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Defining Health Equity: “I know it when I see it”

August 27th, 2019 by Elana Brochin

In the five months since I started at MACDC as the Program Director for Health Equity, I have struggled to define the key term imbedded in my title: health equity. Rather than using a single definition for this important term, I have found that the term is better described through examples, in other words, I know it when I see it.  

“I know it when I see it” is a concept popularized by the former Supreme Court Justice Potter Stewart in 1964 when he described the concept as the threshold test for obscenity regarding protected speech. In the same way that obscenity has variable definitions yet is recognized when it exists, health equity is better defined by examples than by a static definition.  

Health equity is the opening of a grocery store to increase access to healthy, affordable food to low- and moderate-income residents who have disproportionate rates of diabetes, heart disease, and high blood pressure. Health equity is advocating for increased state funding for no-interest lead abatement loans for low- and moderate-income homeowners and landlords. Health equity is providing transportation services for isolated seniors to access health care services and health-promoting activities. But despite having a clear sense of examples of initiatives that fall into the health equity bucket, it is often advantageous to have a succinct definition for health equity for shorter conversations. 

MACDC has not formally adopted a definition for health equity, and so, in order to better articulate what I do, I recently did some research into how other organizations define the term. The following are several definitions of health equity, followed by my initial reactions: 

The World Health Organization (WHO) 

Definition: Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically, or by other means of stratification. "Health equity” or “equity in health” implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential. 

My reaction: I like that this definition begins by defining “equity” and then gets more specific in defining what we mean by health equity. The WHO leaves me wanting more detail about the systems and causes of inequity. 

Center for Disease Control (the other CDC)  

Definition: Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment. 

My reaction: I really like that this definition enumerates how health inequity manifests. This definition made me appreciate an aspect of the WHO definition, which the CDC definition lacks: the WHO names social, economic, demographic, and geographic as ways in which people might be subject to varying health outcomes. 

Robert Wood Johnson Foundation (RWJF) 

Definition: Everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care. 

My reaction: I really like that RWJF names the social determinants of health that cause health inequity. I have mixed feelings about the first sentence in their definition, which on one hand, describes the desired outcome (“everyone….to be as healthy as possible), on the other, doesn’t define what we mean by good health.  

American Public Health Association  

Definition: Everyone has the opportunity to attain their highest level of health. 

My reaction: Wow, this is an even more simplified version than the first sentence of the RWJF definition!I like that the definition is straight-forward, but also am concerned that its simplicity renders makes it less useful than the other definitions. 

I was curious to analyze these definitions together to better understand what they have in common. I started by creating a word bubble: 

To better understand the word bubble, I noted the words that appeared the biggest – meaning that they appeared most frequently. I came up with the following words: everyone, attain, fair, potential, opportunity. These five words seem to be moving toward a consensus definition – in fact, they almost make a sentence. But something is notably missing – there are no words that are specific to health! In fact, the words in this word bubble that are most directly tied to health, consistently appear the smallest. These words include disease, death, care, treatment, disability and almost entirely stem from the CDC definition. 

 

My analysis of the word bubble indicates that the definitions cited are in better agreement about how to define equity than they are about how to define health. I have a few theories as to why: 

 

One theory is that the definitions assume that we know what health is, but assume we need help defining equity.  

 

Conversely another theory is that health is just too difficult to define in the context of a succinct definition.  

 

The most compelling explanation for the absence of health-specific terms in these definitions is that differences in health status or health opportunities stem from the same inequities from which all unequal outcomes stem. Therefore, these definitions are more concerned with the cause (inequity) than the effect (health).  

 

I hope that instead of creating more confusion (which would be understandable), my analysis provides a bit of understanding of what health equity is. I think it helped me! Going forward, when someone asks me what I do, I’m going to go with something along the lines of: 

 

Health equity involves creating and supporting systems, environments, and policies that allow all individuals the potential to lead healthy lives. Health equity further involves dismantling systems, environments, and policies that have historically contributed to health disparities. When time allows, my explanation will undoubtedly be followed by a laundry list of examples of ways in which CDCs, and others, are actively working to promote health equity. I maintain that ultimately real-world examples will better explain health equity than any definition can. 

 

Do you or your organization have a go-to definition for health equity?  

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MACDC Notebook Archive

August 27th, 2019 by John Fitterer
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The Mel King Institute’s Public Housing Training Program trains hundreds of residents across Massachusetts

August 26th, 2019 by Nadine Sanchara

PHTP particpants at a recent training in Ludlow.

“Before the (PHTP) training, I didn’t understand the way things work… The training is serious. I like to say it’s like an oracle, it gives answers.”

Those were the words of Nicole Beckles, a resident leader and peer trainer in the Public Housing Training Program. Nicole gave a moving testimonial of her participation in the program at the Mel King Institute’s 10th Anniversary Breakfast in June.

“Changes to public housing don’t affect where other people lay their heads at night, not the Housing Authority staff, or the legislators, the changes affect public housing residents, where we live every day and raise our kids. This is why this program of training residents to understand the process and giving and getting involved is so important. This is why I’m involved,” she continued.

Since its first training in 2017, the Public Housing Training Program (PHTP) has trained more than 200 residents across the Commonwealth, arming them with the knowledge they need to fully participate in the oversight of their housing developments. A recent evaluation report of the program showed that it is building resident leadership skills and knowledge in a variety of areas such as budgets, tenants’ rights, conflict resolution, community building, etc.

The Mel King Institute for Community Building launched the Public Housing Tenant Training Program in 2016 with the purpose of increasing the voice of residents as stakeholders in decision-making in public housing management and administration. Trainings are all conducted by Sarah Byrnes, Manager of the MKI Public Housing Training Program, along with co-trainers and residents.

Director of the Mel King Institute, Shirronda Almeida said, “We are proud to have this effort under the MKI umbrella. The program reaches residents in public housing across the state and gives them the tools necessary to be leaders within their housing authority.  When we hear from these residents, we learn about the powerful impact the training and networking opportunities is having in their lives, and communities.”

Though the Mel King Institute is based in Boston, trainings are conducted across Massachusetts. Recently, Sarah drove out to Western MA for a week of trainings. The week started in Great Barrington with a learning session with two resident board members, followed by two days of resident leader training, and concluded with a resident board member training in Ludlow.

The trainings in Great Barrington were attended by residents of the community who are working to address challenges around maintenance and other issues. Great Barrington residents take great pride in the physical landscape and beauty of the town, and many of them do their own gardening and landscaping. Peer Trainer Mildred Valentin Torres helped run the training, sharing her lessons of working with tenant groups in Chelsea.

Participants had the chance to sharpen their skills in team building, outreach, conflict resolution and running meetings, as well as the opportunity to learn about state regulations and tenant protections, and how to build a strong tenant organization.

In Ludlow, residents from five housing authorities in the area, including Ludlow itself, participated in the resident board member training. Jessica Quinonez, the Resident Board Member in Springfield, helped out as a Peer Trainer.

Resident board members enjoy meeting each other and being able to share and learn from each other’s experiences and challenges. In addition to networking, participants of this training had the opportunity to learn about budgets, capital plans, and the overall role of the board member.

Moving forward, the residents and resident board members who participated in these trainings will receive continued support from our partner, the Massachusetts Union of Public Housing Tenants. They will also be invited to the ongoing learning community supported by the Public Housing Training Program, which provides regular online meet ups and scholarships to other Mel King Institute trainings.

To learn more about the Public Housing Training Program, please contact Program Manager, Sarah Byrnes at sarahb@macdc.org

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By the Numbers: CDCs That Led the Way in Supporting Families in 2018

August 15th, 2019 by Don Bianchi

MACDC is proud to document the collective impact of CDCs in our annual GOALs Report.  In the 2019 Report, we celebrated this collective impact CDCs achieved in 2018: 

  • Engaged 1,910 Community Leaders 
  • Built or Preserved 1,535 Homes 
  • Created or Preserved 4,305 Job Opportunities 
  • Provided Technical Assistance to 1,369 Entrepreneurs 
  • Invested $801.5 Million in Local Communities 
  • Supported 84,224 Families with Housing, Jobs, or Other Services 

What does it mean that the CDCs collectively supported over 84,000 families?  By digging a little deeper into the numbers, we’ve highlighted CDCs which led the way in delivering programs and services to families that need them. Significant attention is (rightfully) paid to the affordable housing developed by CDCs, but there is so much more to their work.  Click on the links that accompany the numbers below, to see some great examples of how CDCs are improving the lives of those who live in the communities they serve. 

 Helping Families Acquire, Preserve, and Improve Homes: 

  • Through its programs to help low-income residents deal with home repair needs in their homes and address lead hazards, NeighborWorks Housing Solutions preserved 162 homes
  • NeighborWorks Housing Solutions also led the way on homebuyer counseling, providing pre-purchase education to 1,144 first-time homebuyers. 
  • Oak Hill CDC, through its NeighborWorks Homeownership Center of Central MA, offered the assistance of certified housing counselors to 133 families to help them avoid foreclosure, with 77 families receiving a loan modification or other positive outcome.
  • Way Finders helped 1,763 maintain their existing rental housing or obtain new permanent housing (separate from their administration of rental assistance programs) 

 Assistance for Those Seeking Employment and Owning a Small Business: 

  • Codman Square NDC provided Adult Basic Education to 123 individuals.  Its Men of Color/Men of Action Initiative focused on to providing support and leadership development in the Codman Square/ Four Corners Community.  
  • Through its English language program, the Waltham Alliance to Create Housing (WATCH) offered classes at three levels to 255 people, supplemented by one-on-one tutoring. 
  • The Neighborhood Developers provided 1,769 people with Job Training and Workforce Development assistance.  Through its CONNECT Program, TND partners with five agencies working to improve the financial mobility of low-income families. 
  • Common Capital provided personalized business assistance and financing to 505 small business entrepreneurs.  An affiliate of Way Finders, Common Capital is certified by the U.S. Treasury Department as a Community Development Finance Institution (CDFI). 

Building Assets and Financial Stability: 

Helping Youth and Elders: 

  • Community Teamwork assisted 626 elders.  For more than 35 years, Community Teamwork’s Senior Corps Volunteer Program has paired senior volunteers with nonprofit organizations, children and others. 
  • Groundwork Lawrence served 1,753 young people through several initiatives.  Its Green Team offers part-time, paid positions to Lawrence high school aged students each year to learn and lead local environmental and health initiatives. 

For a full list of CDC accomplishments in calendar year 2018, see the 2019 GOALs Survey Tables. 

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Secretary Kennealy and Undersecretary Chan Visit MACDC Members’ Affordable Housing Projects

August 6th, 2019 by Nadine Sanchara

Secretary Kennealy on a visit to Valley Community Development's Sergeant House, a 31-unit supportive housing development in Northampton

MACDC would like to thank Secretary Mike Kennealy, and Undersecretary for Housing and Community Development, Janelle Chan, for taking the time to visit affordable housing projects across Massachusetts.

On August 6, they will be concluding a three-week long tour of 28 affordable housing projects. We are thrilled that they visited the real estate development projects of five MACDC members:

2Life Communities: The 132 Chestnut Hill Avenue project in Brighton boasts 61 units of affordable senior housing.

B’nai B’rith: A vacant elementary school in Swampscott is being redeveloped into affordable housing units for seniors.

B’nai B’rith: Phase 2 of The Coolidge project in Sudbury is currently in development and, when concluded, will add 56 units of affordable housing for seniors.

Housing Corporation of Arlington: The Downing Square project in Arlington spans two sites with a total of 48 units, including 16 deeply affordable, five units for homeless tenants, and a space for a food pantry.

Valley CDC: The Sergeant House Expansion project in Northampton consists of the renovation of 15 Single Room Occupancy (SRO) units, and the construction of 16 new SRO units.

Valley CDC: The Lumber Yard project in Northampton is redeveloping the former Northampton Lumber Company into 55 units of family rental housing and commercial space.

Way Finders: The Live 155 project in Northampton is a 70-unit transit-oriented development, 47 of these units being affordable housing, with access to support services for tenants.

 

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Strengthening Hospital-CDC Partnerships – A new focus of MACDC

August 2nd, 2019 by Elana Brochin

Massachusetts hospitals devote millions of dollars annually to public health programs that serve their surrounding communities. As hospitals shift the focus of their public health programs towards upstream issues such as housing, education, and employment, it is important that they partner with organizations that are engaged in these areas, such as CDCs.

One of my roles as the Program Director for Health Equity at MACDC is to facilitate relationships between CDCs and their local hospitals. I view supporting these partnerships as building upon my previous role in which I worked to strengthen the state guidelines that direct many of these investments. The updated state guidelines provide the tools for hospitals to increase the transparency by which these investments are made and to increase community involvement in program planning and implementation.

Hospitals, as the institutions that ultimately control the focus of these investments, must commit to engaging community partners. While hospitals may have additional tools and incentives for engaging their community partners, many community organizations continue to find the procurement of hospital funding to be an opaque process. For a CDC, securing a seat at the table in which these investments are discussed is not an easy task. However, there are muscles that potential community partners can build in order to achieve successful partnerships with their local hospitals.

One way in which community organizations can learn more about the nuances involved in hospital investments is through trainings offered by the Mel King Institute for Community Building. Last March, the Mel King Institute held a training in which participants had a chance to learn about different types of hospital investments. For example, participants discussed the distinction between Community Benefits investments – which are annually budgeted for – and Community Health Improvement investments – which are episodically tied to capital expenditures.  Becoming well-versed in these different types of investments, is the first step toward meaningful conversations between CDCs and potential hospital partners.

This coming year, in partnership with the Mel King Institute, I will be introducing several trainings in which we will discuss the challenges associated with developing partnerships and continue to develop the language and the tools needed to initiate and deepen these crucial partnerships between CDCs and their local hospitals. The following are examples of topics that we’ll discuss in upcoming Mel King Institute Health Equity trainings:

Establishing a common language to talk about health equity
 CDCs must deepen their understanding of the pathways by which various social determinants of health (e.g., housing, employment, and education) contribute to health disparities. By establishing a robust vocabulary in which to have meaningful conversations with institutional partners CDCs will be better positioned to advocate for hospital investment in their work.

Deepening understanding of hospital funding

It is important to understand how community health programs fit into the complex hospital financing equation in order to better understand the role of community organizations in this process. Better understanding hospital financing is increasingly important as the system changes, such as the trend toward shifting from the pay-for-service model to Accountable Care Organizations.

The importance of long-term partnership building

 It is not surprising that small- and medium-sized community organizations become interested in partnering with hospitals when they hear of potential funding opportunities. Partnerships, however, rarely originate from a grant opportunity. Organizational relationships must be cultivated long before an opportunity becomes available. It is for this reason that CDCs must cultivate relationships with hospitals independent of a specific funding opportunity.

Keeping track of individual investment opportunities

CDCs must devote time and resources to keeping track of opportunities. This can mean there is a lot to keep track of: in many areas of the state, several hospitals serve the same region and the timeline for hospital investments vary by hospital and by type of investment. CDCs must have a mechanism for learning about funding opportunities as they become available.

What are questions that you have about cultivating relationships with your local hospitals? What challenges have you encountered? What would you like to learn about in this area?

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