Health equity refers to the attainment of the highest level of health for all people. When people experience health inequity, they are experiencing preventable differences in health risk or status as a result of root causes of poor health which are avoidable, unnecessary, and unjust. For example, imagine a non-Hispanic white female born to a married couple, living below the federal poverty level and who cannot afford health insurance. Their house is located in a rural area of the county, in an area that lacks sufficient resources such as grocery stores, medical care, parks, and transportation. They live right next to a large industrial plant, which releases thousands of harsh chemicals into the air, affecting the families who live next door. The young woman and her family are more likely to experience health issues due to the poor quality of air in their home environment. With no health insurance, she may end up living with a respiratory condition for several years before it is properly diagnosed and treated. This is a classic scenario exemplifying the need for health equity and why so many public health agencies are working to address the issue and make health attainable for all people, regardless of circumstance.
Health equity refers to the attainment of the highest level of health for all people. When people experience health inequity, they are experiencing preventable differences in health risk or status as a result of root causes of poor health which are avoidable, unnecessary, and unjust. For example, imagine a non-Hispanic white female born to a married couple, living below the federal poverty level and who cannot afford health insurance. Their house is located in a rural area of the county, in an area that lacks sufficient resources such as grocery stores, medical care, parks, and transportation. They live right next to a large industrial plant, which releases thousands of harsh chemicals into the air, affecting the families who live next door. The young woman and her family are more likely to experience health issues due to the poor quality of air in their home environment. With no health insurance, she may end up living with a respiratory condition for several years before it is properly diagnosed and treated. This is a classic scenario exemplifying the need for health equity and why so many public health agencies are working to address the issue and make health attainable for all people, regardless of circumstance.
The High Country Collaborative is a five-county initiative that is striving to achieve health equity in northwestern North Carolina. Funded by the North Carolina Department of Health and Human Services, Division of Public Health, the health departments in Ashe, Alleghany, Avery, Watauga, and Wilkes Counties work together to improve maternal and child health in the region through the Improving Community Outcomes for Maternal and Child Health initiative. One of the goals of the five-county collaborative project is to reduce infant mortality through tobacco cessation and prevention programs. One such program utilized by the High Country Collaborative is the North Carolina Quitline (QuitlineNC). The QuitlineNC is a hotline for tobacco users who are attempting to quit. Through the High Country Collaborative contract with the QuitlineNC, individuals can call the number and receive free tobacco counseling as well as free nicotine replacement therapy (NRT) products for up to eight weeks.
Collaborating with the QuitlineNC results in enhanced services for the five-county region, such as free, comprehensive tobacco counseling and treatment. One of the challenges the High Country Collaborative has faced is whether or not its tobacco prevention efforts are being implemented in a way that effectively reduces health disparities and promotes health equity in the region. To identify exactly how the initiative’s tobacco work is impacting the community, the High Country Collaborative utilized a tool called the Health Equity Impact Assessment (HEIA) in September and October 2017. The HEIA provided a structured process to guide the evaluation of the Collaborative’s tobacco work. The process began by gathering a diverse group of community members and stakeholders via monthly regional leadership team meetings. While the local health departments act as the hub of the High Country Collaborative, the heart of its work lies in the diversity of the community partners involved – from doulas and university professors to nurses and mothers, a wide variety of stakeholders are invested in improving maternal and child health outcomes in the region.
After completing the HEIA over the course of two regional leadership team meetings, primary findings revealed the importance of reaching impacted populations who use tobacco. This included white males between the ages of 18 and 45 and community leaders of influence. Furthermore, the need to explore other forms of contact to the QuitlineNC beyond the call-in option were also highlighted. The younger population is more likely to prefer texting and social media than telephone contact.
Three primary action steps were agreed upon from the implementation of the HEIA, which include: (1) contacting the North Carolina Division of Public Health’s Tobacco Prevention and Control Branch regarding the type of data they track around QuitlineNC web chat and texting options, (2) focus groups with affected community members, and (3) an environmental scan of influential leaders and currently existing business and worksite cessation programs. The HEIA has also resulted in the High Country Collaborative’s first-ever convening of Duke and UNC’s Tobacco Treatment Specialist training to occur April 30 through May 3, 2018 in Boone. Offering the training at no cost and within the Appalachian region is an important response to previous transportation and time barriers to participation, since the training is typically held in the central region of North Carolina.
Completing the HEIA has led the High Country Collaborative to place health equity even more at the center of its regional work, and the team looks forward to the continued use of the HEIA to reduce infant mortality and improve birth outcomes and the health of children aged 0 – 5 in Appalachia.
For more information on the High Country Collaborative, contact Tim Jones, tim.jones@apphealth.com.
This post was submitted by Kimberly Garner at UNC Center for Maternal & Infant Health.