2011 National HIV Prevention Conference. Plenaries. Wednesday.

1. In Pursuit of Health Equity
A Broader Perspective Inclusive of the HIV/AIDS Epidemic
August 17, 2011
National HIV Prevention Conference
Atlanta, GA
Johnnie (Chip) Allen, MPH
Health Equity Coordinator
Ohio Department of Health

2. Presentation Goals
• Achieve a common understanding of health equity
terms.
• Importance of Syndemic Orientation
• Practical considerations for Transforming
Information to Action.

3. Health Equity Office
• Ohio Department of Health—1,300 Employees.
• 70% of all funding is from federal sources.
• Created in December 2008.
• Enterprise/Agency Coordination of all Health Equity Activities.
• Two (2) FTEs----Major emphasis on policy and implementation
of innovative strategies.

4. What’s is the importance of a name?
• Health disparities, health inequality, health inequities, health
equity, social determinants.
• Do these terms mean the same thing?
• Understanding the relation/differences in these terms are
crucial for a proactive response.

5. “Health disparities are differences in health outcomes and their
determinants between segments of the population, as defined by
social, demographic, environmental, and geographic attributes.”
“Health inequalities, which is sometimes used interchangeably
with the term health disparities, refers to summary measures of
population health associated with individual- or group-specific
attributes (e.g., income, education, or race/ethnicity).”
“Health inequities are a subset of health inequalities that are
modifiable, associated with social disadvantage, and considered
ethically unfair.”

6. Definition of Health Equity
“Health equity is when everyone has 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.”

7. Where does HIV/AIDS Fit within the Health Equity Discussion?
Coronary heart disease and stroke are not only leading causes of
death in the United States, but also account for the largest
proportion of inequality in life expectancy between whites and
blacks……………
Despite overall declines in cigarette smoking, disparities in
smoking rates persist among certain racial/ethnic minority groups,
Large disparities in infant mortality rates persist. Infants born to
particularly among American Indians/Alaska Natives. Smoking
black women are 1.5 to 3 times more likely to die than infants born
rates decline significantly with increasing income and educational
to women of other races/ethnicities.
attainment.

8. Where does HIV/AIDS Fit within the Health Equity Discussion?
● Health care quality and access are suboptimal, especially
for minority and low-income groups.
● Quality is improving; access and disparities are not
improving.
● Urgent attention is warranted:
• Cancer screening and management of diabetes.
• States in the central part of the country.
• Residents of inner-city and rural areas.
• Disparities in preventive services and access to care.

9. Root Causes of Misunderstanding
• Misunderstanding of Social Determinants of Health
• Lack of Awareness of SDoH Data-Sets
• Understanding context in which behaviors occur.
• Inexperience of combining different data-sets for 3D picture.

10. Overcoming Challenges in Understanding SDoH
• “Health occurs where we live, work and play” (RWJF)
• What data sources should be used?

11. A Step in the Right Direction
• Health Equity is at the core of this plan.
• Importance of Syndemic Orientation of Health Systems.
• A syndemic orientation is defined as a way of thinking about
public health work that focuses on connections among health-
related problems, considers those connections when
developing health policies, and aligns with other avenues of
social change to ensure the conditions in which all people can
be health.

12. A Step in the Right Direction

13. A Different Way of Understanding/Responding to SDOH
Atlanta, Georgia

14. Atlanta, Georgia
2010 Pop 25+, Some High School, No Diploma

15. Atlanta, Georgia
2010 Pop 25+, Some High School, No Diploma
African American Males Ages 15-34 years

16. Atlanta, Georgia
2010 Pop 25+, Some High School, No Diploma
African American Males Ages 15-34 years
A Closer Look at SDoH in Census Block Group 13210086021

17. Atlanta, Georgia
A Closer Look at SDoH in Census Block Group 13210086021
RACE ETHNICITY
• Population : 5,081 • Hispanic Population: 155
• 96% Black
• 1.0 White • Mexican 89
• 0.06 Asian • Puerto Rican 10
• 0.43 Some Other Race Alone • Cuban 17
• 1.0 Two or More Races • All Other Hispanic/Latino 39

18. Atlanta, Georgia
A Closer Look at SDoH in Census Block Group 13210086021
• 10% Less than 9th Grade Education
• 27% Some High School, No Diploma
• 52% of Households have No Vehicle.
• 1,108 Families live in Poverty
• 52% Families Below Poverty with Children
Population Age 16+ Employment Status
• 39% Employed
• 11% Unemployed
• 49% Not in Labor Force

19. 2010 Pop 25+, Some High School, No Diploma
African American Males Ages 15-34 years
Census Block Group 13210007001

20. Atlanta, Georgia
2010 Pop 25+, Some High School, No Diploma
Hispanic/Latino Males Ages 15-34 years
A Closer Look at SDoH in Census Block Group 13210074001

21. Atlanta, Georgia
Target Audience: Latino Males 15-34 Years
A Closer Look at SDoH in Census Block Group 131210074001
• 3,314 in the population
• 30% White
• 7% Black
• 25% Asian
• 24% Some Other Race
• 34% Speak Spanish at Home
• 18% Speak Asian/Pacific Islander Language at Home
• Pop 25 + (Latino), Population of 1,008
• 56% Less than a 9th Grade Education
• 22% Some High School, No Diploma
• 18 % High School of GED
• 1.5 % Some College, No Degree

22. Atlanta, Georgia
Target Audience: Latino Males 15-34 Years
A Closer Look at SDoH in Census Block Group 131210074001
• Median Household Income is $33K
• Average Household Size: 4
• 607 live in Poverty
Persons 16 + Employment Status
• 60% Employed
• 7% Unemployed
• 32 % Not in the labor force.
• 36% Work in construction.

23. Now you have the capacity to:
• Measure absolute and relative health disparities
• Identify Data Sources
• Map social determinants of health
• Articulate health inequalities in new ways.
So What!

24. Compelling Decision-Makers to Act on SDoH Data
• 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.

25. Actual RFP Language
Statement of Intent to Pursue Health Equity Strategies
• Explain the extent in which health disparities are manifested
within the health focus of this application.
• Identify specific group(s) who experience a disproportionate
burden for the disease or health condition addressed by this
application.
• Identify specific (social determinants)
• Statement s must be supported by data.

26. Program Narrative
Problem/Need Statement
Actual RFP Language
Explicitly describe segments of the target population
who experience a disproportionate burden of the local
health status concern (this information must correlate
with the Statement of Intent to Pursue Health Equity
Strategies.)

27. • Having policy statements for the pursuit of health equity is not
enough!
• Must develop tools to comprehensively monitor and evaluate a
response to Health Disparities and Health Inequities.
• Need political capital to do the first two statements.

28. Program Management Using SPES
Roles
External User
Example Organization with • Consistent processes and workflow with
Internal User User-Defined Roles user customization.
Program • Continuous improvement of project
Supervisor / OH effectiveness due to quality management
Consultant features
Local Project • Sharing of Project success stories and
Manager lessons learned supports a continuous
learning organization
Dept. X ODH
• Management by fact – All levels see same
real-time view of project status
Division A Prevention • Data model and security roles allow
information sharing that is controlled by
each organization.
• S.M.A.R.T objectives and results provide
Bureau I Bureau II BHPRR quantitative measures of success
• Crystal Reports allows ad hoc reports
across projects
Program X Program Y • GIS identifies location of activities within
CVH TOB
legislative districts
Project 1 Project 2 Project 3 Project 5
Project 4 Project 6

29. Thank you for listening!