1 Equity Metrics For Use in HIA Practice National HIA Meeting  Washington, DC  June 17 th, 2015 Jonathan Heller Kim Gilhuly David Liners

HIA Equity Metrics: A Practitioner’s Thoughts Example of piloting the HIA Equity Metrics: Prop 47 HIA How can the Metrics Improve HIA Practice? 2

Prop 47 – The Policy Changes 6 crimes from felonies/wobblers to misdemeanors Drug possession Petty theft < $950 Shoplifting < $950 Receiving stolen property < $950 Writing bad checks < $950 Forgery < $950 Reinvests savings in substance abuse and mental health treatment, education, and victim compensation. 3

4 Prop 47 HIA Advisory Committee

1. The HIA process and product focus on equity MetricAnswer keyAnswer aProposal analyzed in the HIA was identified by and/or relevant to communities facing inequities 0 = No 1 = Proposal identified by HIA practitioner as being relevant to communities facing inequities 2 = Proposal prioritized by communities facing inequities as being important for their health 1 Comments: Topic of HIA identified in collaboration with Californians for Safety and Justice, a coalition of funders in California joined to address the impact of incarceration and the criminal justice system in California. They also work with an affiliated coalition of criminal justice advocates. 5

1. The HIA process and product focus on equity MetricAnswer keyAnswer bHIA goals, research questions, and methods clearly address equity 0 = No 1 = Scope includes equity related goals and questions 2 = Scope includes an extensive focus on equity 1 Comments: The topic was decided upon because of the general huge disparate impact on communities of color, so the scope identified the impact on those communities as inherent in all questions. However we did not create questions of equitable access to programs funded by Prop 47. 6

1. The HIA process and product focus on equity MetricAnswer keyAnswer cDistribution of health and equity impacts across the population were analyzed (e.g., existing conditions, impacts on specific populations predicted) to address inequities; the HIA utilized community knowledge and experience as evidence 0 = Distribution of impacts not assessed and community knowledge/experience not included 1 = Distribution of impacts assessed or community knowledge/experience included 2 = Distribution of impacts assessed and community knowledge/experience included 2 Comments: In some of the chapters we broke out impacts by race/ethnicity; we did extensive qualitative data collection with impacted populations 7

1. The HIA process and product focus on equity MetricAnswer keyAnswer dRecommendations focus on impacts to communities facing inequities and are responsive to community concerns 0 = Recommendations do not address issues related to equity 1 = Recommendations address equity impacts 2 = Recommendations address equity impacts and are responsive to community concerns 2 Comments: The recs are responsive to community concerns; our AC well-represents communities impacted by over-sentencing and the AC was very involved in recommendation prioritization and re-write. One of the larger equity concerns was access to substance abuse and mental health programs, and many of our recommendations had to do with following evidence-based practices for those programs in order to not replicate inequities currently existing in the system. 8

1. The HIA process and product focus on equity MetricAnswer keyAnswer eFindings and recommendations are disseminated to and by communities facing inequities using a range of culturally and linguistically appropriate media and platforms 0 = No dissemination in or by communities facing inequities 1 = Dissemination occurs in or by impacted communities 2 = Dissemination occurs in and by impacted communities with appropriate media and platforms 2 Comments: Our community organizer and advocacy partners used the HIA website/infographic extensively in sharing findings with their base communities; also used the HIA findings to train the on-the-ground community organizers to talk about Prop 47; held a webinar for advocates to explain the HIA and make suggestions for how they could use it in their education efforts. 9

1. The HIA process and product focus on equity MetricAnswer keyAnswer fMonitoring and evaluation (M & E) plan included clear goals to monitor equity impacts over time and an accountability mechanism (i.e., accountability triggers, actions, and responsible parties) to address adverse impacts that may arise 0 = Equity impacts not included in M & E plan 1 = Equity impacts included in M & E plan 2 = Equity impacts included in M & E plan and accountability mechanisms put in place 0 Comments: Ooops. We had good indicators to monitor but did not call out the need to disaggregate them explicitly in our M & E plan. 10

2. Built capacity of those facing health inequities to engage in HIAs and decision making. MetricAnswer keyAnswer aCommunities facing inequities lead or are meaningfully involved in each step of the HIA 0 = No involvement of communities facing inequities 1 - Additional point for each step of the HIA in which communities facing inequities are meaningfully engaged 5 Comments: We had representation from the impacted community on our AC; also community organizations recruited and organized the focus groups; we worked hard to engage community organizers who work on these issues in dissemination. 11

2. Built capacity of those facing health inequities to engage in HIAs and decision making. MetricAnswer keyAnswer b As a result of the HIA, communities facing inequities have increased knowledge and awareness of decision-making processes, and attained greater capacity to influence decision- making processes, including ability to plan, organize, fundraise, and take action within the decision- making context 0 = No increase in knowledge or awareness of decision-making processes 1 = Communities facing inequities acquired knowledge and awareness 2 = Communities facing inequities acquired knowledge, awareness, and greater capacity to take action 0 Comments: In this HIA, I’m not sure that participation in the HIA by the impacted community increased knowledge of the ballot initiative decision-making process because we worked with organizations who were already working on Prop

MetricAnswer keyAnswer aCommunities that face inequities have increased ability to influence decisions, policies, partnerships, institutions and systems that affect their lives 0 = No increased ability to influence 1 = Individuals and groups had increased influence over the decision that was the focus of the HIA 2 = Individuals and groups have increased influence over a broad range of decisions and systems that affect their lives 1 Comments: Our involvement brought some community organizations more actively into the issue (than they might have been engaged by CSJ only), so I think the HIA had a bit of an impact in this way The HIA resulted in a shift in power benefiting those facing inequities

MetricAnswer keyAnswer bGovernment and institutions are more transparent, inclusive, responsive, and/or collaborative 0 = No increase in institutional transparency or inclusiveness 1 = Institutions more transparent and inclusive 2 = A systems level change has been implemented that allows for sustained influence 1 Comments: Our interaction with the Legislative Analyst’s Office, the Department of Education, the Trauma Recovery Center, and extensive digging into the budget for MH/SA treatment encouraged data sharing. More involvement in monitoring/implementation would be even more effective The HIA resulted in a shift in power benefiting those facing inequities

4. HIA contributed to changes that reduced health inequities and SDOH inequities MetricAnswer keyAnswer aAs a result of the HIA, there are measurable improvements in the social and environmental determinants of health within the community and a decreased differential in these determinants between communities facing inequities and other communities 0 = No change in determinants 1 = Communities facing inequities experience improvements in health determinants 2 = Communities facing inequities realize improvements in health determinants and close the gap on inequities 2 Comments: Thousands of people who would have gone to prison have not; thousands of people who were in prison were re-sentenced and released; people living with a felony conviction on their record are applying for resentencing and expungement, changing a barrier to employment. Like in every state, harsh oversentencing for low-level crimes affects, in the majority, communities of color in CA. 15

4. HIA contributed to changes that reduced health inequities and SDOH inequities MetricAnswer keyAnswer b As a result of the HIA, there are measurable improvements in the physical, mental, and social health issues within the community and a decreased differential in these health outcomes between communities facing inequities and other communities 0 = No change in health outcomes 1 = Communities facing inequities experience improvements in health outcomes 2 = Communities facing inequities realize improvements in health outcomes and minimize health disparities NA Comments: Hard to say at this point 16

Pilot Test Comparisons WISDOM Treatment Instead of Prison HIA - 19 Pittsburg CA Railroad Ave HIA - 8 Prop 47 HIA - 17 Out of a possible 26 points 17

How can the Equity Metrics improve HIA practice? Look at the Metrics while developing ideas for and screening HIA topics Check-in using the Metrics midway through your HIA Grade all of your HIAs using the Metrics as part of the process, outcome, and impact evaluations Conduct a national assessment of how HIA is doing at incorporating equity using the Metrics Refer to the Metrics during scoping meetings Other ideas? 18

19 Kim Gilhuly Jonathan Hellder David Liners Thank You!