Department forges pathways to equity

New strategies make HE & EJ measures part of doing business
by Gabi Johnston
As the department continues working toward health equity and environmental justice, a collaborative of more than 70 employees is joining forces with various divisions to help find effective strategies to accomplish those goals.
Formed in 2012, the Health Equity and Environmental Justice Collaborative works to build an organizational culture that empowers staff to find ways to minimize inequities. To achieve that, though, staff must have a thorough understanding of the issues, and that’s not as easy as it might seem.
“Health equity isn't an easy topic. It has many nuances, and some may not even agree that it should be a priority,” said Tara Trujillo, a chronic disease specialist in the Prevention Services Division and member of the collaborative. Most people, she said, understand the concept of equality – making the same services available to everyone. When the conversation evolves into equity, it gets a little more complicated.
“If you think about a running race, equality means everyone starts at the same place and has the same chance to achieve the same goals,” Trujillo said. “Equity accounts for the fact that some racers are starting from miles further back, some racers don't have shoes, some racers have never raced before, and some racers couldn't make it to the race in the first place.”
When it comes to healthy living, some families do not have access to healthy food, either because there are no nearby stores or because the stores in their neighborhood don’t carry affordable items they can easily prepare. Some are working multiple jobs, and some are dealing with housing, child care, legal or other issues. Feeding a family of four at McDonalds might cost less, be easier, take less time or be more available than preparing a complete meal of steamed vegetables, whole grain rice and chicken.
Families in need also often live in areas where there are no sidewalks, or at least none wide enough for a mother with a stroller. In some neighborhoods, pollution, high traffic or crime prevent families from venturing outdoors. Add to that the chronic stress that often accompanies living with limited resources.  
Unhealthy diets, not enough exercise, chronic stress and environmental pollutants can lead to a wide range of chronic health problems, including obesity, diabetes, high blood pressure, cancer and mental illness, among others. This then poses another problem: Many of these same families, for the same reasons, cannot access care. It's harder to find reliable transportation to a clinic. It's harder to afford doctor visits or medicines to help them manage their diseases. The diseases get worse, more costly and result in preventable deaths, Trujillo said.  
Health inequities exist across many groups: individuals with disabilities, older adults, people living in rural areas, people who identify as LGBTQ and people of color. Some inequities exist because of poverty. Some are due to lack of access to care or poor quality of care.  
Health departments might not be able to erase inequity, but they can chip away at the numerous barriers many Coloradans face, Trujillo said. Some divisions have made strides in that regard.  
Trujillo pointed to the recent effort among the Oral Health Unit, Diabetes and Cardiovascular Unit, and Office of Information and Technology’s Clinical Quality Improvement team. Representatives from those three groups developed language included in a recent request for applications that required the contractor, a federally qualified health center, to demonstrate how it provides culturally appropriate care and conducts implicit bias testing for the clinical staff. 
Steve Holloway, branch chief of the Health Access Branch and Primary Care Office, said the most recent efforts raise the bar for clinics seeking assistance, and that’s just one example of what his branch is doing to address health inequities. If you’d like to learn more about the RFA language or how to use it in your own RFA, contact Katya Mauritson.
"As a manager, I encourage staff to get into the communities that benefit from our work through site visits, community meetings and various partnership opportunities," Holloway said.
Site visits are a great way for staff to see health equity work firsthand. For the Chronic Disease and School Health grant team, those field trips have sparked new ideas, and more importantly, new enthusiasm to incorporate health equity concepts into their work.
The team recently visited the Dahlia Campus for Health and Well-being in Northeast Park Hill, which provides a wide range of services, including a preschool, diabetes prevention, children’s dental clinic, mental health services, a community garden and a tilapia farm.
“We don’t always do a good job of thinking of the softer side of things,” said Greta Klingler, PSD’s Health Systems Unit manager. “This definitely creates a different level of engagement.”
Those are just a couple of examples of the department’s work to address inequities, Trujillo said, but there are many more. In an effort to honor the department’s equity work, the collaborative is seeking other examples and will honor the best project at the employee appreciation event in October.
“We have numerous employees dedicated to ensuring all Coloradans have equal opportunity to develop and achieve their full health potential,” Trujillo said. “We want to recognize those efforts and show others how much can be accomplished when we work to eliminate barriers.”