Equity Impact Review Guide NACDD General Member Call June 27, 2013

1. Equity Impact Review Guide NACDD General Member Call June 27, 2013

2. Quick Poll Did you take a look at the Equity Impact Review (EIR) Guide prior to this presentation? Yes No

3. Objectives • Introduce the Health Equity Impact Review Guide, an assessment tool designed to help predict the impact of a public health policy or project on health equity • Help you identify examples in which you can apply the Guide • This presentation supports domains 1, 2, 3, and 4

4. Health as a Human Right “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

5. The BIG Picture HHS National Partnership for Action to End Health Disparities National Stakeholder Strategy for Achieving Health Equity HRSA | CDC plans targeting disparities WA State Dept. of Health Strategic Plan NACDD Strategic Map

6. Equity Impact Review Guide Designed to examine proposals and identify actions to reduce health disparities and achieve health equity

8. 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

9. 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

10. Five Stages of the Guide • Summarize the proposed policy or project • Identify and assess who will be affected • Describe positive and negative impacts • Analyze and prioritize potential actions • Modify the original proposal and build in evaluation

11. 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

12. 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

13. 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.

14. 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

15. 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.

16. 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.

17. 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

18. 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

19. Quick Poll How likely are you to share the EIR Guide with colleagues at work? • Very likely • Likely • Unsure • Not Likely

20. Questions

21. Other Case Studies Worksite Wellness Programs Public Transportation Smoke Free Public Housing

22. 1. Worksite Wellness Programs (WWPs) The ACA allows employers to lower staff premium contribution up to 30% of the cost coverage, if the employee meets specified benchmarks like lowering blood pressure; losing weight; increasing physical activity; smoking cessation; and consuming more fresh fruits and vegetables.

23. 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.

24. Greenlining Institute & Prevention Institute Completed research to seek equitable, non- punitive, and functional Worksite Wellness Programs that benefit California small business owners and their staff. Health, Equity, and the Bottom Line: Workplace Wellness and CA Small Businesses (December 2012)

25. Potential impacts on the following groups of employees • Low wage earners • Work in multiple jobs & have long commutes • Have limited access to healthy affordable food and safe places to be active • Have chronic conditions • Under a lot of stress • Do not have access to computers

26. 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

27. 2. Public Transportation In King County, Washington funding cuts threaten to reduce transportation services to vulnerable populations.

28. 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

29. 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.

30. 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

31. 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?

32. Quick Poll If you have access to training and technical assistance, would you be interested in applying the Guide to a project at work? • Yes • No • Not Sure

33. A few good resources Equity and Social Justice Annual Report, King County, August 2012www.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

34. Questions, Reflections

35. Email Contact for more information: • EMAIL: Gbrandt@chronicdisease.org