Making the Grade:

1. Making the Grade: The Southeastern Health Equity Council’s Health Equity Report Card

2. About the SHEC • The Southeastern Health Equity Council (SHEC) is one of ten Regional Health Equity Councils (RHECs) in the U.S. formed in 2011 to implement the National Partnership for Action to End Health Disparities (NPA) • Vision: A region free of disparities in the health and health care, where all people attain the highest level of health • Mission: Coordinate efforts in the Southeastern region to achieve health equity through policy changes, effective programs, and greater awareness • Priority Areas: Health Care Access, Healthy Food Access, and Cultural Competency

3. About the SHEC Note: 17.5% of SHEC members are also Health Professionals

4. Purpose & Overview of Health Equity Report Card • Significance: The Southeastern region experiences higher rates of illness and death from many diseases compared to the rest of the United States High rates of disparities diminish the region’s potential for economic and societal advancement • The report card was developed to: • Identify where health disparities exist for key indicators related to health care access, healthy food access, and cultural competency • Determine opportunities and areas for immediate target and potential policy action

5. Purpose & Overview of Health Equity Report Card • Primary Audience: policy makers and funders • Current state of the region • Policy Implications • Gaps in Data Collection • Consist of 20 indicators in 3 priority areas • Reported by Race, Ethnicity, Gender, Urban/Rural Status, Sexual Orientation, and Disability Status This report embraces a data-informed approach to identify the social determinants that reinforce health disparities and will utilize it as a benchmark to measure improvements in the future

6. Grading System & Data Sources • A = Equal or better than HP 2020 goal or >25% improved from 2009 to 2012 or >25% improved from national average • B = 1-30% worse than HP 2020 goal or >10-25% improved from 2009 to 2012 or >10-25% improved from national average • C = >30-60% worse than HP 2020 goal or between 10% improved and 10% worse from 2009 to 2012 or between 10% improved and 10% worse from national average • D = >60-90% worse than HP 2020 goal or >10-25% worse from 2009 to 2012 or >10-25% worse from national average • F =>90% worse than HP 2020 or >25% worse from 2009 to 2012 or >25% worse from national average

7. Grading System & Data Sources • Publicly-available, tabulated data broken down by state and subgroup data where available • U.S. Census Bureau American Community Survey • CDC Behavioral Risk Factor Surveillance System • CDC Youth Risk Behavior Surveillance System • CDC National Center for Health Statistics • CDC WONDER • Current Population Survey • USDA Economic Research Service Food Access Atlas • Kaiser Family Foundation

8. Key Findings: Demographics Source: U.S. Census Bureau, 2011 American Community Survey

9. Key Findings: Health Care Access • Roughly 74% of the Southeastern population, aged 18-64, has health insurance, with African Americans and Hispanics being less likely to have health insurance • 7 of the Southeastern States have decided not to expand Medicaid to cover individuals up to 138% of the Federal Poverty Level • 7 of the Southeastern States have defaulted to Federal Exchange, which limits state’s ability to adapt to specific needs of its population Kentucky is the only state in the Southeast to expand Medicaid and opt for state-based Health Exchange

10. Key Findings: Health Care Access Source: 2011 BRFSS; Grade: Compared to HP 2020 goal

11. Key Findings: Health Care Access Source: 2011 BRFSS; Grade: Compared to HP 2020 goal

12. Key Findings: Health Care Access States’ Decisions on Expanding Medicaid Kentucky Tennessee North Carolina South Carolina Mississippi Alabama Georgia Florida Source: Kaiser Family Foundation, Nov 2013

13. Key Findings: Healthy Food Access • The percent of adults who consume ≥ 5 fruits or vegetables per day remains steady in the Southeast (21% from 2003 to 2009), which is lower than the national average of 23% • Individuals living in the Southeastern region are less likely to engage in physical activity compared to the national average (57% and 49% respectively) • 16.1% of Southeastern households experience food insecurity. This rate is more than 100% higher than the Healthy People 2020 goal of 6%

14. Key Findings: Healthy Food Access • Compared to the national average (23.6%), many of the Southeastern states have more than 24% of the population living in areas that do not have access to grocery stores to buy healthy foods • All the Southeastern states have convened local- or state-level food policy councils to address issues of food access through collective, multisectoral efforts In 2011, the Southeast region was #1, compared to other regions, for diagnosed cases of diabetes and hypertension

15. Key Findings: Healthy Food Access Source: 2011 BRFSS; Grade: Compared to 2011 national ave.

16. Key Findings: Healthy Food Access Source: 2011 BRFSS; Grade: Compared to 2011 national ave.

17. Key Findings: Cultural Competency • Largest Black/African American population in U.S (13 million) resides in the Southeastern region • Growing American Indian and Appalachian population • The foreign-born population has been gradually increasing • Florida, Georgia, and North Carolina have the largest foreign-born population • Alabama, Kentucky, Mississippi, and Tennessee have experienced a 50% increase since 2006 South Carolina currently ranks #1 in the U.S. for growth of the Hispanic population

18. Key Findings: Cultural Competency Source: 2011 American Community Survey; Grading N/A

19. Key Findings: Cultural Competency Source: 2011 American Community Survey; Grading N/A

20. Key Findings: Cultural Competency State Action on Requiring Cultural and Linguistic Competency Education/Training among Health Care Professionals Kentucky Tennessee North Carolina South Carolina Mississippi Alabama Georgia Florida Source: DHHS Office of Minority Health, Nov 2013

21. Implications for Practice: Health Care Access • Encourage Medicaid Expansion: More than 2.5 million adults are eligible for coverage if Medicaid is expanded among Southeastern States • Enhance outreach efforts to inform residents of their new healthcare coverage options and how to enroll • Expand Medicaid and coverage through affordable private health insurance plans • Lower mortality rates due to life-threatening conditions • Lower overall healthcare cost through prevention and proper management of chronic conditions

22. Implications for Practice: Food Access • Develop and implement food-financing programs at the state and/or regional level to increase access to full-service grocery stores in areas designated as food deserts • Increase awareness that food financing programs have the potential to create economic benefits in the Southeastern States • Jobs Creation • Long-term benefits to reduce the obesity epidemic • Increase access to affordable and healthy foods

23. Implications for Practice: Cultural Competency • Increase the competency of health care workforce • Enact state-level laws and/or licensure and certification policies that require cultural competency education for new and existing health care professionals • Improve data collection to measure the delivery of cultural competent services by health care facilities to assess impact on health outcomes

24. Implications for Practice: Gaps in Data • Improve data collection by oversampling racial and ethnic groups with small population sizes • Make data collected on subcategories publicly available • Consider including sexual orientation in future data collection and reporting efforts • Merge death certificate data with disability data to report mortality rates by disability status

25. Acknowledgments We would like to thank the following for their efforts in the research and development of the report card: Social Determinants of Health Committee Meka Sales (Co-Chair) Pamela C. Hull (Co-Chair) Ronny Bell Korana Durham Renee S. FrazierKeecha Harris Brenda Hughes Jeongah Kim Mina Li Fern Webb Alfred Yin Susan G. Zepeda SHEC Intern Amirah Abdullah

26. Visit the SHEC's Website: http://region4.npa-rhec.org Sign up for SHEC's Email Listserv: http://region4.npa-rhec.org/get-involved Like us on Facebook: www.facebook.com/SoutheasternHealthEquityCouncil

27. Resources • ACA Resources http://www.enrollamerica.org/http://sosmovement.net/join-the-movement/our-focus/expand-medicaid-in-alabama/ • Food Trust www.thefoodtrust.org • Healthy People 2020 http://www.healthypeople.gov/2020/default.aspx • National Center for Cultural Competence http://nccc.georgetown.edu/ • National Partnership for Action to End Health Disparities (NPA) www.minorityhealth.hhs.gov/npa • Office of Minority Health-Cultural Competence Section http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=3 • Place Matters: The Status of Health Equity Post Civil Rights Movement in Alabama www.jointcenter.org • Policy Link www.policylink.org