Introduction to Health Equity Christopher Nolan, MPA and Shweta Ubhayakar, MBBS, MS Instructors, Rush University College of Health Sciences – Department of Health Systems Management Course Co-Directors, Health Equity and New Models of Care

Agenda Introductions (5 min.) Group Activity – “Heat Wave” (25 min.) Health Equity Concepts (15 min.) Rush’s Commitment and Incorporating Equity (15 min.) Small Group Discussion and Next Steps (10 min.)

Introductions – with a Partner! Name, where you’re from, fun fact How would you define “health”? ©2007 RUSH University Medical Center

Group Activity: “Heat Wave” Read the interview article provided if you have not, individually (10 minutes) Discuss the article in partner/small group setting (8 minutes) Large group discussion and report out (8 minutes) Questions: Identify social/structural determinants that exist in this case and how these play a role in the overall health of an individual and/or communities What would you have done differently in such a scenario?

Defininitions: Health Health, as defined by the World Health Organization (WHO), is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity ©2007 RUSH University Medical Center

Definitions: Population Health “Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group.”  -David Kindig, MD, PhD and Greg Stoddart, PhD, 2003 I have emphasized the word “outcomes” to make the point that the definition focuses on the implicit goal of improving health outcomes.

Definitions: Health Disparity Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation. Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources. - Centers for Disease Control and Prevention – Sept. 2015 Share some examples from your personal/work experiences that demonstrate health disparities

Definitions: Health Equity Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” - Centers for Disease Control and Prevention – Sept. 2015 Share examples from personal/work experiences that demonstrate health equity initiatives. Importance of health equity – Minority health status is changing to US health status. According to census bureau by 2050 people of color will be in majority in the US. Growing prevalence of costly preventable diseases. Quality improvement initiatives have demonstrated effectiveness in addressing health and healthcare disparities.

Social Determinants of Health Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health Healthy People 2020 Approach to Social Determinants of Health A “place-based” organizing framework, reflecting five (5) key areas of social determinants of health (SDOH), was developed by Healthy People 2020. Healthy People 2020 HealthyPeople.gov; HealthyPeople2020

Social Determinants of Health Availability of resources to meet daily needs (e.g., safe housing and local food markets) Access to educational, economic, and job opportunities Access to health care services Quality of education and job training Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination, racism, and distrust of government) Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community) Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it) Residential segregation Language/Literacy Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media) Culture https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health HealthyPeople.gov; HealthyPeople2020

Physical Determinants of Health Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change) Built environment, such as buildings, sidewalks, bike lanes, and roads Worksites, schools, and recreational settings Housing and community design Exposure to toxic substances and other physical hazards Physical barriers, especially for people with disabilities Aesthetic elements (e.g., good lighting, trees, and benches) https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health HealthyPeople.gov; HealthyPeople2020

Definitions: Culture of Health We believe an American Culture of Health is one in which: Good health flourishes across geographic, demographic and social sectors. Attaining the best health possible is valued by our entire society. Individuals and families have the means and the opportunity to make choices that lead to the healthiest lives possible. Business, government, individuals, and organizations work together to build healthy communities and lifestyles. Everyone has access to affordable, quality health care because it is essential to maintain, or reclaim, health. No one is excluded. Health care is efficient and equitable. The economy is less burdened by excessive and unwarranted health care spending. Keeping everyone as healthy as possible guides public and private decision-making. Americans understand that we are all in this together. - Robert Wood Johnson Foundation Why would we move toward this?

Health Equity on the National Stage

Rush will be the leading academic health system Our mission The mission of Rush is to improve the health of the individuals and diverse communities we serve through the integration of outstanding patient care, education, research and community partnerships. Our vision Rush will be the leading academic health system in the region and nationally recognized for transforming health care. Our values Rush University Medical Center's core values — innovation, collaboration, accountability, respect and excellence — are the roadmap to our mission and vision. ©2007 RUSH University Medical Center

Health Disparities in Our Community

Communities we Serve ©2007 RUSH University Medical Center

Disparities Exist ©2007 RUSH University Medical Center

Rush’s Commitment to Health Equity ©2007 RUSH University Medical Center

Who Is Involved? Lead by Senior Leadership - Community Health Equity Governance by Diversity Leadership Council

Strategic Driver: Identify and mitigate the social needs of those we serve Metric: Number and percent of individuals who screen positive and are referred to and connected to appropriate resource Action Plan: Screen for SDoH in Primary Care, Inpatient, EDs, and Community Courage to Quit and Counsel to Quit for Rush System and Smoke-Free Housing Effort SDoH Navigator Farm to Neighbor Expansion Community Health Workers Program Manager, SDoH

West Side Anchor Committee and West Side ConnectED Alliance for Health Equity and Healthy Chicago 2.0 West Side United (WSU) West Side Anchor Committee and West Side ConnectED Rush Community Health Implementation Plan (CHIP) ©2007 RUSH University Medical Center

Anchor Initiatives Buy and Source Locally Hire Locally Invest Locally Volunteer Locally ©2007 RUSH University Medical Center

How are you connected to the concept of health equity? Small Group (15 min.) How are you connected to the concept of health equity? How would you incorporate health equity concepts into your day to day work? ©2007 RUSH University Medical Center

Concluding Thoughts In order to achieve health equity and mitigate health disparities, we must partner in a collaborative approach - including community residents/leaders, “competing” healthcare institutions, community based organizations, local government, and the business community