A survey of Missouri local health departments (LHDs) was conducted to measure core public health functions within maternal and child health (MCH). Measurement was based on a prior key informant study that defined each core function as a set of specific MCH activities, programs, and services. The 59 items in the survey operationalized these activities and enabled the creation of summary scores for assessment, policy development, and assurance. Participation included 93 of the 112 Missouri LHDs (83%) in 1995. Reliability coefficients for the summary scores ranged from .83 to .92. Cluster analysis produced six types of LHDs with differing core function patterns. By matching efforts to improve core function practice to LHD type, more efficient use of capacity building resources may result.
The root causes of racial disparities in access to optimal cancer care and related cancer outcomes are complex, multifactorial, and not rooted in biology. Contributing factors to racial disparities in care delivery include implicit and explicit bias, lack of representation of people of color in the oncology care and research workforce, and homogenous research participants that are not representative of the larger community. Systemic and structural barriers include policies leading to lack of insurance and underinsurance, costs of cancer treatment and associated ancillary costs of care, disparate access to clinical trials, and social determinants of health, including exposure to environmental hazards, access to housing, childcare, and economic injustices. To address these issues, ACS CAN, NCCN, and NMQF convened the Elevating Cancer Equity (ECE) initiative. The ECE Working Group developed the Health Equity Report Card (HERC). In this manuscript, we describe the process taken by the ECE Working Group to develop the HERC recommendations, the strategies employed by NCCN to develop an implementation plan and scoring methodology for the HERC, and next steps to pilot the HERC tool in practice settings.
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