2011 Virginia Rural Health Summit presentation

1. 2011 VirginiaRural Health Summit:Building Capacity to Improve Health Equity in Rural CommunitiesApril 6, 2011Vincent Lafronza, Ed.D.President & CEOvlafronza@commonhealthaction.org

2. Dialogue Goals Explore issues of health equity and social determinants of health Share PLACE MATTERS illustrations as a framing tool to stimulate thinking about health equity Inspire ideas on roles for state and community based organizations serving Virginia’s rural communities to advance health equity

3. CommonHealth ACTION, Washington, DC We are a national, nonprofit (501(c)3) organization with a public health mission. Mission: CommonHealth ACTION works to build community capacity to address social determinants of health and create optimum health for all.

4. What is a Public Health Institute? A Public Health Institute is a multi-sector entity able to function as a neutral convener to improve health status and foster innovations in health systems. Public Health Institutes developed rapidly across the country over the past decade.

5. NNPHI Members Statewide NonprofitUniversity-AffiliatedMunicipal / Sub-State Provisional MemberAffiliate member visit www.nnphi.org for links to members’ Web sites

6. Leveraging CommonHealth ACTION’s Unique Strengths Staff has worked with public health representatives from all fifty states and the District of Columbia CommonHealth ACTION is the lead technical assistance provider to the PLACE MATTERS national demonstration program of the Joint Center for Political and Economic Studies Health Policy Institute IPHi is a regional resource for DC, MD, and VA

8. Innovations and Systems Expansion – Serving as an agile vehicle for designing, testing, evaluating and disseminating innovative approaches to public health.

9. Training and Capacity Building – Strengthening the capacity of government and community-based agencies through education, training and technical assistance.

10. Research and Evaluation – Providing an independent resource for the community to support research and evaluation to improve population health efforts.

11. Policy and Advocacy – Conducting policy analyses and health impact assessments to provide objective information and facilitative leadership to help improve health policy.

12. Resource Development –Leveraging national resources and providing cost-effective services that bring additional funding into the region when a non-governmental mechanism is helpful or desired.

14. Public Health SystemInstitute of Medicine, 2003 Health care delivery system Community Assuring the Conditions for Population Health Governmental Public Health Infrastructure Employers and Business Academia The Media IPHi… Leadership at the intersections of health…

15. Data from Kaiser Family Foundation In VA, compared to 7.2% of white non-Hispanic women reporting fair or poor health status, 12.2% of Black non-Hispanic and 16.8% Hispanic women report fair or poor health status. Compared to 17.2% of white non-Hispanic women reporting obesity, 36.5% of Black non-Hispanic and 17.3% of Hispanic women report obesity.

16. Data from Kaiser Family Foundation In VA, compared to 8.1% of white non-Hispanic women reporting no high school diploma, 13.2% of Black non-Hispanic and 38.5% of Hispanic women report no high school diploma. In VA, compared to 9.6% of white non-Hispanic women reporting living in poverty, 16.4% of Black non-Hispanic and 19.7% of Hispanic women report living in poverty.

17. Defining Health Equity Health inequity involves more than mere inequality, since some health inequalities (e.g., the gap in average life expectancy between women and men) cannot reasonably be described as unfair, and some are neither preventable nor remediable. WHO Commission on SDOH

18. SDOH Examples from WHO Household living conditions conditions in communities conditions in workplaces conditions in health care policies and programs affecting any of these factors

19. SDOH Examples from Canada Aboriginal status early life education employment and working conditions food security gender health care services housing income and its distribution social safety net social exclusion unemployment and employment security

20. SDOH The social determinants of health can be understood as the social conditions in which people live and work. or more simply… "the social characteristics within which living takes place". Tarlov

21. SDOH Point to… specific features of the social context that affect health,and to the pathways by which social conditions translate into health impacts.

22. Social Determinants of Health Social determinants of health refer to conditions of society that reflect root causes of community and individual health and well-being. There is a graded relationship between social position and health status that affects people at all levels of the social hierarchy.

29. PLACE MATTERS National Initiative PLACE MATTERS is a demonstration initiative of the Joint Center to build the capacity of community leaders to address social, economic and environmental conditions in communities that shape health and health outcomes. PLACE MATTERS is designed to improve the health outcomes of participating communities through shared learning experiences. The program assists participating teams in developing and implementing community-based strategies to address the social factors that determine health.

30. PLACE MATTERS: Applying Lessons Learned to Benefit Our Region

31. Disease-focused Approach

32. Community health & well-being (population-level) Land use / policies Transportation Primary health care system Public health system, practice & leadership Culture / demographics Environment / natural resources Gov’t leadership

33. Education(quality, access, affordability) Community health & well-being (population-level) Housing stock / generational wealth Land use / policies Protective factors Transportation Food systems Structural racism Primary health care system Public health system, practice & leadership Culture / demographics Environment / natural resources Gov’t leadership Economic development & opportunity Disinvestment / stigma

34. Marlboro County, SC The Marlboro County Inter-Agency is a non-profit organization with a 35-agency membership and houses the Marlboro County, South Carolina Place Matters Team. The team has targeted action to be taken in the following two areas: (1) Gather ER use trend data and bring together the lead partners in a collaborative initiative to develop a plan to improve access to primary health and mental health care and medical homes; and (2) Gather high school graduation rate trend data , and bring together the lead partners in a collaborative initiative to develop a 5 year plan to provide more constructive after-school activities, reduce expulsion and suspension rates, and increase graduation rates. Also working to attract better jobs to the county.

35. Sharkey-Issaquena County, MS The Mid-Mississippi Delta Team (MMD) has targeted childhood obesity as the focus of its work. With the reduction in childhood obesity, the assumed consequences would be a reduction in Type II Diabetes and Cardiovascular disease. According to aneki.com, the United States has the highest obesity rate in the world. In 2005, Mississippi’s obesity rate of 30.9% was the highest in the nation. The rates are even higher in the African-American population, with obesity rates in boys as high as 49% and 39% in girls.

36. Coahoma, Sunflower, & Washington Counties, MS Our objective is to address the social determinants of obesity and chronic disease in our community. Through community forums and programs that address lifestyles, we are increasing awareness of the problem and its potential solution. We are working on improving access to healthy foods and opportunities for exercise in our communities. As we develop partners in the community through these efforts, we are beginning to network with others in the state and the nation to empower our community to address the policies and social and economic conditions that must be changed to bring about health equity here.

37. San Joaquin Valley, CA The San Joaquin Valley project is a collaborative effort between the Central Valley Health Policy Institute at California State University Fresno and six county health department directors and/or their designees. Motor Vehicle Accidents (MVAs) are the leading cause of death for individuals between the ages of 2 and 34 in the United States, and MVA rates are especially high in rural areas like the San Joaquin Valley (each of the valley’s participating counties has MVA mortality rates above those of the state and the nation). Rural residency, lower socioeconomic status, and Latino ethnicity have been shown to be strongly associated with MVA mortality rates across the country.

38. Innovations Testing PLACE MATTERS example from Boston http://whatsyourhealthcode.com/

40. Identify data sources that will enable evidenced-based benchmarking approaches re SDOH

41. Degree of ‘upstream-ness’

42. Framing, communicating, marketing

43. Funding and Sustainability

45. Ranks health of all 50 states

47. CHR Measures: Health Factors Health FACTORS in the County Health Rankings represent what influences the health of a county. Rankings measure four types of health factors: health behaviors, clinical care, social and economic, and physical environment factors.

48. Virginia Rankings http://www.countyhealthrankings.org/virginia http://www.countyhealthrankings.org/virginia/overall-rankings

49. Opportunities to Advance Health Equity Provide venues for public fora, possibly leveraging Unnatural Causes documentary Establish strategic alliances with CBOs and other groups Support community-based partnerships capacity development Engage state health departments and emerging health equity institutes Implement performance management systems that specifically targets closing gaps in health inequities

50. Opportunities to Advance Health Equity Produce regional social indicator reports that include multiple determinants of inequities, communicate progress and engages public opinion. Include a special focus on advancing health equity on Web site Establish succession planning processes to ensure future workforce well-poised to address health equity Engage local boards of health in regional efforts to address health equity

51. Opportunities to Advance Health Equity Leverage RWJF Rankings to influence policymakers and build support for collaborative practice. Expand collaborative efforts with primary and secondary education Develop new essential services frameworks to expand public health practice vis-à-vis social determinants of health to advance health equity

53. Noted public health historian Elizabeth Fee in her introduction to George Rosen’s: A History of Public Health, 1993. “When the history of public health is seen as a history of how populations experience health and illness, how social, economic and politicalsystems structure the possibilities for health or unhealthy lives, how societies create the preconditions for the production and transmission of disease, and how people, both as individuals and social groups, attempt to promote their own health or avoid illness, we find that public health history is not limited to the study of bureaucratic structures and institutions but pervades every aspect of social and cultural life.”