1. Finger Lakes Health Systems Agency Addressing Disparities and the Social Determinants of Health through Consumer and Community Engagement Wade Norwood, Chief Program Officer PHIP Contractor Orientation January 23, 2015

2. Presentation Aims A model for addressing identified health priorities and making population health data actionable –The High Blood Pressure Collaborative The Social Determinants of Health (SDOH) A model for convening around health disparities –Beyond episodic convening to standing African American and Latino Health Coalitions January 23, 2015www.flhsa.org2

3. High Blood Pressure Collaborative (HBPC) High Blood Pressure Registry Best Practice –Disseminate guidelines, recommendations and literature, design practice reports, address clinical inertia Practice Improvement Consultants –Academic detailing model, clinicians based in local health systems, motivate transformational change Community-Based Interventions January 23, 2015www.flhsa.org3

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5. HBPC Community-Based Interventions Community Engagement –Churches –Barber shops/beauty salons –CBOs, community events –Kiosks Communication –Website –Collateral materials 5January 23, 2015www.flhsa.org

6. Effect of Race/Ethnicity and Socioeconomic Status on Blood Pressure Control January 23, 2015www.flhsa.org6

7. Healthy People 2020 SDOH Framework “The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” - World Health Organization January 23, 2015www.flhsa.org7

8. FLHSA’s African American and Latino Health Coalitions The 2014 editions of "What's Goin' On" and "Nuestra Salud" provide a clear view of the health of the region's African American and Latino communities and of the nature of health disparities. These reports demonstrate that "place matters" in health outcomes and that those who residing in Rochester's poorest neighborhoods experience higher rates of premature death. January 23, 2015www.flhsa.org8

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11. HBPC Consumer Engagement Methodology Registry-generated Consumer Profile –Hypertensive Crescent Residents 35-54 Facilitated Representative Consumer Engagement – 4 Focus Groups (February – May 2014) – 12 Key Informant Interviews (May – July 2014) Finding #1: It’s not awareness! Even among the very poor, the barrier to control is far less about awareness and far more about the situational and socio-economic challenges of behavioral change. Finding #2: It’s hard to be poor! Two Realities, Both Unhealthy: Either too much to do as a single parent!  Overwhelmed, exhausted, stressed, anxious, unhealthy Or TOO MUCH OF NOTHING! = Boredom + disability + no work  Depression and unhealthy negativity. January 23, 2015www.flhsa.org11

12. Finger Lakes Health Systems Agency Finger Lakes Health Systems Agency is the health planning center for Rochester and the Finger Lakes. Through extensive data collection and analysis, the agency identifies community needs, then brings together residents, hospitals, insurers, physicians and other healthcare partners to find solutions. Located in Rochester, FLHSA serves the nine counties of Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates. 1150 University Avenue Rochester, New York 14607-1647 585.224.3101 www.flhsa.org January 23, 201512www.flhsa.org