Post on 12-Jan-2017
Green & Healthy Planning: Livability and Equal Access for All!
SNEAPA 2016Friday, October 21 2016
2:20 – 3:35 PM
Health Equity Zones (HEZ)The Rhode Island Department of Health’s Collective Impact Approach to Community DevelopmentChristopher Ausura
What Determines Population Health?
Determinants of Health
Social Supports
Safe Housing & Neighborhoods
Education & Employment
Seeking Medical Care
Diet & Exercise
Substance Use
Genetics[30%]
Healthcare[10%]
Social & Environmental
[20%]
Individual Behavior
[40%]
Affordability Health Literacy
Access to Care Adapted from Schroeder, SA. (2007).
Health Equity Framework - Equity Pyramid
This pyramid is adapted from Thomas Frieden, MD, MPH, Health Impact Pyramid presentation at the Weight of the Nation conference, Washington D.C., July 27, 2009
1. Education & Counselinge.g. Eat Right
2. Clinical Interventionse.g. diabetes control; pediatric
weight management counseling
3. Long Lasting Protective Public Health Interventions
e.g. immunizations; HIV testing; BMI screening?
4. Changing the Context-Healthy Choices as Default Optionse.g. smoke free laws; healthy food in schools law
5. Social and Environmental Determinants of Healthe.g. housing, education, inequalities; community garden
Lowest Impact
(1)
Highest Impact (5)
Life C
ours
e App
roac
hEm
otional and Social Competencies
Collaboration, Integration, Partnerships
Most Individual
Effort
Least Individual
Effort
Health Equity Zones (HEZ)• In 2015 RIDOH issued an RFP for community led projects called “Health Equity
Zones” that would address the social and environmental drivers of health disparities
• HEZ are contiguous geographic areas that have measurable and documented health disparities, poor health outcomes, and identifiable social and environmental conditions to be improved
• A 4 year, $13 million, investment of state and federal grant dollars by the RI Department of Health spread across 10 health equity zones
• Focuses on the development of sustainable community collaboratives who will work to improve the health of their communities using a collective impact approach to address the social and environmental determinants of health
The Composite of Health Equity Zones for Rhode Island
Health Equity Zone (HEZ) – Implementation Build/expand local collaborative
Evidence of meaningful, true engagement of key stakeholders
Should include: Community residents, local housing authority, Local planning department, local education agency, city or town leaders, FQCHC and mental health community centers, other health care providers (e.g. hospitals. PCPs insurers…), CBO’s, youth organizations
Identify backbone organization
Collectively identify and prioritize local health issues Conduct community health needs assessment
(needs/assets) Review these findings with the community
Develop and implement local plans of action Community-based, evidence-based strategies and programs Address multiple health impact domains Focused on the elimination of disparities
Health Equity Zone (HEZ) Implementation • Build/expand local collaborative• Collectively identify and prioritize local health issues• Develop and implement local plans of action
Strong communities infrastructure begins with genuine community engagement, and the establishment of strong community partnerships. Each community should:
• Understand the community infrastructure, assets, needs and opportunities for development
• Understand the social and environmental determinants of health
• Develop diverse community reflective collaboratives
• Ensure community decision making is fair and equitable, and inclusive of vulnerable community members
• Understand and take ownership of the health and development of their community
• Reach collective agreement on a vision for improved community health, functioning, and prosperity
• Invest in the development of community leaders who reflect the community
• Leverage investments to achieve the highest possible positive impact on the community
To sustain development of resilient, healthy communities and improve population health, resources and policies must be aligned. Multi-sector funders and policy makers should:
• Invest collaboratively to increase the effectiveness of investments while reducing redundant reporting
• Target investments to strategies proven to eliminate disparities of all kinds while growing local economies
• Develop investments that link community development to health improvement
• Listen actively to community needs and be responsive to reinforce genuine commitment
• Prioritize investments that support sustainable community development projects, policies, and strategies
• Support projects and policies aimed at social and environmental determinants of health
• Seek out and engage non-traditional partners
• Utilize health improvement outcomes and costs savings to guide future policy changes and investments
• Implement sustainable design strategies
By responding to community needs, and investing in sustainable community development, Rhode Island communities will demonstrate improvements. Communities will:
• Be more livable places that attract and retain both residents and businesses
• Consist of residents who civically engaged• Have exemplary health and social services• Collectively improve the safety net
needed for healthy human development • Have stronger and healthier economies
driven by the strengths of the communities
• Eliminate or be working to eliminate health, education, and other disparities
• Reduce healthcare costs and expenditures by improving both physical and behavioral health outcomes
• Be stronger, more disaster ready, and adaptable to unforeseen changes
• Have developed sustainable strategies for community development
• Be able to demonstrate returns on investments
• Demonstrate increased self-sufficiency and community pride
Health Equity Zone Theory of ChangeIF Rhode Island collaboratively invests together in defined geographic areas to develop sustainable infrastructure, and aligns a diverse set of resources to support community-identified needs, THEN positive impacts on the social and environmental conditions driving disparities and poor health outcomes will be demonstrated.
Community Development Sustained Investment Positive Impact
Health Impact Domains• Integrated Healthcare DomainThis domain focuses on the system of healthcare and social services, including quality, affordability, and access to physical and behavioral health and the connection to individual biological and psychological behaviors, attitudes, and beliefs that affect patient health.• Community Functioning and Social DomainThis domain focuses on factors that influence the health of individuals in the community. This may include social, cultural, and spiritual aspects, economic drivers, and civic and community engagement. • Physical and Environmental Determinants DomainThis domain focuses on the physical conditions of the environment in which people are born, live, learn, play, work, and age. This may include the natural environment, build environment, critical infrastructure, and hazards and risks. • Socio-Economic and Demographic DomainThis domain focuses on the social standing of an individual or group in relationship to the combination of education, income, and occupation attainment.
Health Impact Domains• Integrated Healthcare Domain• Community Functioning and Social Domain• Physical and Environmental Determinants Domain• Socio-Economic and Demographic Domain
Community Development and Health• Using the Theory of Change to invest in the Health Impact
Domains we envision better connections between the sectors that affect the social and environmental determinants of health• The alignment of community development sectors with
health improvement sectors provides significant opportunities for both to leverage existing work to increase effectiveness and better document impacts• Collaboration between these sectors already occurs, but
the outcomes are frequently not reported collectively and leads to outcome reporting that is undervalued compared to their actual impact
Impact to Date• More than $1,000,000 of additional funding has been
leveraged by HEZ collaboratives to support sustainability, these are dollars the communities have raised for themselves• Over 200 different community organizations, businesses,
and community agencies have come together across the 10 HEZ to collectively improve the health of their communities• HEZ collaboratives are working with town and city leaders
across the state to improve their communities from within by re-designating buildings for community use, creating new policies and regulations, and holding community events to increase civic engagement
Impact to Date• More than $1,000,000 of additional funding raised• Collaboration of over 200 different community organizations• Collaboratives are working with local governments to get things done!
Next Steps• We are currently meeting with partners across the
state to establish indicators of community health based on the Health Impact Domains that will inform community health index scores reflective of the diverse set of factors that affect health in a community• RIDOH wants to create a Health Equity Zone in every
city and town in Rhode Island; to support a HEZ in every city and town RIDOH, in partnership with other private and public funders, plans to raise and invest $70 million in capital into comprehensive community development
Bristol, RI Health Equity ZoneCraig Pereira
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
What will the Health Equity Zone result in for the Bristol community?1. A comprehensive baseline assessment of the factors that drive poor health outcomes across the community.
2. Development of innovative place-based approaches to prevent chronic diseases, improve birth outcomes, and improve the social and environmental conditions of Bristol’s neighborhoods.
3. Implementation of a community Work Plan of action by municipal leaders, residents, businesses, transportation and community planners, law enforcement, education systems and health systems, among others over a three to four year period, to improve the overall health and quality of life for Bristol’s residents.
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Why does Bristol need a HEZ?1. Despite the overall increasing household wealth of Bristol residents from 2000 to 2012, there still remains a population living in Bristol with very limited financial means.
2. 32.1% of all Bristol households have what public agencies define as extremely low income levels, (incomes at or below 30% of the area’s median income) - a significant amount that will affect the general housing, nutrition, and educational needs of the community.
3. The Bristol HEZ will provide the structure for bringing the numerous social services and community-based organizations currently working independently together in a collaborative framework so that more can be accomplished in the area of public health.
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Five Primary PartnersBristol Warren Thrive by Five and Beyond
East Bay Food Pantry
East Bay Community Action Program (EBCAP)
Bristol - Warren Regional School District
Mosaico Community Development Corporation.
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Three Target Demographics
Low to Moderate Income Residents
Elderly Population
Portuguese Population
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Three Primary DeliverablesEstablish a Collaborative
Baseline Assessment of Health Needs in the Community
Development of a Work Plan
Looking Back on Year One... Establish a Collaborative1. Reached out to existing programs, services and leaders in the community2. Conducted in-person interviews and on-line survey 3. Identified individual strengths and personal interests4. Provided training to the Collaborative5. Developed Year 1 scope of work with newly-established Collaborative6. Encouraged Collaborative members to engage with the community7. Structured Collaborative ‘levels of participation’ based on their role in the community, their interest level, and their capacity to participate.8. Community Partners Outreach Survey employed to better understand the community stories related to health issues, community strengths and weaknesses, and health indicators related to at-risk populations.9. Developed list serve/constant contact list of Collaborative member’s constituents.
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Looking Back on Year One... Establish a Collaborative
Looking Back on Year One... Baseline Assessment of Health Needs in the Community1. Utilized Collaborative outreach data to identify general ‘topic areas’ 2. Researched National public health/health equity assessment models3. Identified range of implementation methods4. Implemented on-line and hard copy surveys5. Conducted Focus Groups6. Participated in and organized community events7. Gained a snapshot of the community centered around general ‘topic areas’ by understanding the gaps in services and needs of the community 8. Identified feasible alternatives for programming and delivery of services 9. Created ‘institutional awareness’ of the Bristol Healthy Equity Zone initiative
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Looking Back on Year One... Baseline Assessment of Health Needs in the Community
Looking Back on Year One... Development of a Work Plan1. Adhered to ‘Guidance’ provided by CDC via RI DOH.2. Solicited Collaborative for strategies3. Utilized findings from the Baseline Assessment4. Prioritized submitted strategies with Collaborative5. Refined the details on each strategy6. Approved Work Plan submission with Steering Committee7. Strategy to address the identified gaps in services and needs of the community8. Realization of the strength of the community and desire for improved quality of life9. Celebrated our award of $321,225 towards implementation of strategies for Year 2 at week-long community celebration
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Looking Back on Year One... Development of a Work Plan
Lessons learned... Successful endeavors…
1. Building on the strength of an already-existing organization/network
2. Hitting the streets for public
outreach/Listening
3. Leveraging community resources
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Lessons Learned
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Lessons Learned
Lessons learned... Not so successful endeavors…
1. Time
2. Communications
3. Flexibility
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
What’s Happening in Year 2...
Shift towards a ‘sustainable model’
1. Collaborative’s transition to Working Groups and Champions
2. Higher engagement of Primary Partners
3. Reconstitution of Steering Committee
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
What’s Happening in Year 2...
What’s Happening in Year 2...
Comprehensive integration into the community
1. Bristol Warren Regional School District
2. Roger Williams University
3. Engagement of Primary Care Providers
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
What’s Happening in Year 2...
What’s Happening in Year 2...
Implementation of new programs and services1. Personal Health and Wellness
2. Physical Activity
3. Food and Nutrition
4. Substance Abuse Awareness and Prevention
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
What’s Happening in Year 2...
What’s Really Happening in
Year 2... Implementation…
Evaluation…Revision…
Implementation…Evaluation…Revision…
Implementation…Evaluation…Revision…
Implementation…Evaluation…Revision…
This project is supported by the grant or cooperative agreement number DP005511, funded by the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA).
Public Health Considerations in
City Planning
Patrice Barrett, MPH
https://nextcity.org/daily/entry/visual-primer-social-impact-design.
Presentation• My background• CDC/ATSDR • Grant with Horsley Witten Group• Public health considerations in city
planning projects • Brownfields and public health
ID needs of the population Link health data to specific environment Public engagement & education both
important
Public Health in City Planning
• Good partners & advocates • Provide insight and expertise• Consider: Health Impact Assessment (HIA) -
assessing health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques.• Public health practice a very broad discipline
CDC/ATSDR Grant & Horsley Witten• City Middletown, CT • One year CDC
planning & outreach only brownfield revitalization grant from ATSDR • People recognized
important to be part of a transparent city project
• Learn needs of population • Ask citizens what they
want for community green space • First learn who they are• 3 census tracts centrally
Our Project• Approx. 47,000
population • Small university • SES portrait different
from whole city (much lower income, poorer housing quality)• Densely populated tracts• Mixed business and
residential use• Minimal green space
• Infrastructure issues (prevent safe pedestrian use)• SO – little physical activity
or interest
Quality of life neighborhood survey results at grant start
Insightful and set the stage
Grant Areas & Properties
Brownfield Work• Grant for where abundance
of properties• Portrait of the population
living there: Socioeconomic
characteristics Number of children vs. adults Quality of life issues Health status – obesity,
asthma, child lead issues, other exposures leading to illness
Public Health EducationWhile planners are doing property
research and planning – Public health educates in the community:• What is a brownfield ? (huge task)• Exposures & pathways• Exposure = possible disease. Little
physical activity = obesity, diabetes. OR risky exposure (kids and lead, hands in mouth with soil)• Chronic health disease impacts• How to advocate for issues important to
you and your neighborhood peers….
Education Takes Many Forms
Stakeholders are importantThey fill in the blanks
• Include all community sectors• Provide
valuable insight and wisdom• Help you
navigate the rough spots• Know what the
data do not show
Engagement: a Multi-Headed Friendly Beast
Public Service Announcement on local Public Radio
Photo Voice: A Common Public Health Technique
Litter on the streets . . .
Favorite Things about Middletown:Nice atmosphere Restaurants ∙ ∙Town keeps developing and that helps everyone ∙Any development by the water is good ∙Teachers are great and dedicated, and always push studentsThings they would change:Generally feel safe Cleaner would always be nice ∙ ∙A dog park would be nice
We need new sidewalks
People and things otherwise not heard or seen
What happened?
Favorite Things about Middletown:Like Middletown, nice family townHappy with soup kitchen and that it’s open every dayLike that there are women businesses owners up and down main street, woman taking the leadThings about Middletown that they would change:Parking is hard to find
A familiar North End sight
Some of the Results• Many residents
got their soil tested• Planner site
designs took into account what people felt• Some residents
saw areas of the city they never knew (you live where ?)
Thanks & Contact Info
• Thanks for listening today• Group activity
planned• Can ask questions
during that time
• Patrice Barrett, MPH• PatriceBarrettMPH
@gmail.com• LinkedIn profile
Scenario Activity• Spilt into groups of no more than 8 people• Take 5 minutes to read the scenario• Take 15 minutes to answer the questions
with your group
Greetings from
Cabo San Lobstah
Snappy and Delectable since 1737