Consideration
ExtremeMinimal Moderate
LBHP
HBLP
HBHP
LBLP
Air Quality
Food Safety
HEAL/Obesity
InfectiousDisease
InjuryPrevention
MH/SA
Oral Health
Tobacco Use
UnintendedPregnancies
Water Quality
1
2
3
4
5
6
7
1 2 3 4 5 6 7
Focu
s A
rea
Health Inequity Severity
KeyHB: high burdenLB: low burdenHP: high priorityLP: low priority
Healthy Community CollaborativeGoal Statement
Increase healthy life expectancy for all in El Paso County by offering opportunities and removing barriers that prevent people from achieving optimal health by…
• Reversing the upward trend of obesity by addressing its root causes.
• Decreasing the incidence of poor mental health and substance use and misuse.
El Paso County: Mental Health & Substance Abuse
Ou
tco
mes
Ass
ets
&
Cap
aci
ty
Develo
pm
en
t
Decreased Incidence of Poor Mental Health & Substance Use & Misuse
Alignment of Strategies, Tactics, &
Funding Priorities Across the
Community
Alignment of Advocacy Efforts by Key Leaders
and Community Members
Established and Coordinated
Community Standards of Care
Str
ate
gie
s
Decreased Number of Poor Mental Health Days Among
Adolescent Females
Decreased Substance Misuse Among Adults & Youth
Decreased Death by Suicide Among White Youth &
Adults
Reduce Stigma for Behavioral Health
Conditions
Increase Social Connectedness
Increase Mental Health Screening & Treatment
for Depression and Anxiety
Decreased Suicide Attempt Rates Among Females of All
Ages
Decreased Number of Poor Mental Health Days Among Uninsured and Underinsured
Adults
Increased Access to Needed Mental Health & Substance Use
Servicesfor Underinsured and Uninsured
Expand Clinical Screenings, Community-Based
Screenings, Referrals to Treatment, Zero Suicide
Initiatives
Expand Youth After-School Programming
Expand Adult and Cross-Generational
Programming
Expand Older Adult
Programming
Increase Community-Based Mental Health Education & Training
Increase Sources of Strength, RULER,
Pyramid Plus, Parenting Classes, Restorative
Justice
Intentional Outreach & Engagement with
Populations Experiencing Health Inequities/Disparities
Increase Evidence-Based Mental Health School
Programs
El Paso County: Healthy Eating/Active Living
Ou
tco
mes
Ass
ets
& C
ap
aci
ty
Develo
pm
en
t
Maintain Strong Coalition to Support Implementation of
Evidence-Based Strategies
Alignment of Advocacy Efforts by Key Leaders and
Community Members
Str
ate
gie
s
Reversed the Upward Trend of Population Living at an Unhealthy Body Weight
Increased Vigorous Physical Activity Rates for All Children
& Youth
Increased Duration of Breastfeeding Among WIC
Participants
Increased Number of Non-White Adults at a Healthy Body Weight
Increased Fruit & Vegetable Consumption
Among Low-Income Youth & Adults
Increase the Number of Youth that Get 150 Minutes of Vigorous Physical Activity Per Week
Increase Number of Safe Parks, Sidewalks, and Trails
Increase Use of Public & Private Food Assistance
Programs
Increase & support school-based and child care center physical activity
programs
Increase Community-Based and School-
Based Nutrition Education Programs
Increase Out of School Activities
Reduce Household Food Insecurity
Increase Access to Safe Places for Physical
Activity
Increase Access to a Variety of Healthy Foods Encouraged
by the Dietary Guidelines
Intentional Outreach & Engagement with
Populations Experiencing Health Inequities/Disparities
Questions and Feedback
Kelley Vivian, Development and Strategic Initiatives Officer
Text or call (719) 304-1179 │ Email [email protected]
Facebook │Elpasocountypublichealth
Twitter │ @EPCPublicHealth
County of San Diego
Health and Human
Services Agency
Dr. Wilma Wooten
Questions?
