Posted on 27 Jan 2014
In reflecting on the meaning and spirit of Martin Luther King Day last week and the 50th anniversary of Lyndon Johnson’s Civil Right Act, I decided to share some information and resources on health disparities and what some coalitions and communities are doing to achieve health equity. It illustrates the continuing need to remind ourselves of why the courageous, groundbreaking work of Dr. King and others is very relevant for us today.
In a recent issue of the Center for Disease Control and Prevention’s (CDC) Health Equity Matters newsletter, Leandris Liburd, Associate Director for CDC’s Office of Minority Health and Health Equity, wrote (2013):
“In 2013, our nation celebrated the 50th anniversary of the March on Washington; we remembered the life and legacy of President John F. Kennedy on the occasion of the 50th anniversary of his assassination; and the whole world paused to honor the life, love, and revolutionary contributions of Nelson Mandela in his passing at the age of 95. Mr. Mandela wrote in Long Walk to Freedom (1995), “I am fundamentally an optimist. Whether that comes from nature or nurture, I cannot say. Part of being optimistic is keeping one’s head pointed toward the sun, one’s feet moving forward.” We salute these great men of courage, integrity, and sacrifice, and are inspired by their embodiment of leadership, hope, and perseverance. The same characteristics are needed if we are to win the battle to reduce preventable health disparities and premature mortality in the U.S. and globally.“
What is a Health Disparity? A health disparity is best defined as the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the U.S. The causes of racial and ethnic health disparities are complex and include individual, community, societal, cultural, and environmental factors. The World Health Organization’s Commission on Social Determinants of Health states that to achieve health equity, we must “improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age” (2008, p. 1). Income, education level, sex, race, ethnicity, employment status, and sexual orientation are all related to health and health outcomes for a number of Americans, according to the 2nd Health Disparities and Inequalities Report — United States, 2013 released last November (CDC, 2013).
Why is eliminating health disparities important? Every person should have the opportunity to attain his or her full health potential. The goal should be to eliminate barriers to achieving this potential because of social position or other socially determined circumstances. According to the CDC, health disparities remain widespread among members of racial and ethnic minority populations.
- Heart disease is the leading cause of death for people of most ethnicities in the U.S.
- Non-Hispanic blacks have the highest rates of obesity (44.1%) followed by Mexican Americans (39.3%)
- Compared to non-Hispanic whites, the risk of diagnosed diabetes is 18% higher among Asian Americans, 66% higher among Hispanics/Latinos, and 77% higher among non-Hispanic blacks
What is CDC’s Racial and Ethnic Approaches to Community Health (REACH). The best community-based interventions are community-centered, racially and ethnically appropriate, and practice/evidence based to advance policy, systems and environmental change at local, state and national levels. REACH is the strongest national initiative to eliminate racial and ethnic disparities in health. CDC supports partners, many of which are coalitions, to establish community-based programs and culturally-tailored interventions to eliminate health disparities among African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives, and Pacific Islanders. Coalitions and partners use community-based approaches to identify, develop, and disseminate effective strategies to address health disparities across health priority areas, such as heart disease, diabetes, infant mortality, asthma, and obesity. The initiatives focus on changes in weight, proper nutrition, physical activity, tobacco use, and emotional well-being and overall mental health. For more information about REACH, see: http://www.cdc.gov/nccdphp/dch/programs/reach/about.htm
Does REACH work? REACH Risk Factor Surveys indicate that from 2001-2011:
- Cholesterol screening increased among African Americans, Hispanics, and Asians in REACH communities, while it decreased or remained constant among the same population groups nationwide.
- The proportion of Hispanics who reported having hypertension and were taking medication for it increased.
- Pneumonia vaccination rates increased in black, Hispanic, Alaskan/Pacific Islander, and Native American communities.
Again, I hope this blog serves as food for thought as you engage communities in the work to end disparities in health. I’d like to end, as I began, with wisdom from Lenore Liburd from the Office of Minority Health:
“As we begin the New Year, it is worth reiterating that health disparities are a societal issue and not just the burden of selected populations. In the years ahead, we must identify ways to quantify and communicate to all of our society the benefits to everyone in eliminating preventable health disparities and achieving health equity” (2014).
CDC. CDC Health Disparities & Inequalities Report – United States, 2013. MMWR Supplement, November 22, 2013, 62(3):1-187. (The full report and other information is available at: http://www.cdc.gov/DisparitiesAnalytics
Liburd, L.C. Health Equity Matters Newsletter, 2(4), 2013. http://www.cdc.gov/minorityhealth/newsletter/current.html
Liburd, L.C. Reflections, Revisions, Renewals. Conversations in Equity blog. January 15, 2014. http://blogs.cdc.gov/healthequity/2013/01/15/reflections-revisions-renewals/
WHO Commission on Social Determinants of Health. (2008).Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, Switzerland: World Health Organization. http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf?ua=1
Other Resources & Information
Federal Agencies and Offices
- Agency for Healthcare Research and Quality: Minority Health
- CDC: Minority Health
HHS Office of Minority Health
- HHS Office of Women’s Health: Minority Women’s Health
- Indian Health Service
- NIH National Center on Minority Health and Health Disparities
Other Health Equity Coalitions
- African American Health Coalition
- Coalition to Promote Minority Health
- Health Professionals for Diversity Coalition
- National Coalition for LGBT Health
- National Minorities with Disabilities Coalition
- National REACH Coalition
- Out of Many, One
News Sources on Minority Health
- Asian & Pacific Islander American Health Forum
- The Association of Minority Health Professions Schools, Inc
- The Disparities Solutions Center at Massachusetts General Hospital
- Diversity Rx
- Families USA: Minority Health
- Joint Center for Political and Economic Studies: Health Policy Institute
- Kaiser Family Foundation: Minority Health
- MEDLINEplus: African-American Health
MEDLINEplus: Asian American Health
MEDLINEplus: Hispanic American Health
- UNC: Minority Health Project
- National Minority Quality Forum
- NCSL Disparities in Health 20
Posted on 20 Jan 2014
Smoking causes a host of cancers and other illnesses and is still the leading preventable cause of death in the U.S. (CDC, 2010). 2014 marks 50 years after the first Surgeon General’s Report on Smoking and Health was released. Since then, smoking prevalence among U.S. adults has been reduced by half and the majority of Americans are protected by smoke-free laws in their state or local community (CDC, 2010).
For over 3 decades, tobacco control coalitions have mobilized communities to participate in tobacco free initiatives, combat the tobacco industry, and change the culture around tobacco. After the release of the landmark Surgeon General’s Report, individuals concerned about the health effects of tobacco and secondhand smoke and alarmed at the tobacco industry’s tactics to promote tobacco use, formed nonsmokers’ rights groups across the U.S. Eventually, these groups evolved into tobacco control coalitions that work at local, statewide, and national levels.
Coalitions focus on changing policies, systems and environments. The factors that most influence tobacco use initiation and cessation include: high tobacco taxes, anti-tobacco media campaigns, negative social acceptability of smoking, and limitations on where tobacco use is permitted and how it is accessed (CDC, 2010). Based on these factors, tobacco coalitions have implemented strategies to change behavior by changing policy, community education & mobilization, counter marketing and media advocacy.
Making the case for tobacco control coalitions. Through the efforts of tobacco control coalitions in every state, over 70% of Americans are protected from secondhand smoke due to smoke-free laws and ordinances; half of the states have implemented a tobacco tax of $1.00 or higher; and the tobacco industry is continually exposed for marketing to underage youth, manipulative advertising, and using other deceptive tactics (CDC, 2010). In your work, use the following points to make the case for tobacco control coalitions (CDC, 2010):
Coalitions’ long history and wide adoption as community interventions enhance the reach of tobacco control efforts. Science supports coalitions as an effective community intervention. Tobacco control coalition efforts change social norms through policy change, which leads to decreased morbidity and mortality.
Coalitions are low cost, but their efforts result in a high return on investment. While the financial investment in coalitions is fairly low, the return on investment is high considering the effects tobacco control policies and well-funded programs have on preventing initiation of tobacco use and increasing cessation. Successful coalitions are able to effectively leverage their resources (e.g., volunteer time, services) and member expertise.
Coalitions contribute to program sustainability. Through their advocacy role, coalitions are able to build political and public support for tobacco control programs, help secure and maintain tobacco control funding, and advocate for policy change.
To commemorate the 50th Anniversary of the Surgeon General’s Report on Smoking and Health, the Office of the Surgeon General developed several resources to help you promote and share highlights from the last 50 years of tobacco control efforts. You can be a part of the effort to share information on the dangers of tobacco use by accessing these resources: http://www.surgeongeneral.gov/initiatives/tobacco/resources.html
Centers for Disease Control and Prevention. (2010). Coalitions: State and Community Interventions. Best Practices for Comprehensive Tobacco Control Programs User Guide. Atlanta, GA: http://www.cdc.gov/tobacco/stateandcommunity/bp_user_guide/pdfs/user_guide.pdf
U.S. Department of Health and Human Services. (2014). Surgeon General’s Report on Smoking and Health. Wahington, DC. http://www.surgeongeneral.gov/initiatives/tobacco/index.html
Posted on 13 Jan 2014
The New Year’s celebrations are over. By now, you might have completed your first round of successes (or failed attempts) of resolving to eat less, exercise more or do something that you meant to do last year. For community leaders, January also is the perfect opportunity to look to the future with renewed optimism and make important changes to improve the overall efficiency and effectiveness of your coalition or nonprofit group. So, take a look at the seven resolutions that follow and choose one or two to really implement.
Resolution #1: Take Time to Take Stock
One year is ending and another is beginning, giving your coalition a reason to take stock of all it has accomplished. Revise or create a new action plan and follow up with a report card that grades your progress toward outcomes at the end of the year. Slow down and organize a planning retreat for your leadership team to help them invest and commit to the work ahead. It’s time to put on your creative hat. If a strategy or method isn’t working, stop using it and move on. Look at new trends and figure out ways to make your coalition or nonprofit stand out. Perhaps you’ll breathe a bit of life back into your organization and attract new volunteers and donors in the process.
Resolution #2: Make Your Mission Clear and Tangible.
No matter how “complex” your work is, you can properly describe your mission and organization in less than two minutes. Another exciting idea is to make your appeals for supporters and funds tangible. By equating what a donation level equals to in terms of the mission, your volunteers and donors will have a better idea of what their contribution will give someone. If your organization is able to equate your donation ask to something tangible like a malaria shot or clean water to one person for a year, it connects the donor to the results of their impact. So, think carefully about what you can equate donations to in terms of specific products that your organization provides, living conditions you’re trying to improve, or policies you’re trying to change.
Resolution #3: Define or Redefine Your Coalition’s Brand.
Many organizations don’t see their brand (i.e. their logo, mission statement, colors, fonts or website design, etc.) as important as recruiting volunteers or raising funds. However, your brand is very important when it comes to your content and online marketing and fundraising strategy. Individuals identify with your brand when it’s consistent and clear. So, take an inventory this year of your marketing materials, including your e-newsletter, social media accounts, website, and blog. Making sure the organization’s logos and language are consistent will go a long way in retaining your audience and attracting a new one online.
Resolution #4: Show the Impact and Results of Your Coalition’s Work.
Take a step back and contemplate how you can show the results of your work, whether it’s what you accomplished last year or what you’re looking to accomplish this year. Supporters and donors want to hear about your success and how their contribution of time or money has made a difference. 2014 is the year to start bragging about all you accomplish to the world. Use your online channels, like your website and social media, and your content mediums, like video and your blog, to do this.
Does the task of promoting your coalition often slip to the bottom of your to-do list? If you want to attract attention to your cause, you have to make promotion a priority. Resolve to hire a marketing expert, or take the time to create a marketing plan on your own and follow through. If you’ve seen little success with traditional and social media, it’s time to step it up. If you want your supporters to help you spread the word about your work, give them content to share and a reason to share it via a medium that enables them. Try writing at least one blog post a week and link it to your Facebook page; increase Twitter activity to at least three times per week; and add 10 new social media contacts per week. Develop short catchy pitches that will grab traditional journalists’ attention and email them or call them directly. Provide videos that they can use online and images that will stir their readers’ emotions. You’ll not only benefit from the coverage, but they’ll thank you for the quality information and making their jobs easier.
Resolution #6: Be more productive
When you’re running a coalition, so many tasks must be done that it’s easy to think you need to do all of them. Then you wonder why you’re so tired and frazzled and have no time to do anything meaningful! Learn to delegate and let someone else do some of the tasks for a change. Look at tools that help you share documents, monitor time spent on social sites and in general, operate more efficiently. Pick a few of the following and resolve to use them in 2014: Google Docs for group projects, Dropbox for sharing files, Basecamp for tracking projects. Better yet, pick something to stop doing. Cancel a pointless meeting. Stop stressing about a grant. Do one less event. We all think that we need more time, money or resources, but really we don’t really need more time. But what we really need is to do less, so we can accomplish the few truly important things, with relish and energy. Doing less isn’t a decision to compromise, but a choice of pushing yourself to focus on what truly matters.
Resolution #7: Show Appreciation
Most coalitions would be nothing without the loyalty of their members and partners. One of the best ways to show appreciation is to offer loyal members something special. Some businesses do this through freebies, discounts or customer appreciation events that kick off the year. Coalitions and nonprofits can learn from these practices by acknowledging those who have contributed time or resources over the past year – small tokens or even personalized thank you notes show that you appreciate what your members and community supporters do to promote the work of your organization or coalition. Why not design an online recognition program, tweet about them and get votes for volunteer of the year. People love to be thanked and recognized for their contributions. The recipients will likely be so impressed that they’ll share the news with their friends and contacts, which may result in additional loyal supporters to thank next year. If you thank your partners and supporters more often, they’ll stick around and you’ll have to recruit and fundraise less.
Posted on 05 Jan 2014
What is a Culture of Health? At the American Public Health Association’s annual meeting in Boston in November 2013, Dr. Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation (RWJF), stated that the U.S. “spends more on health care than any other country by far, and yet we are not healthy. In order to create a healthier nation, we must not only treat illness, but also create opportunities to pursue the healthiest lives possible.” Lavisso-Mourey defines a culture of health as “a society in which each person has the opportunity to lead a healthy life, with adequate housing, educational opportunities, safety from violence, healthy food options, exercise, and affordable, quality health care.”
How can coalitions help? We know that businesses, communities and organizations around the country are using coalitions to mobilize, plan and initiate strategies to confront some of these issues. They know that health is connected to community, opportunity, and safety, as well as medical care. Look at what a sample of coalitions have accomplished this past year:
In Virginia, two rural counties created the Eastern Shore Healthy Communities Coalition to combat obesity by initiating Smart Bites to teach teens to eat healthy, healthy menu options in 15 restaurants, an annual fitness challenge for more than 1700 residents, walking trails in 5 towns, and wellness policies in 10 major businesses.
The Healthy Lifestyle La Plata (HLLP) coalition in Colorado used farm-to-school efforts to facilitate policy and purchasing practices that resulted in local producers providing the school district’s 6,800 students and staff members with more than 480 pounds of micro greens; 380 pounds of carrots, squash, tomatoes, broccoli, mixed greens and potatoes; 100 pounds of wheat cereal and 650 pounds of ground beef annually. These changes reduce the unnecessary importation of food and decrease the carbon footprint of food transport.
In Chicago, the Midwest Business Coalition on Health, major health plans, hospital systems, perinatal directors, Il Maternal Child Health Coalition, Childbirth Connection, March of Dimes, Chamber of Commerce, and Northwestern University created the Illinois Perinatal Quality Collaborative to focus on data sharing, appropriate perinatal standards and policies. Partnering with CBS and NBC, they are engaged in a major communications campaign to educate employers and consumers about why full term delivery is the healthy choice for mothers and babies.
The Violence Prevention Coalition of Greater Los Angeles is a critical resource for organizations, policymakers and opinion leaders who are engaged in violence prevention work. Their “Tuesdays at 10” peer learning workshops use a structured format to share knowledge among members. Their Community Safety Scorecard, Breaking the School-to-Prison Pipeline project, and Gun Safety Summit to improve gun safety and reduce lethal violence underscored their prevention efforts.
These are just a few examples of how community coalitions and partnerships are involved in creating a culture of health. While one person (e.g., Nelson Mandela) or one organization (e.g., RWJF) can certainly have an impact, the power of the combined voices and actions within a given community really drives change. And it usually requires a convener organization or coalition to coalesce those voices and encourage the more difficult policy, systems and environmental actions that lead to substantive, lasting change. I submit that building and sustaining those organizations will go a long way toward creating a culture of health.