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National Collaborative for Health EquityCollaboratives for Health Equity The HOPE Initiative Culture of Health Leaders Culture of Health Leaders COHL is a leadership development opportu

HOPE Partners

• Funded by Robert Wood Johnson Foundation

• Lead Investigators:

• Gail Christopher, DN, National Collaborative for Health Equity (PI)

• Dennis Andrulis, PhD, MPH, Texas Health Institute (Co-PI)

• Derek Chapman, PhD, VCU Center on Society & Health (Co-PI)

• Founder:

• Brian Smedley, PhD, American Psychological Association (Former PI)

• National Advisory Committee:

• Led by David Williams, PhD, MPH, Harvard T.H Chan School of Public Health

Our Mission:

National Collaborative for Health Equity

The mission of the National Collaborative for Health Equity is to promote health equity by harnessing

data, developing leaders, and catalyzing partnerships across the many different sectors that share

responsibility for creating a more equitable and just society.

Three Pillars of Our Work

Racial Healing &

Racial Equity

Research and Driven Policy, and Practices

Data-Leadership for Health

Equity

National Collaborative for Health Equity

Collaboratives for Health Equity The HOPE Initiative

Culture of Health Leaders

Culture of Health Leaders (COHL) is a

leadership development opportunity for

people working in fields as diverse as

business, technology, architecture,

education, urban farming, the arts and

many others who want to use their

influence to advance health and equity

HOPE provides a new opportunity approach and actionable data to help our nation and states move beyond

measuring disparities to spurring action toward health equity.

Launched in 2006, Collaboratives for Health Equity (CHE) is a national initiative designed to empower leaders and communities to identify and address social, economic, and environmental conditions that shape health and life opportunities.

Building the Capacity of Public Health to Advance Equity

Healing through Policy: Creating Pathways to Racial Justice

Building Public Health Capacity to Advance Equity explores governmental public health’s role in advancing health equity with racial equity as a major priority and community engagement as a central strategy

An initiative of the de Beaumont Foundation, the American Public Health Association, and the National

Collaborative for Health Equity that is designed to provide local leaders with a pragmatic and achievable, yet

aspirational and innovative set of policies and practices that align with priorities and can be implemented at the local level to promote racial healing and address social inequity.

Truth Racial Healing and Transformation (TRHT) Framework

Health Opportunity and Equity:

New Approaches to Measurement and Action

Brian D Smedley, Ph.D.

American Psychological Association

Residential Segregation is an example of a Social Policy that continues to have pervasive

adverse effects on health

How Segregation Can Affect Health

1 Segregation determines SES by affecting quality of

education and employment opportunities.

housing conditions

3 Conditions linked to segregation can constrain the

practice of health behaviors and encourage unhealthy

ones

4 Segregation can adversely affect access to medical care

and to high-quality care

Source: Williams & Collins , 2001

Residential Segregation and SES

A study of the effects of segregation on young African American

adults found that the elimination of segregation would

completely erase black-white differences in:

Myth: Racial segregation arises from the

unintended consequences of economic forces

Federal, state, and local governments systematically imposed residential

segregation with:

• undisguised racial zoning,

• public housing that purposefully segregated previously mixed communities,

• subsidies for builders to create whites-only suburbs,

• tax exemptions for institutions that enforced segregation, and

• support for violent resistance to African Americans in white neighborhoods.

NCRC - The Persistent Structure of Segregation

and Economic Inequality (2019)

• 3 out of 4 neighborhoods “redlined” on government maps 80 years ago

continuing to struggle economically

• Nationally, nearly two-thirds of neighborhoods deemed “hazardous” in the 1930s are inhabited by mostly minority residents.

• Cities with more of these neighborhoods have significantly greater economic inequality

• On the flip side, 91 percent of areas classified as “best” in the 1930s remain middle-to-upper-income today, and 85 percent of them are still predominantly white.

Source: https://ncrc.org/holc/

Blacks, Hispanics, American Indians over-concentrated in high-poverty tracts

Poor blacks and Hispanics are more likely than poor whites

to live in medium- and high-poverty tracts

Science to Policy and Practice—

What Does the Evidence Suggest?

• A focus on prevention, particularly on the conditions in which people live, work, play, and study

• Multiple strategies across sectors

• Sustained investment and a long-term policy agenda

What’s needed to help correct these problems?

• Data and research that highlight the centrality of social determinants

in producing health and opportunity, and draw connections to policy interventions

• Data that elevate the roles of place, race/ethnicity and

“[I]nequities in health [and] avoidable health

inequalities arise because of the circumstances

in which people grow, live, work, and age, and the systems put in place to deal with illness The conditions in which people live and die are, in

turn, shaped by political, social, and economic

forces.”

World Health Organization Commission on the

Social Determinants of Health (2008)

What is the HOPE Initiative?

About the HOPE Initiative

help our nation and states move

beyond measuring disparities to

spurring action toward health equity.

THE HEALTH OPPORTUNITY & EQUITY (HOPE) INITIATIVE

Defining Health Equity

Everyone has a fair and just opportunity

to be as healthy as possible

This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.

Braveman et al., 2017

HOPE’s New Interactive Data Platform Launched in November 2020

www.HopeInitiative.org

HOPE’s Data Featured in an Interactive Perspective in the

New England Journal of Medicine

https://www.nejm.org/doi/full/10.1056/NEJMp2029139

HOPE’s Unique Value & Contribution

Centered in Equity

Its design, data, and measurement are centered in equity

Opportunity Frame

Instead of deficits and disparities, it focuses on opportunities for all

HOPE’s Unique

Features

Why HOPE Matters Today

• COVID-19 exacerbated deeply entrenched racial & health inequities

• American Rescue Plan Act offers a unique opportunity to reduce “distance to goals” for health care as well as child poverty, food insecurity and other social determinants

• Biden Administration’s strong focus on equity offers “hope”

• HOPE provides a data-driven starting point on the equity journey

• Shifts the narrative to opportunity & what’s possible

• Helps create an understanding of the role of social determinants of health

• Identifies similarities and differences in opportunity and health across racial and ethnic groups with implications for shaping programs and policies

What Does HOPE Measure?

What Does HOPE Measure?

27 conditions that are modifiable by policy and action

Health

Outcomes

Socioeconomic Factors

Community & Safety

Factors

Physical Environment

Access to Health Care

Adult health status

Mental health status

Child health status

Premature mortality

Infant mortality

Low birth weight

Livable income Affordable housing Post-secondary education Youth in school or working Preschool enrollment Employment

Low poverty concentration Low homicide

Low sexual assault Low physical assault Low robbery

Home ownership Housing quality Low liquor store density Food security

Access to primary care Access to psychiatric care Health insurance

Affordable health care Dedicated health care provider

Colorectal cancer screening

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

What Does HOPE Tell Us?

to help national and state leaders chart a path

for achieving equity in opportunity and health

2 Set Equity Goals

3 Measure Distance to Goals

4 Drive Equity Action

1 Identify Equity Gaps

• HOPE helps our nation and states

identify:

• How different racial, ethnic, and

socioeconomic populations are faring on

opportunity and health

• How wide equity gaps are for different

population groups

• Which groups are most affected

1 Identify Equity Gaps

2 Set Equity Goals

3 Measure Distance to Goals

4 Drive Equity Action

2 Set Equity Goals

• HOPE helps our nation and states set

equity goals that are:

1 Identify Equity Gaps

2 Set Equity Goals

3 Measure Distance to Goals

4 Drive Equity Action

3 Measure Distance to Goals

• HOPE helps our nation and states

measure the “Distance to Goal” or

the progress that must be made to

achieve HOPE’s equity goals

• Overall

• By Race and Ethnicity

• By Socioeconomic Status

1 Identify Equity Gaps

2 Set Equity Goals

3 Measure Distance to Goals

4 Drive Equity Action

4 Drive Equity Action

• HOPE helps drive equity action by:

• Illuminating where “bright spots” exist

across states that are effectively closing

equity gaps

• Encouraging “learning” to identify what

policies, programs and conditions have

enabled these states to close equity gaps

• Inspiring “evidenced-informed” actions

1 Identify Equity Gaps

2 Set Equity Goals

3 Measure Distance to Goals

4 Drive Equity Action

What Does HOPE Tell Us?

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

Takeaway 1: HOPE portrays an America that would be dramatically different if everyone had fair and just opportunities to thrive.

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

Takeaway 2: In America’s current reality, opportunity and health vary profoundly by race and place.

WHITE

ADULT HEALTH STATUS

Percent reporting their health as excellent or very good

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

WHITE

LIVABLE INCOME

Portion of adults living in households with income greater than

250% of the Federal Poverty Level

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

WHITE

LOW POVERTY CONCENTRATION

Portion of people in neighborhoods with fewer than 20% of

residents living in poverty

Takeaway 3: Racial and ethnic groups who experience the greatest barriers to opportunity–such as housing, income, and health insurance coverage—face the poorest health outcomes

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

Portion of Households Living in a Home They Own in the United States

White Black Hispanic Asian/PI AI/AN Multiracial

Households headed by College Graduate Black, Hispanic and Multiracial Americans have lower rates of owning a

home than White Americans with less than a high school diploma.

Takeaway 4: While education helps, it does not eliminate racial inequities in opportunity and health.

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

Infant Mortality Rate per 1,000 Live Births in the United States

White Black Hispanic Asian/PI AI/AN Multiracial

Infants born to College Graduate Black Mothers have a similar infant mortality rate as infants born

to White Mothers with less than a high school diploma

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

Takeaway 5: Every state can do more to improve conditions for health & achieve greater equity

0.0 2.0 4.0 6.0

8.0

10.0 12.0 14.0 16.0

CA CO NY OR WA AL MS MO OH WI

Infant Mortality Rate for Select States

White Black AI/AN Asian/PI Multi Hispanic

Number of infants who die before their first

birthday annually per 1,000 live births

Percent with Livable Income

White Black AI/AN Asian/PI Multiracial Hispanic

of U.S adults live in

households with livable

income

HOPE GOAL

88%

of adults living in households with livable

income

LIVABLE INCOME

Portion of adults living in households with

income greater than 250% FPL

DISTANCE TO GOAL

55 Million

more adults in the U.S

living in households with a livable income

CURRENT RATE

77%

of people in the U.S live in

neighborhoods with low

poverty concentration

HOPE GOAL

100%

of people living in neighborhoods with low poverty concentration

LOW POVERTY CONCENTRATION

Portion of people in neighborhoods with fewer

than 20% of residents living in poverty

Percent in Low Poverty Concentration Neighborhoods

White Black AI/AN Asian/PI Multiracial Hispanic

more people in the U.S

living in neighborhoods with low poverty concentration

more Americans would live in

neighborhoods with low poverty,

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

Takeaway 6: Systemic investments to achieve HOPE Goals can help all Americans, while also closing longstanding racial and ethnic equity gaps.

How Can HOPE’s Data Inform Federal

& State Action for Health Equity?

HOPE provides a new way to frame & communicate equity priorities for bipartisan advocacy and policy change

• Shifts the narrative from deficits and disparities

• Focuses on building opportunities for all to thrive

• Shows what’s possible for achieving equity in society

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

HOPE demonstrates that states that invest in social & economic, community & safety, and health care factors yield better health outcomes

What Does HOPE’s State Domain

Score Ranking Tell Us?

A state’s combined performance on:

• Distance to Goal :: How far a state has to

go to achieve HOPE goals

• Racial Inequity :: How much variation there is across racial and ethnic groups

Higher scores correspond with better

performance in terms of outcomes and equity.

HOPE identifies common and distinct challenges faced by racial and

ethnic groups to inform policy solutions

Equity Gaps State Examples from HOPE’s Data Levels of Action

NARROW GAPS:

all people faring

generally well

• Health insurance coverage and access to care measures in

Massachusetts and Hawaii

• Food security in New Jersey and Pennsylvania

Continued monitoring of

equity impact + program

enhancements

Food Security in New Jersey

Source: 2020 Health Opportunity and Equity (HOPE) Initiative Data available at www.hopeinitiative.org#HOPEData

HOPE identifies common and distinct challenges faced by racial and

ethnic groups to inform policy solutions

Equity Gaps State Examples from HOPE’s Data Levels of Action

NARROW GAPS:

all people faring

generally well

• Health insurance coverage and access to care measures in

Massachusetts and Hawaii

• Food security in New Jersey and Pennsylvania

• Health insurance coverage and access to care measures in Southern

states, predominantly those without Medicaid expansion (e.g., Texas, Mississippi, Georgia, Alabama, and others)

Need for broad, systemic

policies and programs

that benefit all people