Moving to Create Health Moving to Create Health Equity; The Louisville Equity; The Louisville

ExperienceExperienceAdewaleAdewale Troutman, MD, MPH, MA, CPHTroutman, MD, MPH, MA, CPHUniversity of South FloridaUniversity of South FloridaCollege College fofo Public HealthPublic Health

My StoryMy Story

How you frame an issueHow you frame an issue

�� The questions you askThe questions you ask

�� Determines your analysis of the issueDetermines your analysis of the issue

�� Determines how you prioritize itDetermines how you prioritize it

�� Determines your policy choicesDetermines your policy choices

�� Determines resource allocationDetermines resource allocation

�� Can determine your allies and your enemiesCan determine your allies and your enemies

�� Can define when an issue has been resolvedCan define when an issue has been resolved

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Reframing Reframing

�� Health vs. HealthcareHealth vs. Healthcare

�� Individual vs. Population HealthIndividual vs. Population Health

�� Market Justice vs. Social JusticeMarket Justice vs. Social Justice

�� Rights vs. Privileges Rights vs. Privileges

�� Biological/Behavioral Determinants vs. Social Biological/Behavioral Determinants vs. Social DeterminantsDeterminants

�� Creating Health Equity vs. eliminating Health Creating Health Equity vs. eliminating Health DisparitiesDisparities

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Leadership BuyLeadership Buy--InIn

Dr. AdewaleTroutman, DirectorLouisville Metro Department of Public Health &

Wellness

Center for Health EquityCenter for Health Equity

CHE works to serve as a catalyst for change through capacity building, policy change & evidenced-based initiatives.

The Center for Health EquityThe Center for Health Equity

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The CHE is dedicated to The CHE is dedicated to a civic process a civic process that builds social engagement,that builds social engagement, autonomy autonomy

and movement to and movement to strengthen strengthen communities and influence public policy communities and influence public policy

in an effort to Create Health Equityin an effort to Create Health Equity

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Current WorkCurrent Work

�� Framing researchFraming research

�� Health Equity Community Hearings Health Equity Community Hearings

�� Civic capacity building mini grantsCivic capacity building mini grants

�� Health Equity Speaker SeriesHealth Equity Speaker Series

�� Web based learningWeb based learning

�� Retraining workforce Retraining workforce ( Dialogue process )( Dialogue process )�� Outreach workers as community organizersOutreach workers as community organizers

�� Undoing Racism workshops ( community wide)Undoing Racism workshops ( community wide)

�� Health Equity SummitHealth Equity Summit

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Current Work ( Cont )Current Work ( Cont )

�� Photo voicePhoto voice

�� Community dialogues/Unnatural CausesCommunity dialogues/Unnatural Causes

�� OperationalizingOperationalizing Health Equity within the departmentHealth Equity within the department

�� CHI projectCHI project

�� HIAHIA--Shepard Square ( Hope 6 )Shepard Square ( Hope 6 )

�� The cabinet dialogueThe cabinet dialogue

�� Food justice/Food security task forceFood justice/Food security task force

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Current Work ( Cont )Current Work ( Cont )

�� Kellogg grantKellogg grant--Racial HealingRacial Healing

�� West End Visioning ProcessWest End Visioning Process

Health in All Policies Health in All Policies addresses the effects on health addresses the effects on health

across all policies such as across all policies such as agriculture, education, the agriculture, education, the environment, fiscal policies, housing, and transportenvironment, fiscal policies, housing, and transport. It seeks . It seeks to improve health and at the same time contribute to the to improve health and at the same time contribute to the wellwell--being and the wealth of the nations through being and the wealth of the nations through structures, mechanisms and actions structures, mechanisms and actions planned and planned and managed mainly by sectors other than health. Thus managed mainly by sectors other than health. Thus HiAPHiAPis not confined to the health sector is not confined to the health sector and to the public health and to the public health community, but is a complementary strategy with a high community, but is a complementary strategy with a high potential towards improving a populationpotential towards improving a population’’s health, with s health, with health determinants as the bridge between policies and health determinants as the bridge between policies and

health outcomes. health outcomes.

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Health Impact AssessmentHealth Impact Assessment

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Health Impact Assessment (HIA)

A combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population (Gothenburg consensus statement, 1999)

Food access and food justiceFood access and food justice

Phyllis Wheatley Students Phyllis Wheatley Students presentpresentPhotoPhoto--voice Exhibits voice Exhibits on on Health Policy IssuesHealth Policy IssuesYouth InvolvementYouth Involvement

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Photo VoicePhoto Voice

�� Youth empowerment through engagementYouth empowerment through engagement

�� Community health and barriersCommunity health and barriers

�� Youth as creators, producers, interpretersYouth as creators, producers, interpreters

�� Raise awareness about the policy processRaise awareness about the policy process

�� Presentation to policy makers ( Mayor Metro Presentation to policy makers ( Mayor Metro Council, Board of Health, Business CommunityCouncil, Board of Health, Business Community

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Every day I go to the community center on the side of it, they Every day I go to the community center on the side of it, they are selling drugs or showing off their guns and sometimes I are selling drugs or showing off their guns and sometimes I

am scared to walk pass because I think they will shoot me. am scared to walk pass because I think they will shoot me. Michael: age 10Michael: age 10

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Health Equity & Public Health Health Equity & Public Health

Practice Practice �� A A Health Equity Orientation Health Equity Orientation is is concerned the societal reasons concerned the societal reasons for the persistence of health for the persistence of health inequities.inequities.

�� It is a distinct It is a distinct ethical & ethical & decision making perspective decision making perspective that should directly affect that should directly affect Public Health Public Health POLICY, POLICY, PRACTICE & CULTURE PRACTICE & CULTURE

�� ConventionalConventional-- What social programs What social programs and services are needed to address and services are needed to address poor health outcomes?poor health outcomes?

��Health equityHealth equity -- What types of What types of institutionalinstitutional and social changes are and social changes are necessary to prevent poor health necessary to prevent poor health outcomes?outcomes?

Changing the QuestionChanging the Question

Changing the ModelChanging the Model

Traditional Equity

Focus

Surveillance, promoting healthy

behaviors & treating diseases

Societal systems, policies & practices.

GoalGoal:: OperationalizeOperationalizehealth equity within health equity within the Dept. of Public the Dept. of Public Health &Wellness by Health &Wellness by engaging engaging all staff all staff in in developing strategies developing strategies to address health to address health

inequities.inequities.

The Essence of The Essence of A Learning A Learning

OrganizationOrganization

�� ““…… where people continually expand their where people continually expand their capacity to create the results they truly desire, capacity to create the results they truly desire, where new and expansive patterns of where new and expansive patterns of thinking are nurtured, where collective thinking are nurtured, where collective aspiration is set free, aspiration is set free, and and where people are where people are

continually learning how to learn togethercontinually learning how to learn together””

-- Peter Senge, 1990

The CHALLENGE:The CHALLENGE:

�� How do we How do we infuse health equity infuse health equity intointoeveryday work & practice?everyday work & practice?

Leadership Personal Leadership Personal Characteristics for ChangeCharacteristics for Change

•• Knowledge base re health inequitiesKnowledge base re health inequities

•• Empowering management styleEmpowering management style

•• Encouraging risk takingEncouraging risk taking

•• InnovatorInnovator

•• Self confidentSelf confident

•• Understanding the dynamics of changeUnderstanding the dynamics of change

•• Uniqueness of the problemUniqueness of the problem

•• Seeing cultural competence as a processSeeing cultural competence as a process

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More personal More personal characteristics characteristics

�� Ability to reframe the issueAbility to reframe the issue

�� Dialogue or didacticDialogue or didactic

�� Challenging the status quoChallenging the status quo

�� Knowledge of the empowerment processKnowledge of the empowerment process

�� ““takintakin it to the streetsit to the streets””

�� Social justice, human rights or Social justice, human rights or ““market justicemarket justice””

�� ““Culturally CompetentCulturally Competent”” organizationorganization

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Slide 33

1 Adewale Troutman, 1/24/2011

2 Adewale Troutman, 1/24/2011