Connecting Race, Place and Health to Equity Mildred Thompson, Director PolicyLink Center for Health Equity and Place September 8, 2012 Maryland Women’s Coalition for Health Care Reform Conference

PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works. ®

The Center for Health Equity and Place Where you live affects how you live. 3

PolicyLink Center for Health Equity and Place 4 Research Capacity Building/ TA Convening Communications Advocacy/Action Thought Leadership

5 Defining Health: Overall state of physical, economic, social and spiritual well-being

THE FACE OF AMERICA IS CHANGING 6

Obesity Data/Statistics – United States* In 2010, African American women were 40% more likely to be obese than Non-Hispanic White women. Native Hawaiian/Pacific Islanders are 2.7 times more likely to be obese than the overall Asian American population. In Mexican American children, between the ages 6 and 17, were 40% more likely to be overweight as Non- Hispanic White Children. American Indian/Alaskan Natives are 40 percent more likely to be obese than Non-Hispanic whites. *US Department of Health and Human Services, Office of Minority Health 15

Obesity Data/Statistics – Maryland Maryland obesity statistics* 2011, Maryland was ranked the 26th most obese state in the US but 15 years ago was ranked the 23rd most obese state. The overall adult obesity rate in Maryland is now at 27.1% Racial and ethnic categories show 36.3% obese rates among Blacks, 27.4% among Latinos, and 24.3% among Whites Overweight and Obesity Rates for Adults by Gender, 2010** 59.1% of women in Maryland were overweight or obese in comparison to 57% of women in the United States *reported in F as in Fat from the Trust for America’s Health and Robert Wood Johnson Foundation **Kaiser Family Foundation State Health Facts 16

Health of Women in Maryland* Heart disease and cancer accounted for nearly half (48%) of all female deaths. The leading causes of death are the same for both White and Black women (heart disease, cancer, and stroke). Black women have higher death rates from heart disease than white women. HIV is the third leading cause of death among black women ages years old. *”The Health of Maryland Women 2011", produced by The Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene (DHMH) 17

Health of Women in Maryland* More women died from lung cancer than any other cancer. Cancer mortality rates for women have declined from 2001 to 2009 by nearly 4%. Death rates from breast cancer were highest for black women than all other race/ethnicities. Hypertension and diabetes was most prevalent among blacks and women over 65 years of age. *”The Health of Maryland Women 2011", produced by The Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene (DHMH) 18

Race, Class, Ethnicity and Health African Americans, Hispanics, Native Americans and some Asian Americans suffer poorer health outcomes than whites, regardless of S.E.S. 19

Social Determinants of Health Poverty, Unemployment Neighborhood Conditions Housing Food Access Parks, Physical Activity Safety Concerns Toxic Environment 20

Making the case for Equity 21

What is Equity? Equity means just and fair inclusion. An equitable society is one in which all can participate and prosper. The goals of equity must be to create conditions that allow all to reach their full potential. In short, equity creates a path from hope to change. Achieving equity requires intentionality, focus, and a commitment to community engagement and participation. 22

Complexity of Health Disparities Institutionalized biases (racism, sexism, etc.) Mental Health Social Support/ Networks Economic Opportunity and Equity Education Background and Opportunity Health Behaviors and Personal Risk Factors Access to Health Services Language and other Cultural Factors Environmental/ Toxic Risk Factors Safety and Perception of Safety Belief and Trust in Health System 23

Health Inequities Systematic and unjust distribution of social, economic, and environmental conditions needed for health: Income Employment Education Housing Access to healthcare 24

EquityEnvironment Health Intersection of Health, Place & Equity Access to Healthy Food Schools/ Child care Health facilities Community Safety/ violence Transportation Traffic patterns Work environments Housing Parks/Open Space playgrounds 25

Parks Grocery Stores Financial Institutions Better Performing Schools Good Public Transportation Vibrant healthy homes Fast Food Restaurants Liquor Stores Unsafe/Limited Parks Poor Performing Schools Increased Pollution and Toxic Waste Sites Limited Public Transportation Increased crime Communities of Opportunity Low- Income Communities Good Health Status Poor Health Status Contributes to health disparities: Obesity Diabetes Asthma Increased injury 26

Equitable Policies Equity as a criteria for inclusion and/or prioritization of policies Identify policies that are important to low-income communities, communities of color and other vulnerable populations specifically Target benefits to vulnerable populations Prioritize the provision of resources to areas that need it most 27

Equity Considerations in Strategy Development 28 1.Is the strategy conceptualized to promote equity/reduce inequities? If so, how? If not, how can you modify it to specifically address inequities? 2.How will you deliberately focus on implementing this strategy in a way that promotes equity? 3.How will your strategy promote meaningful and authentic community engagement? 4.What inequities will be reduced as a result of this strategy? 5.How have low-income communities and communities of color benefited from implementing this strategy? 6. Identify barriers and unintended consequences

1.Ask Key Questions : who benefits, who pays, who decides? 2.Increase Political Power of Vulnerable Populations, including Immigrants 3.Enforce Laws that Prohibit discrimination 4.Shift Public Perceptions 5.Substantive Community Engagement 6.Target Policies that Disproportionately Harm Vulnerable Populations 29 How to Take Action

Health in all policies Health Impact Assessments (HIAS) Healthy Food Access Transportation Reauthorization Joint use Agreements Safe water and safe parks Healthy Housing Policies Leveraging federal resources 1.HFFI (fresh food financing initiatives) 2.Sustainable Communities 3.Promise Neighborhoods Examples of Equity Promoting Policies 30

The California FreshWorks Fund (CAFWF) is a public-private partnership loan fund modeled after the Pennsylvania Fresh Food Financing Initiative and aligned with President Obama’s National Healthy Food Financing Initiative (HFFI). It was created to: 1.Increase access to healthy food in underserved communities 2.Spur economic development that supports healthy communities 3.Inspire innovation in healthy food retailing 31 California FreshWorks Fund (CAFWF)

Benefits: 1.Access to Healthier Food 2.New Jobs 3.Improved Property Values 4.Increased Tax Revenue 32 California FreshWorks Fund (CAFWF)

Principles for Community Engagement Empower residents through meaningful inclusion and partnerships Build capacity for high level engagement Prioritize community knowledge and concerns Target resources to support ongoing engagement Facilitate mechanisms that encourage mutual learning and feedback mechanisms 33

Towards More Equitable Public Engagement Processes Inclusive: What communities and interests need to be represented and in what capacity? Accessible: Will people and organizations from a diversity of backgrounds feel comfortable and engaged? Transparent: How does public engagement interact and influence decision-making? 34

Engagement and Leadership Efforts to achieve revitalized communities of opportunity will not be successful without substantial community engagement Meaningful community engagement requires participation in governance and decision making 35

Community Engagement Context 36 Equity & Improved Health Outcomes Engaged Community Issue Identify issue Agree on priority Research Analysis & Data Mapping Trends Rates Barriers Challenges Contribution Perceptions Explore Solutions Advocacy Policy System Change Affirm Solutions that work Strengths/Cap acity Partners Agencies Policymakers Businesses Schools Churches Communication Message development Spokespersons Media tools & products Actions Legislative School board Legal Administrative Institutional Impact CBPR Create Indicators Monitor & Track Progress Feedback Share successes & challenges Document Progress Host Convening Sustainability Investment Commitment Accountability Persistence

Institutional Structures for Community Engagement 37 Governance Level Appointment to decision making boards and commissions Consortia Membership based group with options for decision making Advisory Groups Provide guidance and advice to decision makers Task forces Short term participation with opportunity to offer recommendations Focus Groups One-time opportunity to provide input Town Hall Meetings Information provided one time, sometimes an ability to offer group comments Ascending Impact Descending Impact

38 Getting Equity Advocacy Results (GEARS)

Measuring Health Equity 1)Measurement of community conditions relevant to health 2)Measurement of the implementation of strategies, campaigns, policies and plans 3)Measurement of health behaviors and health outcomes 39

40 'Of all the forms of inequality, injustice in health care is the most shocking and most inhumane' - Martin Luther King, Jr. (March 25, 1966)

Mildred Thompson, Director PolicyLink Center for Health Equity and Place Thank you!