Health Equity in Action: What It Means for One Foundation Susan
G. Zepeda, Ph.D. March 2014
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Foundation for a Healthy Kentucky Our mission is to address the
unmet health care needs of Kentuckians. We work towards our mission
by Improving access to care Reducing health risks and disparities
Promoting health equity
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Foundation for a Healthy Kentucky We: Make grants Support and
disseminate research Hold educational forums Convene
communities
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Foundation for a Healthy Kentucky Promoting Responsive Health
Policy Increasing access to integrated quality care Supporting
childrens health Increasing KYians in smoke-free communities
Strengthening local public health Investing in Kentuckys Future 7
community coalitions; 5 year commitment Strengthening Communities
Social Innovation Fund Matching Grants Challenge Grants Conference
Support
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What is Health Equity? Health equity is achieving the highest
level of health for all people. Health equity entails focused
societal efforts to address avoidable inequalities by equalizing
the conditions for health for all groups, especially for those who
have experienced socioeconomic disadvantage or historical
injustices. (Healthy People 2020)
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Health Equity Inequities exist across many dimensions: Race
Income Gender Rural versus urban Education level Ethnicity
Immigration status Sexual orientation Social connectedness Other
factors These factors all interact
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How do we know theres inequity? We look for: Inequalities
Disparities ACA requires all federally-funded programs and surveys
to collect data on race, sex, ethnicity, language, and disability
status
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How do we know theres inequity? Health inequalities and
disparities are differences among specific population groups,
including racial and ethnic minority groups in: occurrence,
frequency, death, and burden of diseases other unfavorable health
conditions Source: HHS
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How do we know theres inequity? Inequities are basically
disparities that are Preventable UNFAIR Decreasing disparities is
part of working towards health equity, but it is not enough
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Two Steps Back to Prevention Social and Physical Environment
Exposures & Behaviors Health care/services Approach adapted
from Prevention Institute Health Outcomes
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How do we do our work through an equity lens? Through work on
population health, primary prevention, and policy-level changes,
communities move toward equity
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How do we do our work through a health equity lens?
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Equality is NOT Equity This is Equality This is Equity
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What Health Equity Means to Kentucky Where you live, work,
play, and learn matters when it comes to health
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What Kentucky looks like 36% of KY counties are among Americas
persistent poverty counties More than 20% of residents living in
poverty for > 30 years USDA Economic Research Service Study in
contrasts: Oldham CountyOwsley County High school grads91%56% Per
cap income $34,731 $11,706 Tooth loss 6+15%42% Violent crime
21.8231.3 Per 100,000 Cancer Deaths186270 Per 100,000
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What Kentucky looks like 3 Largest Kentucky Race / Ethnic
Groups Racial Identity: White population is 3,745,655 persons -
86.3%. Black population is 333,075 persons - 7.7%. Ethnic Identity:
Hispanic population is 132,836 persons - 3.1%. Urban/Rural 58.4% of
Kyians live in the States 1,411 urban sq miles 41.6% of Kyians live
in the States 39,486 rural sq. miles Source: US Census Bureau
-Census 2010
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Walking our Talk How do we do our work through a health equity
lens? What changes in our: Grantmaking? Polling? Research?
Training/educational forums? Community convenings?
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Doing our Grantmaking through a Health Equity Lens Learning
from our mistakes Getting our Board and Community Advisory
Committee (CAC) on Board
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Learning from our mistakes Requiring rigorous evaluation design
of applicants coaching/TA on evaluation after selection
Universities community-based organizations One year grants Multi
year support Tidy measurable objectives policy change; collective
impact 0 to 60 in one year planning precedes implementation Bright
idea business plan sustainability Strength of PI strength of
cross-sectoral collaboration Whos at the table? What are their
roles and responsibilities?
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Talking to your board Start where they are, with who they are
Clinical and administrative, outpatient and hospital providers
Business men and women Public health workers Frame the conversation
Various frames shown earlier Engage their input CAC discussion
multiple meetings Program Development and Oversight Committee 9
month study
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What Health Equity Means to Kentucky Where you live, work,
play, and learn matters when it comes to health
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Health Equity and Policy All types of policies health Policies
can: make inequities worse, maintain the status quo, help correct
inequity Policies informed by equity address the causes of health
and disease, not just the outcomes
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Ideas Upstream, Mid- and Down Agree on goals/aims - differ on
approaches, to accommodate differing population or community needs.
Downstream - Track demographic data to spot health disparities
Build the healthcare workforce, change delivery strategies to
increase care access Care navigators Mobile dental, other clinics
Dental hygienists Telemedicine
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IdeasUpstream, Mid - and Down Midstream Behavioral Economics
Financial incentives for desired performance (eg. premium
reductions for folks who maintain positive health behaviors)
Partner with education to enroll eligible children in needed
services Upstream Place-based strategies Policy and systems change
-Cross-sectoral collaboration To reduce exposure to health risks,
support healthy behaviors Promote safe neighborhoods Promote
healthy food, physical activity
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Where we havent gone Equity by the numbers: % of Foundation
dollars provided to Poorest communities Women- and minority-run
organizations Grantees with majority minority boards
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Where we do go. Mapping where the grants go Assessing the
impacts of our work Breaking down barriers to participation
Continuous feedback loop learning as we go