Community Conversation on Advancing Health Equity: Individual Question-group Highlights

Community Conversation on Advancing Health Equity: Individual Question-group Highlights

Findings from the November 14 Public Health Equity Event

On November 14, 2016, the Minnesota Department of Health held a community conversation to discuss progress toward health equity. The goals of this event were to (1) provide an update on MDH’s efforts to advance health equity, (2) to provide a forum for community-based organizations and others to share stories of their efforts to advance health equity and (3) to continue a dialogue about the challenges facing our collective efforts, in order to engage in collaborative problem-solving.

For part of this event, about 30 tables of attendees had small-group discussions around nine different topic areas relating to health equity. These small-group discussions generated over 100 pages of notes and addressed a wide range of health equity advances, challenges and suggestions.

MDH staff read over every comment and attempted to organized and summarize the most common ideas that emerged within each discussion topic. We acknowledge that not every comment is represented here, and that attempting to summarize over 100 pages of notes will not represent the full range of ideas expressed within each small-group. MDH staff are continuing to dive deeper into each page, though we thought it would be valuable to share some of the most common ideas within each question topic.

The following is a brief analysis of the major highlights and trends that came out of each individual small-group discussion.

1) Elevating health considerations in policy development

  • There are strong connections between structural inequalities and health inequalities everywhere we look.
  • In order to bring a health lens to policy issues, community members and partner organizations need:
    • A point of entry into making policy decisions – a way to access political engagement.
    • Cooperation from different institutions, including local health departments and schools.
  • In order to effectively bring a health lens to policy efforts, MDH needs to:
    • Promote culturally-responsive education about health and health literacy in schools and communities.
    • Educate beyond research and facts: utilize stories and real-world experiences.
    • Bring in community members from the very beginning.
    • Make the MDH staff community more representative of the populations it serves.

2) Exploring MDH’s role in strengthening communities to create their own healthy futures

  • To strengthen community groups, MDH needs to:
    • Engage community members from the very beginning and at multiple levels and allow them to lead – become more collaborative learners and real partners.
  • Barriers to influencing the decision making process include:
    • The inability for community partners to create their own agendas.
    • A disconnect between state agencies, local health departments and the community.
    • Too much reliance on “evidence-based research” that does not value other forms of knowledge.
    • A lack of trust in community partners and lack of community representation in the decision making process.
  • A few solutions for overcoming those barriers include:
    • Time and location of community meetings needs to be accessible (evenings/weekends, and accessible by metro transit).
    • Community partners must be treated as valuable and knowledgeable resources.
    • Better communication between different agencies and partners.
  • MDH can help community groups create solutions and influence policy decisions in order to improve the conditions for health by:
    • Empowering and training community leaders so they can participate.
    • Letting go of the leadership role/need to control and trusting partners to be truly collaborative.
    • Acknowledging individual strengths and weaknesses: what is MDH doing well, and what areas need work?

3) Informing MDH policy and program decisions

  • Barriers to people with lived experiences informing the decisions that MDH makes include:
    • Lack of collaboration between agencies and departments.
    • A problematic reliance on an evidence-based approach to health.
    • Small organizations can’t access funding and many need help understanding the grant-making process.
    • The hiring process is not aligned with the strategy to eliminate barriers. How does MDH determine a “qualified employee?” Lived experiences should be an important consideration.
    • There is no guarantee that community input was considered in policy decisions. What is the process for ensuring that the community is heard?
  • Suggestions for overcoming these barriers include:
    • Analyze and listen to what communities and organizations need and modifying projects and work accordingly.
    • Develop an internal compass to assess MDH’s own culture. What are internal biases within the department? How can MDH understand, acknowledge and change them?
    • Modifications to evidence-based guidelines and outcomes and tailoring requirements and services to the different communities served.
    • Providing a point of entry to voices to have an ear at MDH.
    • Increasing communication across departments, agencies and organizations.
    • Sharing information about how community input informed policy, and how decisions were made.

4) Improving MDH Grant Making Procedures and Practices

  • MDH grant making can support culturally specific programming and organizations by:
    • Getting feedback/advice from community organizations and applicants on how to structure the application (RFP) process.
    • Making the process more tailored and personalized (communicating with applicants in person, assisting smaller organizations, providing more feedback).
  • Barriers for smaller organizations participating in the grand making process include:
    • Urban agencies competing with one another.
    • Smaller organizations lacking the capacity to take on grant writing and applications.
    • Measurement challenges – it’s difficult to quantify hard data after only 12 months.
    • Lack of data can be a barrier to applying in the first place.
  • Suggestions for overcoming those barriers:
    • Tailor funding requirements to make it easier for small organizations to access funding.
    • Incorporate site visits into the grant review process.
    • Shorten the application materials and seek applicant guidelines for modifications.

5) Sustaining cultural practices that support health

  • To sustain cultural practices that protect health, communities need:
    • Translation of tailored information and services to best meet different cultural needs.
    • Supportive professionals: translators, patient advocates, navigators – people educated on medical issues and able to help guide patients on health options.
  • Institutional or structural racism can be a barrier to cultural health efforts. For instance,
    • Facilities turn down patients because they do not offer interpreters free of charge.
    • Health issues and services are impacted by stigmas that exist in different communities.
    • How frequently and for what reason people choose to seek out health care differs among communities and is impacted by cultural beliefs.
    • Cultural and community wisdom is often ignored in the medical field.
  • Suggestions for how to overcome these barriers:
    • Require cultural competency trainings for MDH and public health professionals
      • Understand the health aspects of different cultures and religions, meet communities where they’re at and understand how to best share information.
    • Value cultural wisdom and incorporate it into care. Communities know what their needs are and should be a part of a collaborative conversation.

6) Identifying institutional changes needed at MDH

  • Policies and organizational changes that MDH should consider to ensure that the organization and staff are reflective of the state’s diverse communities include:
    • Finding ways to incorporate people from different communities into the formal staff.
    • Including performance evaluations and document metrics to assess accountability.
    • Creating multilevel teams of equity champions throughout the department.
    • Conducting an internal investigation/needs assessment about what is going on at MDH.
  • Structural changes within MDH that are needed to advance health equity include:
    • More consistency in health equity efforts across the whole department, not just within the center for health equity.
    • Building in structural measures of accountability.
    • Incorporating more direct representation throughout the department.
    • Using the equity policy ratified by DHS as a model for contracting, hiring, policy analysis, budgeting, etc.

7) Improving data collection of health disparities and health inequities

  • LGBTQ information, tobacco data, housing insecurity, food, transportation, income, social isolation, socioeconomic status, national origin, income and workforce data should be more regularly collected and made available by race, ethnicity and language.
  • Additional data that would be most helpful to collect or analyze include:
    • More specific race/ethnicity data. (For instance, “Asian” and “African” are too broad).
    • The diversity of staff within MDH and level of cultural competency training.
    • More information on hiring practices.
    • Tracking demographics of services to see if they are reaching the populations that they should be reaching.
    • Data gathered with a method other than a questionnaire/survey.
  • In order to gather data that will be most helpful in supporting communities, MDH should ask communities what information they would like and need to know.
  • MDH can make the health disparities data that it collects more visible by:
    • Explaining why you are collecting data when asking for community participation.
    • Using the website to share data across agencies, organizations and states.
    • Educating partners about how to use data and what to look for.
    • Utilizing graphics, such as maps, that present data in a clear and understandable format.

8) Measuring progress of health equity efforts

  • MDH should conduct an internal and external assessment.
  • External communities should be able to provide feedback on how MDH is doing.
  • What are the entry points into MDH? Expand the number of representative “go-to” people on staff.

9) General questions

  • Questions that still need to be addressed:
    • How do we connect those with more privilege to actually feel the struggle of other populations?
    • How do we best address rural vs. urban populations in working toward health equity?
    • How do we connect people from other parts of the state?
    • How do we actually gather “community” to raise understanding and awareness?
    • How do we move from great ideas to implementation of policies?
  • Suggestions for MDH in continuing Advancing Health Equity recommendations:
    • Need to improve and increase collaboration between MDH and communities being served.
    • Create more frequent and regular opportunities for ongoing dialog between traditional and non-traditional “partners.”
    • Increase community role – we need to trust community partners and solutions need to come from them.