Health Equity Results Are Years Away

by scrosby on September 26, 2008

Good health doesn’t come easily. It’s even harder when you have no health insurance and can’t afford nutritious food. Two years ago, Louisville’s Health Department started the Center for Health Equity to help level the playing field.

They’re finding measurable results are hard to come by. WFPL’s Stephanie Sanders reports.

Your life expectancy is significantly shorter if you live in the West End of Louisville than if you live in, say, Prospect. Cancer, heart disease and other chronic illnesses are more prevalent in the poorest areas of the city. Health Department Director Adewale Troutman says tackling those health disparities is the goal of the center.

“This is not a West End problem,” says Troutman. “This is a city-wide problem. And we have to use our resources as wisely as we can to address that city-wide.”

Its a new frontier in public health, and Louisville’s efforts in the cause were outlined earlier this year in a documentary called Unnatural Causes, which aired nationally on public television.

One of the stars of the film is the Center for Health Equity. The national exposure is one of the center’s crowning achievements over the last two years, according to the center’s director.

With half a dozen employees, the center operates on an 800-thousand dollar annual budget, more than 600-thousand of which comes from Louisville Metro Government. In the last two years, the center has held a lecture series, started a neighborhood store initiative, and promoted fitness and nutrition among kids.

Center Director Lisa Tobe says they’re all small steps in pursuit of a much bigger goal.

“If you’re going to address the root causes of health equity, you can work on almost any topic and do that,” says Tobe.

Tobe actually keeps pieces of paper taped to a wall in her office to make sure all their projects are actually working together… and that imprecise strategy makes it hard to measure success.

“We’re working up to creating an evaluation for the Center for Health Equity, and it’s new actually nationally to measure success for health equity,” says Tobe. “So for right now, we’re sticking to the tried and true, which is using qualitative research to talk to community groups about what differences have occurred.”

Without tangible results, these surveys will at least offer some feedback. Tobe says they are starting to formulate a strategic plan, and set firm goals on how to measure success. And they’re looking for ideas.

Sandra Whitt works for the Alameda County Public Health Department in California. She directs Planning, Policy and Health Equity there, her team has drawn national attention for the way it sets goals and gauges success.

“Ultimately, it’s about life expectancy,” says Whitt, “can we change the life expectancy patterns that we see in our county where you have these huge differences?”

It took Alameda County two years to put together a strategic plan. Mostly because when the main goal shifts from small things like nutrition programs to huge things like extending people’s lives – you have to start thinking differently.

“It really is a structural change, an institutional change, of how all levels of government work together, and that absolutely is a longer-term process,” says Whitt.

University of Kentucky College of Public Health Researcher Dr. Linda Alexander says they’re going about it the right way.

“You cannot build a center and go out into the streets and say, okay, we’ve have x-number of dollars and we want to fix something,” says Alexander.

Alexander says 600-thousand dollars a year isn’t a lot to spend on a project like this, even when no quantitative results could be seen for several years.

“I don’t want to give you the impression that I’m saying you throw money after a problem,” says Alexander, “because if you invest in communities, very often, even small investments, you invest in people.”

This year, the World Health Organization issued a report called Closing the Gap in a Generation, it addresses worldwide health iniquities and how public health advocates can turn the tide. Their best guess on the amount of time a measurable shift could take place— is thirty years.

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