Understanding Community Needs to Advance Health Equity

August 30, 2017|12:24 p.m.| Claire Rudolph, MPH, MCHES, Director, Health Equity, ASTHO

State health agencies are uniquely positioned to advance the health and well-being of individuals in their state. While the national healthcare landscape remains in flux, ensuring that all people have the opportunity to achieve optimal health remains an essential aspect of state health agencies efforts. By engaging with communities, attempting to truly understand community health issues, and focusing on priority populations such as racial minorities, state health agencies can continue to advance health equity.

ASTHO spoke with Leandris Liburd, PhD, director of the Office of Minority Health and Health Equity at CDC to discuss how her office supports state health agencies in advancing health equity and what state health agencies can do to ensure that everyone has the opportunity to achieve their best health.

How does the Office of Minority Health and Health Equity at the Centers for Disease Control and Prevention support state health departments to advance health equity?

The Office of Minority Health and Health Equity (OMHHE) supports state health departments in advancing health equity in a number of different ways. 

  • We work to identify and address the factors that lead to health disparities so that barriers to health equity can be removed. The first step in this process is to identify the problems to be solved. To do that, we publish reports, such as the 2011 and 2013 CDC Health Disparities and Inequalities Report in collaboration with the Center for Surveillance, Epidemiology, and Laboratory Services. Some of these articles identify promising programs and interventions to address health disparities and inequalities in state health departments and across the nation.
  • We collaborated with ASTHO to produce a special issue of the Journal of Public Health Management and Practice on health equity. We used this supplement to lay out our own operating principles for advancing health equity: programs, policy, measurement, and infrastructure. We continue to work with ASTHO to enhance their objectives related to health equity. 
  • OMHHE hosted the National Health Equity Leadership Academy in 2016, bringing together over 100 representatives from state, local, tribal, and territorial departments of public health to share strategies used by selected health departments.
  • We work with CDC’s Office of State, Tribal, Local and Territorial Support in their efforts to promote health equity through the public health accreditation process. We actively participate in two subcommittees of the Advisory Committee to the CDC Director (ACD) - the Health Disparities Subcommittee and the STLT Subcommittee. They regularly coordinate recommendations to ACD, and develop tools to facilitate the work of departments of public health in addressing the social determinants of health, reducing health disparities, and achieving health equity. 
  • We keep over 37,000 subscribers informed through a quarterly e-newsletter, Health Equity Matters, which highlights CDC-sponsored initiatives, data reports, and other public health programs pursuing health equity.  

How can state public health leaders partner with others to reduce the disparities faced by African Americans? 

In May 2017, CDC released a Vital Signs report focused on African Americans and the leading causes of death and risk factors in the United States. The report highlights actions that public health professionals and others can take to create opportunities to improve health for all. Public health professionals can:

  • Use proven programs to reduce disparities and barriers to create opportunities for health.
  • Work with other sectors, such as faith and community organizations, education, business, transportation, and housing, to create social and economic conditions that promote health starting in childhood.
  • Link more people to doctors, nurses, or community health centers to encourage regular and follow-up medical visits.
  • Develop and provide trainings for healthcare professionals to understand cultural differences in how patients interact with providers and the healthcare system.

Partnerships between public health and other sectors can create social and economic conditions that promote better health as well. There are many examples of successful partnerships between state health departments and community-based organizations working to reduce health disparities in African American communities. Some of these examples can be found in A Practitioner’s Guide for Advancing Health Equity: Community Strategies for Preventing Chronic Disease. For instance, studies have shown that communities of color are exposed to elevated levels of tobacco advertising. To counteract tobacco exposure in youth, the New York City Health Department partnered with the New York City Coalition for a Smoke-Free City and other community organizations to enact citywide restrictions on flavored tobacco products such as cigarillos and cigars. With the help of the City Council, New York City restricted the sale of flavored non-cigarette tobacco products in stores throughout the city.

Community engagement is critical to advancing health equity. What should state public health leaders consider when working to enhance relationships with communities?

  • There are many factors that state public health leaders should consider to improve relationships with communities.
  • Take time to understand historical interactions between communities and the health department. 
  • What public health programs have been implemented in particular communities? 
  • What went well in the development, implementation, and evaluation of those programs?
  • What should state public health leaders do differently when proposing a new program in order to build trust and camaraderie with community leaders?
  • Participate in community events.
  • Be transparent about what the health department wants to achieve in terms of improved health outcomes in that community and provide updates on projects.
  • Identify and meet with a range of community stakeholders (e.g., faith leaders, chambers of commerce, elected officials, hospital administrators, civic organization leaders, and others).  

Building relationships with communities takes time, but is likely to save time in the long run. The most important lesson I learned from my journey in public health is the value in knowing the community you’ve been charged to work with, engaging them in decisions about strategies for addressing particular public health problems, and recognizing the influence of the social and environmental context on community health and opportunities to attain the best health possible.

One example of partnering to reduce disparities comes from Baker County, Georgia, a rural area with a primarily African American population. In Baker County, limited transportation or access to healthy foods caused the residents to live in a food desert. Partnerships with the East Baker Historic Society and the Southwest Georgia Project for Community Education led to the creation of farmers markets on unused public land. Due to the work of the partnerships, four new markets have opened across Southwest Georgia in regions similar to Baker County.

Going forward, what is the most important thing for state public health leaders to consider when working to advance health equity?

It is important for state public health leaders to first of all decide what achieving health equity would look like in their state or in selected communities across the state. Identify persons in positions of influence and community leaders who share your vision and are willing to leverage their influence to achieve changes that reduce inequities and create a path toward greater health equity. Health departments pursuing accreditation should also highlight their health equity work and partnerships with a diverse range of stakeholders.

Leandris Liburd, PhD, MPH, MA, is director of the Office of Minority Health and Health Equity at CDC. In this role, she oversees the work of CDC’s Offices of Minority Health & Health Equity and Women’s Health, and of Diversity & Inclusion Management. In addition, she provides agency leadership, direction, and accountability for CDC’s policies and programs to ensure they are effective in improving women’s and minority health. Dr. Liburd has worked in public health at the local, state, and federal levels, and has held a variety of leadership positions at CDC since joining the agency in 1987.

*This article is part of a 2016-2017 blog series on advancing health equity.