Communities in Action Pathways to Health Equity (2017) / Chapter Skim
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8 Community Tools to Promote Health Equity
8 Community Tools to Promote Health Equity
Pages 447-502
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Third, widely available community toolboxes are summarized. Some of the tools shared in this chapter are explicitly designed to address social determinants of health, while others address the consequences of poor health outcomes, and some do both.
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adopting or developing logic models or theories of change; (4) using civil rights law to promote health equity; (5)
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One model that informs health care cost reduction allows the user to simulate outcomes across geographic areas across a host of factors, such as changes to health care delivery, health care payment (e.g., global payments with reinvested savings) , factors that influence healthier behaviors, some social determinants, and some socioeconomic factors.
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Disparities in education perpetuate disparities in income and health. What is the incentive -- the business case -- to improve education and training at individual, employer, and community levels?
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If these efforts around the social determinants of health
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When early intervention programs yield desired outcomes -- which means savings to the public down the line -- the programs pay their investors from public or foundation funds. These solutions are appealing in part as a mechanism for community-building, for reinvigorating local dialogue on the social determinants of health, and for leveraging private institution participation and promoting transparency and efficiency.
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Such data are critical to raising awareness to make health equity a shared vision and value, increasing a community's capacity to design community-based solutions and shape outcomes, and fostering multi-sector collaboration and evaluation of solutions. Data Sources Increasingly, there are sources of electronic data that are publicly available and can be used to examine issues related to health and health
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In other instances, data are available as files (e.g., the National Association of County and City Health Officials [NACCHO] National Profile of Local Health Departments)
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March Annual Social and Economic Supple ment. A public use data set for the CPS March Annual Social and Economic Supplement is available at https://www.census.gov/cps/data (accessed June 14, 2016)
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. A public use data set can be downloaded for free at http://www.samhsa.gov/data/population-data-nsduh/ reports (accessed June 18, 2016)
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Data from 2004, 2006, and 2009–2010 are based on a rolling stratified sample of approximately 7,000 districts and 70,000 schools, whereas 2000, 2011–2012, and 2013–2014 were based on data collected from all of the nation's school districts and schools, making them more useful for communities addressing education disparities. Available at http:// ocrdata.ed.gov (accessed June 18, 2016)
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social determinants of health, (2) making health equity a shared vision and value, (3)
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The National Equity Atlas8 characterizes diversity through the inclusion of a Diversity Index and a Culture of Health measure set that uses residential segregation. None of these indicators explicitly measure attitudes or beliefs related to health equity, which are central to making health equity a shared vision and value.
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The latter two are also present in several other data sources. Other aspects of community capacity building are leadership development, community organizing, organizational development, and fostering collaborative relations among organizations.
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. The Diversity Data Kids interactive tool includes early childhood education and provides rankings and child opportunities by race and ethnicity for states, counties, large cities, and large school districts (Brandeis University, n.d.)
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Community Health Status Indicators: http://wwwn.cdc.gov/CommunityHealth/ info/AboutProject (accessed June 30, 2016) Diversity Data Kids data set: http://www.diversitydatakids.org (accessed June 30, 2016)
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• In the short term there is a need to determine which existing indi cators are most relevant for measuring and monitoring progress toward making health equity a shared vision and value, developing community capacity to shape outcomes, and encouraging multi sector collaboration. • Other aspects of community capacity building, including leadership development, community organizing, organizational development, and fostering collaborative relations among organizations are addi tional areas for potential indicator development.
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Using Civil Rights Law to Promote Health Equity Civil rights laws can support community-based solutions to promote health equity and are an integral part of the culture of health in the United States. Chapter 6 contains a discussion on the broader context of using civil rights law to promote health equity, including background, the relationship to federal and state laws, and implementation of the
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(See below for a few civil rights law examples at the community level, and Box 8-4 provides an example from Baldwin Hills in Los Angeles County, California, of using the Clean Water Act for a civil rights, environmental justice, and health victory.) Civil rights laws offer tools that stakeholders working with public interest attorneys, public health professionals, community groups, government agencies, and recipients of federal, state, and local funds can use to promote health equity.
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SOURCE: Garcia and Sivasubramanian, 2012. Related Examples of Policies and Actions to Promote Health Equity Agencies can also promote health equity through broad-based, more equitable community engagement.
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The Los Angeles County Department of Public Health publishes a physical education model action plan (MAP) and a tool kit to support community action for compliance with physical education and civil rights requirements in public schools (LA County Department of Public Health, 2015)
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The California Education Code mandates that all public schools both provide physical education for students and assess students' physical fitness annually through the Fitnessgram standardized test. Yet many schools fail to meet physical education requirements, and less than half of all assessed students demonstrate full physical health.
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, Civil Rights Project website houses many resources, including community tools for education, transportation, and housing (UCLA, 2016)
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provide on-site services to the Salud Family Health Center in Commerce City and the Colorado Center for Refugee Health (University of Colorado Law School, n.d.)
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, resulting in multiple changes, including a community advisory board at the pediatric hospital and the establishment of a medical–legal partnership at a federally funded health care organization. Fifth, health care or legal professionals or both jointly advance changes to local, state, and federal policies and regulations to improve population health.
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Using Health Impact Assessments to Understand Policy Implications Health impact assessment (HIA) is a tool for analyzing the health effects of proposed programs, policies, and projects.
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The Douglas County Health Department led the HIA with its partners, the African American Empowerment Network and the North Omaha Neighborhood Alliance. They collected and analyzed data on health, demographics, food access, crime, traffic crashes, and land use; interviewed experts; and reviewed scientific research to understand how changes in Adams Park could impact health.
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of the housing component of the EHNP to inform future decisions made by Community Board 11, the EHNP Steering Committee, the Department of City Planning, and the City Council as specific proposals for zoning changes and new development emerge in East Harlem. Key findings of the HIA highlight social determinants of health and include • Health: higher rates of chronic disease than other Manhattan residents; the major health concerns identified by the community include hyperten sion, diabetes, asthma, infant mortality, mental health, and violence • Housing affordability and displacement: more than half of East Harlem residents are rent-burdened or severely rent-burdened; East Harlem is losing nearly 300 rent-controlled or rent-stabilized units each year • Mixed-income development and increased density: mixed-income devel opment could address health disparities through the provision of new, well-maintained housing which could offset the potential effects of in creased density • Increased commercial activity or manufacturing in the neighborhood: the great need for increased economic opportunity that would come from increased commercial activity is expected to counterbalance negative health outcomes; it could potentially have a positive effect through in crease in job opportunities and increased social cohesion
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Selected strategies to maximize health-promoting potential and reduce the potential health risks of the EHNP zoning and affordable housing recommenda tions include, among others: • Reduce the risk of displacement and provide new, affordable housing options for existing East Harlem residents by striving to include the 25 percent affordable housing set-aside at 60 percent Area Median Income (AMI) with 20 percent required at 40 percent AMI and the additional option of 20 percent units at 40 percent AMI in all developments.
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Many of the examples in Chapter 5 illustrate government as a source of funding for their initiatives. Both the Dudley Street Neighborhood Initiative and the Eastside Promise Neighborhood received Promise Neighborhood funding from the U.S.
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raises funds from corporations as well as others. The Dudley Street Neighborhood Initiative's membership includes local businesses.
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Foundations have been a prominent source of funding for the community examples in Chapter 5. For example, the Dudley Street Neighborhood Initiative was founded with assistance from the Boston-based Mabel Louise Riley Foundation.
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Community-level data regarding the social determinants of health were essential in establishing a sense of purpose to facilitate a shared vision among all partners. In some instances, the shared vision targeted youth and families.
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. The Dudley Street Neighborhood Initiative has cultivated a shared vision among residents, families, local organizations, and local businesses regarding their power to achieve a healthier and more vibrant community.
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In many instances, these individuals and grassroots organizations have less power, experience, and capacity to represent the unique goals and needs of the population that health equity interventions are meant to address. Community capacity refers to the ability of community members to make a difference over time and across different issues (Work Group for Community Health and Development, 2016b)
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Strengthening community capacity to develop, implement, and sustain successful interventions depends on specific strategies, which include leadership development, community organizing, supporting the relationships between organizations necessary for collaboration, and organizational development (Chaskin, 1999)
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• Setting leadership development goals for individuals in the context of what leadership skills are needed in the organization and the individuals best suited to learn those skills and write individual leadership development plans with each • Recruiting new members and volunteers to lead, bring new ideas, and challenge existing assumptions and ideas • Continuing to develop as a leader through an individual development plan (Work Group for Community Health and Development, 2016c) health and justice leadership training program to educate community members about the environmental health issues confronting their northern Manhattan neighborhoods.
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Promise Neighborhoods are an example of community organizing with an emphasis on locality development. The Dudley Street Neighborhood Initiative and Eastside Promise Neighborhood have received Promise Neighborhood funding, and their activities, which are described in Chapter 5, are exemplars of locality development.
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Consequently, the program's community-based solutions are multi-sectoral and not solely focused on education: • Education: early childhood, K–12, expanded learning, and mentoring • Economic development: Emerge Community Development, Twin Cities RISE! • Housing: Minneapolis Public Housing Authority, Project for Pride in Living, Urban Homeworks • Health care: Visiting Nurse Agency, The Family Partnership, Northpoint Health & Wellness Center, Washburn Center for Children In reality, community organizing often integrates aspects of multiple models, as reflected in several of the community examples in Chapter 5 (e.g., the Magnolia Community Initiative)
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Though communities vary greatly, successful change efforts are the same in key respects. They all involve people working together with a shared vision and commitment to improve some aspect of life.
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Multiple groups have developed integrated resources for strengthening community capacity in leadership development, community organizing, supporting the relationships between organizations necessary for collaboration, and organizational development. One such multilingual resource is the Community Tool
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Collaboration requires coalition building. A community coalition is a group of individuals or organizations with a common interest who agree to work together toward a common goal aimed at bettering their community (Community Health Innovation, n.d.; Community Tool Box, n.d.)
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The community examples in Chapter 5 highlight the important role of partnership building in the success of their organizations and the importance of investing in partnerships. Multi-sector collaboration was a criterion in the selection of the community examples.
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As with other case studies, the Dudley Street Neighborhood Initiative has multi-sector collaboration as a core organizational strength. The diversity of partnerships goes beyond nonprofits and governmental organizations to include businesses through the Dudley Workforce Collaborative as well as arts and cultural institutions through the Fairmont Cultural Corridor.
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Collective impact initiatives are also characterized by five conditions relevant to advancing community-based solutions for health equity: a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support. The phases of collective impact and related activities are summarized in Table 8-1 according to the four components for success (Hanleybrown et al., 2012)
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. The Magnolia Community Initiative exemplifies a collective impact approach, and a description of its efforts is also included in the Community Tool Box.
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where organizations, initiatives, and collaboratives can share content, data, and resources Community Health U.S. Centers for Hospitals, Community health Improvement Disease Control and public health improvement Navigatorc Prevention sector, infographic; key quotes community from Internal Revenue partners Service final rule on community health needs assessments for charitable hospitals; search engine for evidence-based community interventions Community Tool University of Kansas Broad Online training, Boxd curriculum, community workstations; materials in multiple languages; troubleshooting guide; guestbook to describe use of toolbox continued
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. 17 For more information, see https://www.preventioninstitute.org/publications/developing effective-coalitions-an-eight-step-guide (accessed November 17, 2016)
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prominent tool kits that can inform community-based efforts to promote health equity. REFERENCES AARP (American Association of Retired Persons)
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http:// chsolutions.typepad.com/elevation/2010/04/community-coalition-building-part-1 -fundamentals.html (accessed October 19, 2016)
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Stanford Social Innovation Review. http://jcisd.org/cms/lib/MI01928326/ Centricity/Domain/ 218/Making%20Collective%20Impact%20Work%20Stanford%20 2012.pdf (accessed October 31, 2016)
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Stanford Social Innovation Review Winter. https://ssir.org/images/articles/2011_WI_Feature_Kania.pdf (accessed October 24, 2016)
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http://www.denverregionalequity atlas.org (accessed October 18, 2016)
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2014. Using civil rights tools to address health disparities.
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vdh.virginia.gov/OMHHE/policyanalysis/virginiahoi.htm (accessed October 21, 2016)
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