Health Equity

We will not rest until ALL mothers and babies have an equal shot at a long and healthy life course. North Carolina has a greater than two-fold disparity in infant mortality, with African American and American Indian babies at greater risk of dying before their first birthday than White babies. We must close this gap if we are to achieve our goals. Here are some resources that we hope will inform practice across the state.

Frameworks, Blueprints, and Plans

Tools for framing and understanding racial and ethnic health disparities

• Frameworks Institute – Toolkit for talking about disparities
• North Carolina Medical Journal – Eliminating Racial and Ethnic Disparities
• CityMatCH – Undoing Racism in Public Health: A Blueprint for Action in Urban MCH 
• This Robert Wood Johnson Foundation report to the Commission provides a profile of the current state of health in America, focusing specifically on the role that social factors like income, education, and race and ethnicity play in Americans’ health and the areas that hold promise for improving the opportunities for all Americans to live healthier and more productive lives.
• This Robert Wood Johnson Foundation report outlines 10 recommendations to improve our nations health, including recommendations to improve health equity.
• The Annie E. Casey Foundation provides a series called Race Matters that addresses inequity by race and ethnicity across disciplines.  Their resources include Advancing the Mission: Tools for Equity, Diversity and Inclusion. This document includes addressing these issues in your own agency; and the Race Matters Toolkit.  This invaluable resource addresses inequity by race and ethnicity in children and youth development, family and community success and public systems. It also includes an organizational self-assessment so your agency can reflect on its attitudes and impact toward lessening disparities.
• The WK Kellogg Foundation’s Racial Equity work includes strategies for addressing the problem, American Healing, and stories of fighting for racial equity.
• Michigan Health Equity Roadmap is a vision and framework for improving the social and health status for racial and ethnic populations in Michigan.
• The Applied Research Center fights for racial justice through research, media, and activism. They offer publications on key race-based issues as well as in person trainings.
• The Community Guide to Health Equity is offers a guide to addressing health disparities in your community.
• The Healthy People 2020 goals and objectives indicate our country’s health goals for the comings years. Many of these goals include reducing disparities, and this edition is the first to have specific Social Determinants of Health goals.
• The American Psychological Association’s Division of Health Psychology has investigated the relationship between racism and health for many years. Their research findings represent the most up-to-date information on the topic.
• Evaluation Tools for Racial Equity provides resources to evaluate the work your organization is doing on racial equity.
• Urban Institute on Racial Equity Map is an interactive map that grades and rates the 100 largest U.S. cities based on their standing in terms of racial equity for African Americans and Latinos. If you click on the individual city bubble, you will find a spreadsheet of the data across each measurement.
• NACCHO: Health Equity and Social Justice. A full online course, a health equity campaign, toolkit, and publications to help local health departments begin tackling the problem of health disparities.
• National Partnership for Action to End Health Disparities: This toolkit for Community Action helps individuals, communities and organizations from public and private sectors work together to implement programs and policies and engage with the NPA to reach that goal.
• Health Research and Educational Trust Disparities Toolkit is a web-based tool that provides hospitals, health systems, clinics and health plans information and resources for systematically collecting race, ethnicity, and primary language data from patients.
• Kent County Health Department Health Equity includes a locally developed video called “Framing Social Determinants of Health in Kent County” and the “Framing the Relationship Between Race and Health” toolkit for providers.

• Equitable Development Toolkit – This toolkit from PolicyLink includes 27 tools to reduce patterns of segregation and disinvestment, prevent displacement, and promote equitable revitalization.

Getting the conversation started

Pieces to help start the conversation about racial and ethnic health disparities.

• Unnatural Causes: Is inequality making us sick? This seven part documentary series explores the socioeconomic and racial health inequities in the U.S.
• Race: The power of an illusion  This three part documentary series explores the evolution of race and racism and explains how the construction of race can have very real consequences.
• Where you live matters: Addressing concentrated poverty neighborhoods.  This audio webinar discusses the power of place, and how the neighborhoods we grow up in are inextricably related to our health and our social mobility.
• Hidden Bias Test. Psychologists at Harvard, the University of Virginia and the University of Washington created “Project Implicit” to develop Hidden Bias Tests–called Implicit Association Tests, or IATs, in the academic world–to measure unconscious bias.
• Conversations that Matter: A how-to-guide for hosting discussions about race, racism, and public health.

Online Trainings (no charge)

• Health Equity and Prevention Primer – The Prevention Institute offers a comprehensive online primer on health equity.
• Roots of Health Inequity – NAACHO developed a training institute that aims to explore social processes that produce health inequities in the distribution of disease and illness, strategize more effective ways to act on the root causes of health inequity, and to form relationships with other local health departments who are working to ensure health equity.

Resources

CDC just released (November 2013) its latest health equity resource guidance entitled “A Practitioners Guide for Advancing Health Equity: Community Strategies for Preventing Disease” According to CDC, A Practitioner’s Guide for Advancing Health Equity is a resource for public health practitioners working to advance health equity through community health interventions. While health disparities can be addressed at multiple levels, this guide focuses on policy, systems, and environmental improvements designed to improve the places where people live, learn, work, and play. It is designed to provide guidance to CTG grantees about how to incorporate health equity into the strategies related to the strategic directions. However, the guide also provides strategies for public health professionals to enhance their organizational capacity for advancing health equity in all areas of chronic disease. Here is the link to this resource: http://www.cdc.gov/nccdphp/dch/health-equity-guide/

Databases of information on racial and ethnic health disparities

• U.S. DHHS Office on Minority Health – Website and data base of information about minority health nationwide.

• NC State Center for Health Statistics – North Carolina data and publications on health disparities.

Health equity examples in action

Examples of interventions working to close the gap in health disparities.

• Every Woman Southeast Webinar – The Magnolia Project  –  This webinar shares the story of a women’s health and preconception health intervention in Northern Florida puts the life course into practice.  The founders of the project address challenges, successes, and lessons learned.
• REACH Demonstration Projects – Racial and Ethnic Approaches to Community Health (REACH) is an important aspect of Centers for Disease Control ‘s efforts to eliminate racial and ethnic disparities in the United States.  Their website explains their efforts and details the projects they have funded, as well as those projects’ results.
• East Harlem Children’s Zone – This flagship children’s initiative provides wrap around services for an entire geographical area of Harlem.  Their website outlines their initiatives, their results, and includes a Ted Talk by HCZ founder Geoff Canada.
• The East Durham Children’s Initiative – EDCI is working to create a pipeline of services for children in East Durham, North Carolina from cradle to college or career.  Their website outlines their services as well as the impact the initiative is having on the community.
• LA Best Babies Network – is a dynamic network linking organizations that are dedicated to improving the health of mothers, newborns and their families. The Network works to ensure that high-quality perinatal care and social support are available to all families throughout L.A. County.
• Partnership to Eliminate Disparities in Infant Mortality (PEDIM). Six communities outline how they took the first steps.
• Michigan’s Children – This program is devoted to allowing all Michigan children to thrive.  Check out their initiatives and equity specific work.

Reducing Disparities in Infant Mortality

• Every Woman Southeast Webinar- The Impact of Racism on Disparities in Birth Outcomes –  Speakers include Piia Hanson (Association of Maternal and Child Health Programs), Maureen Gatere (City MatCH) and Kenn Harris (National Healthy Start Association). They presented on their experience, successes and lessons learned from the Partnership to Eliminate Disparities in Infant Mortality.
• CityMatCH and AMCHP framework on women’s preventative health – This report serves as a great starting point for frameworks, priority areas and initiatives for women’s preventative health.
• Unnatural Causes: When the Bough Breaks – This episode of Unnatural Causes addresses the racial and ethnic birth disparities present in the United States and presents the argument that chronic stress from unequal treatment may be the culprit.
• Exercises for Team-Building and Community Action Planning: A Toolkit for MCH Leaders Addressing Racism’s Impact on Infant Mortality – This booklet offers an action plan for teams looking to address the role of racism in birth outcomes in their own communities.
• Turning the Ship: Making the Shift to a Life-Course Framework – This article chronicles the nine year journey in Wisconsin to shift their public health programs to a life-course perspective.  The article includes challenges, successes and lessons learned.
• Southern Center on Environmentally-Driven Disparities in Birth Outcomes – Addresses the environmental pollutants that disproportionately affect low income infants and children.
• National Healthy Start Association – NHSA is committed to improving birth outcomes and health disparities that exist within communities of color throughout the U.S.  Their website highlights successful projects, research and ways to get involved.
• Reducing Racial/Ethnic Disparities in Reproductive and Perinatal Outcomes – Those interested in a longer read can download this free book for a comprehensive look at the problems–and potential solutions–to health disparities.
• Practices to Reduce Infant Mortality Through Equity (PRIME) – This Kellogg funded project seeks to enhance the capacity of the Michigan Department of Community Health to reduce racial disparities in infant mortality in Michigan.  The website includes information on their learning collaborative and an action center.

State of the State

Reports on health disparities in North Carolina

• NC Racial and Ethnic Health Disparities Report Card – This document rates North Carolina’s disparities by health problem, as well as noting which disparities have improved and which haven worsened in the past five years.
• 2010 Report on African American Health in North Carolina – This document outlines the state of African American Health in North Carolina.