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National Teen Pregnancy Prevention Month Webinar Advancing Racial Equity:
The Time is Now! May 27, 2021
Cerise Hunt, PhD, MSW Allison Guarino, MPH
Presenters
▪ Cerise Hunt, PhD, MSW, Associate Dean for Equity, Diversity, and Inclusion; Director, Center for Public Health Practice; Assistant Professor, Department of Community and Behavioral Health at Colorado School of Public Health, University of Colorado
▪ Allison S. Guarino, MPH, Epidemiologist, Office of Sexual Health and Youth Development, Massachusetts Department of Health
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Webinar Logistics
▪ You are muted.
▪ Check your computer audio volume and enable speaker (if trouble hearing).
▪ Use Chat Box for technical issues and interactive activities.
▪ Please use Question and Answer Box for questions.
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National Teen Pregnancy Prevention Month
Committed to the Cause: Addressing Disparities in Adolescent Pregnancy Prevention Efforts
Significance of NTPPM
• Celebrates the significant decline in rates of teen births in the United States and highlights continued efforts to reduce teen pregnancy among vulnerable youth.
• According to the CDC, in 2019, a total of 171,674 babies were born to women aged 15–19, for a birth rate of 16.7 per 1,000 women in this age group. This is another record low for U.S. teens and a drop of 5% from 2018.
• 2019 birth rates for teens:
• Age 15–17: 6.7 births per 1,000 females – down 7% from 2018
• Age 18–19: 31.1 births per 1,000 females – down 4% from 2018
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Digital Media Toolkit
• Adobe Spark Digital Media Toolkit 6
WeThink Twice Campaign NTTPM Awareness Messaging
(Red X emoji) Set comfortable
boundaries and remember that you don’t have to explain yourself. “No” is a
full sentence.
Most teens choose to delay sex until
later in life.
This decision could spare you the stress of potential pregnancy or STIs
and allow you to focus on your future and achieve your goals! (Sunrise emoji)
(Exit emoji) Leave the situation if you feel
pressured to have sex. Your voice deserves to be
heard, and your body deserves to be respected.
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THANK YOU!
Please join us in observing National Teen Pregnancy Prevention Month!
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Objectives
By the end of this webinar, participants will be able to:
▪ Describe disparities, racial equity, and social determinants of health.
▪ Recognize factors in the social environment that can contribute to or impede the health of individuals and communities.
▪ Identify practical strategies and techniques to advance racial equity within their APP programming and to apply theory to practice.
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Agenda
▪ Laying the Foundation - Common Terminology
▪ Rationale for Promoting Racial Equity ▪ Exploration of Tools
▪ Grantee Spotlight
▪ Q&A
▪ Resources, Technical Assistance, and Closure
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Session Overview
• Overview of terminology
• Examples of disparities
• Strategies for taking action: How can you promote equity?
Laying the Foundation: Common Terminology
Health Disparities
• A difference in health outcomes closely linked to social or economic disadvantage
• Negatively affects groups of people who have systematically experienced greater social or economic obstacles to health
• Obstacles stem from characteristics historically linked to discrimination or exclusion: * Race or ethnicity * Sexual orientation
* Religion Geographic location
*
* Gender identity * Behavioral health
Socioeconomic status
*
* Cognitive, sensory, or physical ability
Source: Healthy People 2020
Poll
Will free access to health and wellness services
eliminate health disparities?
~~SB Fami_1y & vauth Adolescent PregnancyII ~ Services Bureau Prevention ProgramF
Social & Economic Factors Determine 40% of our Health
Social and
Economic Factors
40%
Health Behaviors
30%
Clinical Care 10%
Physical Environment
10%
Genes and Biology
10%
Source: County Health Rankings, 2014
Factors that Contribute to Health Disparities
• Individual Factors • Health behaviors
• Provider Factors • Bias • Cultural and linguistic barriers
• Health System • Organized • Financed • Delivered
• Social and Environmental Factors • Poverty • Education • Proximity to care • Neighborhood safety
Source: Ubri, P., & Artiga, S. (2016). Disparities in health and health care: Five key questions and answers. Kaiser Family Foundation.
Soc·a Determinants of Health
The conditions in t he envi onments \Nhere people are born~ live~ learn~ 'Work~ play~ ·worship~ and age that affect a \~ide range of health~ functioning~ and quality-of-life outcon1es and risks ~
Source: U .S Departm ent o H ea h and Human Sen( ces [ n. d. ~ H ea h)t Pe op e2 https:f[hea h .gov{hea hvpeop e{o bj'ect- es~and-data/socia -d et:erm·nants-hea h
Health Equity An Explanatory Model for Conceptualizing the Social
Determinants of Health
NATIONAL INFLUENCES GOVERNMENT POLICIES
U.S. CULTURE & CULTURAL NORMS
SOCIAL DETERMINANTS OFHEALTH
LIFE COURSE
t CONOMIC OPPORTUNITY
PHYSICAL. EN\AAONl\/\£NT
SOCIAL FACTORS
• Parttd patlon• Income IBullt Environment • Emp loyment • Sodal support
• Education • Recreatlon • ~adership • Housing • Food • PollUcal
lnflu~ • Transportation
• OrganizationalNetworlcs
Envil'Ol• t telrtal Quality • Violence • Housing • Racism • Water • Air
Safety
HEALTH FACTORS
HEALTH BEHAVIORS & CONDITIONS
MENTAL. HEALTH
ACCESS. UTILIZATION & QUALITY CARE
II • Nutrlbon I • Mental Health
Staws • Hulth
Insurance • Stress
• Physlcal Activity • Rece;ved
Needed Care• Tobacco Use • Substan<l! Abuse • Provider
Aval labll lty• Skin Cancer • Injury • Functional
stiws • PreventiveCare
• 0raJ Health • Se<ual Health
• Obesity • Choles~rol • High Blood
P~sure
POPULATION OUTCOMES
QUALITY OF LIFE
MORBIDITY
MORTALITY
LIFE EXPECTANCY
PREGNANCY -
EARLY CHILDHOOD
CHILDHOOD
ADOLESCENCE
ADULTHOOD -
I OLDER ADULTS
Public Health's Role in Addressing the Social Determinants of Health • Advocating for and defining public policy to achieve health equity • Data collection, monitoring and surveillance • Coordinated interagency efforts • Population-based interventions to address health factors • Creating organiutional environments that enable change • Community engagement and capacity building
COLORADO
~ Deputmentoa ...._ U•ltb • envuvnm...t
Health Inequities
• Differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age.
• These differences result from systemic, avoidable, and unjust social and economic policies and practices that create barriers to opportunity.
Source: WHO, 2019 (https://www.euro.who.int/en/health-topics/health-determinants/social-determinants/publications/2019/health-equity-policy-tool-2019)
-.. -...... ..... ·--
NM 25.3
NO 16-4
SD 20.4
tE 16.7
KS 20.0
TX 25.3
""'~ HI .ti..
17_2 ...
SOUIROE: NC HS, National Vital Stalistlcs Syst am, Nata Jty_
U .S . rate is 17'.4 b irths per 1 ,.000 ferna!8S aged 15-19 In 2018.: U.S. rate declined 7% f rom 2017 to 201 a_
- Sign flcant declieaso of 10% or more
Cl Sign flcant decJCease of ·less tlian 10%
CJ Nonslgnlllcant decroase
c::J No cM nge l=1 Nonslgnlllca nt lncreaso
Figure 1 . B·irlh rabis for aH leenagers. aged ·1s-191 in 201.S and percenl chang,e in birth rabis from 2017 ·10 2018, b1y state
Source: National Vital Statistics Reports. (2020). State teen birth rates by race and Hispanicorigin: United States, 2017–2018. NationalVitalStatistics Reports, 69(N6). https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR69-6-508.pdf
Women of Color are Particularly Hard Hit by Poverty Poverty rates for adult U.S. women, 2019
18%
15%
12%
9%
6%
3%
Wh te me'l 6%
poverty rate
Asian Black l'ndigenous Latinx White
Source: National Women's Law Center
Black Families are Twice as Likely as Whites to Have No Wealth Estimated percentage of U.S. housefwlds with zero or negative wealth, 1992-2019
40%
.30%
20%
10% • Black
Hispanic
Other
• White, non-Hispanic
1992 1995 1998 2001 2004 2007 2010 2013 2016 2019
Source: Survey of Consumer Finances and Institute fair Policy Studies
The Racial Wealth Divide Has Grown Over Three Decades U .S . median wealth by race adjusted to 2019 doUars, 1989 and 2019, including durable goods
All White Black La tino
$175.000
$ 150.000
$ 125.000
S100.000
$75,000
$50.000
$25,000
$0 -1989 2019 1989 2019 19-89 2019 1989 2019
Source: Survey of Consumer Finances
Nearly six in ten Black Adults and four in ten Hispanic adults report experiencing racebased discrimination in the past year.
Percent who say there was a time in the last 12 months where they felt they were treated unfairly in the following places because of their race or ethnic background:
White Hispanic Black
In a store where they were shopping 8°/o 24o/o 40°/o
Their place of work 5°/o 17%
In dealings with police, such as traffic incidents
While getting health care for themselves or a family member
4% 18°/o 26°/o
• •
•
-·------------------------------------------------------------------------------ ---------------------------------- ------------- ----------------------------------------
Have experienced any of the above
e
SOURCE KFFfThe Undefeated Survey on Race and Health (conducted Aug 20~Sept 14 2020) See topline for full question wording. KFF Source: Kaiser Family Foundation. (2020). The undefeated survey on race and health. https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/
Source: Kaiser Family Foundation. (2020). The undefeated survey on race and health. https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/
Percent of Adults Reporting Perceptions of and Experiences with UnfairTreatment in Health Care
• Black • Hispanic • White
70%1
Health Care System Often Treats People Unfairly Based on their Race
or Ethnic Background
20% 19°/o
- - 5°/o Persona Uy Tireated Unfairly Based on
Race While Getting Health Care in Past Year
Source: Kaiser Family Foundation. (2020). The undefeated survey on race and health. https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/
Black adults are more likely than White adults to report providers not believing they were telling the truth and refusing tests/treatment they thought they needed.
Share of the Adults who Reported that a Doctor or Health Care Provider did the Following 1n the Last Three Years~
22°'0 18°/o 17o/o
Didn't believe they were telling the truth
• Black • Hispanic • White
19°/o 12°/o 12°10 - -Refu ed to order a
lest or treatment they thought they needed
18°/o 11°/o 13o/o - -Refused to prescribe
pain medication they thought they needed
Source: Kaiser Family Foundation. (2020). The undefeated survey on race and health. https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/
Barriers to Care
Lack of awareness about available services
Distrust of the health and wellness system
Lack of providers from diverse racial/ethnic backgrounds
Lack of culturally and linguistically competent providers
Economic barriers (e.g., cost, lack of insurance, underinsurance)
Many people of color and LGBTQ people have reported experiencing stigma and discrimination
Dr. Camara Jones Explains the Cliff of Good Health https://www.youtube.com/watch?v=to7Yrl50iHI
Our Charge: Racial Justice or Equity
• Racial justice—or racial equity—is the systematic fair treatment of people of all races, resulting in equitable opportunities and outcomes for all.
• It goes beyond “anti-racism.” It is not just the absence of discrimination andinequities, but also the presence of deliberate systems and supports to achieve and sustain racial equity through proactive and preventative measures.
Source: National Education Association. (2018). Racial justice in education a resource guide.
Equity in Resource Allocation
Inequality Equality?
justice
📱Design in Tech Report 2019 | Section 6 | Addressing Imbalance – John Maeda | Design in Tech Report
Making the Transition from Theory to Practice
“Too often providers use the language of social determinants of health and the need to reduce disparities, but do not internally transform in ways that allow for nontraditional actions required to address social injustice as a risk to the public's health/The major challenge is/to move theoretical knowledge about the relationship of social injustice to increased health risks and poorer health outcomes into broad sustainable changes in agency policies and practices”
Source: Hofrichter, R. (2006). Tackling health inequities through public health practice: A handbook for action. NACCHO. Available at: https://nccdh.ca/resources/entry/tackling-health-inequities
Our Call to Action: Strategies for Advancing Racial Equity Support racial equity as a value and social right
Support continuous workforce development and education
Conduct a Racial Equity Assessment
Engage in interagency/multi-disciplinary coordination
Partner and work with communities
Protect people from health problems and health hazards
Give people the information they need to act collectively in improving their health Build advocacy alliances and coalitions
Develop and analyze public policy
Use data to track efforts: measure and promote what works
Sustain the work
Source: Hofrichter, R. (2006). Tackling health inequities through publichealth practice: A handbook for action. NACCHO. Available at: https://nccdh.ca/resources/entry/tackling-health-inequities
Recognize and Mitigate Your Unconscious Bias
The best way to mitigate the impact of biases is not only to be aware of them, but to put processes in place to safeguard against them:
• Take implicit association test
• Engage in annual implicit bias training
• Foster reflections on bias
• Slow down
• Be mindful of your reactions
• Notice when your responses, decisions, or behaviors might have been caused by bias or stereotypes
• Consider your team’s, client’s, or co-worker’s perspectives
Even the most well-intentioned person unwittingly allows
unconscious thoughts and feelings to influence
apparently objective decisions. Mahzarln R . Banajl, Max H . Bazerman , & Dolly Chugh, How ( Un)ethlcal Are You?, Harvard Busl ne!UJ Revi e w
!9.#'PY4SB Fami_ly & Youth Adolescent Pregnancyrt'! I II~ Services Bureau Prevention Program
I I I I
Tips for Leading with Equity
• Integrate equity into everything you do
• Conduct your work through an equity lens (programs and interventions)
• Keep equity at the top of your mind in every decision and team relationships
• Remember that you lead by example
• Understand your team’s unique strengths • Be flexible
• Support ongoing leadership and group/team development
Source: Trailhead: https://trailhead.salesforce.com/en/content/learn/modules/inclusive-leadership-practices/practice-the-five-Strategys-of-inclusive-leadership
Final Thoughts
Instead of hoping that racial equity will result from our work, we must make it the core “design principle” of initiatives.
We must be intentional about progressing racial equity, shifting from theory to actual practice and doing the work.
Source: Reos Partners. (2017). A conversation guide for health equity. http://reospartners.com/wp-content/uploads/2017/07/AConversationGuideforHealthEquity_Feb2017.pdf
Spotlight from the Field
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MA* PREP's Focus on Racial Equity
A L L I S O N S . G U A R I N O, M P H E P I D E M I OLOG I ST O F F I C E O F S E X U A L H E A LT H A N D YO U T H D E V E L O P M E N T M A S S A C H U S E T T S D E PA R T M E N T O F P U B L I C H E A LT H ( M A D P H )
M A Y 2 7 , 2 0 2 1
Art by Farah Jeune *Massachusetts
MAInequities in Sexual and Reproductive Health in MA
MA has the lowest teen birth rate in the country but
some of the highest inequities
Key Elements of MA Department of Public Health’s Racial Equity Movement
Created by Stephanie S. Campbell and Katie Stetler
Racial Equity Work at MA DPH
- 2-Day training on the Groundwater Approach ◦The Groundwater Approach acknowledges that we live in a racially structured society, and this
causes racial inequity. It states the following:
◦Racial inequity looks the same across all systems
◦Socio-economic difference does not explain racial inequity
◦Inequities are caused by systems, regardless of people’s culture or behavior
-6-week lab session in affinity
- People of Color Affinity, Black Affinity, Men of Color Affinity, Asian American/Pacific Islander affinity, White People Challenging Racism affinity groups
- Bureau-wide monthly Racial Lunch & Learn meetings and monthly Racial Justice learning within the Office of Sexual Health and Youth Development
Our Office’sValues
Racial Justice Reframing Tool - ie. Teen Pregnancy
Framing Element Traditional Approach Racial Justice Approach
1. What is the Problem Teenage Black and Latina girls are getting pregnant at a n early age and drain ing public resources such as welfare.
Youth of color receive inequitable access to sexual and reproductive health education and opportunities for a successful transition into adulthood resulting in limited access to health, employment, and other Social Determinants of Health.
2. What is the Cause? What/Who is Responsible?
Lack of sexual hea lth education
Generational impact of teen pregnancy
Cultural acceptance and norm of teenage pregnancy
Individuals
Historical and current examples of medical racism, the eugenics movement in the US, reproductive coercion and eugenics
Federal, state, and local government, schools, businesses, and other decision makers.
3. What is the Solution? Increase sexual health educa tion
Long acting reversible contraception
Equitable economic and other resource investment in community stabilization and schools, clinics, using a racial equity impact assessment.
Acknowledge that teen pregnancy in not the problem, but potentially a symptom of structural racism
4. What Action is Needed? LARC awareness, sex education in schools, shaming of teen parents
Engagement of adolescents in creating solutions
Ensuring clinics are youth friendly
Address the systemic racism that limits opportunities for adolescents of color in schools
5. What Values are Highlighted? Personal Responsibility Equity; Justice; Fairness; Shared Responsibility
Adapted by Stephanie S. Campbell
Art by Farah Jeune
VOICES program - Valuing Our Insights for Civic Engagement (VOICES) is a six-session positive youth development curriculum
- Created in collaboration between MA DPH and the Posse Foundation
- Aims to build youth leadership skills through critical analysis and exploration of self-identity, power, privilege, and community
PREP Equity Measure We began to explore whether our PREP budget was aligned with our Office values and decided to allocate additional funds to agencies based on their commitment to Racial and Reproductive Justice.
This was an opportunity to integrate equity into how we funded our community-based organizations.
We evaluated variousqualitative and quantitative metrics, such as PREP performance measures, percentage of LGBTQ+ youth served, if youth had a long-term disability, and context-specific considerations(e.g., If staff were furloughed because of COVID-19)
We then ranked the agencies based on their measures and awarded them accordingly.
Key Takeaways: ✓Rankings were challenging given each site serves different populations, in different
contexts, etc. ✓Difficult to determine if and what to weight
✓Some variables felt duplicative
✓Would like to use the process again once finetuned
Racial Equity Work at our Funded CBOs Lowell Community Health Center - Civil Rights education during Black History month - Teen BLOCK program ◦ Tutoring and homework help ◦ Mentorship ◦ Leadership
Citizens for Citizens - Youth-led drive for homeless population in Fall River - Work with systems involved youth
Family Services of the Merrimack Valley - Wellness visits during the height of COVID-19 - Work with systems-involved youth
Family and Children’s Services of Greater Lynn - Youth-led holiday drive for children & families - Provision of supplies for youth/families
Gándara Center - Work with systems-involved youth - Wellness checks with youth
So how do I make my PREP program more Racially Equitable? Racial Equity is very buzzwordy right now—recognize what it is and what it isn’t!
◦ It’s not just hiring people of color as tokens without addressing and dismantling systemic racism in your organization today.
◦ It is hiring people of color in leadership roles in a culture that is safe where their points of view are respected and listened to.
◦ It is funding agencies where the staff are from the communities they serve and are paid equitably.
So how do I make my PREP program more Racially Equitable? It is understanding your Sphere of Influence.
What is my Sphere of Influence?
It is the people, communities, and spaces you are a part of, that you can influence on your journey toward anti-racism:
1) Be aware
2) Educate yourself
3) Understand yourself (your values and feelings)
4) Examine how you want to live in ways that are aligned with your values and feelings
5) Associate with others who share your values and desires for change
6) Hold one another accountable to grow influence
Self-Reflection and Share
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Taking Action
▪ What is one next step that you might take after this webinar related to advancing health equity in your work?
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Making Your PREP Program More Racially Equitable – Consider exploring and using racial equity
tools to ensure that your PREP program and sub-recipients, have deliberate attention to racial and social justice.
– Use tools to make strategic and equitable decisions in assessing existing or proposed: • Policies
• Practices
• Plans
• Programs
• Grantmaking
• Contracting
• Budgets
Example Tool: Race Forward Toolkit for Creating Cultures and Practices for Racial Equity https://www.raceforward.org/practice/tools/creating-cultures-and-practices-racial-equity
Resources on The Exchange
▪ Snapshot: Inputs and Outcomes: PREP Programs Serving Highly Vulnerable Youth - PREP Snapshot
▪ Webinar: Practical Strategies for Creating Welcoming & Supportive Environments for All Youth
▪ Webinar: Reaching Youth of Incarcerated Parents and Migrant Workers
▪ Blog Post: Narrowing the Disparities Gap
▪ Tip Sheet: Supporting Young Fathers' Engagement with Their Children
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References • Hofrichter, R. (2006). Tackling health inequities through public health practice: A handbook for action. NACCHO. Available at:
https://nccdh.ca/resources/entry/tackling-health-inequities • Ingham County Michigan. (n.d.). Health equity and social justice.
http://hd.ingham.org/DepartmentalDirectory/CommunityHealth,Planning,andPartnerships/HealthEquityandSocialJustice.aspx • Kaiser Family Foundation. (2020). The undefeated survey on race and health. https://www.kff.org/report-section/kff-the-
undefeated-survey-on-race-and-health-main-findings • National Education Association. (2018). Racial justice in education a resource guide • National Vital Statistics Reports. (2020). State teen birth rates by race and Hispanic origin: United States, 2017–2018. National
Vital Statistics Reports, 69(N6). https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR69-6-508.pdf • Office of Health Equity. (n.d.). Checking assumptions to advance equity. Colorado Department of Public Health & Environment.
https://drive.google.com/file/d/1gB_AfBr9bcdq6TJLEw16LFMx6dvrxOz0/view • Prevention Institute. (2016, February). Adverse community experiences and resilience: a framework for addressing and preventing
community trauma. https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilienceframework-addressing-and-preventing
• Reos Partners. (2017). A conversation guide for health equity. http://reospartners.com/wp-content/uploads/2017/07/AConversationGuideforHealthEquity_Feb2017.pdf
• Shervington, D. (2019). Applying racial equity lens to creating trauma-informed resiliency-promoting organizations. Community Action Partnerships. https://communityactionpartnership.com/wp-content/uploads/2019/10/Applying-Racial-Equity-Lens-to-Creating-Trauma-Informed-Org-Dr-Shervington.pdf
• Trailhead: https://trailhead.salesforce.com/en/content/learn/modules/inclusive-leadership-practices/practice-the-five-Strategys-of-inclusive-leadership
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Contact
▪ Training and Technical Assistance: [email protected]
▪ Cerise Hunt: [email protected]
▪ Allison Guarino: [email protected]
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Let’s Hear From You!
▪ Please complete a short survey about your experience with today’s webinar.
https://survey.alchemer.com/s3/6328757/Webinar-Feedback-Survey-Health-Equity
▪ If you attended the webinar with other team members, please share the link and complete the evaluation separately.
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Thank you!
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