1. 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

2. 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.)

3. 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

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

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

6. Tasks 4 - 6 Locate the Issues Define Goals & Scope of Assessment ¤Generate List of Local EH Issues Describe the Context of the Issues

7. Tasks 7 - 9 Quantify and Qualify the Issues ¤Develop Local Indicators ¤Select Relevant Standards Create Issue Profiles

8. Tasks 10 - 13 Set the Stage for Action ¤Rank the Issues ¤Set Priorities for Action ¤Develop Action Plans Evaluate Progress

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

10. 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

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

12. 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

13. 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

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

15. 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

16. 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.

17. PACE EH Contacts at NACCHO Jonathan Schwartz Senior Analyst Jschwartz@naccho.org (202) 783-5550 x250 Jennifer Li Program Manager Jli@naccho.org (202) 783-5550 x234 Grace Ibanga Program Assistant Gibanga@naccho.org (202) 783-5550 x249 Gea Jackson Program Associate Gjackson@naccho.org (202) 783-5550 x268