I think about health disparities, health equity and health inequities every day – in my professional and personal life. As a public health professional, I know the definition of these terms and I understand how they impact my life, the life of my friends, my family, my co-workers and other North Carolinians. What I struggle with is how do we change the systems that increase health inequities? How do we work differently?
A health disparity is defined as “differences in health status between different population groups.” Equity is defined as “the attainment of the highest level of health for all people,” while a health inequity is defined as “preventable differences in health risk or status between different population groups.” Equity is about having the resources and opportunities that promote good health. Inequities refer to differences in the root causes of health that are avoidable, unnecessary and unjust. But, how do we untangle what the root causes of inequities are?
Nationally, maternal and child health outcomes vary by a person’s race, ethnicity, geography, education level, household income and insurance status. North Carolina is no different. Infant mortality rates, poverty and insurance status vary by where you live in the state, the color of your skin, how much money you make and your insurance status. For example, Robeson County has the highest percentage of children under 18 years of age living in poverty. 1 Hertford County has the highest rate of infant mortality.2 Buncombe County has the largest African-American-white infant mortality disparity ratio2 and Randolph County has the highest rate of uninsured children, under the age of 19.1
What contributes to these disparities and inequities between our counties? Social determinants of health are the conditions in the environment in which people are born, live, learn, work, play, worship and age. More than 40 percent of our health status is associated with social and economic factors. Clearly, our environment affects our health. But so many times, our public health programs or our clinical interventions do not focus on our environment. We get stuck doing the same thing over and over, even though we see increases, not decreases, in disparities. We get stuck in understanding how to change the system.
So, how do we address these inequities in our state? How do we change the system? That’s the question we are trying to answer with a multi-factorial, comprehensive maternal and child health program at the North Carolina Division of Public Health (N.C. DPH). The statewide, Improving Community Outcomes for Maternal and Child Health Initiative, provides funding to five lead local health departments (covering 13 counties) to implement evidence-based public health strategies to address infant mortality, birth outcomes and the health of children, ages 0-5.
N.C. DPH has been collaborating with #impactEQUITYNC, a collaborative made up of members from N.C. DPH, the N.C. Office of Minority Health and Health Disparities, and N.C. Child, for over a year to develop, test and implement a health equity impact assessment tool. Collectively, we have adapted a tool created by public health colleagues in the state of Washington to better understand how a program, policy or intervention may impact groups in different ways or potentially cause unintended consequences that increase health disparities. The vision of #impactEQUITYNC is “a North Carolina where every resident has the resources and opportunities to achieve his/her best health.”
The local health departments funded by the initiative will implement the health equity impact assessment tool.
Over the coming months, the health equity impact assessment will be implemented by the funded health departments and their teams. They are engaging community members, other public health and human services agencies, private partners (clinical and non-clinical), faith-based and community-based organizations, non-profits and other stakeholders to better understand “the bigger picture” of health inequities in their communities. They will work collaboratively to develop and implement strategies to address these inequities. Will change happen overnight? No, changing systems, reducing barriers and changing perception takes time. Working collectively across the multi-layered systems in North Carolina is a start.
Do you want to be part of the change? Do you want to get involved? Email impactEQUITYNC@gmail.com for more information.
#impactEQUITYNC is a collaboration between NC Child, Rockingham County Division of Public Health, NC Division of Public Health Women’s Health Branch, and the NC Office of Minority Health and Health Disparities. For more information contact, impactEQUITYNC@gmail.com or http://www.ncchild.org/promoting-health-equity/
1 Interactive Small Area Income and Poverty Estimates (SAIPE) Data and Mapping Tool, https://www.census.gov/programs-surveys/sahie.html
2 North Carolina State Center for Health Statistics, NC resident (<1 year) death rates per 1,000 live births, 2012-2016. http://www.schs.state.nc.us/data/databook/CD9C%20inf%20death%20rates.rtf
3 North Carolina State Center for Health Statistics, 2016 North Carolina Infant Mortality Report, Table 3b, Infant Mortality Racial Disparities between White Non-Hispanic & African-American Non-Hispanic: 2012-2016. http://www.schs.state.nc.us/data/vital/ims/2016/table3b.html