Culture of Health Institute for Leadership Development Online Training Resource Guide

Essential Tools for Health Equity Practice Course Description Health equity is a value, process, practice, and outcome.1 As health equity field-building efforts deepen and expand, practitioners face the task of transforming the conceptual to the practical. Given this, how can health equity be operationalized? What does it look like in practice? And what are the core tools for pursuing health equity? This training addresses such key questions by describing process-based tools and interventions for applying a health equity lens. In this session, participants will explore different tools that can be used by individuals, organizations, and partnerships to ensure that their strategies are addressing the root causes of health inequity, deepening community engagement and partnerships, and targeting structural change. Learning Outcomes By the end of this module, participants will be able to:

• Articulate a framework for operationalizing health equity, • Distinguish strategies for process-based interventions to shift practice including

organizational change tools to institutionalize equity within your organization, and • Identify tools that support strategies for operationalizing health equity.

1. Rockeymoore, Maya. 2017. Equity and the Culture of Health. Center for Global Policy Solutions (Unpublished Report).

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Essential Tools Resource Guide

Module Outline Unit 1: Health Equity

I. Defining health, disparities, inequities, and equity II. Health equity concepts and values

References and Suggested Readings

• Braveman, Paula. A., Shiriki Kumanyika, Jonathan Fielding, Thomas LaVeist, Luisa N. Borrell, Ron Manderscheid, and Adewale Troutman. 2011. Health Disparities And Health Equity: The Issue Is Justice. American Journal of Public Health 101(S1): S149-S155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222512/

• Brennan Ramirez Laura K., Elizabeth A., and Marilyn Metzler. 2008. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/sdoh-workbook.pdf

• Iton, Anthony, and Shrimali, Bina Patel. 2016. Power, Politics, And Health: A New Public Health Practice Targeting The Root Causes Of Health Equity. Maternal And Child Health Journal 20(8): 1753-1758.

• Solar, Orielle and Alec Irwin. 2010. A Conceptual Framework For Action On The Social Determinants Of Health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf

• National Association of County & City Officials. 2014. Expanding the Boundaries: Health Equity and Public Health Practice. https://nnphi.org/wp-content/uploads/2016/09/Expanding-the-Boundaries-Final_508-091814.pdf

OUTCOMES DECREASE IN

OVERALL NEGATIVE HEALTH

OUTCOMES

•  Fragmented Systems •  Powerlessness •  Disinvestment •  Disconnected

Members

•  Adverse Living Conditions

•  Unemployment •  Occupational Hazards •  Institutional Racism

COMMUNITY ASSETS

CONDITIONS

•  Smoking •  Depression •  Infant Mortality •  Malnutrition •  HIV/AIDS

•  Sense of Community •  Social Networks •  Social Support •  Participation •  Leadership •  Political Influence

•  Quality Schools •  Adequate Income •  Transportation

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Essential Tools Resource Guide

• National Association of County & City Officials. 2014. Exploring the Roots of Health Inequity: Essays for Reflection. https://nnphi.org/wp-content/uploads/2016/09/RootsOfInequity_final-091814_508.pdf

Unit 2: Operationalizing Health Equity

I. Health equity practice II. The concept of health equity tools III. Levels of change in practice IV. Frameworks for operationalizing health equity

References and Suggested Readings

• Ehlinger, E.P. 2015. We need a Triple Aim for Health Equity. Minnesota Medicine, October: 28-29.

Unit 3: Process interventions on orientation and practice

I. Getting started with assessment and planning II. Expanding the understanding of what creates health III. Building and supporting leadership and capacity IV. Advancing healthy policy and practice, targeting structural changes

PRACTICE AND TOOLS LIST

•  Frameworks for Health Equity •  Systems Mapping •  Root Cause Analysis •  Pathway Diagramming •  Reframing and Narrative Analysis

•  Intervention Planning Matrix •  Racial Equity Planning Tool •  Health in All Policies •  Health Impact Assessment

•  Stakeholder Analysis •  Community Organizing •  Power Mapping and Analysis

Implement Health in All

Policies

Expand Understanding

of Health

Strengthen Community

Capacity Adapted from the Minnesota Department of Health

Overview of Health Equity Practice: •  Inter/Intra Personal Change •  Organizational Change •  Inter-organizational change

Getting Started: •  Organizational and Community

Assessments

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Essential Tools Resource Guide

Reflection Questions Equity-Based Stakeholder Analysis

1. What is the capacity of our current team to represent the needs of those experiencing inequities (either through partnerships or direct experience)?

2. What values do we uphold as a leadership team to ensure equitable and meaningful participation of stakeholders?

3. What processes can we develop to regularly assess who else should be invited to help achieve our health equity goals?

4. What decision-making processes are we using and who actually has the opportunity to shape decisions using these processes?

Intervention Planning Matrix Analysis of Equity and Spheres of Influence

1. Are there communities experiencing inequities that need to be prioritized for efforts? 2. How is engagement and capacity building occurring with communities affected by

inequities to shape efforts in the short and long term? 3. How are coalitions and alliances fostered to build power and convening groups and

individuals for broader goals and impact? 4. How are structures, institutions, and policies that support/inhibit equity being

addressed? How are conditions of power being addressed? 5. How do the levels of influence interact to build healthy communities? 6. Is a health lens used to inform broad decision making and incorporated into narratives? 7. To what extent does cross sector collaboration occur (public, private, content specific)? 8. To what extent is a culture of health and equity supported?

Suggested Readings Organizational and Community Assessments

• Nelson, Julie, Lauren Spokane, Lauren Ross, and Nan Deng. 2015. Advancing Racial Equity and Transforming Government: A Resource Guide to Put Ideas into Action. Local and Regional Government Alliance on Race & Equity. http://www.racialequityalliance.org/wp-content/uploads/2015/02/GARE-Resource_Guide.pdf

• Nelson, Julie and Lisa Brooks. 2016. Racial Equity Toolkit: An Opportunity to Operationalize Equity. Local and Regional Government Alliance on Race & Equity. https://www.racialequityalliance.org/wp-content/uploads/2015/10/GARE-Racial_Equity_Toolkit.pdf

• Harris County Public Health. 2016. 5 Steps to Health Equity Transformation. • Health Resources and Services Administration, Region V Collaborative Improvement

and Innovation Network on Infant Mortality. 2016. Foundational Practices for Health Equity: A Learning and Action Tool for State Health Departments. http://www.health.state.mn.us/divs/opi/healthequity/resources/docs/DRAFT-Health-Equity-Learning-and-Action-Tool_HRSA-COIIN.pdf

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Essential Tools Resource Guide

• Bay Area Regional Health Inequities Initiative. 2010. Local Health Department Organizational Self-Assessment for Addressing Health Inequities Toolkit and implementation Guide. barhii.org/download/toolkit/self_assessment_toolkit.pdf

• Race to Equity. 2016. A Roadmap to Equity, A Two Generation Approach to Reducing Racial Disparities in Dane County. http://racetoequity.net/uploads/Roadmap-to-Equity.pdf

Expanding Understanding of Health

• Harris County Public Health. 2016. Moving Upstream: The State of Healthcare in Houston/Harris County and Its Response to Social Determinants. http://publichealth.harriscountytx.gov/About/Organization/OPP/Health-Equity

• King County. 2016. King County Equity and Social Justice Strategic Plan. http://your.kingcounty.gov/dnrp/library/dnrp-directors-office/equity-social-justice/201609-ESJ-SP-ACK-EX-SUM.pdf

• WHO Commission on Social Determinants of Health, & World Health Organization. 2008. Closing the gap in a generation: health equity through action on the social determinants of health: Commission on Social Determinants of Health final report. World Health Organization. http://apps.who.int/iris/bitstream/10665/43943/1/9789241563703_eng.pdf

• Becker, S. and Alexander, L. 2016. Understanding the Impacts of Incarceration on Health. ReThink Health. https://www.rethinkhealth.org/wp-content/uploads/2016/04/ReThink-Health-March-17-Report.pdf

Strengthening Community Capacity

• Centers for Disease Control and Prevention. 1997. Principles of Community Engagement. Atlanta, GA: CDC/ATSDR Committee on Community Engagement, 9. https://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf

• IOM. 2015. Organizing Around the Social Determinants of Health, Chapter 4: The Role and Potential of Communities in Population Health Improvement. from https://www.nap.edu/read/18946/chapter/5

• Mondros, Jacqueline B. and Scott Wilson. 1994. Community Psychology in Organizing for Power and Empowerment, p. 43–63. Columbia University Press.

• Schrantz, Doran M. 2012. Drawing On Community Organizing To Advance Public Health In Minnesota And Beyond. Health Affairs, 31(12): 2799-2800.

• Speer, Paul W., Eric A. Tesdahl, and Jeanne F. Ayers. 2014. Community Organizing Practices in A Globalizing Era: Building Power For Health Equity at The Community Level. Journal of Health Psychology, 19(1): 159-169. https://www.myctb.org/wst/CEJ/SiteAssets/Community%20organizing%20practices%20in%20a%20globalizing%20era.pdf

• Tesfai, Afomeia. 2015. Does Organizing Have a Place in Public Health? http://www.humanimpact.org/from-the-hip-blog/does-organizing-have-a-place-in-public-health/

• Wellstone. The Organizers Guide to the Galaxy: Strategic Planning. http://www.wellstone.org/resources/organizer%E2%80%99s-guide-galaxy-strategic-planning

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Essential Tools Resource Guide

• Zimmerman, Marc A. 2000. Empowerment Theory in Handbook of Community Psychology, p. 43-63.

Implementing Health in All Policies

• American Public Health Association. 2012. Promoting Health Impact Assessment to Achieve Health in All Policies. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/11/16/51/promoting-health-impact-assessment-to-achieve-health-in-all-policies

• Collins, J. and J.P. Koplan. 2009. Health Impact Assessment: A Step Towards Health In All Policies. JAMA 302(3): 315–317.

• Healthy Wisconsin Leadership Institute. Community Health Improvement Toolkit. http://www.hwli.org/chip-toolkit/

• Human Impact Partners and WISDOM. 2012. Healthier Lives, Stronger Families, Safer Communities: How Increasing Funding for Alternatives to Prison Will Save Lives and Money in Wisconsin. http://www.humanimpact.org/wp-content/uploads/documents/HIA-Policy/WI-Funding-Alternatives-to-Prison.pdf

• Rudolph, Linda, Julia Caplan, Karen Ben-Moshe, and Lianne Dillon. 2013. Health In All Policies: A Guide For State And Local Governments. Washington, DC and Oakland, CA: American Public Health Association and Public Health Institute. https://www.phi.org/uploads/files/Health_in_All_Policies-A_Guide_for_State_and_Local_Governments.pdf

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