Equity Impact Review GuideEquity Impact Review Guide

American Public Health Association American Public Health Association November 5, 2013November 5, 2013

Question

How many of you have heard about the Equity Impact Review Guide?

Objectives

• Describe the five stages of the EIR Guide application

• Identify the value of applying the EIR Guide to policy or project decision making processes

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”

Preamble to Constitution of the World Health Organization

Health as a Human Right

The BIG Picture• HHS National Partnership for Action to End

Health Disparities

• National Stakeholder Strategy for Achieving Health Equity

• HRSA | CDC plans targeting disparities

• State and Local Health Departments are including health equity as part of strategic plans

Equity Impact Review Guide

Designed to examine proposals and identify actions to reduce health disparities and achieve health equity

King County Equity andSocial Justice Initiative

• Built on a “Fair and Just” principle • County public agencies are required to

consider social justice in all decision-making • Apply a health equity lens in making those

decisions

Helpful Advice on Guide Use

• Intended for internal use• Begin early in the planning process• Assumes a commitment to work with

community groups• Can accompany a Health Impact Assessment

Five Stages of the Guide

1. Summarize the proposed policy or project

2. Identify and assess who will be affected

3. Describe positive and negative impacts

4. Analyze and prioritize potential actions

5. Modify the original proposal and build in evaluation

Stage 1: Summarize proposed policy or project p.4 & 5

• Here you will describe the policy or plan• Discuss your expected outcomes• Which community groups will your reach

with the proposal• Predict determinants of health equity that

will be impacted• Determine level of impact and why

Determinants of Equity p.5-6

Social, economic, geographic, political, and physical environments in which people live. These lead to the creation of a fair and just society.• Healthy living conditions• Fair opportunities in education, jobs, & economic

development• Reliable public services and safety• Non- discriminatory practices

Stage 2. Identify and assess who will be affected p. 7

Gather data about your communities Have discussions with community

members Create maps and detailed descriptions of

populations

Stage 3: Describe positive and negative impacts p. 9 & 10

• Identify potential positive and negative impacts of the proposal on each population.

• Describe what you can do to strengthen the positive impacts and/or ease negative impacts.

Stage 4: Analyze potential actions and prioritize p. 11 & 12

Use the list of actions from Stage 3 to determine criteria to prioritize potential actions to enhance positive impacts or ease negative ones.

Stage 5: Modify proposal and plan evaluation p. 16

Use information from Stage 4 to list priority actions for success

Describe how original proposal needs to be adjusted, modified, or dropped

Identify measures to evaluate impact of proposal on health equity

List names of participants

Case Study: Hiring and PromotionStage 1

Public Health King County wanted to examine why there is less diversity in the highest paid classifications within the department of health.

Recommended action• Countering Bias – one hour training that

provides statistical data on applicants and hires, information on impact bias and the effect it can have on hiring, and measures to counter bias.

• Hiring managers are encouraged to have diverse panels and provide Countering Bias training for panelists

Other Case Studies

1. Worksite Wellness Programs (WWPs)

2. Public Transportation

3. Smoke Free Public Housing

1. Worksite Wellness Programs

Reduce health insurance premiums for employees who achieve specified benchmarks like: lowering blood pressure; losing weight, increasing physical activity; quit smoking; and consuming more fresh fruits and vegetables.

WWP Recommended Action

Involve staff and employers in creating benchmarks that all employees have equal opportunity to achieve

Employ strategies that look at both individual risk reduction and create a healthy workplace environment and culture

2. Public Transportation

In King County, Washington funding cuts threaten to reduce transportation services to vulnerable populations.

2. Public Transit Recommended Action• Commit to providing travel opportunities for

populations such as: low-income, people with disabilities, students, youth, seniors, people of color, and others with limited transportation options.

• Set higher target service levels for low income and minority residents

• Use concrete performance measures to track progress

3. Smoke-free public housing

To reduce exposure to second hand smoke,

a local health department partnered with the regional public housing authority to ban smoking in government subsidized housing programs.

3. Smoke-free Housing Recommended Action

• Involve residents in solutions that affect their current and future housing

• Offer smoking cessation resources• Identify safe areas on campus where

smokers can go until they have succeeded in quitting

• Develop a phase-in approach

Questions

Feedback• What situations in your work would benefit

for applying the Guide?• What barriers do you see to using the

Guide? • What additional help do you want before

you can apply the Guide?• Who else should know about the Guide?

Question

If you have access to training and technical assistance would you be interested applying the Guide to a project in your workplace?

A few good resourcesEquity and Social Justice Annual Report, King County, August 2012

www.kingcounty.gov/equity

10 Promising Practices to Reduce Social Inequitieshttp://www.sdhu.com/uploads/content/listings/Briefing_10PromisingPractices.pdf

A Time of Opportunity: Local Solutions to Reduce Inequities in Health and Safetyhttp://www.preventioninstitute.org/component/jlibrary/article/id-81/127.html

Social Determinants of Equity, Camara P. Jones, MD, MPH, PhDhttp://minorityhealth.hhs.gov/Assets/pdf/Checked/1/CamaraJones.pdf

Life Spans Shrink for Least-Educated Whites in the U.S.

http://www.nytimes.com/2012/09/21/us/life-expectancy-for-

less-educated-whites-in-us-is-shrinking.html?pagewanted=all&_r=0

Deteriorating International Ranking of U.S. Health Status

http://www.annualreviews.org/eprint/iESYF775U2Mw

VfrxfAR2/Full/10.1146/annurev-publhealth-031811-124649