Putting health equity into practice
A remarkable conversation with three leading practitioners of health equity in the U.S.
Dr. Nicole Alexander-Scott, center, the director of the R.I. Department of Health, talking with Linda Golder Blount, left, president and CEO of the Black Women's Health Imperative, and Tricia Rose, right, director of the Center for the Study of Race and Ethnicity in America at Brown.
Here in Rhode Island, the budget gap for the current fiscal year is projected to be some $60 million, much of it attributed to alleged “overspending” on developmental disabilities and human services. However, that budget gap could be much larger, because it calculated state-only funds and did not figure in federal dollars being spent on services.
While the extra money spent on correcting glitches in the Deloitte software in UHIP can be considered part of a continuing boondoggle, the reality is that there are many other factors driving up costs: the demographics of an aging population, the increasing number of residents needing services because of economic and social disruption, and the past failures of the R.I. General Assembly to adequately fund things like mental health and disability services.
PROVIDENCE – Three of the leading practitioners of health equity in the U.S. shared their strategies on Friday, Nov. 17, as part of a roundtable discussion and lecture series sponsored by the Brown University School of Public Health and the Center for the Study of Race and Ethnicity in America.
The participants included: Linda Golder Blount, president and CEO of the Black Women’s Health Imperative; Karen Hartfield, lecturer in the Department of Health Services, University of Washington, and administrator for the HIV/STD program at Public Health, Seattle and King County, and Dr. Nicole Alexander-Scott, director of the R.I. Department of Health.
Visiting Professor Ronald Aubert, the Chief Science Officer for Research and Evaluation Analytics, LLC, moderated the panel discussion, which followed presentations Hartfield, Alexander-Scott and Goler Blount.
It was a remarkable conversation, held in an intimate academic setting, where three African American women public health leaders provided insights into how to reshape health delivery around the concept of health equity, focused on community needs, and a redistribution of resources.
One of the more powerful slides was a breakdown of factors that were causative for health outcomes: genetics was 10 percent, clinical care as 10 percent, and the remaining 80 percent were social, economic and community factors related to health equity.
We create the messages
Hartfield, at the request Aubert, spoke about her work in public health to address the opioid overdose epidemic in Seattle and the economic, racial and social inequities associated with the epidemic.
She spoke about the double-edged impact of tech jobs created by Amazon and Microsoft and the economic pressures it had created on Seattle’s housing market, with the median price for a home now above $700,000. [In comparison, the median price for a home listed for sale in Rhode Island is $298,000.]
While whites were dying at a higher rate in recent years, Hartfield continued, the levels of justice system incarceration for drug crimes was still disproportionately skewed by race, with blacks arrested at twice the rate of whites, with a much higher conviction rate than whites.
Hartfield talked at length about the efforts to establish what she called Community Health Engagement Locations, rather than safe injection sites, based upon the work done by Insite in Vancouver, B.C. providing wrap-around services to save people’s lives today and provide pathways to treatment, as a way to implement a comprehensive harm reduction strategy.
[Rhode Island’s harm reduction strategy, promised to be developed by November in the most recent executive order signed by Gov. Gina Raimondo in July, has not yet be shared publicly. For members of the task force not to be able to engage with Hartfield – or at least listen to what she had to say about harm reduction – appeared to be missed opportunity.]
Long, bumpy rode toward health equity
In her presentation, Linda Golder Blount talked about the importance of changing the narrative around health, with some simple rules: we leverage assets, we advocate, we create messages, and we reduce barriers.
Golder Blount talked about the differences of perception by African American women when they described their lives and their health, differentiated from the stereotypes.
In response to a question from the audience about poverty, and why it was not mentioned in the presentations, Golder Blount responded by saying: “People could be poor, but the people didn’t perceive themselves as being poor.”
Health equity zones
Dr. Nicole Alexander-Scott, who was recently promoted to be an associate professor at Brown University, talked about how civic engagement is a public health issue.
She described the efforts to create 10 Health Equity Zones in Rhode Island, and how the work by the community groups to define their needs have changed the landscape and the conversation in Rhode Island.
Alexander-Scott described the way the dimensions of a federal public health grant had changed by interactions and conversations with the community HEZs on the ground. [See link below to ConvergenceRI story, “Making health equity zones part of the RI vernacular.”]
