PACE EH Redefining Local Environmental Health PACE EH National Summit March 28-29, 2006 Louisville, Kentucky PACE EH and Health Equity PACE EH and Health Equity

What is Health Inequity? Health inequities refer to differences in population health status and mortality rates that are systemic, unfair, unjust, and actionable. (Paraphrased from Margaret Whitehead, The Concepts and Principles of Equity and Health.)

Manifestations of Health Inequity Lower income Americans live more disabled less healthy lives, and die far younger than wealthier Americans African-Americans suffer 2.4 times higher infant mortality rates than do other Americans Low income Americans have 2.5 times higher rate of coronary heart disease than Americans above the poverty line

Why Address Health Inequity? Proactive Establish the Conditions for Health Address Institutions and Policies

Tasks 1- 3 Prepare for the Process Facilitators examine potential for a CEHA ¤Facilitators map the target community ¤Invite key community/staff members

Tasks Locate the Issues Define Goals & Scope of Assessment ¤Generate List of Local EH Issues Describe the Context of the Issues

Tasks Quantify and Qualify the Issues ¤Develop Local Indicators ¤Select Relevant Standards Create Issue Profiles

Tasks Set the Stage for Action ¤Rank the Issues ¤Set Priorities for Action ¤Develop Action Plans Evaluate Progress

PACE EH – The Five Primary Challenges Data limitations Lack of consensus Scientific view v. public perception Authority Indicators

Data Limitations Not Existent Not Relevant Not Accessible ___________________________________ Range of options: Rely on existing data Develop new data Work with usual partners Develop new bridges

Lack of Consensus Proof that given environmental factor has human health impact ___________________________________ Range of options: Scientific Evidence Precautionary Principal

Science versus Perception Public health activities driven by science Interventions tend to be science-based Communal sense of health driven by perception Needs of community often not grounded in valid health science _______________________________________ Range of options Science-based agenda Perception-based agenda Science to community Community to science

Authority to Determine Environmental Health Agenda Disparate local agencies Distinction between public and environmental health State determined funding streams ___________________________________ Range of options: Stealth interventions Transparency Status Quo Assumption of greater leadership

Indicators Choice of indicators Rationale for indicators Viability of indicators ___________________________________ Range of options: Inspired by data Inspired by need Scientific standards Community standards

Meeting the Challenges in support of Health Equity Data limitations – Dont rely on Existing Data Lack of consensus – Use Precautionary Principle Scientific view v. public perception – Translate and Unite Authority – Embrace Advocacy Indicators – Encourage Local Ownership

Addressing Health Inequities: A Reinvention of Public Health The local health agency identifies and addresses the causes of poor health, not just the effects. The local health agency uses available resources to eliminate poor health, not just treat the victims.

PACE EH Contacts at NACCHO Jonathan Schwartz Senior Analyst (202) x250 Jennifer Li Program Manager (202) x234 Grace Ibanga Program Assistant (202) x249 Gea Jackson Program Associate (202) x268