Central Valley Health Policy Institute
Place Matters Initiative
Place Matters Regional Equity Forum
The SJV Regional Equity Forum
National Policy Context
There is a growing consensus that groups defined by race/ethnicity, gender, class, and place have different health outcomes (health disparities) and that some of these differences are the unfair impacts of historic and current inequalities in opportunity (health inequities). Addressing health inequities has emerged as one of the most promising approaches to improving the quality and constraining the costs of health in the US.
The Institute of Medicine defined public health as “what we as a society do to collectively assure the conditions in which people can be healthy.” That certain conditions commonly referred to as social determinantsÑincluding access to affordable healthy food, potable water, safe housing, and supportive social networksÑare linked to health outcomes is something on which most of us can agree. The unequal distribution of these conditions across various populations is increasingly understood as a significant contributor to persistent and pervasive health disparities (Woolf S., 2004).
Healthy People 2020 suggests that population health is determined by a complex interaction of multiple factors including individual behaviors, biological factors, physical and social factors, environmental factors, policies, interventions and access to health care services. Healthy People 2020 also recommends that the development of comprehensive strategies to eliminate health disparities will require close collaboration and linkages with community assets, workforce diversity, economic development, and a more responsive, accessible and efficient health care delivery system.
The Joint Center for Political and Economic Studies, Health Policy Institute and CommonHealth Action have brought together PLACE MATTERS' 16 teams, representing 22 counties, and other key partners. These communities, including the San Joaquin Valley, experience persistent, extreme inequities in health. Through the national program and local efforts, the PLACE MATTERS teams are developing and implementing strategies to understand community health concerns, develop evidence-based strategies for intervention, raise public awareness of social determinants of health, build broad community-based coalitions, engage policy makers, and involve a broad array of community stakeholders.
San Joaquin Valley PLACE MATTERS
Along with key partners from throughout the region, the Central Valley Health Policy Institute (CVHPI) has participated in the national PLACE MATTERS since its inception. Recognizing the need to build a broader collaborative in the Valley, CVHPI at California State University, Fresno facilitated the first of its kind, Place Matters: San Joaquin Valley Regional Equity Forum. This remarkable event brought together over 150 regional key stakeholders in an effort to begin developing a regional agenda to reduce and eliminate health inequities. Key leaders in air and water quality, healthy food access, physical activity environments, access to health care, affordable housing and community economic development contributed to a full day of broadly inclusive discussions. Presentations from diverse perspectives highlighted how variations across the region in the policies and environments that shape community life also determine place-based inequities in the burden of chronic disease and years of productive life.
During the event, researchers from the CVHPI and the Virginia Network for Geospatial Health Research, Inc. released preliminary findings from a ground-breaking report on how years of productive life lost and ambulatory care sensitive hospital admissions (avoidable hospitalization) varies across the region's communities as defined by zip codes. The full report, Equity in Health and Well-Being Equity in the San Joaquin Valley: A New Approach , is scheduled to be released in Fall 2010 and will be available online at: www.cvhpi.org. The report focuses on available data from 1998-2008. Dr. John Capitman, Nickerson Professor of Public Health and Executive Director, CVHPI, California State University, Fresno presented preliminary findings and framed the goals for the day.
Dr. Brian D. Smedley , Vice-President and Director , Health Policy Institute Joint Center for Political and Economic Studies and lead person on the national Place Matters initiative, was Keynote Speaker at the event and spoke on “ Building stronger communities for better health.” Smedley shows how at the national level, health inequalities add to the overall costs of health care and can be linked to enduring patterns of racial/ethnic segregation and poor living conditions in the segregated communities where most people of color live. He outlines key policies for eliminating health inequities.
Dr. John Capitman moderated presentations and a panel discussion for leaders representing several regional and local initiatives addressing social determinants of health.
The panel included: Dr. Cassandra Joubert, Director, Central California Children Institute (CCCI) Click here to view presentation. Genoveva Islas-Hooker, Coordinator, Central California Regional Obesity Prevention Program (CCROPP) Click here to view presentation. Jenny Saklar, Campaign & Programs Manager , Central California Air Quality (CVAQ) Click here to view presentation. Keith Bergthold, Assistant Director Planning and Development , City of Fresno Click here to view presentation. Phoebe Seaton, Attorney , California Rural Legal Assistance (CRLA) Click here to view presentation.
In the afternoon participants in the forum engaged in small group activities in an effort to discuss and identify: a) Equity frameworks and value for collaboration, b) Shared agenda and next steps, and c) each organizational mission statement/talking points.
Forum presenters and participants emphasized the shift in thinking about what determines health outcomes -- from a focus on individual genetics and behavior to a more inclusive approach that recognizes the additional roles of living conditions and health promoting opportunities. This new focus challenges policy makers and communities to think about how environmental, community development, education and health care/public health policies and programs influence the quality of life and opportunities for health in every community. Most felt that consistent and coordinated messaging could help in building the grassroots coalitions and policy/program change objectives needed to reduce and eliminate health inequities. As local, regional, and state policymaking and program implementation come to reflect the new understanding, there is the potential for greater alignment between the aspirations of historically excluded and under-resourced communities and proponents of regional and community economic opportunity and development. Forum presenters and participants acknowledged the difficulty in fostering policymaking based on the “ social determinants of health” framework in a period of recession, governmental budget crises, and flagging philanthropic investments. Most participants endorsed the idea of moving forward together, through a shared agenda, improved communications, and specific collaborative projects. Regional and multi-sectoral collaborations was seen as a strategy to increase the effectiveness and sustainability of each participating initiative.
In summary, the forum provided the following key challenges, recommendations and next steps:
Initially, participants met in groups defined by the broad interests of regional and local initiatives: air and water quality, community and economic development, (3rd group), and neighborhood leadership for change. In these discussions, they explored how issues of regional health equity linked to their work. They also identified the organizational and initiative challenges and needs that might be addressed through broader coalitions based on the social determinants of health equity approach.
Some of the challenges noted were:
- Lack of grassroots involvement in the decision-making process in the development, implementation, and evaluation of programs, policies, and funding to address disparities.
- Lack of inclusion of communities affected most by disparities at state and local “tables” where discussions on policies, interventions, programs, or research and evaluation decisions are made.
- Limited “ownership” and accountability by local policy makers and provider organizations for the elimination of health disparities and their root causes.
- Lack of diverse health professionals to representative of the communities served in the region.
- Heath and social service and educational systems fail to address the communities Socio-cultural differences such as lack of trust, language differences, and differences in attitudes, values, beliefs, and myths.
- Lack of, or limited shared understanding of health inequities across the region's providers and programs. This includes the lack of a uniform definition of disparities and clear programmatic strategies to address health inequities individually and collectively.
- Lack of communication across the different divisions and programs on health disparities.
Towards a Regional Health Equity Agenda
Later, meeting in groups with diverse interests, participants shared their individual and organizational policy and program change priorities. Inclusion in a regional health equity agenda were highlighted in two or more small groups as follows:
- Build Economic development /infrastructure
- Promote healthy community/environment
- Provide affordable housing
- Offer education/ adult and child literacy
- Integrate Land use policy
- Provide Access to affordable healthy food for all
- Control out of pocket cost for access to care and meds
- Provide affordable and accessible public transportation
Priorities for Action:
Although groups came to consensus on the need for regional health equity shared agenda, they also voiced several priority strategies that stakeholders needed to engage in and address prior to discussing the shared agenda. They sought consensus within each of the 8 small groups on several priorities for action. Click here for a summary
- Increase understanding and application of social determinants framework among health, social service, community/economic development and education professionals through professional education and other tools.
- Document and implement successful practices for address inequities from experiences here and in other communities and regions.
- Increase the capacity of communities to shape policies and environments that influence health through building the capacity of grassroots/community leaderships building
- Encourage collaborations and coalition building by encouraging skills development, cross-training opportunities, and support for collaborative projects.
- Develop grant-seeking capacity within organizations and multi-sectoral initiatives.
- Develop collaborative decision-maker education and advocacy efforts to direct programs and funding to addressing regional challenges.
Latino Life with Graciela Moreno
The program highlighted the amazing work of regional and local efforts addressing inequities in health and wellbeing, living conditions and service access across the Valley. The Forum provided a unique opportunity to share new research about how lost lives and avoidable hospitalization are linked to our social, economic and environmental factors, laying the groundwork for a cross-cutting regional equity and civic engagement agenda.
The national Place Matters initiative addresses the social factors that determine health by cultivating leadership and advancing a Fair Health Movement-one community at a time.
"Place Matters is a national initiative of the Joint Center for Political and Economic Studies, Health Policy Institute (HPI) designed to improve the health of participating communities by addressing social conditions that lead to poor health."