Healthy People (HP) 2010 Disparity Elimination Goals: Case Studies of State Efforts

1. Healthy People (HP) 2010 Disparity Elimination Goals: Case Studies of State Efforts June 28, 2009 AcademyHealth Annual Research Meeting, Chicago, Illinois Marsha Gold, Sc.D., and the MPR Research Team

2. National Goals but Decentralized Interpretation and Execution • HP 2010 set eliminating health disparities as one of two overarching national goals, along with increasing quality and years of healthy life. • However, public health authority and activity rests heavily at the state and local levels, and public and private sectors are involved. • What can we learn about the state role and what it means for disparities reduction?

3. Basis of Presentation • Study funded by Robert Wood Johnson Foundation through Health Care Financing and Organization • Two-part study: (1) national inventory of capacity to measure disparities on leading health indicators at the state and local level and (2) case studies of relevant initiatives in North Carolina and Washington state

4. Determinants of Effective Prevention Policy* • Political will: Public’s understanding and support, with development of public/private consensus • Knowledge base: Data to identify priorities and develop solutions • Social strategy: Plan for applying knowledge base and political will to generate improvements * Source: Richmond and Kotelchuk in Oxford Textbook on Public Health 1991.

5. National Perspective: How Well Can States Identify Disparities? • Depends on shared federal/state data sources and what they capture • Behavioral Risk Factor Surveillance System, Youth Risk Behavioral Surveillance System, National Vital and Health Statistics System • Aggregate state estimates available for 24 of 26 Leading Health Indicators (LHIs) though definitions sometimes differ • Estimates often not available for many relevant subgroups or subjurisdictions • Timeliness, power, and effective state use of data also an issue

6. State/Local Disparities Initiatives • Environmental scan shows most state efforts are still in their “infancy.” • States employ diverse strategies and modify national goals in light of state or local priorities. • Two mid-size states in the forefront of work were selected for case studies using documents and telephone interviews with staff and involved stakeholders.

7. Two Case Studies • North Carolina: Underway since 1990s; based on empowering communities to identify disparities and address them, with public health officials forming community coalitions • Washington state: Still in planning stage with a statewide emphasis on identifying priorities under the leadership of the Governor’s Interagency Council

8. North Carolina • Led by Governor’s Task Force on Healthy Carolinians and supported by Democrats/Republicans • Broad-based multi-stakeholder involvement—state and localities • 100 local partnerships drive planning and execution with centralized technical assistance, but no common pool of funds

9. North Carolina (cont’d.) • Mandated community assessments fill data gaps. • State has diverse county-based priorities and actions (coalitions are easier than cohesive actions; not all coalitions focus on race/ethnic disparities). • Healthy Carolinians viewed as “jewel in crown” of North Carolina’s public health system.

10. Washington State • Interagency Council was formed to identify action plan to reduce disparities. • State agencies and minority commissions were included, with input from community meetings/surveys. • Focus on identifying five priorities through a quantitative assessment comparing magnitude and impact of various options. Initial results differed from drivers of action, which were modified. • Framework emphasizes social determinants, but Council found it hard to apply.

11. Cross-Cutting Lessons • Engaging multiple stakeholders (inside and outside of government) is key to political support. • Data gaps are an issue, though states and counties have developed workarounds. • Evidence-based action is impeded by limited information on effective strategies to eliminate disparities. • Creative interventions are still needed.

12. Broader Insights • HP 2010 can serve as a catalyst for state and local champions for acting on disparities. • State structures for proceeding will reflect unique features of state environment (e.g., North Carolina’s strong county-based system). • There is limited centralized information within states to understand history and status of initiatives or to track activity/results.

13. Enhancing State/Local Efforts to Eliminate Disparities • More case studies documenting efforts • Vehicles for states to share lessons • Tool kits for technical challenges: building coalition infrastructure, developing data, return on investment (ROI) • Research on what makes for effective interventions; areas with greatest payoff • Resources: staff and money

14. Where to Find More Information • Gold, M., A. Hedley-Dodd, and M. Neuman. “Availability of Data to Measure Disparities in Leading Health Indicators at the State and Local Levels.” Journal of Public Health Management Practice, 2008, pp. S36-44. • Conwell, L., M. Neuman, and M. Gold. “State Efforts to Address Healthy People 2010 Goal to Eliminate Health Disparities: Two Case Studies.” September 2008. Available at [www.mathematica-mpr.com].