1. Equity Impact Review Guide American Public Health Association November 5, 2013

2. Question How many of you have heard about the Equity Impact Review Guide? Equity Impact Review Guide

3. Objectives Describe the five stages of the EIR Guide application Identify the value of applying the EIR Guide to policy or project decision making processes

4. “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” Preamble to Constitution of the World Health Organization Health as a Human Right

5. The BIG Picture HHS National Partnership for Action to End Health Disparities National Stakeholder Strategy for Achieving Health Equity HRSA | CDC plans targeting disparities State and Local Health Departments are including health equity as part of strategic plans

6. Equity Impact Review Guide Designed to examine proposals and identify actions to reduce health disparities and achieve health equity

8. King County Equity and Social Justice Initiative Built on a “Fair and Just” principle County public agencies are required to consider social justice in all decision-making Apply a health equity lens in making those decisions

9. Helpful Advice on Guide Use Intended for internal use Begin early in the planning process Assumes a commitment to work with community groups Can accompany a Health Impact Assessment

10. Five Stages of the Guide 1.Summarize the proposed policy or project 2.Identify and assess who will be affected 3.Describe positive and negative impacts 4.Analyze and prioritize potential actions 5.Modify the original proposal and build in evaluation

11. Stage 1: Summarize proposed policy or project p.4 & 5 Here you will describe the policy or plan Discuss your expected outcomes Which community groups will your reach with the proposal Predict determinants of health equity that will be impacted Determine level of impact and why

12. Determinants of Equity p.5-6 Social, economic, geographic, political, and physical environments in which people live. These lead to the creation of a fair and just society. Healthy living conditions Fair opportunities in education, jobs, & economic development Reliable public services and safety Non- discriminatory practices

13. Stage 2. Identify and assess who will be affected p. 7  Gather data about your communities  Have discussions with community members  Create maps and detailed descriptions of populations

14. Stage 3: Describe positive and negative impacts p. 9 & 10 Identify potential positive and negative impacts of the proposal on each population. Describe what you can do to strengthen the positive impacts and/or ease negative impacts.

15. Stage 4: Analyze potential actions and prioritize p. 11 & 12 Use the list of actions from Stage 3 to determine criteria to prioritize potential actions to enhance positive impacts or ease negative ones.

16. Stage 5: Modify proposal and plan evaluation p. 16  Use information from Stage 4 to list priority actions for success  Describe how original proposal needs to be adjusted, modified, or dropped  Identify measures to evaluate impact of proposal on health equity  List names of participants

17. Case Study: Hiring and Promotion Stage 1 Public Health King County wanted to examine why there is less diversity in the highest paid classifications within the department of health.

18. Recommended action Countering Bias – one hour training that provides statistical data on applicants and hires, information on impact bias and the effect it can have on hiring, and measures to counter bias. Hiring managers are encouraged to have diverse panels and provide Countering Bias training for panelists

19. Other Case Studies 1.Worksite Wellness Programs (WWPs) 2.Public Transportation 3.Smoke Free Public Housing

20. 1. Worksite Wellness Programs Reduce health insurance premiums for employees who achieve specified benchmarks like: lowering blood pressure; losing weight, increasing physical activity; quit smoking; and consuming more fresh fruits and vegetables.

21. WWP Recommended Action Involve staff and employers in creating benchmarks that all employees have equal opportunity to achieve Employ strategies that look at both individual risk reduction and create a healthy workplace environment and culture

22. 2. Public Transportation In King County, Washington funding cuts threaten to reduce transportation services to vulnerable populations.

23. 2. Public Transit Recommended Action Commit to providing travel opportunities for populations such as: low-income, people with disabilities, students, youth, seniors, people of color, and others with limited transportation options. Set higher target service levels for low income and minority residents Use concrete performance measures to track progress

24. 3. Smoke-free public housing To reduce exposure to second hand smoke, a local health department partnered with the regional public housing authority to ban smoking in government subsidized housing programs.

25. 3. Smoke-free Housing Recommended Action Involve residents in solutions that affect their current and future housing Offer smoking cessation resources Identify safe areas on campus where smokers can go until they have succeeded in quitting Develop a phase-in approach

26. Questions

27. Feedback What situations in your work would benefit for applying the Guide? What barriers do you see to using the Guide? What additional help do you want before you can apply the Guide? Who else should know about the Guide?

28. Question If you have access to training and technical assistance would you be interested applying the Guide to a project in your workplace?

29. A few good resources Equity and Social Justice Annual Report, King County, August 2012 www.kingcounty.gov/equity www.kingcounty.gov/equity 10 Promising Practices to Reduce Social Inequities http://www.sdhu.com/uploads/content/listings/Briefing_10PromisingPractices.pdf http://www.sdhu.com/uploads/content/listings/Briefing_10PromisingPractices.pdf A Time of Opportunity: Local Solutions to Reduce Inequities in Health and Safety http://www.preventioninstitute.org/component/jlibrary/article/id-81/127.html Social Determinants of Equity, Camara P. Jones, MD, MPH, PhD http://minorityhealth.hhs.gov/Assets/pdf/Checked/1/CamaraJones.pdf http://minorityhealth.hhs.gov/Assets/pdf/Checked/1/CamaraJones.pdf Life Spans Shrink for Least-Educated Whites in the U.S. http://www.nytimes.com/2012/09/21/us/life-expectancy-for- less-educated-whites-in-us-is-shrinking.html?pagewanted=all&_r=0 Deteriorating International Ranking of U.S. Health Status http://www.annualreviews.org/eprint/iESYF775U2Mw VfrxfAR2/Full/10.1146/annurev-publhealth-031811-124649