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Partnerships to Address Health Disparities

This report is one section of of Healthy People, Healthy States: Promising Practices to Address Health Disparities. See the full resource guide.

“Moving at the speed of trust.”
- AK State Official

Successful approaches to address health disparities rely on state agency collaboration and partnership with communities to identify and align resources and efforts toward common goals. Providing state agencies the tools they need to effectively engage their communities is a critical aspect of this goal.

In the state of Washington, the Department of Health published a Community Engagement Guide that lays out expectations for agencies but also provides them with the tools and resources to adhere to those expectations; this can be a good model for states seeking to provide such a resource to their agencies. The second phase of Louisiana’s comprehensive initiative includes the creation of equitable community engagement practices (see state example below for more detail).14        

States either forged or revitalized partnerships with credible messengers in communities during the COVID-19 pandemic to identify and act on community-specific needs. For example, Alaska health officials partnered with fishing captains to deliver information and connect their communities to resources. The Tennessee Health Disparity Task Force of 800 community partners worked together to address health disparities by disseminating information, linking people to requested resources, and building trust, in part through storytelling and exchange of personal narratives.15 Washington, DC partnered with faith-based community leaders and faith institutions and community-based organizations such as a Faith in Vaccine initiative, where places of worship hosted vaccine clinics.16 Michigan’s Health Equity Roadmap incorporates community member voices otherwise not captured in quantitative approaches into its analysis of routine standardized measures of a variety of health data.

Below are various state examples of population-based initiatives and community-based partnerships designed to address health disparities.

Louisiana

Louisiana developed a Health Equity Roadmap to integrate health equity throughout the Louisiana Department of Health’s (LDH’s) practices and to address inequities exacerbated by the pandemic. The roadmap was spearheaded by the Bureau of Community Partnerships and Health Equity and created internal and cross-agency accountability by establishing health equity action teams and health equity ambassadors in program offices. The first iteration of the roadmap provided a community engagement framework describing suggested action steps for building community partnerships between LDH and community-based organizations. The action steps included exploring partnerships with the Louisiana Community Health Outreach Network, developing public health internships for local university students, and reviewing data and needs assessments.

The second phase of the roadmap continued to emphasize community engagement principles. The action steps for this phase included creating a Review, Advise, and Inform Board comprised of community members from diverse demographics to provide feedback to LDH, working with a newly appointed community engagement officer to develop a Community Engagement Toolkit as part of LDH’s business plan, and assessing data and information-sharing efforts.

Utah

Utah’s Office of Health Equity (OHE) identified people from racial and ethnic minority communities who experienced higher rates of COVID-19 cases, hospitalizations, and deaths and therefore may benefit from enhanced supports and resources. OHE partnered with community health workers employed by community-based organizations and local health departments to gather qualitative information about barriers community members were facing. Those partnerships were also leveraged to provide low-barrier testing, access to vaccines, and screening and referrals for SDOH. With new funding from CDC, this program will be expanded statewide through partnerships with 21 community-based organizations and the 13 local health districts.17 Utah’s COVID-19 response also used the states’ existing Health Improvement Index, a composite measure of SDOH by geographic area, to identify priority and higher-risk populations as part of its vaccination distribution process.18

Alaska

Alaska addresses health inequities through a community-based lens with direct partner and shareholder input. This is reflected in Alaska’s State Health Improvement Plan, Healthy Alaskans 2030, and the Healthy and Equitable Communities Strategic Plan, which were developed in collaboration with the Alaska Native Tribal Health Consortium to directly incorporate Tribal communities’ perspectives. In addition to these strategic plans, state officials built strong and trusting relationships with community leaders of geographically isolated fishing communities to partner on addressing community pandemic response needs. Beyond geographic isolation, the Alaska’s Health Equity Index visualizes demographic data across the state to further illustrate and shape policy around the social determinants that are affecting vulnerable populations.

Maryland

Maryland’s Health Equity Resource Act provides $45 million in grants over three years to evidence-based, community-led efforts in designated underserved communities that experience disparities and/or poor health outcomes. In addition, the RELIEF Act (SB496) provided $14 million for the grant program, which provides two years of initial funding to assist applicants in becoming a Health Equity Resource Community (HERC), also known as Pathways to Health Equity. Grantees are expected to implement programs that reduce health disparities, improve health outcomes, improve access to primary care, promote primary and secondary prevention services, and/or reduce health care costs and hospital admissions and readmissions. HERC/Pathways are both issued by the Maryland Community Health Resources Commission (CHRC), which is an independent commission within the Maryland Department of Health created to expand access to health care services in underserved communities. The Office of Minority Health and Health Disparities provides technical assistance to the CHRC in implementing the programs.

District of Columbia

In 2021, the District of Columbia’s Office of Health Equity (OHE) held its first Health Equity Summit for the District after engaging residents in planning efforts called “Community Conversations,” open dialogues designed for communities to share their concerns and perspectives on health and SDOH. Three of the Health Equity Summit’s six recommendations for the District promote community engagement: sustain a whole-of-community response, prioritize community-engaged practices to include investments in community listening and valuing lived experience, and anchor equity efforts in collaborative, multi-sectoral action in government and community.

Other key OHE initiatives include:

  • The OHE’s Healing Futures Fellowship program, a capacity-building and public health approach to address injury and violence prevention.
  • DC’s partnership with Howard University, a local Historically Black College and University, to establish the Five Centers of Excellence, which will provide care and services tailored to the specific needs of the community and will focus on sickle cell disease, women’s health, oral health, trauma and violence prevention, and substance use and co-occurring disorders.

Supporting Howard University in a new hospital construction with a $225 million 20-year tax abatement, $25 million in infrastructure support, and $26.6 million to support the Five Centers of Excellence.

North Dakota

North Dakota leveraged CDC funding to rapidly develop a robust Community Engagement Unit by implementing its strategic plan, Addressing COVID-19 in Special Populations, to eradicate pandemic inequities and expanding department staffing to hire four Tribal health liaisons who build trusting relationships with Tribal communities across the state. The Community Engagement Unit was also able to hire for positions such as community engagement specialist, community engagement training coordinator, community engagement immunization coordinator, and a community liaison for underserved groups such as rural, new American, foreign-born, and immigrant populations. These positions, along with efforts focused in the COVID-19 strategic plan, place emphasis on working directly with communities through advisory boards, community-based organizations, education, and a multitude of other efforts.

New Mexico

New Mexico provided two years of funding to the County and Tribal Health Councils using CDC COVID-19 Disparity grant dollars. The state and Tribal Health Councils collaboratively developed the Community Rebuilding Initiative with a focus on capacity building so health councils can foster healthy communities. Year one provided support for vaccination activities in rural, Tribal, and higher-risk populations. Year two will focus on community rebuilding and equity. Program activities include establishing health equity committees, assessing internal capacity, creating action plans, data collection and community input, developing goals, and cultivating partnerships.

References

  1. Bureau of Community Partnerships and Health Equity. “Health Equity Roadmap, Phase 2: Nothing About Us Without Us.” Louisiana Department of Health, 2021. ldh.la.gov/assets/cphe/resources/Health-Equity-Roadmap-Phase2.pdf.
  2. “Tennessee Covid-19 Health Disparity Task Force Builds Trust to Battle Misinformation.” Centers for Disease Control and Prevention, 2021. cdc.gov/vaccines/covid-19/health-departments/features/tennessee.html.
  3. “District of Columbia COVID-19 Vaccination Plan.” Government of the District of Columbia, 2021. coronavirus.dc.gov/sites/default/files/dc/sites/coronavirus/page_content/attachments/DC_COVID-19-Vaccination%20Plan_FINAL.pdf.
  4. “COVID Community Partnership Project 2020–2021: Outcomes of Integrating Community Health Workers into COVID-19 Response Efforts.” Utah Department of Health, Office of Health Disparities, 2021. healthequity.utah.gov/wp-content/uploads/2022/02/CCPProject2020-2021.pdf.
  5. “Striving Toward Equity Utah’s COVID-19 Vaccine Distribution Roadmap.” Utah Department of Health, 2021. coronavirus-download.utah.gov/Health/Vaccine_Equity_Roadmap.pdf.
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