Directors of Health Promotion and Education Health Webinar Series: Health Equity

1. Directors of Health Promotion and Education Health Webinar Series: Health Equity • Responding to Health Inequities Through Grant-Making July 5, 2012 Johnnie (Chip) Allen, MPH Director of Health Equity Ohio Department of Health Chair, DHPE Health Equity Committee

2. Background Information • Office of Health Equity (OHE) created in 2008 • Dr. Steve Owens • 1 FTE Initially; 1 Additional FTE added in 2010 • Responsible for advancing statewide health equity initiatives for the entire agency.

3. DHPE Health Equity Background Information • DHPE Health Equity Structure Formalized in 2010. • DHPE hired the first Health Equity Manager in 2011 • Additional health equity staff hired in 2011 • Several high profile health equity initiatives.

4. Placement of Health Equity Office Robyn Taylor, Asst. Hlth Equity Coordinator

5. Current Strategic Plan

6. Projects/Activities • Advise senior management on policies to eliminate health inequities • Provide consultation to other cabinet-level agencies on health disparity elimination activities • Assist in the development of RFPs and other funding opportunities to address health inequities • Develop techniques to use market research and geospatial technology to address health equity • Provide ongoing training opportunities to help health care providers understand and address health disparities

7. Aligning Public Health Resources for Health Equity • Critical Questions to Answer! • Is it possible? • Is it simple? • Is it necessary? • Do we have the skills? • Can we acquire the skills? • Can we acquire the skills quickly? • What happens if we don’t do it?

8. Incorporating Health Equity Within Grants • Understanding Central Challenges! • ODH annually provides over $511 million dollars in grant/subsidy agreements to implement and sustain local public health activities. • Differing priorities from categorical funders. • Lack of a Syndemic Orientation • Scarcity of health equity subject-matter experts within programs. • Lack of centralized information repository to track activities.

9. Overcoming Central Challenges • Implement systematic processes which direct funding and guide the development strategies to address health inequities. • Strategies must be broad enough in scope to have a statewide impact. • Coordinated to avoid duplication and achieve synergy; • Focused enough for implementation through local public health activities.

10. Overcoming Central Challenges Guiding Principles • Implement systematic processes which direct funding and guide the development strategies to address health inequities. • Strategies must be broad enough in scope to have a statewide impact. • Coordinated to avoid duplication and achieve synergy; • Focused enough for implementation through local public health activities.

11. How Did We Do It?

12. GOAL Implement and sustain a comprehensive approach to eliminate Health Disparities in Ohio by increasing synergy between ODH fiscal, programmatic and financial resources • Incorporate health equity and health disparities throughout the lifecycle of the grants process. • Enhance a three-dimensional understanding the root causes of health disparities to develop effective interventions. • Develop programs with respond to health disparities,  health equity and the connection to  social determinants.

13. Objectives of Health Equity Language • Achieve 100% compliance for grant prepares to incorporate health equity throughout the lifecycle of their grants (as opposed to being an afterthought). • Empower funders to understand and identify root causes of health disparities for funded activities. • Apply health equity concepts to grant funded interventions.

14. Basic Structure of a Grant • What is your funder requiring you to do? • Abstract • Proposal Summary • Needs Statement • Methodology (Plan of Action) • Who will carry out the work • Budget Narrative • Evaluation Plan

15. How we really did it! • As of April 1, 2009, all new RFPs were required to incorporate a 1 ½ page Intent to Pursue Health Equity Statement featuring the following information: • Explanation of the extent in which health disparities are manifested within focus of the application. • Identification of specific group(s) who experience a disproportionate burden for the disease or health condition addressed by application. • Identification of specific social and environmental conditions which lead to health disparities which had to be supported by data

16. How we really did it! (continued) • Modified of the RFP Program Narrative requiring applicants to demonstrate cultural competence and explain health inequities as part of the Problem/Need Statement and Methodology sections. • Required applicants describe the demographic characteristics (e.g., age, race, gender, ethnicity, socio-economic status, educational levels) of the target population.

17. How we really did it! (continued) • Required of the use of standard levels of geography (i.e. , county, city, or township, census tracts, census block groups, census block) to strengthen evaluation studies. • Establishment of standard review criterion to determine the how well the application explicitly identified specific groups who experience a disparities as well an analysis of the root causes of health disparities.

18. Initial RFP Template Language

19. Ohio Department of Health RFP Template

20. Early Indicators of Success • The Office of Health Equity was invited by the Grants Management to conduct presentations for on the new language. • Opportunities to discuss the health equity language with local health departments. • Two (2) programs requested technical assistance in the preparation of forthcoming RFPs. • The ODH website featured at least three (3) competitive RFPs which featured the new health equity language

21. Grant Availability from ODH

22. Overcoming the Psychology of Seduction Overestimating Success of Health Equity Policy “Naively assuming health equity initiatives within grants would increase because health equity language was now codified within the RFP development process. “

23. Lessons Learned • Conducted an Environmental Scan in 2011 • After the early momentum in 2009, programs developing RFPs were not seeking health equity technical assistance • The introduction of standard health equity language was an important policy milestone • Programs are not using health equity language as designed to influence RFPs

24. Need for Advanced Health Equity Strategies • Program staff developing RFPs need structured technical assistance to better incorporate health equity concepts • Additional processes are needed to assure that the $511 million in grant funds are working towards an integrated health equity solution • RFP Template needs revision to enable programs the ability to customize standard health equity language

25. Advanced Health Equity Strategies • Modification of the RFP Template • All programs developing new competitive RFPs must meet with the Office of Health Equity for technical assistance. • Abandonment of the 1 ½ Intent to Pursue Health Equity Statement in exchange for the opportunity for programs to customize standard health equity language. • Streamlined explanations of basic health equity concepts based upon national health equity documents.

26. Advanced Health Equity Strategies • Structured Health Equity Consultation • Three-phased consultation strategy based upon a project management model using lessons learned from programs using the RFP health equity language since 2009. • Discovery • RFP Development • Training

27. Phase 2 (RFP Development) PHASE 1 ( Discovery) Collaborative consultation between ODH program staff to understand program scope and purpose and goals of RFP health equity language Structured Health Equity Technical Assistance Flow Chart • Collaborate with program staff to craft RFP language with a health equity lens including: • Identification of disparate groups. • identify SDOH which drive health disparities. The RPF Development App allows ODH Programs to develop RFPs, identify review criteria and facilitate score grant proposals. PHASE 3 (Training) EVALUATION RFP Development Team will train program staff on the new language which will strengthen proposal review. In turn, program staff will also be to communicate language to potential grantees . Review of the final RFP and random scan of grant proposals to determine the inclusion of health equity concepts within the RFP and adherence to standards by grant reviewers. Final RFP developed with a health equity lens.

28. Advanced Health Equity Strategies • Use of Information Technology to Monitor Compliance • Assist in the development of RFPs and review criteria. • Impossible to monitor compliance and/or widespread impact of health equity RFP strategies with any level of integrity with only 2 FTEs. • Grant reviews are done manually and not stored in a central database repository.

29. Advanced Health Equity Strategies • Assistance of Third Party Evaluators • In 2005 the Ohio Commission on Minority Health (ODH) created the Research & Evaluation Enhancement Program (REEP). • REEP consists of program evaluators with experience of developing standardized evaluation systems for assessing outcomes of health disparity elimination projects. • REEP evaluators will be contracted to review information from the OHE to determine fidelity of the enhanced RFP Health Equity Protocol.

31. Health Equity Tool

32. Tools to Support RFA Language

33. Support for RFP Review – All Grants

34. Advanced Health Equity Strategies

35. Advanced Health Equity Strategies

36. Questions

37. Thank You • J. (Chip) Allen, MPH • Health Equity Director • Ohio Department of Health • chip.allen@odh.ohio.gov • Steven Owens, MD MPH • Directors of Health Promotion and Education • Director of Health Equity • sowens@dhpe.org