Planning for Healthy Communities Conference

Transcription

1 Planning for Healthy Communities Conference Charles Mack Citizen Center Mooresville, NC September 13, 2013 Inclusion, Health Equity and Community Engagement: Connecting the Dots Presenter: Dr. Forrest Toms Associate Professor Department of Leadership Studies NC A&T State University

2 AICP Principle Planners have an obligation to expand choice and opportunity for all persons, with a special responsibility towards the needs of the disadvantaged. How do we integrate this AICP core principle into planning for community health?

3 Context for Inclusion Acting Director Thomas L. Mesenbourg states, The next half century marks key points in continuing trends the U.S. will become a plurality nation, where the non-hispanic white population remains the largest single group, but no group is in the majority. The non-hispanic white population is projected to peak in 2024, at million, up from million in Unlike other race or ethnic groups, however, its population is projected to slowly decrease, falling by nearly 20.6 million from 2024 to 2060 (U.S. Census Bureau, 2012).

4 Context for Inclusion In 2012, the Hispanic population was 53.3 million. It is projected to more than double to million by Consequently, by the end of the period, nearly one in three U.S. residents would be Hispanic, up from about one in six today. The black population in 2012 was estimated at 41.2 million and projected to increase to 61.8 million by The Asian population is projected to more than double, from 15.9 million in 2012 to 34.4 million in 2060, with its share of the nation s total population climbing from 5.1 percent to 8.2 percent in the same period (U.S. Census Bureau, 2012).

5 Context for Inclusion American Indians and Alaska Natives would increase from 3.9 million in 2012 to 6.3 million by 2060, a percentage population jump from 1.2 percent to 1.5 percent. The Native Hawaiian and Other Pacific Islander population is expected to nearly double, from 706,000 to 1.4 million. The number of people who identify themselves as being of two or more races is projected to more than triple, from 7.5 million to 26.7 million over the same period.

6 Context for Inclusion It is projected that the United States will become a majority-minority nation for the first time in While the non-hispanic white population will remain the largest single group, no group will make up a majority. At present, 37 percent of the U.S. population is represented by minority groups; the number is expected to grow to 57 percent by 2060 (U.S. Census Bureau, 2012).

7 Adults=18+ *Physical Inactivity=Respondent answered No to During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? Data Source: North Carolina Division of Public Health, State Center for Health Statistics. North Carolina Behavioral Risk Factor Surveillance System, Extracted by: Heart Disease and Stroke Branch: 10/16/2012.

8 Social inclusion and health equity for vulnerable groups The Social Exclusion Knowledge Network of the Commission on Social Determinants of Health defines social exclusion as consisting of dynamic, multidimensional processes driven by unequal power relationships interacting across four main dimensions economic, political, social and cultural and at different levels including individual, household, group, community, country and global.

9 Social inclusion and health equity for vulnerable groups It results in a continuum of inclusion/exclusion characterized by unequal access to resources, capabilities and rights, which leads to health inequities. In this definition, resources refers to the means that can be used to meet human needs and capabilities to the relative power people have to use the resources available to them. This definition of social exclusion focuses on multifactorial relational processes driving differential exclusion.

10 Equity Equity is just and fair inclusion into a society in which all, including all racial and ethnic groups, can participate, prosper, and reach their full potential. Equity gives all people a just and fair shot in life despite historic patterns of racial and economic exclusion. PolicyLink, 2012

11 The Economic Imperative of Equity Equity is not only a moral imperative it is also an economic one. Economists now recognize that inequality hinders economic growth and that greater economic inclusion brings about more robust economic growth. Research in the United States, for example, has shown that greater economic and racial equality in metropolitan regions corresponds with more robust growth and longer periods of growth. PolicyLink, 2012

12 The Economic Imperative of Equity To compete in the global economy, America s emerging people-ofcolor majority must be able to contribute fully as leaders, workers, innovators, and entrepreneurs. If we do not boost the education and skills of our fastest-growing groups, we will not meet the nation s workforce needs. By 2018, 45 percent of all jobs in the United States will require higher education at least an associate s degree. But among today s workers only 27 percent of African Americans, 26 percent of U.S.- born Latinos, and 14 percent of Latino immigrants have that level of education. PolicyLink, 2012

13 Health Equity Key Concepts Social justice Fairness and equality Social advantage Health distribution Moral/ethical obligation Human rights Societal values Health needs and resources Equal access for equal need Resource allocation

14 Health Equity Key Concepts Systematic Historical Structural Laws, regulations, policies Systems Population based Individuals vs groups Multi-sector approach Collective impact

15 Health Equity is Good Public Health Health equity is the concept that everyone should have a fair opportunity to attain their full health potential. 1 Public health is what we, as a society, do collectively to assure the conditions for people to be healthy M. Whitehead, World Health Organization EUR/ICP/RPD, Institute of Medicine, Future of Public Health in the 21 st Century, 2002.

16 Health Equity: A Paradigm Shift Expanding the work of public health to collaborate with a broader set of stakeholders Emphasize addressing the root causes of health disparities Integration and coordination of state, local and community based activities Address issues related to equitable distribution of resources and services in underserved areas

17 CTG Project Core Principles Maximize health impact through prevention Advance health equity and reduce disparities Use and expand evidence base for policy and environmental changes that improve public health

18 Integrating Health Equity into the Planning Process Identifying the Issues Partnership Development & Community Engagement Intervention design, selection and implementation Evaluation Organizational Capacity and Supports

19 Developing a Strategy Map Using a Health Equity Lens Who What Where When Why How Who are priority populations that have highest burden and greatest needs? What needs to be done or what actions need to be taken? Where should strategies be implemented? When should activities occur? Why is it important to use a health equity lens? How could intervention affect health inequities and how do we know if they have been reduced?

20 But how is this different Requires a shift in perspective Addressing more upstream factors to eliminate health disparities Its about our collective impact Large scale social change that requires broad cross-sector coordination, rather than a focus on isolated interventions of individual organizations

21 National partnership for action September 10,

22 DEFINING COMMUNITY ENGAGEMENT What is Community Engagement? Working collaboratively with and through groups of people who are: Affiliated by geographic proximity Have a special interest or similar situation Trying to address issues affecting the well-being of those people Working to include a wide range of people in processes and practices to achieve a shared goal Building partnerships for sustainable change F.D. Toms & S. Burgess, 2013, All Rights Reserved. 22

23 COMMUNITY ENGAGEMENT Community engagement involves a systems perspective which focuses on the dynamics and interrelationships among various stakeholders, both internally (within public health) and externally (individual stakeholders, and community organizations). It includes building capacity for the development of partnerships with various stakeholders. F.D. Toms & S. Burgess, 2013, All Rights Reserved. 23

24 WITH AND THROUGH OF COMMUNITY ENGAGEMENT The with of community engagement suggest that elected officials, community leaders and other stakeholders must seek to include community representation in all aspects of civic and political engagement. The through of community engagement implies working relationships and partnerships with communities to ensure participation and engagement of issues and policies affecting their wellbeing Toms, 2010; Toms, et al.,

25 ENGAGEMENT A RECIPROCAL PROCESS Carnegie Foundation describes engagement as a collaborative process between entities (educational) and their larger communities for the mutually beneficial exchange of knowledge and resources in a context of partnership and reciprocity

26 PHILOSOPHICAL CONNECTION BETWEEN BELIEFS, IDEALS AND ACTIONS PHILOSOPHY Beliefs IDEOLOGY Ideas/Ideals Individual Organization THEORY METHODS (ACTIONS) Assumptions What You Do F.D. Toms & S. Burgess, 2013, All Rights Reserved. VALUES What You Want 26 To Protect

27 ENGAGING DISPARATE COMMUNITIES Your work is important, but not sufficient by itself How to think differently about how you do your work WHY are you doing what you do? WHO are you engaging to do the work? WHERE is your focus.you must be strategic INTENT should be towards equity KNOW this is an ongoing process Know when and how to expand the sphere for engaging other partners and stakeholders Adapted from Advancing Health Equity: From Theory to Practice, Tucker & Brooks,

28 Connecting Back to Philosophy/ Ideology Why do individuals and organizations appear to be less skilled with or not as effective in establishing on-going connections and relationships with certain groups, certain areas of the community and not with others? F.D. Toms & S. Burgess, 2013, All Rights Reserved.

29 Multifaceted Approach to Engagement INTERNAL APPROACH

30 Consider Community Engagement From A Multi-faceted Approach - Agencies Intra-agency capacity building through, policies, programs Community stakeholders involved in planning, committees, boards Practices, planning, & assessment Equip staff to engage communities Community Education Intentional partnership building Cultural Competency Strategic supporthuman and fiscal Convene and facilitate meetings, offer technical assistance Improve the quality of and availability of information to the community F.D. Toms & S. Burgess, 2013, All Rights Reserved. 30

31 Multifaceted Approach to Engagement EXTERNAL APPROACH

32 Community Engagement A Multifaceted Approach - Communities Intracommunity capacity building meetings with key stakeholders Establish strategy to communicate with community on a consistent basis Create forums for community input and for them to identify their own needs Know how agencies operate and their key stakeholders Know the status of consumers and services needed and offered (collect data) Establish a group to visit and discuss issues and concerns with provider agencies Set times to consistently interact with agency stakeholders F.D. Toms & S. Burgess, 2013, All Rights Reserved. Identify community stakeholder who have the skills and time to be on committees, boards and planning groups. 32

33 UNDERSTANDING THE PROCESS OF COMMUNITY ENGAGEMENT

34 COMMUNITY ENGAGEMENT Community engagement involves an ecological perspective which focuses on the dynamics and interrelationships among various stakeholders, both internally (within public health) and externally (individual stakeholders, and community organizations). It includes building capacity for the development of civic engagement with various stakeholders. 34 Adapted from Communities In Transition: Challenges And Opportunities Of Community Building, Forrest D. Toms, Ph.D. President, Training Research Development Inc All Rights Reserved

35 Challenges to Engagement Ability to Build Capacity in the Community Working Relationships (teams, committees, volunteers) Challenges Across Race, Class, Organizational and Religious Groups Leadership Skills and Competence Accepting and Sharing Responsibility for Getting the Work Done Communication Rules for Decision-Making, Learning How to Agree to Disagree Keeping Leaders Focused on Vision/Goal Not Personal Power Commitment to Process 35

36 Leadership and Community engagement Develop A Plan To Engage Communities in Dialogue Convene meeting with selected groups to frame and discuss issues and needs around health disparities Develop strategies to engage community in dialogue about issues facing individuals Educate community on how they are key players in leveraging support for policies, programs and services F.D. Toms & S. Glover, 2007, All Rights Reserved

37 UNDERSTANDING THE PROCESS OF MULTI-SECTOR PARTNERSHIP

38 Multi-Sector Partnerships A multi-sector collaboration is the partnership that results when government, non-profit, private, and public organizations, community groups, and individual community members come together to solve problems that affect the whole community.

39 Multi-sector partnerships Based on cooperation, rather than competition Puts the decision-making process back in the hands of people at multiple levels within the community Each partner has specific roles and responsibilities that contribute to design and implementation of joint activity

40 Key Factors in the Effectiveness of Multi-sector Partnerships Partnership resources Common vision and goals Leadership and guidance Organizational structure Cohesion and communication Ability to help partners build other relationships

41 The Health Equity Mandate PURPOSE: In order to fulfill the legislative mandate of CTG, it is critical that communities work to advance health equity and reduce health disparities. All CTG activities must build capacity to achieve or actually achieve both area-wide health improvements and reductions in health disparities. This will require both targeted strategies for populations experiencing health disparities and jurisdiction-wide strategies with an explicit focus to ensure equitable impact. When working on policy and environmental improvements across a jurisdiction, it is critical to ensure that the changes do not neglect or further health disparities.

42 WHY THE NEED FOR ENGAGEMENT CHANGES IN THE SOCIAL CONTEXT DEMOGRAHIC SHIFTS IN COMMUNITIES AND HEALTH CARE IMPACT OF ECONOMY ON CITY & COUNTY GOVERNMENTS, INDIVIDUALS, AND FAMILIES READINESS AND PREPAREDNESS OF LEADERSHIP TO LEAD AROUND ISSUES OF HEALTH DISPARTIES DISTRUST BY INDIVIDUALS AND COMMUNITIES OF PREVIOUS INITIATIVES F.D. Toms & S. Burgess, 2013, All Rights Reserved. 42