Promote equitable social, economic and environmental conditions to achieve optimal health, mental health, and well-being for all. Office of Health Equity MISSION

“Health equity” means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives. Source: California Health and Safety Code Section

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Wealth is Health The life expectancy used is the average of the male and female life expectancies for Compiled by SFRB. Life Expectancy: Institute for Health Metrics and Evaluation, Life Expectancy US Counties, 2009.

The Office of Health Equity (OHE) was established in 2012 to align state resources, decision making, and programs to accomplish all of the following:  Achieve the highest level of health and mental health for all people, with special attention focused on those who have experienced socioeconomic disadvantage and historical injustice  Work collaboratively with the Health in All Policies (HiAP) Task Force  Advise and assist other state departments in their mission to increase access to, and the quality of, culturally and linguistically competent health and mental health care and services  Improve the health status of all populations and places, with a priority on eliminating health and mental health disparities and inequities CA Health and Safety Code

 Conduct policy analysis and develop strategic policies and plans regarding specific issues affecting vulnerable communities and vulnerable places.  The policies and plans shall also include strategies to address social and environmental inequities and improve health and mental health.  The office shall assist other departments in their missions to increase access to services and supports and improve quality of care for vulnerable communities. Key Duties of the Office of Health Equity

Achieving equity at every level Achieving Health & Mental Health Equity At Every Level. Source: California Department of Public Health, Office of Health Equity as inspired by World Health Organization, Robert Wood Johnson Foundation, and many others.

Addressing the causes of the causes Bay Area Regional Health Inequities Initiative (BARHII) Conceptual Framework, 2006.

Stakeholder guided process 10 Demographic analysis Coordination with HIAP Guidance from OHE-AC

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Demographic Report 12 The California Statewide Plan to Promote Health and Mental Health Equity Source: California Department of Public Health, Death Records; and California Department of Finance, Race and Ethnic Population with Age and Sex Detail, Sacramento, California, July Note: Age-adjusted rates are calculated using year 2000 U.S. standard population.

About 33% of female-headed households and 9% of married- couple households live below the federal poverty level Source: U.S. Census Bureau, American Community Survey, 5-year Estimate ( ).

Percentage of people aged 0-64 without health insurance † during the past 12 months, by race/ethnicity and gender, California, 2001 to Source: University of California Los Angeles, California Health Interview Survey, Note: Asian includes Native Hawaiian and other Pacific Islander. † Had no insurance the entire year or had insurance only part of the past year. * Statistically unreliable data. Latinos have the highest rates of being uninsured for health insurance of any racial/ethnic group in California *

1 in 4 children in California does not have enough food to eat Child food insecurity rate: percentage of children under 18 years old who are food insecure, California, Source: Feeding America, Map the Meal Gap, 2012; U.S. Census Bureau, American Community Survey, 3-year Estimate ( ) and 5-year Estimate ( ); and California Department of Education, Graduation Data, †Median family income with own children under 18 years.

Number of violent crimes per 1,000 population, by cities and towns, Los Angeles County and Bay Area, California, Source: Federal Bureau of Investigation, Uniform Crime Reports, Analysis by CDPH-Office of Health Equity and UCSF, Healthy Community Indicators Project. The risk of crime can be highly disparate for neighboring California cities and towns

Percentage of adults who reported having seriously thought about committing suicide, by race/ethnicity, sexual orientation and gender, California, Source: University of California Los Angeles, California Health Interview Survey, Note: Other includes not sexual/celibate/none/other. * Statistically unreliable data. Rates of suicidal thoughts are higher among bisexual, gay and lesbian adults

Strategic Elements of Plan

Tangible goals ASSESSMENT Build capacity to collect and analyze data highlighting social determinants of health Assess data shortcomings and explore disaggregated data Scan environment for local community responses 19

The Healthy Communities Data and Indicators Project (HCDIP) What is the HCDIP? HCDIP uses the “Healthy Community Framework” as the basis for the selection of a standardized set of indicators or measures of economic, geographic, social, and physical environmental conditions, that are recognized as important determinants of population health. Work is conducted by CDPH’s Office of Health Equity. What is the Healthy Community Framework? It is a set of twenty aspirational goals grouped in five domains that outline what is a healthy community. It was developed by the California Department of Public Health in consultation with Health in All Policies Task Force members and stakeholders.

The Healthy Communities Data and Indicators Project (HCDIP) What has the HCDIP achieved? The project identified 56 indicators of healthy communities, researched data sources and methods to produce the indicators, conducted focus groups, and produced Excel data files for 26 indicators. Depending on availability the data files contain information (1) at the state, region, county, city/town, and census tract level; (2) for multiple time periods; (3) for race/ethnicity subgroups. A How-to Manual that helps users create a community report card. Website: What is the future of the project? The project continues the development of indicators and is searching for new funding opportunities to create an interactive website and to update the existing indicators.

Tangible goals COMMUNICATION Create comprehensive marketing and communications plan Build broad-based communications network to engage stakeholders Develop and launch state-of-the-art website Provide leadership in sharing health equity efforts for adoption state wide 22

“It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.” Institute of Medicine 23

California Health In All Policies Task Force

Health in All Policies: A Guide For State and Local Governments (October 2013) Created in partnership by: American Public Health Association Public Health Institute The California Endowment California Department of Public Health ograms/Pages/HealthinAllP olicies.aspx ograms/Pages/HealthinAllP olicies.aspx

Tangible goals INFRASTRUCTURE Partner on existing equity summits for practitioners and policymakers Recommend equity be embedded as a priority in funding streams Monitor and partner with federal efforts to reduce disparities Ensure gender lens is used when assessing promotion of health equity Leverage community efforts to impact equity issues statewide 26

CRDP Overview Community Mobilizing/Grassroots Partnership Community-Defined Evidence (CDE) This is a key statewide policy initiative to improve : o Access to care o Quality of care o Positive mental health outcomes for racial, ethnic, and cultural communities 28

CRDP Vision Identification of strategies developed across targeted communities to improve outcomes and reduce disparities Implementation of selected community-identified strategies Culturally and linguistically competent Community Participatory Evaluation of community-defined evidence (CDE) for racial, ethnic, and cultural communities Replication of approaches to reduce mental health disparities 29 “service delivery defined by multicultural communities for multicultural communities” 29

CRDP Population Reports 30

Community Recommended Actions Systems Level Workforce development Capacity building Community Level Community involvement/engagement Community leadership Provider Level Linguistic access Robust community engagement/cultural brokering 31

Status of CRDP Phase II Solicitations went out for public comment and the deadline for all feedback was April 8, CDPH finalized edits. Solicitations were released in August and updated in September Find Frequently Asked Questions on the webpage. Direct all CRDP-related questions to

Everyone Has a Role Make recommendations to OHE on implementing the plan Public comment - OHE Advisory Committee meetings and your local equivalent Respond to calls for action and solicitations Educate and engage your spheres of influence Local replication of statewide efforts Model and implement health equity practices and policies – build knowledge and network through trainings, webinars and summits Distribute the plan and complementary documents, media, or other tools 33 The California Statewide Plan to Promote Health and Mental Health Equity

We Want to Hear from You Which communities or populations are being disproportionately impacted and what are the causes and consequences of their inequities? Recommendations on policies or practices that OHE or other governmental entities might be able to impact? Data to collect, analyze or distribute? Processes for improved stakeholder or decision-maker engagement? Resource or partnership opportunities? 34 The California Statewide Plan to Promote Health and Mental Health Equity

Aligning Efforts for Plan Implementation What equity issues are you addressing? What have been your successes? What have been your challenges? In what ways is your work aligned with the Statewide Plan? 35

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