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

Furtado, Karishma; Brownson, Carol A.; Fershteyn, Zarina; Macchi, Marti; Eyler, Amy A.; Valko, Cheryl; Brownson, Ross C.

doi:10.1377/hlthaff.2017.1173

Cited by 23 publications

(31 citation statements)

References 16 publications

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“…Our findings also build upon past research on crosssector collaboration, which are instrumental in reducing preventable deaths attributable to chronic disease [31,32]. Ameliorating health inequities requires a multisystemic approach [33,34]. We found that in HHI crosssector collaboration was largely accomplished through coalition work.…”

Section: Discussionsupporting

confidence: 73%

“…The socio-ecological model informed program development, shaped evaluation questions and metrics, and encouraged community partners see how policy, system, and environment affected community health [30]. Cross-sector collaboration was used [31,32,33,34]. In this, communty partners were encouraged to use the socio-ecological model, and to focus on the outer rings of it.…”

Section: Resultsmentioning

confidence: 99%

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The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

et al. 2020

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Background: The Healthy Hawai'i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. Methods: From interviews with key informants, we analyze two decades of the Healthy Hawai'i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. Results: The Healthy Hawai'i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making "the healthy choice the easiest choice." Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. Conclusions: This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

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Section: Discussionsupporting

confidence: 73%

Section: Resultsmentioning

confidence: 99%

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

et al. 2020

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“…NACDD is a professional organization dedicated to improving "the health of the public by strengthening state-based leadership and expertise for chronic disease prevention and control in states and at the national level" within the United States [38]. In 2015, a national survey was conducted of state chronic disease directors and state chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors [31,39]. States were ranked by overall capacity in EBPH using participants' responses to items in the national survey about the use of EBDM in their health department, public health accreditation status (accreditation indicating higher capacity), and the preventable burden of disease in each state.…”

Section: State Site Selectionmentioning

confidence: 99%

Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study

Mazzucca

Valko

Eyler

et al. 2020

Implement Sci Commun

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Background: Public health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners' perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs. Methods: Chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo. Results: Twenty seven interviews were conducted with practitioners in four states (5-8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM. Conclusions: Results of this study highlight practitioners' perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.

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“…Prior work has described the important role of the public health system in general and health departments in particular on intervening to reduce health inequities, which Liburd et al describe as part of a three-way linkage between practice, policy and research [ 17 ]. The current study complements other studies that have examined the capacity of health departments to engage in health equity-related work that have been either qualitative in nature [ 25 ], have focused on other aspects of capacity [ 26 – 28 ], examined state rather than local settings [ 29 ], or require high levels of resources and commitment [ 21 ].…”

Section: Discussionmentioning

confidence: 85%

Development of a measurement tool to assess local public health implementation climate and capacity for equity-oriented practice: Application to obesity prevention in a local public health system

et al. 2020

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The objective of this study was to develop a measurement tool to capture local public health department (LHD) organizational characteristics that align with implementation of equity-oriented practice, which may be used to gauge progress in building public health structures and functions that address the needs of vulnerable populations and reduce health inequities. Methods We developed and tested a measurement tool, with practitioner input, based on an implementation science framework and informed by previous work defining public health essential services and practice recommendations for health equity. Measures assessed types of vulnerable populations served by the LHD, organizational climate, and four equity-oriented practice areas, including: assessment and planning, monitoring and analysis, leadership support, and obesity prevention. We also assessed opportunities for capacity building by identifying training needs of practitioners. Primary data were collected from Missouri local health department practitioners (n = 92, 80% response rate) via an online questionnaire, with a subset of the sample providing data for test-retest reliability. Results Measures of equity-oriented implementation climate indicated areas of variability with respect to strengths and gaps across LHDs. While implementation climate was strong with respect to perceived importance (86%), a substantial proportion of LHDs cited concern over other priorities conflicting with equity-oriented implementation (32%). Likewise, a strong

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

Cited by 23 publications

References 16 publications

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study

Development of a measurement tool to assess local public health implementation climate and capacity for equity-oriented practice: Application to obesity prevention in a local public health system

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