Applying a Health Equity Lens When Completing Bill Analyses Gail Brandt, BS, MPH, EdD Washington State Department of Health | Heath Equity Manager Kristin Villas MPAc Evans School of Public Policy and Governance | University of Washington

Background Standard bill analysis template Two new questions added in 2015 No staff preparation to answer new questions

New Questions for 2015 Legislative Session

Purpose and Scope of Project Identify Resources and Training Needs on Health Equity and Tribal Health Four Phases 1.Contact other states 2.Review responses on two new questions 3.Meet with legislative coordinators and liaisons 4.Interview sample of analysts (n =21 )

Analyst Responses: Health Equity 180 bills received a hearing 70 different analysts

Bill Analysis – Health Equity example Populations near major roadways are exposed to more air pollution and suffer health impacts of poor air quality. These populations near major roadways are lower income and composed of more minorities than state. They will benefit more from improved air quality as a result of this legislation.

Analyst Responses: Tribal Health

Bill Analysis – Tribal Health example Data indicates that Native Americans and Alaska natives have the highest rate of suicide out of all population groups in the state; however, tribal health concerns are not addressed in this bill and the bill does not include tribal colleges (such as Northwest Indian College). The tribes are stakeholders in the department’s state plan efforts.

Meet with Legislative Liaisons and Coordinators 1.Inform about project 2.Obtain names of analysts to interview 3.Gather suggestions for training and resources 4.Meet with Workforce Development Manager to prepare for training needs

A Few Interview Questions Briefly describe what the term health equity means to you. What factors do you consider when deciding how a bill would impact health equity? If you were unsure of how to answer either the tribal health or health equity question, what did you do? What training and resources would be helpful?

Interview Findings Understanding of Health Equity varies Confusion with the Tribal Question Some difficulty identifying how bills impact tribal health and health equity Analysts used a diversity of resources What’s behind “N/A”? Want rationale/goals/evaluation

Training Recommendations Incorporate into existing Bill Analyses training Clear definition of health equity Include relevant examples of good answers and answers needing development Communicate expectations for citations, research time, and order of impact Short video explaining rationale from leadership

Training Recommendations Develop a matrix of social and economic factors and their link to health outcomes (e.g. non-graduation leads to lower lifetime earnings and shorter life expectancy) Provide key health trends by race/sexual orientation/age Tribal member to give overview of tribal law and governments All training information posted to intranet Resource list on intranet

Related Suggestions Add “please explain” to both questions Revise tribal health to specify both legal and health considerations Help “in my backyard” list

What should we do with the answers? Discuss during agency level bill reviews Recommend amended language to bill Determine position on legislation Develop talking points for testimony Explore future training and resource needs

What should we do with the answers? Assess impact on tribes to comply with Consultation Requirements Meet legal and agency requirement to consult with tribes on issues with significant impact Know who is most impacted to make policy/work relevant to tribes

Next Steps Recommend to leadership Develop training and resources Test Apply Evaluate

Gail Brandt Kristin Villas Thank you