PROVIDENCE – In case you missed it, last week, more than 800 leaders in urban maternal and child health gathered at the Rhode Island Convention Center for the 2019 CityMatCH national conference, entitled: “Make WAVES: Intentional disruption to advance health equity.”

The conference featured a unique twist, as CityMatCH partnered with the annual Rhode Island Health Equity Summit, organized by the R.I. Department of Health.

As organizers explained it, health equity is a core value that organizers elevate every year at the annual CityMatCH conference, including spending an entire day showcasing how communities nationwide are prioritizing health equity in order to build healthier, more resilient, and more just communities.

To accomplish that goal, the conference made explicit its intention to display how local maternal and child health leaders were:

• Purposely bringing the equity and justice lens to the forefront of every conversation

• Persistently leveraging community voices, science and data to uncover issues of injustice and equip participants in the pursuit of health equity.

• Unwaveringly pursuing leadership strategies and practices that combined the power of local communities with a national network of maternal child and health leaders to advance equity and justice.

At the forefront of health innovation
Here in Rhode Island, often occurring under the radar screen of news media attention, the work by local communities to create a series Health Equity Zones has been a driving force in changing the focus to develop community-based solutions to improve health outcomes and address health disparities.

In the context of the national conference, Rhode Island is viewed as an important national leader in these efforts.

Following the conference, which was held for three days on Sept. 23-25, ConvergenceRI had the opportunity to catch up with Ana Novais, deputy director of the R.I. Department of Health, to talk about what had occurred.

ConvergenceRI: Can you describe the way that you saw the conference this week as putting words and data around health equity into action?
NOVAIS: The theme of the conference, was “Making Waves: Intentional Disruption to Advance Health Equity.” We saw that theme throughout the whole conference, throughout all the presentations that we had.

In terms of translating data into action, we made sure throughout the conference, whatever topic was being presented, we had the contextual data to set the stage and give the background information. But then, we pivoted toward the “what’s next” question.

One example, we opened the conference with a national speaker that focused on the “untold truth” of tribal nations’ relationships with the United States and its relevance to today’s divisions in America.

The speaker presented a lot of data about all of the failed treaties and all of the things related to our history, in terms of what he called “America’s original sin.”

But he was able to pivot and talk about what are the policies, interventions that need to follow today.

ConvergenceRI: What was your reaction to the new Census statistics around poverty in Rhode Island?
NOVAIS: The same, as usual. Was it a surprise to you?

ConvergenceRI: No.
NOVAIS: That is not new data. That is a confirmation of the data that we’ve known that support the approaches that we have been taking in public health. We know the impact of poverty, we know that minority communities have a higher burden, we know that Blacks and Hispanics have a higher burden of poverty, and we know that Rhode Island has ongoing issues with concentrated poverty – the lack of affordable, healthy housing, of transportation, of healthy food, the impact on school systems, and how that all impacts the lives of residents.

That’s the whole conversation [around health equity] that we have been having for many, many years, about how 80 percent of health outcomes and life outcomes have nothing to do with health care; it has to do with your zip code and everything that happens – or doesn’t happen – within that zip code.

And, how we need to address it from a place-based perspective of improving those conditions.

I think we are seeing, hopefully, in those areas where we have our Health Equity Zones, we’ve been able to see improvements, not only in overall health conditions, but also in some of the health outcomes, and on some of the environmental conditions.

Such as in West Warwick, where they didn’t have a bus route that went by the community health centers. Or, the utilization of vacant lots into an opportunity for urban farming.

I think it also points out [some of the successes] in what we’ve been able to do so far, such as a decrease of childhood lead poisoning in Pawtucket and Central Falls by something like 40 percent.

It has been an amazing initiative and an amazing investment, but we need to sustain that investment and we need to grow that investment, and expand the initiative around Health Equity Zones.

I’m seeing Health Equity Zones being replicated across the nation – in Florida, in New Orleans. But we need more investment, and we’re working on getting that.

ConvergenceRI: Does it suggest that there is a need to develop a way to measure the economics of poverty differently, to address what are often referred to as “externalities” – and to measure the kinds of “solutions” being developed on a community level? Do we need to create a new kind of economic index that supports the community-led vision about what the solutions are?
NOVAIS: I hope so. I think at the Department of Health, we have begun to take the steps toward that. As you may know, we developed our co-indicators of health equity, to help us tell the story and help change the narrative.

The way you define the problem, it leads you to a certain kind of solution.

I was talking with a colleague at the conference about the high number of avoidable maternal deaths for black women every year during delivery. It is a horrible statistic, absolutely.

But if you focus only on those 800 women [who died], which we need to focus on them, but we do not look at the millions of women who do give birth successfully and in a healthy way, then we are not looking at the [potential] solutions.

So, the way you define a problem, you also need to look at the solutions that are being successful in addressing the problem, so you can be responding from a “stength” perspective, and not necessarily always from a negative perspective.

Yes, I agree with you, we can start defining things differently.

ConvergenceRI: The ongoing work of health equity zones in Rhode Island is changing the conversation around health in the state: what are the next steps, in your vision, of where we need to go?
NOVAIS: We need to continue to engage with our key stakeholders. We have developed a new brochure that is reaching out to the business community to make sure we do not just engage with our usual partners in public health, but health equity zones becomes part of the normal conversation in other areas.

We’ve been in conversations with R.I. EOHHS that has definitely created an awareness and a desire to utilize the Health Equity Zones in a much more clear way.

We’ve had conversations with the Governor’s office and I think that she is very supportive of the Health Equity Zones initiative.

In fact, we had an afternoon plenary luncheon session at the conference that was just about the Health Equity Zones. We had 800 people in the room, and the Governor came to that lunch to launch that conversation. It showed her support for the initiative.