Adjusting the Equity Lens: Gaps in Addressing Health Equity in State Chronic Disease Prevention.

Purpose: Chronic diseases cause a significant proportion of mortality and morbidity in the United States, although risk factors and prevalence rates vary by population subgroups. State chronic disease prevention practitioners are positioned to address these issues, yet little is known about how health equity is being incorporated into their work. The purpose of this study was to explore perceptions of health equity in a sample of state chronic disease practitioners. Methods: Participants were selected in conjunction with a related evaluation of the National Association of Chronic Disease Directors (NACDD) capacity-building and evidence-based efforts. Four states were chosen for study based on variance in capacity. Directors in each of the states were interviewed and using snowball sampling, 8-12 practitioner interviews were conducted in each state, digitally audio recorded and transcribed. Using a comparative coding technique, themes and analyses were developed. Results: Comments from the practitioners fell into three main and inter-related categories. First, they discussed the varying degrees of integration of health equity in their work. The second theme was collaboration and the importance of working within and outside of departments, as well as with the community. The third theme related to measurement and the need for better data that can be used to garner support and measure impact. Conclusion: Chronic disease practitioners can play an important role in achieving health equity. Integrating this work more fully into chronic disease prevention and health promotion, developing strategic partnerships, tracking efforts, and measuring impact will improve practice and ultimately population health.

Health Departments With A Commitment To Health Equity: A More Skilled Workforce And Higher-Quality Collaborations.

Health equity is a public health priority, yet little is known about commitment to health equity in health departments, especially among practitioners whose work addresses chronic disease prevention. Their work places them at the forefront of battling the top contributors to disparities in morbidity and mortality. A random sample of 537 chronic disease practitioners working in state health departments was surveyed on health equity commitments, partnerships, and needed skills. A small percentage of respondents (2 percent) worked primarily on health equity, and a larger group (9 percent) included health equity as one of their multiple work areas. People who rated their work unit's commitment to health equity as high were more likely to engage with sectors outside of health and rate their leaders as high quality, and less likely to identify skills gaps in their work unit. Opportunities exist to more fully address health equity in state public health practice through organizational, institutional, and governmental policies, including those regarding resource allocation and staff training.

Administrative Evidence-based Practices in State Chronic Disease Practitioners.

INTRODUCTION: Research and lessons from community implementation have informed evidence-based practices that can improve the effectiveness of health initiatives. Administrative evidence-based practices (A-EBPs) facilitate the role of public health departments in implementing the most effective programs and policies. The purpose of this study is to describe A-EBPs in relation to characteristics of chronic disease practitioners in state health departments. METHODS: Randomly selected chronic disease practitioners who worked in state health departments were invited to complete an online survey in 2016. The survey included questions on five domains of A-EBPs: workforce development, leadership, culture and climate, relationships and partners, and financial practices. State-level variables that could potentially affect the use of A-EBPs were collected and used in a regression model. RESULTS: Analysis was conducted in 2016 on data from 571 respondents. Mean percentages of those who strongly agreed/agreed were lowest for financial practices (41.49%) and leadership (42.33%) with higher means for culture and climate (54.52%) and relationships and partners (58.71%). State poverty level was the only significant predictor of A-EBP scores after adjusting for other covariates in a regression model. CONCLUSIONS: These results show several areas of high agreement with A-EBP within the domains measured as well as opportunities for improvement. Highlighting the importance of A-EBPs to public health leadership level may enhance practice. There is also need for developing plans for an aging workforce and cultivating partnerships with health care and other sectors. Findings can be used to target training for enhancement of A-EBPs within state health departments.