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Kimi Watkins-Tartt Director of Community Health Services Alameda County Public Health Department Transforming Systems: Achieving Health Equity October 14, 2011. Transforming Public Health Practice: Social and Health Equity in Alameda County. Acknowledgements.

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slide1

Kimi Watkins-Tartt

Director of Community Health Services

Alameda County Public Health Department

Transforming Systems: Achieving Health Equity

October 14, 2011

Transforming Public Health Practice: Social and Health Equity in Alameda County

acknowledgements
Acknowledgements

The information presented in this presentation represents the ideas , hard work, and expertise of many Alameda County Public Health Department Staff, partners, and community members.

overview
Why focus on achieving health equity in Alameda County?

What were the key components of developing our Strategic Plan?

Howare we working towards health equity?

How are we implementing our Strategic Plan?

What does it take?

What’snext?

Overview
why do we focus on health equity
Our Mission

To work in partnership with the community to ensure the optimal health and well being of ALL people through a dynamic and responsive process respecting the diversity of the community and challenging us to provide for present and future generations.

Why do we focus on health equity?
slide5

Place Matters:

Health Inequities by Where People Live

income matters health inequities by neighborhood poverty
Income Matters:Health Inequities by Neighborhood Poverty

In 1999, the federal poverty level was $8,500 for one person living alone and $17,000 for a family of four.

slide7

7.8 years

4.9 years

2.3 years

Race and Racism Matters:Health Inequities by Race/Ethnicity

slide8

1.5 times more likely to be born premature or low birth weight

2.5 times more likely to be behind in vaccinations

5 times more likelyto be hospitalized for diabetes

7 times more likely to be born into poverty

4 times less likely to read at grade level

2 times more likely to die of heart disease

Cumulative impact:

15 year difference in life expectancy

Racism, Place, and Income

impact health

Compared to a White child in the affluent Oakland Hills, an African American born in West Oakland is…

INFANT

CHILD

ADULT

health inequities
Health Inequities

Health inequities are “differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.”

-Margaret Whitehead

Department of Public Health

University of Liverpool

slide11

A Framework for Health Equity

A Framework for Health Equity

Socio-Ecological

Medical Model

A Framework for Health Equity

Socio-Ecological

Medical Model

A Framework for Health Equity

Socio-Ecological

Medical Model

Socio-Ecological

Medical Model

INDIVIDUAL

HEALTH

KNOWLEDGE

INDIVIDUAL

HEALTH

KNOWLEDGE

INDIVIDUAL

HEALTH

KNOWLEDGE

GENETICS

INDIVIDUAL

HEALTH

KNOWLEDGE

GENETICS

Upstream

Downstream

GENETICS

Upstream

Downstream

GENETICS

Upstream

Downstream

Upstream

Downstream

  • Discriminatory
  • Beliefs (Isms)
  • Race
  • Class
  • Gender
  • Immigration status
  • National origin
  • Sexual
  • orientation
  • Disability
  • Institutional Power
  • Corporations & other businesses
  • Government agencies
  • Schools
  • Social
  • Inequities
  • Neighborhood conditions
  • - Social
  • - Physical
    • Residential segregation
    • Workplace conditions
  • Risk Factors &
  • Behaviors
  • Smoking
  • Nutrition
  • Physical
  • activity
  • Violence
  • Chronic Stress
  • Disease
  • & Injury
  • Infectious
  • disease
  • Chronic
  • disease
  • Injury (intentional & unintentional)
  • Mortality
  • Infant
  • mortality
  • Life
  • expectancy
  • Discriminatory
  • Beliefs (Isms)
  • Race
  • Class
  • Gender
  • Immigration status
  • National origin
  • Sexual
  • orientation
  • Disability
  • Institutional Power
  • Corporations & other businesses
  • Government agencies
  • Schools
  • Social
  • Inequities
  • Neighborhood conditions
  • - Social
  • - Physical
    • Residential segregation
    • Workplace conditions
  • Risk Factors &
  • Behaviors
  • Smoking
  • Nutrition
  • Physical
  • activity
  • Violence
  • Chronic Stress
  • Disease
  • & Injury
  • Infectious
  • disease
  • Chronic
  • disease
  • Injury (intentional & unintentional)
  • Mortality
  • Infant
  • mortality
  • Life
  • expectancy
  • Discriminatory
  • Beliefs (Isms)
  • Race
  • Class
  • Gender
  • Immigration status
  • National origin
  • Sexual
  • orientation
  • Disability
  • Institutional Power
  • Corporations & other businesses
  • Government agencies
  • Schools
  • Social
  • Inequities
  • Neighborhood conditions
  • - Social
  • - Physical
    • Residential segregation
    • Workplace conditions
  • Risk Factors &
  • Behaviors
  • Smoking
  • Nutrition
  • Physical
  • activity
  • Violence
  • Chronic Stress
  • Disease
  • & Injury
  • Infectious
  • disease
  • Chronic
  • disease
  • Injury (intentional & unintentional)
  • Mortality
  • Infant
  • mortality
  • Life
  • expectancy
  • Discriminatory
  • Beliefs (Isms)
  • Race
  • Class
  • Gender
  • Immigration status
  • National origin
  • Sexual
  • orientation
  • Disability
  • Institutional Power
  • Corporations & other businesses
  • Government agencies
  • Schools
  • Social
  • Inequities
  • Neighborhood conditions
  • - Social
  • - Physical
    • Residential segregation
    • Workplace conditions
  • Risk Factors &
  • Behaviors
  • Smoking
  • Nutrition
  • Physical
  • activity
  • Violence
  • Chronic Stress
  • Disease
  • & Injury
  • Infectious
  • disease
  • Chronic
  • disease
  • Injury (intentional & unintentional)
  • Mortality
  • Infant
  • mortality
  • Life
  • expectancy

HEALTH STATUS

HEALTHCARE ACCESS

HEALTH STATUS

SOCIAL FACTORS

HEALTHCARE ACCESS

HEALTH STATUS

SOCIAL FACTORS

HEALTHCARE ACCESS

HEALTH STATUS

SOCIAL FACTORS

HEALTHCARE ACCESS

SOCIAL FACTORS

- Adapted by ACPHD from the Bay Area Regional Health Inequities Initiative, Summer 2008

- Adapted by ACPHD from the Bay Area Regional Health Inequities Initiative, Summer 2008

slide12

When the External Becomes Internal How Health Inequities Get Inside the Body

Physical and Mental Health Impacts

Increased commute times

Transportation

Stress

Stress

Lack of access to stores, jobs, services

Poor air quality

Stress

Stress

Segregation

Stress

Stress

Crime

Housing

Stress

Poor quality Education

Stress

health equity
Health Equity

Everyone in Alameda County, no matter where you live, how much money you make, or the color of your skin, has access to the same opportunities to lead a healthy, fulfilling and productive life.

acphd s approach to achieving health equity

Policy & Systems Change

Programs

Services

HEALTH EQUITY

Community Collaborations & Partnerships

Institutional Change

Data and Research

ACPHD’s Approach to Achieving Health Equity
acphd s approach to achieving health equity1
ACPHD’s Approach to Achieving Health Equity

Policy & Systems Change

Programs

Services

HEALTH EQUITY

Community Collaborations & Partnerships

Institutional Change

Data and Research

slide17

Community Capacity Building: Community Identified Projects

Sobrante Park

  • Improve Tyrone Carney Park/streetscape
  • Reduce drug dealing and violence
  • Create more positive activities for youth
  • Prepare the neighborhood for disasters

West Oakland

  • Renovate Durant Park
  • Reduce blight
  • Create a continuum of improved and connected youth services & employment
successes community capacity building
Successes: Community Capacity Building

 Meaningful opportunities for

participation

 Civic participation

 “Social Capital”

Improved built environment

 Emergency preparedness

 Cleanliness

 Community deterioration

 Blight

 Lower crime (in SP)

acphd s approach to achieving health equity2
ACPHD’s Approach to Achieving Health Equity

Policy & Systems Change

Programs

Services

HEALTH EQUITY

Community Collaborations & Partnerships

Institutional Change

Data and Research

local policy agenda
Local Policy Agenda

The Alameda County Place Matters team promotes health equity through a community-centered local policy agenda focused on education, economics, criminal justice, housing, land use, and transportation.

place

matters

community engagement | criminal justice| economics| education | housing | land use + transportation

acphd s approach to achieving health equity3
ACPHD’s Approach to Achieving Health Equity

Policy & Systems Change

Programs

Services

HEALTH EQUITY

Community Collaborations & Partnerships

Institutional Change

Data and Research

what were the key components of developing our strategic plan
What were the key components of developing our Strategic Plan?
  • Key principals
    • Our goal is achieving health equity
    • Our methodsare participatory—all voices are needed for a strong plan
    • Our approach is grounded in the principals of social justice
    • Our implementation will only be successful with widespread ownership of and support for the strategic plan
internal and external participation
Internal and external participation

Leadership Fellows

CBOs & other Partners

Community Residents

Strategic Planning Process

Public Health Department staff

Public Health

Commission

Management Fellows

Leadership Team

internal participation
Internal Participation
  • Social Justice Dialogues and Group Discussions
    • Institutional Racism, Gender & Class Exploitation
    • SWOT analysis and recommendations
  • All-Staff Survey
    • Vision
    • Analysis of Strength, Weaknesses Opportunities and Threats (SWOT)
    • Recommendations
    • Completed by 340 staff (about 57%)
external participation

6 forums in 5 supervisorial districts (237 participants)

  • 1 forum in Spanish (44 participants)
  • Key Informant Interviews (10 with Board of Supervisors and agency directors)
  • Youth retreat

External Participation

acphd strategic plan for health equity
ACPHD Strategic Plan for Health Equity

Transform our organizational culture and align our daily work to achieve health equity.

Enhance Public Health communications internally and externally [to achieve health equity].

Ensure organizational accountability through measurable outcomes and community involvement.

Support the development of a productive, creative, and accountable workforce.

Advocate for policies that address social conditions impacting health.

Cultivate and expand partnerships that are community-driven and innovative.

slide30

Howare we implementing our Strategic Plan?

Cross-Departmental Workgroups

Divisions

slide31

Hypothetical Example: Divisional Work Plan

What we already have

  • Divisional Work Plan for CHS
  • Goal 1.1: Incorporate principles of social justice into public health activities.
    • CHS Objective: By end of fiscal year 2009-2010, CHS will develop criteria to ensure contractors are addressing health inequities.
      • Alcohol and Drug Program Objective: By the end of fiscal year 2009-2010, all contractors will participate in 3 trainings (institutional racism, health equity, and policy).
      • Alcohol and Drug Program Objective: By the end of fiscal year 2010-2011, all contracts will contain language that ensures contractors are meeting CHS Health Equity criteria.

Strategic Direction 1: Transform our organizational culture and align our daily work to achieve health equity.

What divisions are working on

staff capacity root causes of health inequities

Public Health 101

  • ACPHD Internal Trainings and Staff Support:
  • Strategic Planning process & implementation
  • All-staff meeting: speakers, spoken word, films
  • BBUs
  • Unnatural Causes screenings

Module 1:

History of Public Health & the Public Health System

Module 2:

Cultural Competency and

Cultural Humility

Module 3:

Undoing Racism

Leadership and Management Fellows

Module 4:

Social and Health Equity

Module 5:

Community Capacity Building

Staff Capacity: Root Causes of Health Inequities
slide33
Isms
  • Strategic Direction 1: Transform our organizational culture and align our daily work to achieve health equity
    • Goal 3: Expand staff understand of “isms” and health equity.
  • Internal Isms Trainings and Staff Support:
  • PH 101 Module 3
  • Place Matters Orientation
  • BBUs
  • Leadership and Management Fellows
  • Strategic Planning Institutional Racism Discussions
  • CAPE Institutional Racism Discussions
  • Workshop with Dr. Kenneth Hardy

Dr. Camara Jones

Dr. Kenneth Hardy

Photos: www.pbs.org/race

www.unnaturalcauses.com

www.psychotherapy.net/interview/Kenneth_Hardy

what s next
What’s next?
  • Quarterly Leadership Team oversight meetings to guide cross-departmental and division work
  • Tracking and evaluation of activities
  • Alignment with the HCSA Convergence process
acphd s approach to achieving health equity4
ACPHD’s Approach to Achieving Health Equity

Policy & Systems Change

Programs

Services

HEALTH EQUITY

Community Collaborations & Partnerships

Institutional Change

Data and Research

programs services measure a
Programs & Services: Measure A

Chronic Disease Prevention and/or Obesity Prevention Funding

  • Equity focused RFP including health inequity data
  • 2 info sessions focused on health equity
  • Call for socio-ecological solutions
  • Inclusive & transparent review

panel

  • Support & feedback for those

who didn’t receive the grant

  • Additional capacity building

support is needed

acphd s approach to achieving health equity5
ACPHD’s Approach to Achieving Health Equity

Policy & Systems Change

Programs

Services

HEALTH EQUITY

Community Collaborations & Partnerships

Institutional Change

Data and Research

success stories
Success stories
  • Increased:
  • organizational infrastructure and support for health equity work, including addressing isms
  • support, commitment, participation, ownership
  • activities throughout the department & community
  • engagement in policy
  • Cutting-edge work
  • Community Engagement
  • Passionate Staff
  • Creativity
  • Setting a Model
what it takes
What it Takes
  • Work with communities as partners
  • Constantly reflecton difficult issues
  • Createcommunication loops to hear positives and negatives
  • Involve and empower all levels of staff, which leads to ownership and progress
  • Stay focused on vision while breaking it into smaller steps
  • Engagediverse staff & supporthiring for diversity
  • Show long term commitment
  • Invest in building staff capacity and leadership
  • Address interpersonal and institutional “-isms”
  • Be open to conflict – it’s okay to be uncomfortable
slide41

What it takes

What questions are we asking?

How do these questions define the problem?

How does the definition of the problem define the solution?

flipping the question
Why do people smoke?

What social conditions and economic policies predispose people to the stress that encourages smoking?

Flipping the Question

DoakBloss, Ingham County Health Department

flipping the question1
How can we create more green space, bike paths, and farmers’ markets in vulnerable neighborhoods?

What policies and practices by government and commerce discourage access to transportation, recreational resources, and nutritious food in neighborhoods where health is poorest?

Flipping the Question

Doak Bloss, Ingham County Health Department

flipping the question solution
Flipping the Question/Solution
  • We need to teach people how to eat more healthful meals.

What policies and practices by government, commerce, and corporations led to the decline of food stores in West Oakland?

vision of health equity
Vision of Health Equity

Everyone in Alameda County, no matter where you live, how much money you make, or the color of your skin, has access to the same opportunities to lead a healthy, fulfilling and productive life.

slide46

Policy Makers

Childcare

Medical Care

Jobs

Healthy Food

We each have a role

Clean Air

Parks and Activities

Housing

Education

Economic Justice

Preschool

Safe Neighbor-hoods

Residents

Transpor-tation

contact information
Contact information

Kimi Watkins-Tartt

Kimi.watkins-tartt@acgov.org510-208-5902

what do we know
What Do We Know?
  • Major improvements in health outcomes
  • Major health inequities persist or are growing - poorer residents and African Americans bear the greatest burden of poor health outcomes
  • Big gap in life expectancy
  • Major inequities in life expectancy and mortality driven by chronic diseases
what staff capacity is needed to address health inequities
What Staff Capacity is needed to Address Health Inequities?

Knowledge

Skills

Sensibilities

  • Policy analysis and advocacy
  • Using new tools and technology
  • Communication
  • Cultural competency
  • Community Capacity Building
  • Engaging partners and community
  • Root causes of health inequities
  • Isms: historical and current; and impact on health
  • Understanding our communities
  • Principles of social justice
  • Feeling empowered
  • Innovation
  • Cultural Humility

Adapted from ACPHD Strategic Plan www.acphd.org/healthequity/strategic

cross departmental workgroups roles
Cross-Departmental Workgroups: Roles

Leadership Team Sponsors

  • 4-6 hours/month
  • 1 year commitment
  • Leadership Team member who serves as a liaison to leadership team

Leadership Team Oversight

  • Leadership Team will meet regularly to provide oversight to the workgroups

Team Members

  • 4-6 hours/month
  • 1 year commitment
  • Looking for participation from all divisions and all positions.

Team Facilitators

  • 8-10 hours/month
  • Will rotate every 6 months to 1 year
  • Will start out as Strategic Planning Implementation Team or Leadership Team member

Support staff

  • 4 hours/month
  • Write up & distribute minutes, assist with scheduling & logistics, etc.
  • Assigned by Leadership Team member of each workgroup
slide52
Jan. 2009 1st FHS Retreat (mgrs only)

Jan - Mar 2009 Case Studies (program mgrs in small groups to reflect on their programs through health equity lens)

June 2009 2nd FHS Retreat, three priority areas identified: Workforce development, Community Partnerships & Policy

September 2009 Building Blocks Event – community presentation and workgroup kickoff

October 2009 Strategic Plan work session, focus: building staff capacity/ infrastructure

Family Health Services

community health services
Community Health Services
  • CHS held a series of health inequity education sessions to inform all staff about the strategic plan and the social determinants of health.
  • Program case studies were used to help staff think about how CHS programs could be pushed to move our work further upstream.
  • Example of impact: Community Target Funds (Measure A) for Chronic Disease Prevention and/or Obesity Prevention
emergency medical services
Emergency Medical Services
  • December 2008: EMS Staff presentation on strategic plan and brainstorming on potential division activities
  • Spring 2009: EMS Supervisor meetings on Strategic Plan
  • July 2009 to present: Contract with consultant to work with Supervisors and EMS staff to integrate strategic plan into the EMS work plan by program focus
  • Early 2010: Integrated plan will be compiled and approved
information systems
Information Systems
  • Iterative process of working through the 5 phases
  • Focusing on 3 priority directions through IS-focused workplan
  • Through the process of completing the actions outlined in the workplan:
    • already functioning better as a unit
    • increased utilization of staff talent
    • increased staff participation in discussions and action
strategic planning retreats
Strategic Planning Retreats
  • Oct. 1-2, 2007 & February 1, 2008
  • Reviewed findings
  • Visioning & consensus building workshop to create strategic directions & goals
where are we now cross departmental highlights
Communication

Develop training, support, and policies for strategic social media use

Improve communication between leadership, staff, and community

Community & Partnerships

Conduct internal survey and interactive video interviews

Develop toolkit and training materials based on staff need

Policy

Seek funding to support staff training & staff time dedicated to health equity policy

Create a division & program policy reporting tool & protocol

Measuring Success

Results Based Accountability (RBA) train-the-trainer workshops

Pilot a population-based RBA for use by internal & external programs

Workforce Development

Establish ACPHD as a “Best Company to Work For”

Assess Rule of 5

Ensure all staff receive necessary supervision, grounded in a set of standards

Where are we now?Cross-Departmental Highlights