Health Equity in Action: What It Means for One Foundation

1. Health Equity in Action:What It Means for One Foundation Susan G. Zepeda, Ph.D. March 2014

2. Foundation for a Healthy Kentucky Our mission is to address the unmet health care needs of Kentuckians. We work towards our mission by • Improving access to care • Reducing health risks and disparities • Promotinghealth equity

3. Foundation for a Healthy Kentucky We: • Make grants • Support and disseminate research • Hold educational forums • Convene communities

4. Foundation for a Healthy Kentucky • Promoting Responsive Health Policy • Increasing access to integrated quality care • Supporting children’s health • Increasing KYians in smoke-free communities • Strengthening local public health • Investing in Kentucky’s Future • 7 community coalitions; 5 year commitment • Strengthening Communities • Social Innovation Fund • Matching Grants • Challenge Grants • Conference Support

5. What is Health Equity? “Health equity is achieving the highest level of health for all people. Health equity entails focused societal efforts to address avoidable inequalities by equalizing the conditions for health for all groups, especially for those who have experienced socioeconomic disadvantage or historical injustices.” (Healthy People 2020)

6. Health Equity • Inequities exist across many dimensions: • Race • Income • Gender • Rural versus urban • Education level • Ethnicity • Immigration status • Sexual orientation • Social connectedness • Other factors • These factors all interact

7. How do we know there’s inequity? We look for: • Inequalities • Disparities ACA requires all federally-funded programs and surveys to collect data on race, sex, ethnicity, language, and disability status

8. How do we know there’s inequity? Health inequalities and disparities are differences among specific population groups, including racial and ethnic minority groups in: • occurrence, • frequency, • death, and burden of diseases • other unfavorable health conditions • Source: HHS

9. How do we know there’s inequity? Inequities are basically disparities that are • Preventable • UNFAIR Decreasing disparities is part of working towards health equity, but it is not enough

11. Two Steps Back to Prevention Population-level Individual-level Health Outcomes Approach adapted from Prevention Institute

12. How do we do our work “through an equity lens?” Through work on population health, primary prevention, and policy-level changes, communities move toward equity

13. How do we do our work “through a health equity lens”?

14. Equality is NOT Equity This is Equality This is Equity

15. What Health Equity Means to Kentucky Where you live, work, play, and learn matters when it comes to health

16. What Kentucky looks like… 36% of KY counties are among America’s “persistent poverty counties” More than 20% of residents living in poverty for > 30 years USDA Economic Research Service Study in contrasts: Oldham County Owsley County High school grads 91% 56% Per cap income $34,731 $11,706 Tooth loss 6+ 15% 42% Violent crime 21.8 231.3 Per 100,000 Cancer Deaths 186 270 Per 100,000

17. What Kentucky looks like… 3 Largest Kentucky Race / Ethnic Groups Racial Identity: • White population is 3,745,655 persons - 86.3%. • Black population is 333,075 persons -7.7%. Ethnic Identity: • Hispanic population is 132,836 persons -3.1%. Urban/Rural 58.4% of Kyians live in the State’s 1,411 urban sq miles 41.6% of Kyians live in the State’s 39,486 rural sq. miles • Source: US Census Bureau -Census 2010

18. Walking our Talk How do we do our work “through a health equity lens?” What changes in our: • Grantmaking? • Polling? • Research? • Training/educational forums? • Community convenings?

19. Doing our Grantmaking through a Health Equity Lens • Learning from our mistakes • Getting our Board and Community Advisory Committee (CAC) on Board

20. Learning from our mistakes • Requiring rigorous evaluation design of applicants coaching/TA on evaluation after selection • Universities community-based organizations • One year grants Multi year support • Tidy measurable objectives policy change; collective impact • 0 to 60 in one year planning precedes implementation • Bright idea business plan sustainability • Strength of PI strength of cross-sectoral collaboration • Who’s at the table? • What are their roles and responsibilities?

21. Talking to your board • Start where they are, with who they are • Clinical and administrative, outpatient and hospital providers • Business men and women • Public health workers • Frame the conversation • Various frames shown earlier • Engage their input • CAC discussion – multiple meetings • Program Development and Oversight Committee – 9 month study

22. What Health Equity Means to Kentucky Where you live, work, play, and learn matters when it comes to health

23. Health Equity and Policy • All types of policies  health • Policies can: • make inequities worse, • maintain the status quo, • help correct inequity Policies informed by equity address the causesof health and disease, not just the outcomes

24. Ideas… Upstream, Mid- and Down Agree on goals/aims - differ on approaches, to accommodate differing population or community needs. Downstream - • Track demographic data to spot health disparities • Build the healthcare workforce, change delivery strategies to increase care access • Care navigators • Mobile dental, other clinics • Dental hygienists • Telemedicine

25. Ideas…Upstream, Mid - and Down • Midstream – • “Behavioral Economics” – Financial incentives for desired performance (eg. premium reductions for folks who maintain positive health behaviors) • Partner with education to enroll eligible children in needed services • Upstream – • Place-based strategies • Policy and systems change • Cross-sectoral collaboration To reduce exposure to health risks, support healthy behaviors Promote safe neighborhoods Promote healthy food, physical activity

26. Where we haven’t gone… Equity by the numbers: % of Foundation dollars provided to – • Poorest communities • Women- and minority-run organizations • Grantees with “majority minority” boards

27. Where we do go…. • Mapping where the grants go • Assessing the impacts of our work • Breaking down barriers to participation • Continuous feedback loop learning as we go

28. Thank you Questions? Email: szepeda@healthy-ky.org