Building Strategic Connections without Borders to enhance Population Health Equity Amy Ansehl, DNP, FNP-BC 1 Executive Director,Partnership for a Healthy Population Associate Professor and Director of Public Health Practice NYMCSHSP Padmini Murthy MD, MPH,MS,MPhil, CHES, FRSPH 2 Associate Professor Dept. of Health Policy and Management Global Health Director NYMCSHSP Agustina Lopez Novillo MPH 3 Assistant Director Public Health Practicum NYMCSHSP

Learning Objectives Identify a minimum of 3 strategies to promote strategic connections that enhance health equity. Define Health Equity and give 3 examples. Identify an evaluation metric that can be utilized to promote health equity across borders.

Introduction Building Community health systems across borders is of paramount importance to Global Health promotion. Achieving health equity involves developing and implementing interventions at the local, community, state, and national levels. Public Health practica are important connectors which provide students with unique opportunities to develop professional networks, practice competencies learned in the classroom, gain experience in different environments, and share lessons learned with others in our field. The diversification of the public health practice workforce is increasingly recognized as crucial in building health equity. Health Promotion Practice, 2014

What is Health Equity? Healthy People 2020 defines health equity as "attainment of the highest level of health for all people.” Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. Students work within community health systems locally, nationally, and globally in an effort to promote health and reduce disparities. Health Equity Institute; U.S. Department of Health and Human Services, 2014

Why Health Equity Matters Basic human right. Health disparities continue to undermine opportunities for economic and social development of too many communities. The Unites States ranks No. 41 in infant mortality rates (IMR) - with death rates 2.4 times higher among African-Americans than non-Hispanic whites - and near the bottom in healthy life expectancy at age 60. Respiratory and diarrheal diseases together account for more than half of child deaths worldwide. 529,000 women die in childbirth worldwide every year. In the U.S. alone, combined costs (direct and indirect costs) of health inequities totaled $1.24 trillion over a three-year period ( ). Source: Health Equity Institute, 2012

Examples of Health Equity Practicum Projects :NYMC Re-opening of “Woman’s Resource Center” in Baltimore This project at Bon Secours Community Works focused on outreach to underserved and abused female community members in Southwest Baltimore. Primary population includes African American women and their families.

Examples of Health Equity Practicum Projects :NYMC Education on Maternal, Child, and Family Health Services in Westchester County This project at the Lower Hudson Valley Perinatal Network Community focused on community outreach, eliminating disparities, and improving child and maternal health in the diverse Lower Hudson Valley region. Primary populations include African American and Hispanic communities. Mount Vernon, new Rochelle and Yonkers have higher percentages of disadvantaged minority populations in the county.

Examples of Health Equity Practicum Projects :NYMC The Somali Refugee Health Crisis: Public Health Concerns as a Result of Security Deficiencies and Ineffective Policy This project at the Somali American Community Association focused on promoting education and awareness of current public health threats in Somalia, building support in domestic Somali populations to encourage changes in policy.

Strategies to Promote Strategic Connections that Enhance Health Equity Development of a Virtual Course Site The course site is a tool for providing students with all the resources, course materials and information they will need at every stage of their practica. This is where all the important announcements and new site opportunities are posted. The course site explains what is expected from students at each stage of their practica and contains examples to guide students throughout the process.

Practicum Virtual Course Site

Strategies to Promote Strategic Connections that Enhance Health Equity Practicum Site Development Spreadsheet This is a tool that students are encouraged to use to document the sites they reach out to. This tool helps students to create a table listing the organizations they contact, their addresses, websites, phone numbers, s, and important follow us reminders.

Strategies to Promote Strategic Connections that Enhance Health Equity Virtual Office Hours Virtual office hours are held once a week and it is an additional opportunity for students to chat with their course instructors

Strategies to Promote Strategic Connections that Enhance Health Equity Interim and Final Site Evaluations and Student Evaluations There are three evaluation points; An interim evaluation of the student after 50 hours and a final evaluation of the student at the end of the project are completed by the site supervisor. At the end of the practicum the student completes an evaluation of his or her practicum experience. These evaluations are entered into a practicum database so data can be accessed for continuing quality improvement, tracking site development, and maintaining site supervisor contact information.

Strategies to Promote Strategic Connections that Enhance Health Equity Practicum GIS The Practicum GIS is an interactive map which will allows students to find practicum sites all across the country as well as internationally. Students can click on the link posted on the course site and access the map which contains the names and website addresses of sites that other students have used in the past.

Practicum GIS

Evaluation Metric to Promote Health Equity Across Borders The Practicum Dashboard The practicum dashboard represents data collected from site supervisor/preceptor evaluations, and practicum student evaluations. The dashboard allows collected metrics to be visually represented and evaluated for quality assurance purposes and it is an important metric to be utilized in assessing and planning for future practica. The dashboard captures important data correlated to students meeting their objectives and professional competencies. It is also a measurement that demonstrates students project based work in promoting health equity locally, nationally, and globally.

Practicum Evaluation Dashboard Academic Year 2010 AY 2010 All ProgramsDid not meetMetExceededTotal Students Access to site supervisor Level of guidance from site supervisor03067 Access to agency resources12274 Access to academic advisor12868 Access to director/assistant director of practicum23758 Meeting objectives and competencies03859 Overall experience02770 Total all categories Percent:0.6%30.5%68.9% Table 2.a Academic Year 2011 AY 2011 All ProgramsDid not meetMetExceededTotal Students Access to site supervisor Level of guidance from site supervisor02669 Access to agency resources12668 Access to academic advisor02174 Access to director/assistant director of practicum12569 Meeting objectives and competencies03560 Overall experience02669 Total all categories Percent:0.5%26.5%73.1% Table 3.a Academic Year 2012 AY 2012 All ProgramsDid not meetMetExceededTotal Students Access to site supervisor Level of guidance from site supervisor11862 Access to agency resources12159 Access to academic advisor02457 Access to director/assistant director of practicum02259 Meeting objectives and competencies02457 Overall experience01863 Total all categories Percent:0.7%24.7%74.6% Table 4.a Academic Year 2013 AY 2013 All ProgramsDid not meetMetExceededTotal Students Access to site supervisor Level of guidance from site supervisor12561 Access to agency resources12462 Access to academic advisor12660 Access to director/assistant director of practicum02065 Meeting objectives and competencies03253 Overall experience01768 Total all categories Percent:0.5%27.7%71.8% All ProgramsDid not meetMetExceededTotal Students Total all categories (AY2010-current) Percent:0.6%27.4%72.0% Academic Year 2010 AY 2010 All ProgramsDid not meetMetExceededTotal Students Student matched to site Student met expectations26431 Communication from school36925 Student met competencies and objectives16927 Total all categories Percent:1.5%70.9%27.6% Table 6.a Academic Year 2011 AY 2011 All ProgramsDid not meetMetExceededTotal Students Student matched to site Student met expectations05738 Communication from school47120 Student met competencies and objectives06332 Total all categories Percent:1.1%68.9%30.0% Table 7.a Academic Year 2012 AY 2012 All ProgramsDid not meetMetExceededTotal Students Student matched to site Student met expectations14733 Communication from school15624 Student met competencies and objectives04437 Total all categories Percent:0.9%60.2%38.9% Table 8.a Academic Year 2013 AY 2013 All ProgramsDid not meetMetExceededTotal Students Student matched to site Student met expectations15630 Communication from school16521 Student met competencies and objectives05829 Total all categories Percent:0.6%65.5%33.9% All ProgramsDid not meetMetExceededTotal Students Total all categories (AY2010-current) Percent:1.0%66.7%32.3% Site Supervisor Final EvaluationsStudent Evaluations of Practicum

Practicum Evaluation Dashboard

Conclusion The practicum is an important bridge to help students develop and enhance the real life skill sets of either existing public health practitioners, or future public health practitioners. It is an important connector on the global stage. At the same time that students are being empowered, they are promoting health equity in the community where they are applying their public health skills.

References Hernandez K.E, Bejarano S, Reyes FJ, Chavez M, Mata H. (2014) Experience preferred: insights from our newest public health professionals on how internships/practicums promote career development. Health Promotion Practice. 15: 95-99, first published on October 22, Schiavo, R. (2012) Raising the Influence of Community Voices on Health Equity: Introducing Health Equity Exchange. Available at: content/uploads/2012/03/Health_Equity_Exchange_-Renata_Schiavo.pdfhttp:// content/uploads/2012/03/Health_Equity_Exchange_-Renata_Schiavo.pdf U.S. Department of Health and Human Services. Healthy People. Foundation Health Measures- Disparities. Page last updated: Thursday, August 28, available at: