Session
Advancing equity and addressing social determinants of health through community engagement
APHA 2022 Annual Meeting and Expo
Abstract
Strengthening community engagement strategies to address social determinants of health
APHA 2022 Annual Meeting and Expo
Background and objectives
Community engagement is critical to advance health and racial equity in community-based public health. Since 2019, the Public Health Institute Center for Wellness and Nutrition (CWN) through funding from the Center for Disease Control and Prevention (CDC) offered training and technical assistance (TA) to CDC’s Racial and Ethnic Approaches to Community Health (REACH) grant recipients across the country to help organizations increase, expand, or deepen their community engagement (CE) efforts to advance local systems change.
In 2019, CWN conducted baseline key informant interviews with the REACH recipients to measure their level of CE and identify priority focus areas before offering training and TA. In 2021, CWN conducted follow-up key informant interviews with recipients to identify progress with implementation of CE strategies and the facilitators and barriers to implementing their CE strategies.
Methods
Recipient organizations (n=8) that participated in baseline interviews and received high-touch training and TA from CWN (i.e., attended trainings and participated in 1:1 TA) were selected to participate in follow-up key informant interviews. In total, seven organizations participated in both baseline and follow-up interviews.
Results
At baseline, organizations did not report involving community residents in project decisions. However, at follow-up, six out of the seven organizations interviewed described co-creating solutions or involving community residents in the decision-making processes surrounding project implementation, resource development, and local systems change. Recipients also noted the benefits of the collaborative TA process.
Conclusions
As a result of CWN’s CE training and TA, REACH grant recipients reported including community residents throughout project planning and implementation. In addition, some organizations reported a shift in power whereby residents began leading local projects. Since community engagement efforts have been known to lead to sustainable and equitable programming, offering this model of collaborative training and TA to organizations should be replicated and scaled within the public health community for greater impact.
Abstract
Leveraging community-academic partnerships to enhance equity work and address social determinants of health in Liberal, Kansas
APHA 2022 Annual Meeting and Expo
Authors: Sarah Mersdorf-Foreman, LMSW, Susan Lukwago, PhD, Kay Burtzloff, MA, Clarissa Carrillo, BA, Christina M. Pacheco, JD, MPH, Vicki Collie-Akers, PhD, MPH, Mariana Ramirez, LSCSW, Allen K. Greiner, MD, MPH, Sarah Finocchario Kessler, PhD, MPH
Affiliations:
1.Liberal Area Coalition for Families
2.University of Kansas Medical Center
Issues: Liberal, the county seat of Seward County, Kansas and is a hub for agriculture, natural gas and oil, and meatpacking industries. While these industries have brought an influx of jobs and diversity to Liberal (58% speak a language other than English, 30% foreign-born of whom 65.5% are not US citizens), this region continues to struggle with many social determinants of health (SDoH). Among the 2022 County Health rankings, Seward County is 79/104 for health outcomes, leaving much room for improvement.
Description: In 2001, the Liberal Area Coalition for Families (LACF) was formed to advance community health and services through multi-sector partnerships. With a robust history of addressing health behaviors through partnerships and policy advocacy to improve health equity for its residents, e.g., tobacco bans in outdoor spaces. Throughout LACF’s history, partnerships with academia have provided technical expertise to support public health efforts. Our current partnership with the University of Kansas Medical Center through Communities Organizing to Promote Equity Project is allowing us to extend our equity work from addressing key behaviors to addressing SDoH as drivers of health.
Lessons Learned: We have worked hard to teach academic partners that success occurs when it is done “with communities and not “to communities. It is the inclusion of community voice and using a bottom-up approach that gets buy-in from communities.
Recommendations: Academic partnerships are most effective when communities are heard and strengths are leveraged. Communities should be included in every step to ensure the initiatives are relevant to the intended populations.
Abstract
Community engagement to advance health equity – Lessons from California Accountable Communities of Health
APHA 2022 Annual Meeting and Expo
Introduction: Community engagement is critical to the design and implementation of community health improvement initiatives and efforts to improve health equity. But this does not mean it is easy to do. While a number of excellent frameworks and resources exist for groups seeking to meaningfully engage community members, each of these must be adapted to the particular context.
Program Theory: The California Accountable Communities for Health Initiative (CACHI) aims to create a “a more expansive, connected, and prevention-oriented health system. Since 2017, CACHI has funded thirteen locally-based ACHs to align partners from different sectors and collectively address community health priorities. Community engagement is one key component of the CACHI model and is intended to include community member participation at all levels of an ACH, active involvement in decision-making, and regular communication with and engagement of the community at large. “Authentic community engagement is one of several ways CACHI believes an ACH demonstrates accountability to its community.
Program activities & outcomes: CACHI ACHs have used a variety of approaches to engaging community members. Passive strategies include gathering input on health improvement priorities or the design of hospital and housing facilities. Increasingly, ACHs are reducing barriers to resident participation by providing interpretation and direct payment to community members for their time; ACHs are also working with community-based organizations to represent resident needs, assets, and perspectives. More active strategies have included: resident leadership training; hiring community members in roles such as “trust builder, “family leader, or “neighborhood navigator; residents accepting leadership roles in ACH governance; and allocating ACH funds directly to community members or to resident-led projects. Despite these efforts, less than half of ACH stakeholders feel they have made significant progress in community engagement. Examples of barriers include the inability to change meeting times and formats to accommodate resident needs, to modify program direction based on resident recommendations, or to pay residents for their time.
Conclusions and recommendations: More active community engagement strategies can help ensure ACHs meet the needs of their communities and bring greater equity to their work. In the CACHI context, the use of multiple, complementary community engagement strategies shows promise. But meaningful community engagement takes time, financial resources, and a willingness to share power. To promote equity, residents should be paid for their time and expertise. Community health planners should seek—and funders should allocate—dedicated funding for resident stipends and for staff time to support sustainable engagement.
Abstract
Improving equitable disaster response: A case study of dialysis care during Hurricane Ida
APHA 2022 Annual Meeting and Expo
In 2021, Hurricane Ida battered much of New Orleans, leaving thousands of people without electricity and degrading accessibility to major streets throughout the region. This restricted access to essential healthcare resources such as dialysis centers, which provide critical services for patients with end-stage renal disease (ESRD). Indeed, ESRD patients were forced to travel significantly further distances to receive dialysis treatment. Thus, this research employed a mathematical location model combined with a set of visualization tools to determine the optimal reassignment of ESRD patients to operational facilities during three phases - pre-disaster,
mid-disaster, and post-disaster. The results offer ESRD patients information in regards to their optimal care centers during the hurricane and identify overreliance on distinct dialysis centers in New Orleans. Additionally, via cluster analysis, disproportionate differences in travel distance during Hurricane Ida were found among key demographic groups, highlighting potential
socio-spatial inequalities in disaster recovery. In particular, the mathematical location model determined that areas with high populations of residents aged 65+ were significantly more impacted than areas with few residents 65+, which is critical to note as senior citizens are the most susceptible to ESRD. From a socio-economic perspective, high income clusters in New Orleans exhibited much stronger resilience post-disaster compared to their low-income counterparts. Finally, racial inequalities were also evident: areal clusters of Black populations experienced much greater travel times and exhibited poor resilience compared to other
race-dominant areas. These findings highlight specific dialysis facilities in New Orleans that should be fortified to improve equitable disaster response. Further, from a planning perspective, the proposed analysis framework can be utilized to effectively connect patients to healthcare resources and combat intrinsic socio-spatial inequalities within other regions.