From Health Disparities to Health Equity: A Movement, Not an Event
Racial and Ethnic Approaches to Community Health Across West Virginia: A Roadmap for Success
Racial and Ethnic Approaches to Community Health Across West Virginia: A Roadmap for Success From Health Disparities to Health Equity: A Movement, Not an Event
REACH WV Staff Charlene Hickman, Program Manager Sheryn Carey, Program Coordinator Stanley Blanks, Program Assistant Ron English, Program Consultant
Gloria Thompson, Office Assistant
For more information contact: REACH WV West Virginia Department of Health and Human Resources 350 Capitol Street, Room 206 Charleston, WV 25301 Phone: 304.558.0644 Fax: 304.558.1553
Table of Contents
Table of Contents.............................................................................3 Purpose ............................................................................................5 Fact Sheet ........................................................................................6 REACH WV Observes Minority Health Month .............................7 From Health Disparities to Health Equity: A Movement, Not an Event..................................................9 REACH WV Overview..................................................................10 Phases of a Social Determinants of Health Initiative....................16 Community Action Planning..........................................................17 Glossary of Terms..........................................................................20
Purpose The purpose of this document is to provide an overall framework for community and coalition members to acquire skills and resources to assess the health of their community and plan, implement and evaluate the activities that change behaviors, the environment and systems, to reduce health disparities among our African American population in West Virginia. Our hope is that this document will reconfirm the significance of utilizing community based participatory approaches by encouraging collaboration, community action and partnership development. Racial and Ethnic Approaches to Community Health Across West Virginia focuses on six key areas: data collection, policy, health care access, healthy behaviors, environment and health equity. We have provided you with broad and basic guidelines to help shape your understanding of the REACH concept and inspire your commitment to eliminating health disparities. We hope you will use this document as a roadmap to furthering your efforts in improving the community in which you live. This document is not intended to be all-inclusive. Therefore, we expect and encourage you to request additional training on certain topics that are mentioned within.
Fact Sheet Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) is a national program and important cornerstone of the Centers for Disease Control (CDC) efforts to eliminate racial and ethnic health disparities in the United States. REACH U.S. supports and disseminates programmatic activities that are successful in the elimination of racial and ethnic health disparities.
The West Virginia Department of Health and Human Resources through its Racial & Ethnic Approaches to Community Health across WV project (REACH WV) is addressing the disparities in health status and access to quality medical care for racial and ethnic minority populations in the state of West Virginia. The REACH West Virginia Program, which operates through the Bureau for Public Health , is funded through the CDC which selected West Virginia because a disproportionate rate of the State’s minority population suffers from health disparities associated with heart disease and stroke, diabetes, cancer, HIV and chronic kidney disease. The first funding cycle began in September 2007. The goal of the REACH WV project is to mobilize community coalitions to effectively address diabetes-related health disparities among African Americans. Five counties have been designated for this effort: Kanawha, McDowell, Fayette, Raleigh and Mercer. REACH WV is a community-driven movement designed to engage community activists, health care providers, faith-based organizations, social and civic organizations, and government agencies in efforts to eliminate health disparities and achieve health equity for minorities.
REACH WV Observes Minority Health Month In an effort to eliminate health disparities and improve the health status of the Minority populations, Minority Health Communications, a healthcare communications company, and its partners, launched National Minority Health Month (NMHM) in April 2001. Improving the health status of minorities has always been a serious concern for minority leaders. It was such a concern in 1914 that Booker T. Washington spearheaded the implementation of National Negro Health Week (NNHW). This initiative garnered support and encouragement from civic clubs, work places, businesses, hospitals, churches and minority health professionals. The week was launched in April 1915. In 1921, the U.S. Surgeon General was asked by the oversight committee of NNHW to assist in expanding the capabilities of this effort. The Surgeon General complied and became a source of sustaining support, by publishing a nationally circulated Negro Health Week Bulletin that was designed to reach large audiences. The launching of National Minority Health Month in April 2001 is a rebirth of this important, well-organized effort to eliminate disparities across the country. NMHM is in response to and in support of Healthy People 2010, a national health promotion and disease prevention initiative launched by the U.S. Department of Health and Human Services and the U.S. Surgeon General.
The goals of NMHM are to build public/private partnerships, foster cultural competency among health care providers, and encourage health education and training. NMHM created a nationally recognized, annually recognized month, to serve as the impetus to raise awareness of and implement initiatives to reduce the problem of the minority health disparity throughout the subsequent days of the year. The objectives of West Virginia’s Minority Health Month are to heighten awareness of the root causes of health disparities among racial and ethnic minority populations, specifically in the African American community, and to empower community members and health professionals to address the critical issues related to the Health Care-Social Justice Agenda .
“From Health Disparities to Health Equity: A Movement Not an Event” “The future health of the nation will be determined to a large extent by how effectively we work with communities to reduce and eliminate health disparities between non-minority and minority populations experiencing disproportionate burdens of disease, disability, and premature death.” ~ Guiding Principle for Improving Minority Health Minority Health Awareness Month is recognized as a health promotion and disease prevention campaign to encourage collaboration between health care, community-based, and faith-based organizations to educate the public about health disparities and advance health equity to sustain the quality of life for all West Virginians. Medicare was passed as a civil rights bill. Health care became a right under this universal entitlement program, which was driven to creation by the most powerful grass roots social movement this country has ever experienced. The time has come to return to the basic premises of this movement. Therefore, the theme of Minority Health Month 2009 is meant to magnify how significant health disparities are determined by social inequalities that constitute the “Unnatural Causes” for chronic health conditions that have accounted for the excessive differences in the incidence, prevalence, and mortality rate among minority groups for preventable health conditions and diseases like cancer, cardiovascular disease, stroke, diabetes, HIV/AIDS, and infant mortality. The social conditions into which we are born, live and work have a profound effect on our well-being and longevity. It is our hope that by beginning a dialogue about these issues, we can encourage collaboration between political officials, policy makers, health care professionals and community leaders to recognize health care as a civil rights issue.
REACH WV Overview Vision: No health disparities exist between our racial and ethnic minority population and their white counterparts. Mission: REACH WV will mobilize community coalitions to affect behavioral, environmental and systems change in eliminating diabetes related health disparities in African American communities in West Virginia. REACH WV is funded by CDC to address health disparities related to Diabetes in African American communities. REACH WV covers five counties: Kanawha, McDowell, Fayette, Mercer and Raleigh. Health disparities are preventable differences in the burden of disease, injury and violence, or opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic and other population groups and communities. These disparities are unjust, unfair and directly related to the historical and current unequal distribution of social, political, economic and environmental factors.
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Health Inequity is defined as systematic and unjust distribution of social, economic, and environmental conditions needed for health: • • • • • • • • •
Access to healthcare Employment Education Access to resources (e.g., grocery stores, car seats) Income Housing Transportation Positive social status Freedom from discrimination.
Examples of Health Inequities: • •
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Education - Infants born to African American mothers with only a high school education were 2.2 times more likely to die in the first year of life compared to their White counterparts. Income - Low socioeconomic status is associated with an increased risk for many diseases, including cardiovascular diseases, arthritis, diabetes, chronic respiratory diseases, cervical cancer and frequent mental distress. Access to resources - Lower income and racial/ethnic minority communities are less likely to have access to grocery stores with a wide variety of fresh fruits and vegetables.
REACH WV utilizes Community-Based Participatory Approaches (CBPA). CBPA are processes that equitably involve research and health professionals, community members, and organizational representatives, in all aspects of program and evaluation activities.
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Key Principles of Community-Based Participatory Approaches: • • • • • • • •
Recognizes the community as unit of identity Emphasizes local relevance of public health problems and ecological perspectives that address multiple determinants of health Builds on community strengths and assets Promotes co-learning and capacity building among all partners Involves systems development through a cyclical and iterative process Balances knowledge generation and action Involves disseminating results and other knowledge gained to all partners Involves long-term process and commitment to sustainability.
CBPA and Sustainability: • • • • • •
Promotes community ownership of solutions Pools and leverages resources to extend reach Strengthens and expands partnerships Fosters the development of local leaders Improves community readiness Develops capacity to adapt to changing local needs and political climate.
The Socio-Ecological Model takes into account the influences at various levels of social organization: individual (knowledge, attitude and skills); interpersonal (family, friends and social networks); organizational (organizations, social institutions); and public policy (national, state and local laws).
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Figure 1: Socio-Ecological Model Landscape of Influeneces on Health Disparities and Arenas for Policy Action
Coalitions must conduct assessments of the Social Determinants of Health, those life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education and health care, whose distribution across populations effectively determines length and quality of life. Below is a diagram of the Pathways from Social Determinants to Health.
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Coalitions may use various APPROACHES to address health disparities such as: • • • • • • •
SOCIAL ACTION MEDIA ADVOCACY CONSCIOUSNESS RAISING HEALTH PROMOTION COMMUNITY DEVELOPMENT POLICY & ENVIRONMENTAL CHANGE BEHAVIORAL CHANGE.
Successful coalitions possess the following characteristics: • • • • • • • • • •
Trust Empowerment Culture and History Focus on Causes Community Investment & Expertise Trusted Organizations Community Leaders Ownership Sustainability Hope.
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Community Action Planning A healthy community is a form of living democracy: people working together to address what matters to them. —Stephen B. Fawcett, et al. The community action plan is a road map for creating community change by specifying what will be done, who will do it and how it will be done. In other words, the plan describes what your group wants to accomplish, what activities are needed during a specified timeline, what resources (money, people and materials) are needed to be successful. The Community Action Plan Framework consists of Outcomes, Goals, Objectives and Strategies. Program outcomes, goals and strategies follow directly from the community assessment and visioning process. Outcomes are part of the vision, what results you want to see. Goals, objectives, and strategies are building blocks to make sure that you produce the desired outcomes and are ways to hold each other accountable. Accountability is evaluation. Consider goals as measurable accomplishments and objectives as smaller, measurable milestones along the way to the goals. Strategies are broad sets of activities to reach the goals or objectives. Outcomes are what you would like to see different as a result of the work that you do. Outcome statements declare what changes you want to happen as a result of the partnership’s efforts.
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Community Action Plans should be developed using SMART Objectives. SMART stands for: Specific – Objectives should specify what they want to achieve. Measurable – You should be able to measure whether you are meeting the objectives or not. Achievable – Are the objectives you set, achievable and attainable? Realistic – Can you realistically achieve the objectives with the resources you have? Timely – When do you want to achieve the set objectives? Example of a SMART Objective: By September 29, 2009, REACH WV will increase its coalition membership by 50%. This can be easily measured by knowing how many members there are currently. It is specific, achievable, realistic and time-bound. Evaluation, dissemination and sustainability are critical components of the Community Action Plan. When developing objectives for the Community Action Plan, consider whether the activities you are planning will lead to the desired outcome without compromising the integrity of the community. You should be able to determine to some degree if these activities will impact positive change and influence. Dissemination includes developing materials and information that reflects the coalition’s work and generates political, social and financial support to achieve the mission and sustain the organization.
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The overarching framework for REACH WV places emphasis on data collection, policy, health care access, healthy behaviors, environment and health equity. REACH WV seeks to address other issues that contribute to the poor health status of our African American population. Some of these contributing factors are inequitable healthcare access, as it relates to quality care, including cultural competence, knowledge of services and physical access to healthcare facilities; behavior, attitudes and environmental conditions. Our efforts are focused on the afore-mentioned through comprehensive data collection, a multimedia campaign, training and education of healthcare providers, health professionals, policy makers and community members, in the areas of cultural competence, policy, self-management, doctor/patient communications, health literacy and sustainable communities. A multimedia campaign will be a key factor in not only promoting health equity as a social justice issue, but in drawing attention to a system that is broken and unyielding to a population group that comprises only three percent of the population through a comprehensive report that will expose many system deficiencies. Sustainability is important in maintaining the coalition and its work. This can be done by constantly seeking funding opportunities, developing programs that attract funding and support, institutionalization, building and maintaining partnerships, maintaining a core leadership group, affecting policy and systems change, and capacity building.
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Glossary of Terms Coalition: A group of people who have pooled their resources and work together to advance their common interest in order to achieve a specific purpose. Chronic Stress: High Demand + low control = chronic stress. People at the top certainly face pressure, but they are more likely to have the power and resources to manage those pressures. The lower in the pecking order we are, the greater our exposure to forces that can upset our lives—insecure and low paying jobs, uncontrolled debt, capricious supervisors, unreliable transportation, poor childcare, no health care, noisy and violent living conditions—and the less access we have to money, power, knowledge and social connections that can help us cope and gain control over those forces. Community Based Participatory Approaches: Processes that equitably involve community members, organizational representatives, and research and health professionals in all aspects of program evaluation activities. CBPAs are used in communities to assess the social determinants of health, based on Socio-Ecological Models. Contact Person: The individual who voluntarily agrees to serve as the liaison between the state and community for the purpose of convening an organizational meeting of the Coalition. Dissemination: Broadcast of an idea or message on a large scale to make it reach a wide audience. (See Community Action Planning (CAP) section) 20
Evaluation: Analysis of completed or ongoing activities that determine or support accountability, effectiveness and efficiency of impact or outcomes. Fiscal Agent: A non-profit organization that operates on behalf of and at the direction of the Coalition to carry out its financial responsibilities in accordance with all applicable federal, state and local requirements. Health Disparities: Differences in the incidence and prevalence of health conditions and health status between groups based on: • Race/Ethnicity • Socio-economic Status • Sexual Orientation • Gender • Disability Status • Geographic Location • Any combination of these Health Equity: Distribution of disease, disability and death in such a way as to not create a disproportionate burden on one population. Health Inequity: A difference in incidence or prevalence of a disease that is unnecessary, avoidable, unfair and unjust. Institutionalization: The processes of making something become embedded within an organization, social system or society as in an established custom or norm. Minority: Someone of one of the following racial and/or ethnic groups: Black; Hispanic; Native American, Asian and Pacific Islander. 21
Race: A category of humankind that shares certain distinctive physical traits. Racism: A belief that race is the primary determinant of human traits and capacities and those racial differences produce an inherent superiority of a particular race. SMART (objectives): specific, measurable, achievable, realistic, timely. (see CAP section) Social Determinants of Health: Life enhancing resources such as food supply, housing, economic and social relationships, transportation, education and healthcare, whose distribution across populations effectively determines length and quality of life. Economic and social conditions that influence health, factors in the social environment that contributes to or detract from the health of individuals and communities. Social Justice: A concept based on ideas of fairness, equal distribution of resources, equality, and human rights. Stress: Forces from the outside world impinging on the individual - Stress is a normal part of life that can help us learn and grow Conversely, stress can cause us significant problems. Sustainability: Using, developing and protecting resources at a rate and in a manner that enables people to meet their current needs and also provides that future generations can meet their own needs. SWOT Analysis: Inventory of strengths, weaknesses, opportunities and threats. This activity should be conducted periodically to determine program composition, effectiveness and efficiency. 22
Wealth-Health Gradient: A concept used to explain that one’s health is tied to their economic position. The more affluent one is, the lower the rate of disease. Accordingly, the lower one is on the scale of income, the higher the rate of poor health outcomes the identification, selection and promotion of innovative lifestyles activities to help eliminate diabetes.
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