Torrie T. Harris, Dr.P.H., MPHDirector, Office of Health Equity

KY Dept. for Public Health

ObjectivesDefine health equity and health disparities.Define and identify social determinants of health.Discuss the Health and Human Services Action Plan

to Reduce Racial and Ethnic Health Disparities. Discuss principles of the National Stakeholder

Strategy for Achieving Health Equity.Discuss the Kentucky Office of Health Equity (OHE).Describe OHE’s activities towards achieving health

equity as model for public health practice.

DefinitionsHealth Equity

When all people have “the opportunity to attain their full health potential and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance.”

DefinitionsHealth Disparity

A type of difference in health that is closely linked to social or economic disadvantage. Health disparities negatively affect groups of people who have systematically experienced greater social or economic obstacles to health. These obstacles stem from characteristics historically linked to discrimination or exclusion such as race or ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, or geographic location, or cognitive, sensory or physical ability.

DefinitionsHealth Inequality

Differences, variations, and disparities in the health achievements of individuals and groups of people.

Health InequityA difference in disparity in health outcomes that

is systematic, avoidable, and unjust.

Social Determinants of Health According to the World Health Organization,

(WHO) the social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system.

These circumstances are shaped by the distribution of money, power, and resources.

Addressing Health Disparities and the Affordable Care Act (Health Reform)

Aligned with the Affordable Care Act: Data Collection

Directs new Assist. Sec of Health Information to Set standards for data collection Coordinate analysis of data on health disparities with HHS

Language Access and Cultural Competence Qualified health plans have appropriate communication and services Test models and curricula that train health professionals Require a study on how Medicare can reimburse health professionals

providing language services and create a 3 yr grant program to test Extend matching rates for states that provide language services to

for Medicaid beneficiaries not just children. Workforce Diversity

Permanent advisory committee Increase funding and scholarships for disadvantaged students, with

special consideration to institutions with a track record of training individuals from minority communities

Office of Minority Health, US Dept. of Health and Human Services: Action Plan to Reduce Racial

and Ethnic Health Disparities“A nation free of disparities in health and health

care.”HHS Strategic Plan for Fiscal Year (FY) 2010-2015

Transform health care;Strengthen the nation’s Health and Human Services

infrastructure and workforce.Advance the health, safety, and well-being of the

American people;Advance scientific knowledge and innovation;Increase the efficiency, transparency, and

accountability of HHS programs.

HHS Initiatives to Reduce Health DisparitiesHealthy People 2020Let’s MoveStrategic Action Plan to End the Tobacco

Epidemic Efforts to Reduce Disparities in Influenza

VaccinationInteragency Working Group on

Environmental Justice

National Partnership for Action: Strategies for Achieving Health Equity

Awareness: Increase significance of health disparities, their impact on the nation, and actions necessary to improve health outcomes.

Leadership: Strengthen and broaden leadership for addressing health disparities at all levels.

Health and Health System Experience: Improve health and healthcare outcomes for racial and ethnic minorities and for underserved communities.

Cultural and Linguistic Competency: Improve competency.

Research and Evaluation: Improve coordination and utilization of research and evaluation outcomes.

A Practical Context for Change National Partnership for Action (NPA): National

Stakeholder Strategy: promotes systematic and systemic change that improves the overall health of the nation.

Action Plan responds to the voices of thousands of leaders who called for actions to effectively and efficiently address health and healthcare disparities.

Action Plan is also based on Congressional language which called for a national strategy that is implemented and monitored in partnership with state and local governments, communities and the private sector.

KY Office of Health Equity Established in Fall 2008Funded by the U.S. DHHS, Office of Minority

Health and the KY Dept. for Public Health, REACH US, and Cervical Cancer Free KY

Overarching Goals:To eliminate health disparities among racial

and ethnic minorities, rural and low income populations in the state of KY.

To promote health equity in the state of KY.

Statewide Plans to Reduce Health Disparities as of 2005

Source: National Conference of State Legislatures.The Office of Minority Health.Health Disparities Plan, January 2009.

Kentucky Health Disparities: Infant Mortality Rates* by Race; Kentucky 1993, & 2000-2006

6.3 6.3

14.1

7.16.3 6.66.6

5.6

7.4

15.114.714.8

11.7

10.5

1314.1

7.6

6.86.86.87.25.9

6.78

0

2

4

6

8

10

12

14

16

1993 2000 2001 2002 2003 2004 2005 2006

Rat

e pe

r 1,

000

Liv

e B

irth

s

White

African Am.

Total

Health Disparities in the Leading Causes of Death in Kentucky 2005

Age-Adjusted Rate per 100,000 Population

White African-American

Heart Disease 321.5

Heart Disease 382.8

Cancer (all sites) 213.82

Cancer (all sites) 244.13

Stroke 50.0

Stroke 69.0

Diabetes 26.1

Diabetes 51.8

Achieving Health Equity

KY Office of Health Equity Goals and Strategies

Awareness: Increase the awareness of the significance of health disparities, their impact on the nation, and the actions necessary to improve health outcomes of racial, ethnic, and underserved populations.

National Partnership for Action (NPA)

KY Office of Health Equity

Healthcare Agenda KY Dept. for Public Health Strategic Planning

Partnerships •Promoting Health Equity Project •KY Migrant Network Coalition

•National Rural Health Association •Kentucky State University•Human Rights Commission

•Kentucky Cancer Consortium Steering Committee

Media •Newspaper Articles• Television Spots

•Kentucky Entertainment Television

Communication •Racial and Ethnic Approaches to Health (REACH) Breast and

•Cervical Cancer Project, Cervical Cancer Free KY Project,

•Preconception Care Project

Kentucky Department for Public HealthStrategic Map: 2011- 2016

Mission: Prevent, promote and protect to improve the health and

safety of people in Kentucky.

Vision: Healthier People …. Healthier Communities.

1

2

3

4

6

5

Improve the Health of DisparatePopulations

Implement a Department-wide

Performance Manage-ment System

Promote EffectiveUse of Technology &

Information Exchange

Develop & ImplementA Focused Healthy

Kentuckians 2020/SHIPPlan

Develop & EnhanceRelationships

with Key Partners

Support Evidence-Based and Promising

Practices

Support Public Health

Population-Based Practice & Research

Strengthen Internal& External

Communications

Implement a Culture of Customer Service/Satisfaction

Attain and SustainPHAB Accreditation

Promote Best PracticesThat Support Healthy

Communities &Individuals

Cultivate a PositiveWork Environment

& a SatisfiedWorkforce

Implement SoundFinancial &

Business Practices

Attract & Retain a

Competent & DiverseWorkforce

Implement a QualityImprovement Plan

& Curriculum

P

People

Q OE

QualityImproved Outcomes

Efficiency & Effectiveness

11/4/2011 RevisionFollowing 11-4-11Executive Staff Meeting

Leadership: Strengthen and broaden leadership for addressing health disparities at all levels.

NPA KY Office of Health Equity

Capacity Building •State Accreditation Advisory Committee

•Obtained Administrative Order to establish Office in organization

structure•Pursing Executive Order &

Legislation to mandate funding•Governor’s Office of Minority

Empowerment •Foundation for a Healthy Kentucky

Funding Priorities •Secured Funding from Public Health Commissioner $ 200k

•Regional Health Equity Council

Youth University of Kentucky, Student National Medical Association and

Multicultural Affairs Student Office

Health and Health System Experience: Improve health and healthcare outcomes for racial and ethnic minorities and for underserved communities.

NPA KY Office of Health Equity

Access to care •Health People/Healthy Kentuckians State Coordinators

•KY Health Literacy Steering Committee

•Hispanic Diabetes Health Education Program

•Social Determinants of Health Workgroup

Children

Older Adults

Health Communication

Education

Social and Economic Conditions

Cultural and Linguistic Competency: Improve cultural and linguistic competency and the diversity of the health-related workforce.

NPA KY Office of Health Equity

Workforce •Developed Infrastructure study to assess level of competency and compliance with

the Civil Right Acts at the local health department level.

•Developed training program to develop and support public health practitioners at

the state and local level •Hired a Cultural and Linguistic

Competency Coordinator

Diversity •Developed Health Equity Fellowship for MPH students

•Mentor Preventive Medicine Residents•Serve as Practicum Advisor

•Serve as Capstone/Dissertation Committee Member

•Teach graduate level students Public Health Practice and Management

Ethics and Standards, and Financing for Interpreting and Translational Services

•Evaluating Language Access programs on the state level

•Developing Performance Management and Improvement project across state

public health Divisions

Research and Evaluation: Improve coordination and utilization of research and evaluation outcomes

NPA KY Office of Health Equity

Data •First Comprehensive KY Minority Health Status Report

•Sponsored and Funded BRFSS oversampling of minority populations in

KY•Lesbian, Gay. Bisexual, Transgender Pilot

Study•Community Health Assessments

Coordination of Research •Conducted infant mortality social determinants study with Louisville Metro

Health and Wellness and Center for Health Equity

•Practice Based Research Supplement Grant with Robert Wood Johnson

Foundation •Hired Health Equity Epidemiologist

Knowledge Transfer •Hosted Health Equity Summit•Tri-State Diversity Conference

•Academy Health, Health Disparities Workgroup

•Journal Publications•Conference Presentations•Speaking Engagements

Lessons LearnedStrategic Planning is key: Be a visionary !Align goals and strategies with local, state, and

national priorities.Collaborate and partner with those that share the

same goals and strategies.Recruit people with a passion and interest in goals

and strategies and who can produce.Cast away self interests and egos and remember the

cause. Integrate goals and strategies into organizational

vision, mission, and strategies.Network, network, network. Remember that health equity is a movement not a

one-time program.