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Achieving Health Equity From planning to action. Ana Novais, MA Peter Simon, MD, MPH Division of Community, Family Health & Equity Rhode Island Department of Health CityMatCH, September 2011. Situation Review. For the first time in modern years, the next

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achieving health equity from planning to action
Achieving Health EquityFrom planning to action

Ana Novais, MA

Peter Simon, MD, MPH

Division of Community, Family Health & Equity

Rhode Island Department of Health

CityMatCH, September 2011

situation review
Situation Review

For the first time in modern years, the next

generation (our children’s generation) has a

lower life expectancy than the previous


situation review healthy ri 2010
Situation Review - Healthy RI 2010

Summary of Changes from 2004 to 2007 Reports

  • Native American: 5↑ 7↔ 6↓
  • African American: 12↑ 11↔ 7↓
  • Asian & Pacific Islander: 9↑ 11↔ 4↓
  • Hispanic Latino: 12↑ 13↔ 5↓
  • State Overall: 12↑ 14↔ 4↓
cfhe vision
CFHE Vision

CFHE aims to achieve health equity for all

populations, through eliminating health

disparities, assuring healthy child

development, preventing and controlling

disease, (including HIV/AIDS and Viral

Hepatitis), preventing disability, and working to

make the environment healthy.

community family health equity
Community, Family Health & Equity
  • Community- because all health is local
  • Family- because families are our key partners in health
  • Equity- because our mission is to assure that all Rhode Islanders will achieve optimal health
community family health equity1
Community, Family Health & Equity
  • Our values guide us in the work we do internally and with our key partners:
    • Diversity
    • Health Equity and social justice
    • Open communication
    • Team work
    • Accountability
    • Data driven & science based
cfhe priorities
CFHE Priorities
  • Health Disparities and Access to Care
  • Healthy Homes and Environment
  • Chronic Care and Disease Management
  • Health Promotion and Wellness
  • Perinatal, Early Childhood and Adolescent Health
  • Preventive Services and Community Practices
cfhe equity framework
CFHE Equity Framework
  • Social and environmental determinants of health
  • Lifecourse developmental approach
  • Program integration
  • Social and emotional competency
social and environmental determinants of health
Social and Environmental Determinants of Health
  • Determinants of health = range of personal, social, economic, and environmental factors that influence health status.
    • Biology
    • Genetics
    • Individual behavior
    • Access to health services
    • Environment
    • Age
social determinants of health
Social Determinants of Health
  • Social determinants of health are life-enhancing resources, such as:
    • food supply, housing, economic and social relationships, transportation,
    • education, and health care

whose distribution across populations and communities effectively determines length and quality of life for the individual, the community and the population.

sdh education
SDH: Education

In Rhode Island in 2009, the median income of adults without a high school diploma or GED certificate was $20, 547 compared to $28, 785 for people with a high school degree, and $48, 845 for those with a bachelor’s degree.


sdh education1
SDH: Education

Dropout rate in RI by race and ethnicity in 2010:


RI vs. National 14% 8.1%

White 11% 5.2%

Asian 13% 3.4%

Black 20% 9.3%

Hispanic 22% 17.6%

Native American 18% 13.2%

Source: 2011 RI KIDS COUNT; U.S. Department of Education, National Center for Education Statistics. (2011). The Condition of Education 2011 (NCES 2011-033), Indicator 20.

sdh poverty
SDH: Poverty

In RI (2005-2009 American Community Survey 5-Year Estimates)

  • Under 18 years old 16.7%
  • 18-64 years old 10.3%
  • 65 years and over 9.4%

Live below poverty level…

sdh poverty race
SDH: Poverty & Race

Below poverty level by race, ethnicity and gender

White 8.8%

Black 24.4%

American Indians 23.6%

Asian 16.4%

Hispanic 28.6%


Male 10.5%

Female 12.7%

life course developmental approach
Life Course Developmental Approach
  • Today’s experiences and exposures influence tomorrow’s health (Timeline)
  • Health trajectories are particularly affected during critical or sensitive periods (Timing)
life course developmental approach1
Life Course Developmental Approach
  • The broader community environment- biological, physical, and social- strongly affects the capacity to be healthy (Environment)
  • While genetic make-up offers both protective and risk factors for disease conditions, inequality in health reflects more than genetics and personal choice (Equity)
example of the life course approach in obesity prevention
Example of the Life CourseApproach in Obesity Prevention
  • (Source: Mary Haan, DrPH, MPH, University of Michigan. Adapted from: World Health Organization, Life course perspectives on coronary heart disease, stroke and diabetes: Key issues and implications for policy and research. Summary Reports of a Meeting of Experts, 24 May 2001. ) Available at:
integration projects umbrella
Integration Projects Umbrella

Division of Community, Family Health & Equity

Integration Projects Umbrella

New (CCD)

Coordinated Chronic Disease and CTG Grants

ARRA CDC Communities Putting Prevention to Work


CDC Team Works Project DCFHE Healthy Communities Pilot Project in Olneyville

Multiple DCFHE

Policy and Practice

Integration Efforts

cfhe integration initiative
CFHE Integration Initiative
  • Provides for consistency in approaches, data use and evaluation to address common:
    • Socio-economic determinants of health and health equity issues
    • Population risk and protective factors
    • Opportunities in venues like CBOs, FBOs, workplaces and schools, health care and other systems
cfhe integration initiative1
CFHE Integration Initiative
  • Common vision
  • Joint leadership
  • Joint planning and quality initiatives
  • Common outcomes
  • Common policies
  • Common financing and implementation at the state and local level
common vision
Common Vision
  • Creates a common vision of a healthy community that will increase HEALTH’s impact:


joint leadership
Joint Leadership
  • Joint problem solving and decision making mechanisms (MOUs, policy advisory groups, facilitation, criteria for priority setting, etc.)
  • Weekly leadership meetings
  • Monthly program manager meetings
  • Policy work group meetings
joint planning quality
Joint Planning & Quality
  • Assessment, monitoring, technology tools; common assessment tools that address subpopulations across the life span.
  • Community input/feedback
  • Evaluation
  • Dissemination of information
common outcomes
Common Outcomes
  • Performance measures, and/or proxy measures of success - behavioral, risk and protective factors, diseases and conditions, injuries, well-being and health-related Quality of Life and Equity.
  • Categorical data layered by populations across life course, geographic areas, income, race/ethnicity, etc.
  • Different look at surveillance and data analysis: Providence DataHub
common policies
Common Policies
  • Common legislative and policy agenda.
  • Common communications messages with integrated information and education activities.
  • Integrated advocacy strategies.
  • Common mechanisms for community input and empowerment, integrated training/TA, and capacity building of community advocates.
common financing implementation
Common Financing & Implementation
  • Joint leveraging of funds
  • Integrated initiatives and common strategies by community, population, and/or settings, supported with pooled Federal, state and/or state private categorical funds using integrated RFP’s and contracts
  • Joint management of activities
hands on exercise

Hands on Exercise

Work plan assessment using Pyramid and four questions

4 equity questions
4 Equity Questions
  • What does “achieving health equity” means for your program/team?
  • How comprehensive are your interventions (meaning, are your interventions reaching all five levels of the Equity Pyramid?)
  • If you are not addressing all levels of the pyramid, why not? What else are you doing?
  • What support will your program/team need in order to develop a comprehensive public health program, which addresses all levels of the pyramid?
cfhe strategic challenges
CFHE Strategic Challenges
  • Build a shared public health equity agenda across the state
  • Adopt a community development frame for our work
  • Transform comprehensive service delivery model and culture of service delivery
  • Build capacity to collaborate internally
cfhe next steps
CFHE Next Steps
  • Meeting with Teams
    • 4 Equity questions
  • Grants review
  • Local investments
  • Staff training
  • Equity workgroup
  • Responding to the 4 Strategic Challenges
strategic challenge 1 update
Strategic challenge #1 - update

Building a shared public health equity agenda

across the state:

  • On-going effort (presentation at key community events and with key constituencies)
  • CFHE Booklet
strategic challenge 2
Strategic challenge #2

Adopt a community development frame for our


  •  CFHE has completed several local assessment processes and is working with three communities to develop community driven action plans and activation based on the results from the assessments. 
  • CFHE adopted a coordinated approach to community engagement and advocacy training across the division.
  • MCH Block Grant Local Initiative RFP
strategic challenge 3
Strategic challenge #3

Transform comprehensive service delivery model

and culture of service delivery:

  • Several initiatives are being implemented across the division with the home visiting program, healthy homes initiative, Chronic Care Collaborative (to name a few) so CFHE presence at the local level is coordinated and we are more effective in our approach.
  • Alignment of CTG proposed strategies/interventions with proposal for CCDHP grant
strategic challenge 4
Strategic challenge #4

Build capacity to collaborate internally:

  • On-going activity. Examples:
    • Health equity grant checklist
    • Equity pyramid exercise with Teams  
    • Core competency training  
    • Standardization of local assessment tools 
    • Asset mapping project
    • MCH Block Venture Capital
hands on exercise1

Hands on exercise

Use of grants check list

implementation examples
Implementation examples
  • Tobacco /Pregnancy Risk Assessment Monitoring Survey (PRAMS)
  • Healthy Living Campaign (Diabetes/Obesity)
  • Healthy Housing (Lead, Asthma, Radon, Asbestos); Healthy Housing Strategic Planning Process; Refugee Housing Workgroup
  • Special Populations Emergency Response (Minority Health and Disabilities)
implementation examples1
Implementation examples
  • Olneyville Project (Office of Minority Health, Initiative for Healthy Weight, Healthy Communities, Prevention Block Grant – Community Planning)
  • Community Skills Capacity Building (Office of Minority Health, Tobacco Control Program, Initiative for Healthy Weight, Office of HIV/AIDS)
  • HPV (Immunization Program, Woman’s Cancer Screening Program and Adolescent Health)
implementation examples2
Implementation examples
  • Chronic Care Collaborative(Heart Disease & Stroke, Asthma, Cancer, Diabetes)
  • HIV/STD’s (Renew Program)
  • Lead/Refugee Health
  • Workforce Development Project

Questions?Ana P. Novais&Peter Simon(401)