Promoting Health and Behavioral Health Equity in California.

Behavioral health disparities are not usually considered part of the same system of health disparities. However, the California Department of Public Health focused its health equity strategies on reducing behavioral health disparities through its California Statewide Plan to Promote Health and Mental Health Equity. This statewide plan was developed through a community-wide stakeholder engagement and outreach process. In addition, the California Reducing Disparities Project is a prevention and early intervention effort to reduce mental health disparities in underserved populations. This strategic plan represents the voice of several racial/ethnic communities, such as African American, Asian and Pacific Islander, Latino, Native American, as well as lesbian, gay, bisexual, transgender, and queer and questioning communities in California, through 5 strategic planning workgroups. The workgroups were composed of a broad range of stakeholders, including community leaders, mental health care providers, consumer and family members, individuals with lived experience, and academia. This case example highlights the various efforts of California's Office of Health Equity in eliminating behavioral health disparities and promoting mental health equity, as well as discusses the unique statutory and regulatory role of the Office of Health Equity's deputy director.

State and Territorial Infrastructure for Health Equity and Minority Health.

OBJECTIVE: With support from the National Partnership for Action to End Health Disparities, the Association of State and Territorial Health Officials conducted a survey of state and territorial health agencies (STHAs) to identify agencies' infrastructure and capacity for addressing health equity and improving minority health outcomes. DESIGN: The Minority Health Infrastructure Survey was a census design survey distributed to STHAs in 2007, 2010, and 2014. Both cross-sectional and select longitudinal data are presented. METHODS: Descriptive data from the Association of State and Territorial Health Officials' Minority Health Infrastructure Survey were recorded, and χ tests were performed on selected variables. RESULTS: In 2007, 95.7% of jurisdictions had a primary contact person for health equity initiatives. That number rose to 98.0% in 2010 and to 100% in 2014. In STHAs with a primary contact person, that individual worked full-time on health equity initiatives in 63.6% of STHAs in 2007, 82.0% of STHAs in 2010, and 81.1% of STHAs in 2014. The proportion of STHAs with an organizational unit devoted to minority health was 78.3% in 2007, 90.2% in 2010, and 84.9% in 2014. In 2014, 92.6% of STHAs had included minority health in an agencywide or dedicated strategic plan. The most common strategies for addressing health equity included in strategic plans were collecting and tracking disparities data (91.8%), leveraging and engaging public/private partners in solutions for health disparities (87.8%), and increasing cultural competency or health literacy (87.8%). All respondents collaborated with external partners on health equity initiatives in some way. CONCLUSIONS: STHAs increased their organizational resources to address minority health between 2007 and 2010, but resources leveled off or decreased in some areas between 2010 and 2014. Closing the disparities gap will require substantial nationwide investment and implementing strategies with the potential to make a lasting impact.

Cross-Sectoral Collaboration: The State Health Official's Role in Elevating and Promoting Health Equity in All Policies in Minnesota.

CONTEXT: For many years, the Minnesota Department of Health (MDH) has been intentionally engaged in decreasing race- and ethnicity-based health disparities in the state. It has seen modest success in some areas, but overall, the disparities remain. Research over the last several decades has shown that race- and ethnicity-based health disparities are the result of persistent social and economic inequities, which have a greater influence on health outcomes than either individual choices or interventions by the health care system. SETTING: The MDH leaders recognized that to focus health improvement efforts solely on access to health care and individual behavior change (the traditional public health approaches of the last 30 years) would fail to make adequate advances in eliminating health disparities. Working with a statewide group known as the Healthy Minnesota Partnership, MDH decided to shift the public conversations about health in Minnesota to focus on the factors that actually create health. CONCLUSIONS: This effort to develop and implement a new narrative about health, focused on upstream issues such as education, employment, and home ownership, led to an emphasis on health in all policies approach for MDH and its partners. This case example will highlight Minnesota's efforts and discuss the new Council on Institutional Collaboration initiative in partnering large research universities with state health departments in addressing the social determinants of health.

Balancing Tribal Sovereignty and the Role of Interjurisdictional Partnerships in Oklahoma.

CONTEXT: Oklahoma has a history of strong partnerships with their tribal health leaders and tribal communities. In 2012, the Oklahoma State Department of Health (OSDH) established the Office of the Tribal Liaison, as Oklahoma has 39 tribal nations in the state, of which 38 are federally recognized. The Office of the Tribal Liaison is responsible for promoting relationships with Oklahoma Tribal Nations and implementing the OSDH Tribal Consultation policy. SETTING: The strength of the partnership between the OSDH and the Tribal Nations enabled a new collaboration during an event hosted by a tribal casino event center that brought tattoo artists to provide tattoos to patrons over 3 days. Licensure issues that crossed the jurisdiction boundaries of the OSDH emerged before the event, which required the OSDH, Indian Health Service, and the Tribal Nation to work together to protect the public's health. The 3 jurisdictions drew upon their previously established partnership, OSDH's tribal consultation policy, and their open and trusting relationship to come together quickly to protect the public's health. CONCLUSIONS: This event and interjurisdictional partnership highlighted the importance of adopting the "Spectrum of Processes for Collaboration and Consensus-Building" model as outlined by Orenstein et al to help guide and support state, tribal, and federal collaborations. This case example highlights the opportunities for collaboration between different regulatory public health and tribal bodies to improve the communities' health.

Opening up their doors: perspectives on the involvement of the African American faith community in HIV prevention in four communities.

In 1998, the U.S. government launched the Minority AIDS Initiative (MAI) to address growing ethnic and racial disparities in HIV/AIDS cases. The CDC performed an evaluation of its MAI-funded programs, including an assessment of community stakeholders' perspective on the involvement of the faith community in HIV prevention. Individual interviews (N = 113) were conducted annually over 3 years in four communities. The majority of participants described a change in faith community's attitudes toward HIV and a rise in HIV-related activities conducted by faith-based organizations. Participants attributed changes to faith-based funding, acknowledgment by African American community leadership that HIV is a serious health issue, and faith leaders' desire to become more educated on HIV/AIDS. Participants reported conservative faith doctrine and stigma as barriers to faith community involvement. The findings suggest that although barriers remain, there is an increased willingness to address HIV/AIDS, and the faith community serves as a vital resource in HIV prevention.

Community stakeholders' perspectives on the impact of the minority AIDS initiative in strengthening HIV prevention capacity in four communities.

OBJECTIVE: The Minority AIDS Initiative (MAI) was launched in 1998 to address the disproportionate rates of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among racial and ethnic minorities in the United States. The Centers for Disease Control and Prevention (CDC) conducted an evaluation to assess the influence of MAI in four communities, and the extent to which these communities increased their capacity to meet the HIV prevention needs of racial and ethnic minorities. DESIGN: Retrospective data were collected annually through individual interviews over three years. Individual interviews were conducted with community stakeholders across the three waves of data collection. Data were analyzed using standardized qualitative methods including codebook development, coding, inter-coder agreement assessments, and data interpretation. This paper will highlight one area of inquiry - community stakeholders' perceptions of the impact of MAI in their communities. RESULTS: Community stakeholders reported that MAI increased capacity to respond to the HIV epidemic and provide services to racial and ethnic minorities. Specifically, MAI was perceived to have increased community empowerment, involvement, and awareness of HIV/AIDS; expanded HIV-related services and organizational self-sufficiency; and improved collaboration and the coordination of services in the community. Although recognizing MAI gave national focus to the impact of the epidemic on minority communities, respondents raised concerns about the implementation process and the lack of sustainability planning. CONCLUSION: MAI represented an initial national attempt to address the disproportionate rates of HIV/AIDS among racial and ethnic minorities. However, other strategies are also needed to address these significant health disparities. At CDC, steps are currently underway to develop a comprehensive strategy to prevent and reduce the burden of HIV/AIDS among racial and ethnic minorities. As community stakeholders are critical partners in the effort to prevent the spread of HIV, strengthening their capacity and promoting their involvement can help combat the epidemic.