Innovation Ecosystem

Building up public equity in health

The 2018 Health Equity Summit in Rhode Island promises to serve as a tipping point in changing the way that health care is defined and practiced

Image courtesy of the R.I. Department of Health

The cover image from the brochure promoting health equity zones in Rhode Island, which will be featured at the 2018 Health Equity Summit on Sept. 20

By Richard Asinof
Posted 8/27/18
The 2018 Health Equity Summit on Sept. 20 is expected to attract more than 600 participants to engage in conversation and dialogue around the model of building community resilience through the work of health equity zones in Rhode Island.
When will health equity zones become part of the political vernacular in Rhode Island? Will funding from national foundations investing in the health equity zone model in Rhode Island change the equation? How does place-based health outside of the current health delivery system factor into the metrics of economic development investments? Which political reporter in Rhode Island will be the first to ask a candidate running for governor in 2018 to define health equity zones and identify the nine cities and towns where they are currently operating? Is there a way that collaboration can be fostered between health equity zones and neighborhood health stations? When will local media polling begin to ask questions about health care policy issues to potential voters?
Whether it is health equity zones, neighborhood health stations, or harm reduction strategies such as statewide distribution of fentanyl test strips, the news media tends to ignore these developments, in part because they do not fit with the current playbook for selling the news – murder, mayhem, anxiety, mass shootings, hurricanes, and outrage at being caught in traffic jams.
The importance of conversation and convergence, to engage with neighbors and friends at a neighborhood level, to build a sense of connectedness, may require a different kind of story telling, a different way to define where we belong, to recognize the ability to change the conditions where we are living. To build a network of place-based health requires a different kind of engagement, one that is inclusive.

PROVIDENCE – On Thursday, Sept. 20, the R.I. Department of Health will host the 2018 Health Equity Summit, an all day conversation to be held at the Providence Convention Center, focused on building healthy and resilient communities and showcasing the work being done by nine community-based Health Equity Zones now operating in Rhode Island.

The gathering will bring together an expected 600 participants to engage with each other around the concept of how best to achieve health equity in neighborhoods and communities across Rhode Island.

The organization of the summit has put a distinct emphasis on conversation and engagement, featuring four breakout sessions, each with 12 presentations, culled from more than 80 applicants, according to Deb Garneau, one of the co-chairs of the Health Equity Summit and the director of the Health Equity Institute at the R.I. Department of Health.

“We wanted to focus on engaging with community stakeholders that will be attending, with less emphasis on power point presentations and technology,” Garneau explained.

Among the diverse topics scheduled for one of the morning breakout sessions are:

Stand up to stigma: Let’s talk about mental health

Ten years of providing health care, lifestyle coaching to uninsured patients at Clinica Esperanza

Criminalization and inequity in Rhode Island’s overdose and addiction crisis

Mindfulness: a key ingredient for resilience in the face of toxic stress

Climate change is a civil and human rights issue

When the pie is too small, how do we prioritize? Strategies for the greatest impact

Cultural barriers to refugees seeking and accessing health care services

The engagement strategy at the Health Equity Summit seeks to renew the call to action through cross-sector collaborations and networking opportunities.

The 2018 Equity Summit will conclude with the launch of the 2018 Association for State and Territorial Health Officials [ASTHO] President’s Challenge, to be issued by Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health and co-chair of the 2018 Health Equity Summit, who is currently serving as president of the ASTHO.

The theme for the President’s Challenge is to look at place-based initiatives and building community infrastructure around resilience and community connectedness, according to Garneau. “Obviously, these themes really resonated with Rhode Island’s communities,” she said.

The voice of the community
The concept of health equity is a narrative that often runs counter to the traditional conversations around the delivery of health care services, which are mostly controlled by hospitals, health systems, health insurers and large employers, focused largely on achieving business outcomes and strategies to reduce medical costs for employee-based health insurance.

As some, such as Dr. Michael Fine, have described it, the health care delivery system in Rhode Island is not really a system but rather a market, good at extracting wealth.

In many ways, the concept of achieving health equity has been an underground river of ideas that is now emerging as an important component of the health policy vernacular in Rhode Island, particularly as it gains traction in neighborhoods and communities – and becomes a priority with local and national funders.

The overarching question being asked by the 2018 Health Equity Summit is this: “How can we work together to ensure all Rhode Islanders have the opportunity to live a healthy life?”

The basic concept underpinning the work on health equity is that “place matters when it comes to health.” As the brochure promoting the event says, “Data show that nearby zip codes, or even adjacent neighborhoods, can often have striking differences in health outcomes. It’s not just access to medical care that causes such differences.”

We spend an enormous amount on health care as a society, the brochure continues, “Yet 80 percent of our health is determined outside the doctor’s office and inside our homes, schools, jobs, and neighborhoods.”

To have the biggest impact on health outcomes – and help curb the rising cost of care, the brochure argues, “We must shift our investment to the place where health happens the most: our communities.”

Further, the brochure concludes, “Research tells us that healthy communities have adequate transportation; employment opportunities; clean, safe, and affordable housing; parks and open space; access to fresh, healthy food and clean water; a high-quality education system; and safe streets. These are the best return on investment in health: places where people want to live, work, learn, and play.”

Translating the vision into a working reality
Health equity and health equity zones have not yet become an accepted part of the current political vernacular. Many of the candidates running for Governor – and most political reporters, for that matter – would have a hard time defining what a health equity zone is and where the nine currently operating health equity zones in Rhode Island are located.

But, as Ana Novais, the executive director of the R.I. Department of Health described it, there is a “creative tension” on the journey between the reality of today and where one wants to be as part of the reality of tomorrow.

Part of the recognition that comes with the work around developing health equity zones in neighborhoods and communities, working on the social determinants of health, Novais continued, is the collaborative nature of the work. “No one single organization can accomplish the work by themselves,” she said. “It requires collaboration, with everyone participating, to create a shared common vision. It is a journey of creative tension.”

Here is the ConvergenceRI interview with Ana Novais, the executive director of the R.I. Department of Health, and Deb Garneau, the director of the Health Equity Institute at the R.I. Department of Health, talking about the upcoming 2018 Health Equity Summit.

ConvergenceRI: How many people do you expect will attend the 2018 Health Equity Summit?
We are planning for 600; we have registrations right now at 350, so we have a little room to grow.

ConvergenceRI: How will the conversations at the summit reflect where the concept of health equity has been and where you want to go?
We want to become more engaged with stakeholders. Certainly, great connections can occur at the local levels of activities at individual health equity zones. We see the summit as an opportunity to showcase that work and to build solidarity around the concepts of health equity and achieving health equity within our state.

NOVAIS: We want to continue the conversation around health equity and the social determinants of health; we are trying to do that not just from our perspective, but to have that dialogue and conversation with our stakeholders, responding to what they see as the calls to action needed.

As much as we [at the R.I. Department of Health] are a big driving force behind creating health equity zones in the state, at the Health Equity Summit, we will be leading a conversation, facilitating that conversation, that we all need to own in the state.

ConvergenceRI: Two years ago, when we spoke, one of the challenges was integrating health equity as part of the vernacular around health care in Rhode Island. How have you progressed in addressing that?
[laughing] You may be able to assess that better than us, Richard, because you are out there talking with people.

In all seriousness, I believe that we have made great strides in making health equity zones a part of the vernacular.

One of the reasons that we have brought on Sophie O’Connell as part of our team is because we wanted to have someone help us from a communications perspective, to enable us to move forward with that conversation into the mainstream.

I can say with confidence, in the geographic areas where local health equity zones have been active, in the cities and towns and neighborhoods, people recognize it, it has become part of the vernacular. We have identified local champions for health equity zones.

We also continue to work in parallel at the national level, to make sure the model continues to be talked about and written about.

GARNEAU: The overwhelming response to our call for proposals is a measure of the growing interest in health equity work. I don’t think we would have had the same reception several years ago.

ConvergenceRI: What are the challenges in terms of sustainability of funding for the ongoing work on health equity zones? As I recall, the initial funding came from the Centers for Disease Control and Prevention. Has the R.I. General Assembly been willing to help fund the initiative through general revenue funds?
There was a proposal that went nowhere; the legislation was introduced, but it didn’t pass.

ConvergenceRI: Beyond the potential of the President’s Challenge, to be launched at the Health Equity Summit, what are the other potential funding sources that you are exploring to move toward sustainability?
When I think about sustainability, I think about it in three different ways.

One is the funding: how much money do we have to continue to expand and create new health equity zones.

The second way I look at sustainability goes back to the question you asked about becoming part of the vernacular. When people living in the community recognize it, and organize around it, HEZs becomes a sustainable part of the conversation.

The third way is to look at HEZ is as a sustainable model; when it is being implemented, are people staying true to the model as they move forward?

Those are three ways to measure sustainability.

You asked specifically about funding. What I can tell you is that we continue to present the model of health equity zones in Rhode Island to national foundations. We’ve had conversations with the Robert Wood Johnson Foundation and the Kresge Foundation, and so far the reception has been very enthusiastic.

At the state level, we are pursuing local foundation support.

Our challenge has not been: how do you invest in health equity zones, but rather, can we, as a state, create a common, agreed-upon vision of how we are making investments in the community? How do we get out of our silos?

Instead of the Rhode Island Foundation will fund this, the Health Department will fund these, and Blue Cross will fund that, can we agree on a vision and an agenda, one that is agreed upon by the community and the community participates in the conversation? That is a conversation that we are currently engaged in.

We are also engaging with the state government agencies to showcase the work that is being done by local health equity zones, creating a road show, where we have created a road map for every state agency.

ConvergenceRI: It all sounds very promising.
I am keeping my fingers crossed.


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