FIVE YEAR HEALTH EQUITY PLAN 2012-2017
Updated September 2012
Sign-Ons as of August 21st, 2012
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
211info.org
American Association of Retired Persons - Oregon
American Heart Association of Oregon
American Lung Association of Oregon
Asian Pacific American Network of Oregon
Cascade AIDS Project
Center for Children and Families at PSU
Center for Intercultural Organizing
Coalition of Community Health Clinics
Elders in Action
Latino Network
LGBTQ Health Coalition of the Columbia-Willamette
Metropolitan Alliance for Common Good
NAYA Family Center
Oregon Latino Health Coalition
Oregon Medical Association
Oregon Primary Care Association
Portland Community Reinvestment Initiatives
Q Center
SEIU 503
Sisters of the Road
THE TREE Institute
Tobacco Free Coalition of Oregon
Upstream Public Health
Urban League of Portland
DRAFT. SEPTEMBER 26, 2012
TABLE OF CONTENTS
BACKGROUND ...............................................................................................................................3
STAKEHOLDER ENGAGEMENT AND CONVENING ..................................................................5
CRITERIA FOR HEALTH EQUITY ISSUE PRIORITIES ................................................................................................. 7
CRITERIA FOR HEALTH EQUITY POLICY PROPOSALS.............................................................................................. 7
HEALTH EQUITY IN THE FOUR COUNTY REGION .................................................................9
CHRONIC DISEASE AND OTHER ILLNESS FACTORS .............................................................................................. 10
CULTURAL COMPETENCY AND WORKFORCE DIVERSITY...................................................................................... 24
IMPROVED DATA COLLECTION AND ANALYSIS .................................................................................................. 25
ACCESS TO HEALTH CARE ............................................................................................................................. 27
MENTAL HEALTH, SUBSTANCE ABUSE AND ADDICTIONS .................................................................................... 32
LESSONS LEARNED .................................................................................................................... 37
CONCLUSIONS ............................................................................................................................ 38
APPENDICES................................................................................................................................ 39
HOPE COALITION POLICY CRITERIA ......................................................................................................... 40
HOPE COALITION HEALTH EQUITY QUESTIONNAIRE .............................................................................. 42
HOPE COALITION POLICY ISSUES AND STRATEGIES ................................................................................ 46
WORK GROUP PARTICIPANTS ........................................................................................................................ 52
ONE ON ONE INTERVIEW SUMMARIES ................................................................................................... 53
HOPE COALITION DOCUMENT SOURCE LIST ........................................................................................... 67
2
DRAFT. SEPTEMBER 26, 2012
HEALTHY OREGON PARTNERSHIPS FOR EQUITY COALITION
FIVE YEAR HEALTH EQUITY PLAN
BACKGROUND
We have an imperative and opportunity to reform health policy, health systems and
health delivery structures to reduce health disparities across different communities
Recent research tells us that inequities are no longer a luxury we can afford to live with.
Our overall prosperity requires us to have racial inclusion, to reduce concentrations of
poverty and reduce income inequalities1. Yet vulnerable communities—including
communities of color, people experiencing low incomes, immigrant and refugee
populations; lesbian, gay, bisexual, transgender, queer/questioning and intersex;
people living with mental illness; and people with disabilities--are disproportionately
experiencing various health challenges. These include higher rates of diabetes, higher
rates of cardiovascular disease, higher rates of obesity, higher rates of accidental
injuries, higher rates of infant mortality, lower rates of academic attainment, and higher
rates of un-insurance, to name just a few23. While these highly productive communities
make clear and meaningful contributions to the state economy, their potential is limited
because they experience health inequities. The HOPE Coalition aims to change that by
implementing a strong and wide-reaching health equity agenda over the next five
years.
The HOPE Coalition is a regional partnership of communities of color, health advocates
and policy makers working together to create and implement a five- year plan to
increase health equity in Clackamas, Marion, Multnomah and Washington Counties. By
1
Eberts, R. , Erickcek G., Kleinhenz, J. 2006 Dashboard indicators for the Northeast Ohio economy:
prepared for the fund for our economic future, Federal Reserave Bank of Cleveland, Working Paper 06-05
2
Ngo, Duyen L. , Ph.D.; Leman, Richard F., M.D., “Keeping Oregonians Healthy: Preventing Chronic
Diseases by reducing Tobacco Use, Improving Diet, and Promoting Physical Activity and Preventative
Screenings”. Oregon Department of Human Services. July 2007.
3
Oregon Health Authority’s Public Health Division Data & Statistics
3
DRAFT. SEPTEMBER 26, 2012
bringing together community voice and experience around the most pressing health
equity issues in the region, this partnership is a unique vehicle for driving regional
change and making true advances toward health equity.
Oregon is becoming a more culturally and linguistically diverse state, and there are four
counties in the Portland metropolitan area are leading this trend: Clackamas, Marion,
Multnomah, and Washington. In fact, Oregon’s population has seen significant growth
in communities of color and other diverse and underrepresented communities, including
a 63 percent growth in the Latino population, a 43 percent growth in the Asian
community, a 21 percent growth in the state’s black population and a 22 percent
growth in the Native American community over the past ten years4.
This dramatic growth has helped to turn what was once a largely white state into a
more linguistically and culturally diverse place to live. In fact, just twenty years ago,
more than nine out of ten Oregonians were white. Today, it is fewer than eight in ten1.
These communities continue to grow at significant rates, with 64 percent of all people
of color in Oregon residing within the HOPE Coalition’s four county region5.
The HOPE Coalition believes that our most vulnerable communities need improved
access to care and better health outcomes. The HOPE Coalition aims to increase
vulnerable communities’ opportunities to live to their full health potential.
To increase opportunities for health equity among priority populations, APANO, Urban
League of Portland, Upstream Public Health, Center for Intercultural Organizing,
TOFCO, the Native American Youth and Family Center, and the Oregon Latino Health
Coalition formed a cross county collaborative across this four county region. The
Healthy Oregon Partnership for Equity, or the HOPE Coalition is working together to
envision a better and healthier Oregon.
4
5
Data calculated from 2010 Census.
Data calculated from 2010 Census.
4
DRAFT. SEPTEMBER 26, 2012
Working to develop an effective and equitable partnership, the steering committee set
out to identify and forge meaningful relationships with county health departments,
health services providers, and local health advocates who work to affect the many
social determinants of health6.
Grounded in the belief that local communities understand their own needs best, the
HOPE Coalition also met with grassroots community leaders and community based
organizations to surface their priorities and sustainable solutions for remediating
systemic barriers to better health and creating relevant policy change.
The strategies that surfaced as a result of an in-depth outreach and coalition-building
process reflect the four county area’s most pressing health equity needs and build upon
years of community advocacy efforts in the region.
This document illustrates the community- based process the HOPE Coalition used to
develop a 5- Year health equity plan for the four county region. It also describes the
five policy areas around which the plan is framed, including the current state of health
equity within each of the policy areas: Chronic Disease and Other Illness Factors;
Cultural Competency and Work Force Diversity; Improved Data Collection and Analysis;
Access to Health Care; Mental Health, Substance Abuse, and Addictions. Finally, this
document describes the fourteen strategies that make up the 5-Year plan.
STAKEHOLDER ENGAGEMENT AND CONVENING
The HOPE Steering Committee worked diligently to create an authentic community
engagement process throughout the region. A strong stakeholder engagement process
The Oregon Department of Human Services defines “social determinants of health” as “Life enhancing
resources, such as food supply, housing, economic and social relationships, transportation, education,
and health care whose distribution across populations effectively determines length and quality of life.”
6
5
DRAFT. SEPTEMBER 26, 2012
was the foundation of the HOPE Coalition’s first year. Engagement was critical from the
onset and included targeted outreach to leadership from community based and
grassroots organizations. As a result, over 100 organizations took part in the HOPE
Coalition engagement process in the first year. The HOPE Coalition also reached out to
county health departments, who in turn proved to be invaluable partners and shared
their community assessments and other data collection instruments. The HOPE
Coalition’s approach to strategy development also included a review of the current state
of health equity in the region through in-depth literature and data review, and a
discovery process by which we surfaced potential health equity allies and systems.
The high level of turn out and active participation from a range of community partners
and county representatives was essential to the success of a truly collaborative effort.
Their input directly informed the development of strategies and recommendations for
the five-year plan.
The Steering Committee will continue to solicit reflection, feedback and refinement of
policy priorities from members of diverse community based organizations representing
priority populations7, public health advocates, policy advocates, tribal health authorities,
regional county health departments, decision-makers and elected officials and their
staff.
The Steering Committee’s intent was to seek the missing voices from the region to take
part in the HOPE Coalition. This became more important as the Steering Committee
began reviewing community assessments and found a lack of substantive data on the
priority populations. To overcome this hurdle, the Steering Committee developed a
questionnaire to collect information from key community based organizations and
regional county health departments through one-on-one interviews. The questionnaire
was designed to surface the most pressing needs of priority populations experiencing
health disparities in the region; and to ensure that the 5-Year Plan prioritized strategies
The Oregon Department of Human Services defines “priority populations” as: “Communities of color;
migrant populations, lesbian, gay, bisexual, transgender, queer/questioning and intersex; people living
with mental illness; people with disabilities; and people living with fewer financial resources”
7
6
DRAFT. SEPTEMBER 26, 2012
and solutions that have the broadest reach, effect, and political feasibility, while
reflecting community values.
The Steering Committee conducted twenty-two one-on-one interviews; a summary of
these interviews is attached (Appendix E). A summary of the interviews was later
presented to the larger HOPE Coalition. This, combined with regional data and literature
review, resulted in a long list of health equity policy areas that ultimately helped build
the foundation of the 5-Year Plan.
After some basic research was completed and community assessments were collected
and summarized, the HOPE Coalition began its community forums. The HOPE Coalition
held four constituent forums, reaching out to and inviting at least 100 community based
organizations to participate. The forums were intentionally held in each of the four
counties to provide local community members with better access and to support their
ability to participate. The forums began as listening sessions, progressed into policy
analysis and later informed the HOPE Coalition’s final strategies and strategies.
For the purpose of analysis, the HOPE Steering Committee developed policy criteria and
used these criteria as a lens to review a long list of potential health equity policy areas
the coalition would consider for the 5-Year Plan. Together with the larger coalition, the
Steering Committee used these criteria to help decide which policy areas to focus on in
the 5 Year Plan (Appendix A). The criteria are included below.
Criteria for Health Equity Issue Priorities
1. Is there evidence/data that demonstrates a health inequity?
2. Is there a realistic opportunity to impact health disparities in multiple
populations?
3. Is there demonstrated community support from community groups?
Criteria for Health Equity Policy Proposals
1. Does it impact a wide range of priority populations?
7
DRAFT. SEPTEMBER 26, 2012
2. Will it have a measurable impact on reducing chronic disease and health
disparities?
3. Are there clear goals and objectives?
4. Is it winnable in the next 5 years?
5. Does it strengthen or build new partnerships between HOPE coalition members
and allies?
6. Is there funding available?
After getting input from the larger coalition through coalition meetings and an online
survey, the Committee broke down policies into five basic policy areas that are reflected
in the final plan:
1. Chronic Disease and Other Illness Factors
2. Access to Health Care
3. Workforce Diversity & Cultural Competency
4. Mental Health / Substance Abuse / Addictions
5. Improved Data Collection & Analysis
Once the policy areas were crafted, the Steering Committee divided into five
Subcommittees, each responsible for convening HOPE stakeholders with an interest in a
given area. All members of the coalition were invited to submit policy
recommendations and strategies to any of the five Subcommittees. Team Leads were
identified and each subsequently convened their issue area Subcommittee to review
suggested strategies as well as best practice models. After this series of meetings, each
Team Lead drafted finalized strategies based on partner feedback, in order to obtain full
approval by the broader coalition.
To ensure transparency, the Steering Committee presented the finalized policy
strategies to the full coalition where they were discussed and ultimately approved
(Appendix C). The 5- Year Plan and its stratgies are not final or static and are instead a
8
DRAFT. SEPTEMBER 26, 2012
living, breathing document, which may evolve in response to a changing policy
environment.
After the final report was drafted by the Steering Committee, it was submitted to each
partner organization for an official sign on and endorsement.
HEALTH EQUITY IN THE FOUR COUNTY REGION
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”8.
These socially determined circumstances (also known as “social determinants of
health”) are rooted in social and economic injustices that in turn lead to health
inequities, or unequal distribution of disease across populations. Social determinants of
health have a direct impact on a person’s physical, built, and social environments that in
turn directly correlate to that person’s risk for chronic diseases9. For example, children
living in low-income neighborhoods often have increased exposure to toxins and
pollutants (e.g. lead, dirty air, noise), which can lead to an increased incidence of
asthma and other negative health outcomes. Many communities of color and lowincome communities have limited access to healthy food options, setting the stage for
inequitable rates of childhood and adult obesity and diabetes10. Finally, many vulnerable
communities, including communities of color, LGBTQ, seniors and disabled, and the
mentally ill, face discrimination and barriers to health care.
We know that certain populations in the United States are at increased risk for higher
mortality, lower quality of life, increased prevalence and severity of disease, disability,
http://www.cdc.gov/chronicdisease/healthequity/index.htm
http://www.bphc.org/chesj/resources/Documents/presentations/Center%20Presentations/Racism,%20H
ealth%20Equity%20and%20Community%20Health.pdf
10
http://www.bphc.org/chesj/resources/Documents/presentations/Center%20Presentations/Racism,%20H
ealth%20Equity%20and%20Community%20Health.pdf
8
9
9
DRAFT. SEPTEMBER 26, 2012
and death and decreased access to treatment11. Communities in Oregon are no
exception to this trend.
As noted in the section called “Stakeholder Engagement and Convening”, the HOPE
Coalition used an in-depth community process to surface the most pressing health
equity needs of the four county region’s most vulnerable communities. While our work
was certainly informed by a thorough literature and data review, we prioritized
community voice and experience in our decision- making process. In the following
section of the report, we describe in some detail the community needs, history, range
of policy solutions and best practices for each of the five policy areas where the HOPE
Coalition intends to focus its work over the next five years.
In addition, it is worth noting that all of the selected policy areas and strategies are
built on a history of community advocacy, policy or research. Some strategies have
already been brought to the state legislature, while others emerged from a specific
group or coalition’s advocacy or research and will be bolstered by a coordinated effort
from the HOPE Coalition. Rather than putting forth fourteen untested strategies, the
HOPE Coalition has instead sought to build on existing community efforts and best
practices from across the nation.
Chronic Disease and Other Illness Factors
Chronic diseases such as heart disease, stroke, cancer, diabetes and arthritis are among
the most common, costly and preventable of all health problems in the U.S.12
Nationwide, seven out of ten deaths among Americans each year are from chronic
diseases. Heart disease, cancer and stroke account for more than 50 percent of all
deaths each year. One in every three adults is obese, and diabetes continues to be the
11
12
http://www.cdc.gov/chronicdisease/healthequity/index.htm
http://www.cdc.gov/chronicdisease/overview/index.htm#ref7
10
DRAFT. SEPTEMBER 26, 2012
leading cause of kidney failure, non-traumatic lower-extremity amputations and
blindness among adults aged 20-7413.
Health trends for Oregonians are just as alarming as nationwide trends, according to a
recent report from the Oregon Department of Human Services14:

Heart disease is the second leading cause of death in Oregon for both men and
women, accounting for 22 percent of all deaths. .

Diabetes15 was the sixth leading cause of death among Oregonians in 2005.
More than 179,000 Oregonians report having been diagnosed with diabetes, and
perhaps as many as 62,000 adults in the state have diabetes but have not been
diagnosed. Type 2 diabetes has been on the rise among children.

Obesity increased 57 percent among Oregonians between 1995 and 2005..
Nearly two out of three adults (61 percent) are overweight or obese, more than
twice the rate seen just 15 years ago

16
Asthma is the one of the most common chronic disease among children,
affecting 8.4 percent of Oregon youth.
A closer look at chronic diseases and tobacco use in Clackamas, Marion, Multnomah,
and Washington counties show that overall, trends in the four county region mirror
statewide trends17.
http://www.cdc.gov/chronicdisease/overview/index.htm#ref7
Ngo, Duyen L. , Ph.D.; Leman, Richard F., M.D., “Keeping Oregonians Healthy: Preventing Chronic
Diseases by reducing Tobacco Use, Improving Diet, and Promoting Physical Activity and Preventative
Screenings”. Oregon Department of Human Services. July 2007.
15
Includes both diabetes type 1 and diabetes type 2
16
http://www.statehealthfacts.org/profileind.jsp?rgn=39&ind=89
17
Prevalence of Major Diseases and Risk Factors in the Four County Region, Age- Adjusted
2006-2009 Chart data source:
http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/Pages/pubs.aspx#data
13
14
11
DRAFT. SEPTEMBER 26, 2012
Prevalence of Major Diseases and Risk Factors in the Four County
Region, Age- Adjusted
2006-2009
35%
30%
25%
OREGON
20%
Multnomah
Clackamas
15%
Marion
10%
Washington
5%
0%
Heart Attack
Stroke
Diabetes
Obesity
Tobacco Use
Unfortunately, the trends shown above actually mask some of the health disparities
faced by communities of color as well as low-income communities living in Oregon18.
18
Prevalence of Chronic Conditions among Selected Communities, 2004-2005 Chart Data Source: Ngo,
Duyen L. , Ph.D.; Leman, Richard F., M.D., “Keeping Oregonians Healthy: Preventing Chronic Diseases by
reducing Tobacco Use, Improving Diet, and Promoting Physical Activity and Preventative Screenings”.
Oregon Department of Human Services. July 2007.
12
DRAFT. SEPTEMBER 26, 2012
45%
Prevalence of Chronic Conditions among Selected Communities,
2004-2005
40%
35%
30%
25%
20%
15%
10%
5%
0%
ASTHMA
HEART ATTACK
HEART DISEASE
STROKE
HIGH
PRESSURE Economically
Non-LatinoDIABETES
AfricanAmerican
Asians
andBLOOD Latinos
Whites HIGHAmericans
Indians and Pacfic Islanders
Disadvantaged
BLOOD CHOLESTEROL
Alaska Natives
Oregonians
The graph above shows several disturbing trends. First, the Native American community
clearly fairs worse in comparison to all other groups when it comes to chronic
conditions. Frequency for heart attack and stroke is more than twice as high compared
to non-Latino whites, and rates for diabetes and coronary heart disease are two times
higher. African-Americans in Oregon suffer from higher levels of diabetes, high blood
pressure, and heart attack, among others. Latinos show an increased risk for diabetes,
and Economically Disadvantaged Oregonians19 almost across the board show an
increased prevalence for chronic diseases.
We know that certain behaviors, such as lack of physical activity, poor nutrition,
tobacco use and excessive alcohol consumption, are responsible for much of the illness,
Note: People were considered to be “Economically Disadvantaged Oregonians” if they made less than
or equal to 100% of poverty level and had not completed high school. Also, the original report compares
Economically Disadvantaged Oregonians with the “General Population”, whose percentages differ only
very slightly from that of Non- Latino Whites included in this chart.
19
13
DRAFT. SEPTEMBER 26, 2012
suffering and early death related to chronic diseases20. But we also know that social
determinants of health profoundly influence the health of individuals.
How will the HOPE Coalition Improve Chronic Diseases and Other Illness
Factors in the Region?
The HOPE Coalition narrowed its focus from a potentially overwhelming range of
chronic diseases, associated behaviors and risk factors to focus on two areas: tobacco
cessation and obesity among children and families. Coalition members opted to look at
policy solutions to these policy areas that addressed both modifiable risk factors and
social determinants of health.
Obesity
Overweight and obesity have numerous health consequences, including premature
death, heart disease, diabetes, cancer, breathing problems, arthritis and reproductive
complications, among others21.
Obesity rates in Oregon increased 80 percent between 1996 and 201122. Similarly, the
prevalence of diabetes increased 61 percent between 1995 and 200523. Oregon youth
are experiencing similar trends. In 2007, 23 percent of Oregon 11th graders were
overweight or obese, compared to 21 percent in 2001, an increase of 13 percent in six
years24.
20
21
22
http://www.cdc.gov/chronicdisease/overview/index.htm#ref7
http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.html
http://healthyamericans.org/assets/files/TFAH2011FasInFat10.pdf
23
http://public.health.oregon.gov/PreventionWellness/PhysicalActivity/Documents/Oregon_PANfactst_2012.
pdf
24
http://public.health.oregon.gov/PreventionWellness/ObesityPrevention/ObesityTaskForce/Documents/sb
931ob esitytaskforce2009final.pdf
14
DRAFT. SEPTEMBER 26, 2012
Obesity is second only to tobacco use as a leading cause of preventable death,
responsible for the death of approximately 1,400 Oregonians each year25. Furthermore,
communities of color and low-income communities are at greater risk for obesity and
overweight than their white and/or higher income counterparts26.
Oregon Adult Obesity Rates, 2008
45%
40%
35%
38%
30%
33%
25%
20%
25%
25%
White
Hispanic
25%
15%
10%
5%
0%
African
American
Income < Income >
$15,000/yr $50,000/yr
(all races) (all races)
25
http://public.health.oregon.gov/PreventionWellness/PhysicalActivity/Documents/Oregon_PANfactst_2012.
pdf
26
Obesity and Diabetes rates obtained from:
http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/Diabetes/Documents/burdenreport20
08.pdf
15
DRAFT. SEPTEMBER 26, 2012
Oregon Diabetes Rates, 2008
14%
12%
13%
12%
10%
10%
8%
6%
4%
7%
6%
2%
0%
White
API
Hispanic
Nat American
AfricanAmerican
A major contributing factor to the obesity epidemic is the consumption of sugarsweetened beverages. Sugared drinks have been shown to increase the risk of
overweight and obesity. For each additional sugared drink consumed each day, the
likelihood of a child’s becoming obese increases by 60 percent27. In response, many
advocates across the nation are pursuing implementation of a statewide tax on sodas
and sugary drinks. Research on the effects of soda taxes on obesity is prolific, with one
study in particular showing:
“A [penny-per-ounce excise] tax would reduce consumption of these beverages
by 15 percent among adults ages 25–64. Over the period 2010–20, the tax was
estimated to prevent 2.4 million diabetes person-years, 95,000 coronary heart
events, 8,000 strokes, and 26,000 premature deaths, while avoiding more than
$17 billion in medical costs. In addition to generating approximately $13 billion
in annual tax revenue, a modest tax on sugar-sweetened beverages could
“Taxing Sugared Beverages Would Help Trim State Budget Deficits, Consumers’ Bulging Waistlines, and
Health Care Costs.” Center for Science in the Public Interest. 2010 Report.
http://cspinet.org/new/pdf/state_budget_report_-_sugar_tax.pdf
27
16
DRAFT. SEPTEMBER 26, 2012
reduce the adverse health and cost burdens of obesity, diabetes, and
cardiovascular diseases28.”
The HOPE Coalition intends to support implementation of a model soda tax, first
targeting Multnomah County with funds collected being dedicated to obesity prevention
(PE requirements in schools, healthy food access for low-income families, Farm to
School programs, etc.). The soda tax will generate a dedicated revenue stream that will
fund obesity prevention, nutrition improvement and other community-specific public
health initiatives.
Anti-obesity advocates and organizations such as the Centers for Disease Control and
Prevention, PolicyLink and the Food Trust have also focused efforts on increasing
access to affordable, healthy foods. Research has shown that “lack of access to healthy,
affordable foods has a direct, measurable impact on our health… [and the] presence of
supermarkets and grocery stores selling fresh fruits and vegetables in a community
helps people maintain a healthy weight29.” The HOPE Coalition aims to evaluate and
assess existing programs and best practices for implementation across the four county
region and potentially the entire state.
Tobacco
Tobacco is the leading cause of preventable death in Oregon. Smokers are much more
likely than non-smokers to have chronic diseases such as diabetes, chronic obstructive
pulmonary disease and asthma30. In fact, over 22 percent of deaths in Oregon can be
attributed to tobacco use31.
28
Wang, C.Y., Coxson, P., Shen, Y., Goldman, L., Bibbins-Domingo, K. (2012). A penny-per-ounce tax on
sugar-sweetened beverages would cut health and cost burdens of diabetes. Health Affairs, 31.1, 199 207.
29
http://www.thefoodtrust.org/php/programs/super.market.campaign.php
http://tobaccofreeoregon.org/resources/facts_stats
http://public.health.oregon.gov/PreventionWellness/TobaccoPrevention/Documents/countyfacts/clackfac
.pdf
30
31
17
DRAFT. SEPTEMBER 26, 2012
Communities of color are disproportionately affected by tobacco use and are therefore
more likely to experience negative health outcomes resulting from its use. The graph
below illustrates the use of tobacco products in Oregon’s adult population. African
Americans and Native Americans are at particularly high risk for tobacco use, and these
groups are also the highest users of medical assistance programs in the state.
Tobacco Use and Health
Among Oregon Adults
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
41%
44%
41%
14%
African
American
American
Indian/Alaska
Native
Asian/Pacific
Islander
2004-2005 tobacco use
15%
Hispanic/Latino
White
2007 Medicaid/OR Health Plan
Adding to the problem, Oregon’s youth are accessing tobacco at alarming rates. An
estimated 38,000 Oregon youth smoked in 2009. Sixteen percent of high school
students continue to smoke. In 2009, nearly 11 percent of 11th graders reported
smoking cigars, cigarillos or little cigars32. Young Oregonians have not been protected
from becoming tobacco’s next generation of users. In fact, Oregon has the highest rate
of tobacco sales to minors in the nation33. In the 2011 Legislative Session the predatory
32
33
http://tobaccofreeoregon.org/resources/facts_stats
http://www.samhsa.gov/prevention/2010_Annual_Synar_Report.pdf
18
DRAFT. SEPTEMBER 26, 2012
tobacco retail environment and lack of regulation was brought to attention and action
for creating greater enforcement was passed34.
The HOPE Coalition proposes a full assessment of tobacco retail environments,
enforcement of youth tobacco access laws and appropriate restrictions on tobacco
retailers. Examples of retail environment protections include restrictions on tobacco
retailers near schools and a minimum price law on tobacco products in order to increase
the price and therefore decrease the sales of these products. While the tobacco industry
will fight these policies, there are at least two counties in the HOPE Coalition region that
are prepared to move on local action.
Chronic Diseases and Other Illness Factors Strategies
CDIF.1 – Limit Youth Access to Tobacco
Decrease youth initiation to tobacco by limiting access to and marketing of tobacco
products in the retail environment.
CDIF.2 – Promote Healthy Food Financing Initiatives
Promote healthy food financing initiatives (e.g. Healthy Corner Store initiative and Fresh
Food Financing) with strategies (e.g. seed funding and capital) designed to promote
retailers that provide access to healthy food, and encourage food distribution systems
that do the same.
CDIF.3 – Reduce Obesity for Children and Families
Implement a model soda tax, first targeting Multnomah County with funds collected
being dedicated to obesity prevention (PE requirements in schools, healthy food access
for low-income families, Farm to School programs, etc.).
34
See 167.407 “Locating tobacco products in retail store”
19
DRAFT. SEPTEMBER 26, 2012
Cultural Competency and Workforce Diversity
The 2010 US Census confirms that our state population has become more ethnically
and racially diverse. The Latino population has almost doubled in the past 10 years and
is now the largest minority population with well over 452,000 people. Asian Americans
number more than 130,000 in the state. American Indian and Alaska Native and African
American populations number 67,000 and 63,000 respectively; both experience
disproportionate health burdens that result in unacceptable costs for individuals,
families, communities and health systems. International migration is adding to the
cultural and language diversity of the state, with the Russian community continuing to
grow, along with Somali and Iraqi populations. Oregon is expected to add 197,000
people through international immigration over a 30-year period ending in 2025.
As we continue to grow in diversity, more diverse health care systems and providers are
needed to respond to specific socio-cultural factors that influence health and wellbeing.
In state comparisons, Oregon’s African American diabetes mortality rate is surpassed
only by West Virginia’s. Only seven states have higher rates of African American stroke
mortality than Oregon. Nationally, the state is 25th and 30th for African American and
Latina mothers beginning prenatal care in the first trimester, respectively. Both levels
are below U.S. averages.
Recruiting and retaining a racially and ethnically diverse workforce is essential to
ensuring effective health practices, access to care and health outcomes for populations
experiencing significant health burdens. As these groups and other minority populations
continue to grow, it is important to have health care providers who understand each
minority population’s cultural norms and expectations (including patients’ values,
beliefs, religion, and communication styles) and who speak the language, or to have
high quality translation and interpretation services available.
20
DRAFT. SEPTEMBER 26, 2012
Integrating and using diversity best practices in recruitment, hiring, retention,
performance management, contracting and procurement, and leadership and employee
development will enhance the cross-cultural skills of public health and health care
professionals in ways that will improve outcomes and reduce health disparities for our
target populations35.
There is a tremendous opportunity to address the health disparities faced by
communities of color as health reform in Oregon unfolds. As the new Coordinated Care
Organizations (CCOs) are shaped and preventive care is prioritized, more emphasis
must be placed on developing a workforce that can effectively work with populations
experiencing the worst health outcomes. Successful health systems transformation will
require providers to close health care quality gaps that exist by race, ethnicity,
economic class, language, sexuality, religion, gender and geography to achieve the
vision of “a healthy Oregon.” Unfortunately, few of Oregon’s medical school graduates
represent communities of color. In 2009, only eight of 121 graduates were Latino,
African American, Native American, or Asian/ Pacific Islander.
There is a lack of local research linking a providers’ cultural knowledge and awareness
to improved health outcomes for communities of color, largely due to lack of funding
and methodological difficulties. However, Oregon State University academics have
conducted research and are continuing to develop studies that effectively evaluate
cultural competence training. In 2009 they conducted an evaluation study of 43 health
care professionals who attended a four-hour cultural competency workshop. Following
the training, the participants self-reported not only enhanced understanding of health
care experience of patients with diverse backgrounds but also an improvement in their
skills to effectively work in cross-cultural situations36.
Oregon’s Action Plan for Health, December 2010
Cultural competency in Health Care: Evaluating the Outcomes of a Cultural Competency training
Among Health Care Professionals (OSU)/Author: Sunil/Journal of the National Medical Association
35
36
21
DRAFT. SEPTEMBER 26, 2012
OHSU is using the American Association of Colleges of Nursing’s (ACCN) Cultural
Competency in Baccalaureate Nursing Education Toolkit as a guide in education. The
OHSU team successfully integrated cultural experiences into simulations, so nursing
students can start their careers with a patient-centered focus, improving quality of care
for patients. Promising practices bring nurses together to discuss cultural competence
as a group and use members of the specific cultural community to provide invaluable
insight.
Unfortunately, there are very few measures that report patient satisfaction with the
care they receive, especially by race and ethnicity37. In particular there is no systematic
analysis of all of the barriers to accessing effective, quality care, including barriers of
culture, language and communication. However, the State’s Office of Equity and
Inclusion is making an effort to fill this gap by convening a Cultural Competency
Committee to research and report on current status of cultural competency training and
practice in the state.
Despite the lack of studies looking at specific outcomes related to improved cultural
competency and workforce diversity, existing studies show the benefits to include:
•
Improved quality of care, including appropriate use of preventive asthma
medications and patient satisfaction with care.
•
Patient education approaches on cancer prevention and early detection
consistent with the audience's values, beliefs, and preferred ways of getting
information significantly increased behavior changes compared with
either no intervention or interventions that were not culturally competent.
•
Culturally competent diabetes intervention programs significantly improved
outcomes in terms of physiologic measures associated with better
long-term outcomes.
The risks of limited cultural competency are:
County health rankings in Oregon, County Health Rankings & Roadmaps A Healthier Nation, County by
County 2012 Rankings Oregon.countyhealthrankings.org
37
22
DRAFT. SEPTEMBER 26, 2012
•
Costly legal judgments against health care entities for failure to provide
language access services mandated by Title VI of the Civil Rights Act.
•
Patients with limited English proficiency have more adverse events, such
as inaccurate or incomplete information, questionable advice, questionable
tracking and follow-up, incorrect diagnosis and questionable intervention.
•
Children of families with language barriers are more likely to experience
medical errors38.
Understanding of the role of cultural competence in improving health outcomes for
vulnerable population is growing. In response, many health care providers and health
care users in the United States are prioritizing cultural competency training for existing
staff and ensuring that staff reflect the growing diversity of their patient profile. For
example, the Patient Protection and Care Act of 2010 includes provisions for promoting
cultural competency training in health care. The Institute of Medicine report, Unequal
Treatment, recommended that all health care professionals receive training in cultural
competence to help address racial or ethnic disparities in health care.
How Will the HOPE Coalition Improve Cultural Competency and Workforce
Diversity in the Region?
The HOPE Coalition developed three specific strategies in response to the local need
and promising practices trending nationally. Many partners are already engaged in
efforts to build on local and national trends to reform the current standards and are
exploring administrative as well as legislative options for 2013. Legislation to set up
structures for cultural competency continuing education for health care providers
(SB97) was close to passing in the 2011 legislative session. There was wide support
amongst health provider professional associations. In the interim period, many provider
associations have moved forward with internal training programs, and work has been
done on developing standards and competencies. Community Healthcare Workers have
been written into the legislation establishing Coordinated Care Organizations (CCOs)
38
The Common Wealth Fund, 2006
23
DRAFT. SEPTEMBER 26, 2012
and have been highlighted by the Governor as a means of reducing costs. The
movement also continues to explore additional administrative measures to include
cultural competency across all state agencies.
Cultural Competency and Workforce Diversity Strategies:
CCWD.1 – Support and Expand Non-Traditional Workforce39
Implement standards in CCOs that support and expand Non-Traditional Workforce40
including Community Health Workers, with strategic linkage to populations experiencing
poverty and/or homelessness. Require uniform collection and reporting of nontraditional workforce information. Require CCOs to develop a plan regarding nontraditional workforce that links to appropriate programs and peer support structures,
and make the plan publicly available.
CCWD.2 – Finance Community Health Worker Services
Establish sustainable financing for Community Health Worker services, especially
through payment for their services in Medicaid, CHIP and other major funding streams.
Ensure availability of workforce development resources such as training, career
progression, standards for training and certification where appropriate and common
guidelines for evaluation. Establish state funding set-asides for diverse workforce
development through Community Health Worker training. Ensure that comprehensive
payment methodologies and reimbursement guidelines for CHWs are created.
CCWD.3 – Cultural Competency for Health Professionals
Implement legislative and/or administrative mandatory cultural competency education
for health professionals. Source and expand available curriculum.
39
Recommendations from Access to Health Care around community health workers were incorporated
into CCWD.1.
40
Non Traditional Health Workers is a term that distinguishes from currently licensed health care
professions such as medical doctors and nurses. NTHW represent an emerging profession who has
expertise in marginalized communities where traditional health care providers have not been successful.
These include community health workers, patient navigators, peer wellness specialists, peer mental
health specialists, doulas, etc.
24
DRAFT. SEPTEMBER 26, 2012
Improved Data Collection and Analysis
Oregon will develop an equitable health care system by eliminating disparities and
building cultural specificity and understanding. Efforts to identify disparities and
monitor their effects have been limited due to a lack of specificity, uniformity and
quality in data collection and reporting procedures. This issue is magnified by persistent
and growing health disparities and the significant growth of communities of color,
immigrants and refugees in Oregon. To begin to both eliminate disparities and build
cultural competence, it is necessary to collect meaningful data on patients’ race,
ethnicity, language, sexual orientation, gender, housing status and uninsured status.
Effective data collection can enhance capacity to perform accurate and culturally
appropriate services and can increase access to needed services. With the expanded
coverage options through the Affordable Care Act, more than 4.5 million people of color
across the nation will be newly eligible for health insurance in 2012. We must ensure
that our health care system, both locally and nationally can meet the needs of diverse
patients41.
While there is a range of health and health care entities that collect data, current
methods do not yield the numbers and type of information needed to meaningfully
analyze health care performance. Studies show data collection efforts are inconsistent
across health care organizations, are hampered by a widespread lack of understanding
about the most effective strategies to improve data collection or cohesive and lack a
standardized way of integrating and sharing the data. Data collection methods like
over-sampling programs are already being utilized in various public agencies in order to
have more accurate information with which to make policy and funding decisions.
Coordinating efforts of these stakeholders to ensure accurate collection and reporting of
41
http://www.jointcenter.org/hpi/sites/all/files/PatientProtection_PREP_0.pdf
25
DRAFT. SEPTEMBER 26, 2012
uniformly categorized race and ethnicity data could lead to more powerful analysis of
aggregated data.
There is growing support from local health departments and leadership from the Office
of Equity and Inclusion and the Northwest Health Foundation. Advocacy efforts from
community based organizations like the Coalition of Communities of Color and
institutions like Portland State University are applying pressure to expand data
collection standards42. The Affordable Care Act recommendations provide a strong
framework for expanding data collection43. Effective data collection requires trained and
confident staff who understand the rationale and methodology to perform accurate and
culturally appropriate data collection.
There are many entities, such as health plans, health professionals, hospitals,
community health centers, nursing homes, funereal directors, public health information
systems and the public who are categorizing, collecting data and reporting on these
data for quality improvement purposes and analysis in the region, including: the Oregon
Racial Equity Report Card, Oregon Office of Health Policy and Research, Oregon
Department of Human Services Medical Assistance Programs and Children, Adults and
Families Division, Oregon Center of Health Statistics and OCHIN. There is a strong
internal support within State and County government to increase staff competency in
this area. Oregon’s health care reform is expanding electronic records and establishing
new database systems with a stronger political commitment to eliminating health
inequities. This provides a unique and timely opportunity to address data collection
standards and create a system that is better than what we currently work under.
://coalitioncommunitiescolor.org/research/research.html#
42
43
Patient Protection and Affordable Care Act Section 4302
26
DRAFT. SEPTEMBER 26, 2012
Improved Data Collection and Analysis Strategies
IDCA.1 – Expand Data Collection by Race, Ethnicity, Language, Sexual Orientation,
Gender, Housing Status, and Uninsured Status
Adopt improved uniform data collection and analysis protocols at the county level that
provide for increased disaggregation by categories including, but not limited to race,
ethnicity, housing status, language, gender, sexual orientation, and uninsured for all
patients, clients, etc., through integration in Electronic Medical Records and other
forms. Integrate data through backend connections for proprietary health systems for
dual-enrolled Medicaid/Medicare members, and integrate patient data for both mental
health and substance abuse treatment. Strive to implement the US HHS Ethnicity, Race
and Language Data Standard44 and Coalition of Communities of Color data protocol.
IDCA.2 – Data Collection Training
Develop and adopt data collection training program for service providers, administrative
and professional staff to improve accuracy and effectiveness of collection methods at
county, regional and/or state level.
IDCA.3 – Expand Over-Sampling
Develop and adopt over-sampling45 program integrated with existing surveys and data
collection to provide better data and analysis of community status at county region
and/or state level.
Access to Health Care
According to 2008-2010 American Community Survey data, almost 20 percent of
Oregon’s population has no health insurance coverage, almost 40 percent have public
44
http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.shtml
45
Definition of over-sampling
27
DRAFT. SEPTEMBER 26, 2012
coverage, and just over 50 percent have private insurance. Of the uninsured
population in Oregon, 55 percent of African Americans, 31 percent of Hispanic/ Latinos,
and 18 percent of Asian/Pacific Islanders are served by safety net clinics, compared to
just 15 percent of Whites. Almost 40 percent of Oregon Health Plan enrollees are
people of color46.
People with poor or no health coverage have poorer health outcomes and are less likely
to receive preventive services, resulting in increased emergency and hospital visits. This
has perpetuated and worsened health disparities for people of color, who are
disproportionately represented in the uninsured and underinsured population.
A 2011 racial equity survey conducted by the Urban League of Portland found that of
the 20 percent of African Americans interviewed reported that when they are sick or
have health concerns, they go to the emergency room. Only 50 percent stated they go
to a family doctor.
It should be noted that discrimination based on race, national origin or language spoken
is also a reality for these immigrant communities and many receive differential
treatment in care.
Those without health insurance face additional barriers to care which include:
economic marginalization, geographic isolation, cultural and linguistic isolation and
difficulty navigating a complex and often foreign health care system.
For immigrant communities there is often added mistrust of health care providers,
clinics and hospitals. These are often associated as having a connection or relationship
to the Department of Homeland Security, and immigrants subsequently forgo care for
fear of being deported or of incurring a “public charge” designation, which will later
have an adverse effect on their naturalization process.
46
State of Equity Report, Summary of Findings June 2011
28
DRAFT. SEPTEMBER 26, 2012
Children and families who are undocumented face additional barriers to care and are
categorically excluded in Oregon from receiving state sponsored health care services.
The few resources for approximately 170,000 individuals who are without
documentation in Oregon include the safety net clinics which include Community Health
Centers, Migrant Health Centers and School Based Health Centers.
Portland and Multnomah County have community health clinics and/or Federally
Qualified Health Centers (FQHC) that serve different priority populations:

SW Community Health Center, located in downtown Portland, focuses on
immigrant population and serves 40 percent racial and ethnic minorities.

NXNE, located in northeast Portland, serves a predominantly African American
population.

Wallace Medical Concern, located in east Portland and focuses on Latino
population.

Outside In, located in downtown Portland and provides services to homeless
youth.

Old Town Clinic, located in downtown Portland and focuses on adult homeless
population.
Project Access Now also serves the Greater Portland Metro area’s uninsured population.
They work specifically to connect people with donated care from safety net clinics,
hospitals and others specialty care services.
Overall, the current uninsured and underinsured populations receive services through
limited donated care and/or high-cost, emergency visits.
Currently, there is no precedent that ensures all Oregonians have healthcare. Recent
legislative gains have improved health care access in Oregon. One of these is the
Health Care for All Children Act, which rallied enough political and legislative support to
29
DRAFT. SEPTEMBER 26, 2012
pass and become law in Oregon in 2009. However, undocumented children are still
excluded from this state sponsored program. Establishing health care as a basic human
right for all Oregonians is a critical next step. Without it, there will continue to be a lack
of funding for long-term primary care services, dental and mental services. Poor
preventive dental and mental healthcare can result in other health complications that
require specialty care services, discussed in the next section.
In the past, there has been a lack of meaningful collaboration around improved health
care policy between top-level hospital administrators, safety net clinics, legislators, state
and county agencies and others. Coordination is essential to guaranteeing services to
the most vulnerable populations.
There is also not enough funding for preventive education and services, including
community health workers. They are a vital and emerging workforce in Oregon and are
a proven vehicle for institutionalizing community health for marginalized communities
and diversifying Oregon’s health care workforce. There are approximately 300 to 600
community health workers in Oregon. This workforce has proven its effectiveness in
helping to connect marginalized communities to health care services. They are also
proven health educators, patient navigators, patient advocates and care coordinators.
Unfortunately, community health workers in Oregon do not enjoy the professional
standing and financial support necessary to grow this vital workforce. In order to
ensure stable funding, training and education standards need to be developed and
adopted by the state. There is already political and structural support for this policy
solution in the form of the Non-Traditional Healthcare Workforce Council and the newly
created Oregon Community Health Workers Association, which was started by the
Oregon Latino Health Coalition. Additionally CHW supportive language is now present
in HB 3650.
30
DRAFT. SEPTEMBER 26, 2012
How Will the HOPE Coalition Improve Access to Health Care in the Region?
The community has been advocating for the requirement of culturally competent
training so that primary care providers are more accessible. A great deal of organizing
and support was aimed at legislative bill SB 97, which recommended the health
authority include training for all licensed care providers. While passage of this bill failed
in 2011, movement continued through dialogues with the Governor’s office. In the
following year, health care policy reform shifted towards major system changes that
would provide for increased health literacy and preventative care. State legislation HB
3650/ SB 1550 passed in 2011 and allowed for the creation of the Coordinated Care
Organization (CCO). It specified how these organizations should be utilized; one of
those methods is through community health workers, a best practice in improving
outcomes through preventative education.
The HOPE Coalition built its strategies on the local history and emerging best practices
from across the region and nationally. Improving access to long-term health care is a
first step towards improving outcomes. We need to first establish healthcare as a basic
right, expand access for all Oregonians to basic healthcare and finally support methods
of outreach that are proven to be effective at reducing health disparities. It will take a
combination of increased preventive education and community based services as well
as top-level administration and legislative collaboration and leadership to start to move
Oregon’s health care system in the direction that benefits the health of all Oregonians.
Access to Health Care Strategies
AHC.1 – Legislative sponsorship on basic health care as a human right
Executive order for Health Equity.
Legislative action.
AHC.2 – Expand Health Care for All
a. Expand Prenatal Care for all women in Oregon.
31
DRAFT. SEPTEMBER 26, 2012
b. Provide state-funded health coverage for all, including currently categorically
ineligible children and families.
AHC.3 – Expand workforce diversification through support and codification of
community health workers in Oregon. Implement strategies as represented in CCWD.1
and CCWD.2
Mental Health, Substance Abuse and Addictions
The region served by the HOPE coalition comprises just over half of the state’s
population. It’s fair to say that the direction taken by the local mental health authorities
in the four county region often sets the tone for other local jurisdictions and state
policy. Given that influence, Mental Health, Substance Abuse, and Addictions (MHSAA)
was repeatedly identified as a priority area for our coalition and for our advocacy
moving forward. As the state moves toward reforming its health care delivery system,
it’s no longer possible to talk about mental health as a separate silo. As we move
toward greater integration of physical and mental health services, we need to focus on
improving service delivery at all levels. This is especially true given that, according to
the Kaiser Family Foundation, Oregonians report a higher rate of “poor mental health”
than the national average47.
“Mental Health, Substance Abuse, and Addictions” is a broad category. It includes
individuals who experience addictions to drugs, alcohol and gambling, as well as a wide
variety of mental health conditions, such as depressive illnesses, schizophrenia, anxiety
disorders and Attention Deficit-Hyperactivity Disorder.48
47
Oregon’s rate is 36.7% of adults compared to 34%
nationally:http://www.statehealthfacts.org/profileind.jsp?cmprgn=1&cat=2&rgn=39&sub=28
48
http://www.ohsu.edu/xd/health/health-information/topic-byid.cfm?ContentTypeId=85&ContentId=P00753
32
DRAFT. SEPTEMBER 26, 2012
The state’s mental health, substance abuse and addictions services are handled through
the Addictions and Mental Health Services division of the Oregon Health Authority
(AMH). AMH provides policy coordination for local mental health authorities, offers
prevention and treatment services, manages the state’s commitment system and
operates the Oregon State Hospital in Salem. Most services themselves are provided in
partnership with county mental health authorities and programs. Each of the four
counties in the HOPE Coalition’s target area operates its own MHSAA system as a part
of this partnership and provides a similar core set of services. Clackamas County
Behavioral Health, Marion County Mental Health, Multnomah County Mental Health and
Addictions Services and Washington County Mental Health Services are all responsible
for outpatient services for individuals experiencing mental health crises, alcohol and
drug treatment, treatment for individuals experiencing severe mental health challenges
and comprehensive crisis services.
One particularly limiting factor in charting the impact of MHSAA services on our
populations is the lack of reliable data that disaggregates utilization of the MHSAA
system by race and ethnicity. A study by the Coalition of Communities of Color, for
example, shows that Portland’s Slavic community self-reports high incidence of mental
health challenges due to external pressures such as acculturation and lack of access to
health services; unfortunately, the available data don’t allow us to analyze these reports
in a quantitative way.49 Other groups collecting state-level health data, such as the
Kaiser Family Foundation, have been unable to analyze the full correlation between
MHSAA challenges and race/ethnicity.50 Given this deficiency, it is impossible here to
give a full review of data on MHSAA by race/ethnicity.
49
50
http://coalitioncommunitiescolor.org/docs/AN%20UNSETTLING%20PROFILE.pdf
http://www.statehealthfacts.org/profileind.jsp?ind=95&cat=2&rgn=39&cmprgn=51
33
DRAFT. SEPTEMBER 26, 2012
How will the HOPE Coalition Improve Mental Health, Substance Abuse and
Addictions in the Region?
Throughout our discussions with advocates and counties, three best practices and
policy priorities stood out as models for advocacy.51 Our focus in this area was driven
by two primary goals: more effective integration of Mental Health, Substance Abuse,
and Addictions in the greater web of health policy, and a desire to see that coordination
of care lead to improved health outcomes for patients.
1. The first best practice we identified was the development of local Early
Intervention Support Teams. This model for early intervention has been
successfully piloted in many Oregon counties; it enables individuals who may be
displaying only the early signs of mental health challenges to receive early
treatment and thus increase the chance of successful intervention and treatment.
Multnomah County’s Early Intervention and Support Alliance, for example, is an
outreach and intervention program targeted at “people ages 15 to 25 who are
experiencing the first symptoms of psychosis.”52 The program provides
counseling and treatment services and social supports designed to help clients
receive care before the onset of severe symptoms. Adopting such teams in all
counties would drastically increase the state’s capacity to provide early
intervention services and greatly improve the possibility of positive care
outcomes.
2. One roadblock to reforming care for MHSAA consumers has been the lack of a
standardized assessment and screening system. The initiative to change intake
and screening for the children’s mental health system provides a useful model:
the state has adopted (and issued to county mental health authorities) a
This list comes with one important caveat – an under-engagement with consumers of mental health
services. Going forward, the HOPE coalition intends to deliberately increase our work to engagement
service consumers, in order to better inform our policy-based direction.
51
52
http://web.multco.us/mhas/early-assessment-and-support-alliance
34
DRAFT. SEPTEMBER 26, 2012
standardized list of intake criteria based on severity of diagnosis, potential for
self-harm and other factors in order to provide a singular model of assessment
and screening for child MHSAA service consumers. In interviews with our
partners, it was reported that families find the standardized system to be more
reliable, thus increasing families’ subjective satisfaction.
The state should develop standards for a standardized screening and assessment
process in the adult system, and tie the implementation of that system to the
disbursement of funds to local mental health authorities. We acknowledge that
identifying one system over another would be controversial, so we have
consciously avoided singling out any particular set of standardized intake criteria.
As our advocacy continues, we hope to identify a workable system through
greater stakeholder engagement and review of national models.
3. Many coalition partners identified a lack of full investment in MHSAA services as
a roadblock to successful outcomes and noted a strong need for increased
support for community mental health programs and integration of social needs
supports.
First, at a basic level, state and local funding for MHSAA services should be
increased to an adequate level to enable local mental health authorities to easily
operate and serve their entire client base effectively. Although we recognize the
challenges posed to adequate funding due to state budget constraints and the
impact of legislation such as Ballot Measure 5 on local jurisdictions, we argue
that counties and the states should prioritize these services.
At the same time, funding should be re-designed to better integrate substance
abuse/addictions and mental health services, similar to the model provided by
the recently created Coordinated Care Organizations (CCOs). Although initially
serving Oregon Health Plan consumers (and thus impacting about half of the
35
DRAFT. SEPTEMBER 26, 2012
state’s mental health, substance abuse and addictions service consumers), the
CCO model of care will be applicable to a broader array of services. In order to
improve patient outcomes, funding should be allocated to allow for relationship
building rather than a simple medical model of treatment, and should support
the integration of treatment services with social support programs, such as
housing assistance, childcare and transportation assistance.
As the HOPE coalition continues its work going forward, we are eager to increase our
engagement with stakeholders impacted by MHSAA services as we advocate for a
system that provides high-quality care for everyone.
Mental Health, Substance Abuse and Addictions Strategies
MHSAA.1 – Standardize County Assessment and Screening Systems
The initiative to change intake and screening for the children’s mental health system
provides a useful comparative model: families have a greater satisfaction because
outcomes are more reliable and predictable. The state should develop standards for a
standardized screening and assessment process (for adult mental health and substance
abuse/addictions), and tie the implementation of that system to the disbursement of
funds to local mental health authorities.
MHSAA.2 – Increase Investment in Community Mental Health and Social Needs
Programs
Treatment should be culturally and linguistically competent and informed by a patient’s
life circumstances (including Trauma-Informed Care). Funding should be increased to
an adequate level, and funding systems should be re-designed to better integrate
substance abuse/addictions and mental health care, similar to the model provided by
Care Organizations. Funding should be allocated to allow for relationship building rather
than a simply medical model of treatment, in order to improve patient outcomes, and
should support the integration of treatment services with social support programs.
36
DRAFT. SEPTEMBER 26, 2012
These programs would include, for example, housing assistance, childcare and
transportation assistance.
MHSAA.3 – Workforce Development
The state should develop and implement programs that promote cross-training and dual
credentialing in both mental health and substance abuse/addictions services, to provide
for a more robust workforce. The state should also take care to ensure that the mental
health systems workforce is culturally diverse and culturally competent (including peer
coaches). Finally, law enforcement professionals should receive comprehensive training
on working with individuals suffering from mental health crises.
We specifically hope to engage additional organizations in the development of these
strategies.
LESSONS LEARNED
Over the course of the past year, the HOPE Coalition has learned invaluable lessons
including the value of intentionally forging authentic relationships with community,
county and state partners. We have learned not to underestimate the effort and time
required to move forward a body of work across a distinct and unique four county
region. The time and resources required to conduct a needs assessment,
environmental scan and to collect and synthesize data is considerable and far exceeds
the resources provided.
We learned that it is important to make sure that all voices are heard and that we have
representation from as many Oregon communities as possible. For example, NAYA
joined the steering committee in the Spring, which ensured that the Native American
community was engaged in the development of the 5-Year Plan.
37
DRAFT. SEPTEMBER 26, 2012
We learned the importance of developing working agreements within the Coalition and
its partners, establishing core values and rules of engagement which include how we
communicate, defining our decision making process and deepening our relationships
with each other from a common platform of respect.
CONCLUSIONS
We see this 5- Year Plan as an active, living document the value of which is preserved
only if its strategies and recommendations are implemented. There is limited value in
developing another report that will be quickly shelved, so we hope instead that this will
serve as changing, adaptive roadmap for achieving health equity in this four county
region and across the State of Oregon.
We trust that the state, foundations, partners and our communities will see the value of
this work and provide the financial support necessary for implementing the strategies
outlined herein and move us closer to full health equity for the many communities
represented in this 5- Year Plan.
38
DRAFT. SEPTEMBER 26, 2012
APPENDICES
(This page intentionally left blank)
DRAFT. SEPTEMBER 26, 2012
APPENDIX A
HOPE COALITION POLICY CRITERIA
Abbreviated Edition (version 3/Mar 2012)
Edited for the ability to conduct an analysis of policy recommendations and strategies
given organizational capacity.
Criteria for Health Equity Issue Priorities
1.
Is there evidence/data that demonstrates a health inequity?
2.
Is there a realistic opportunity to impact health disparities in multiple
populations?
3.
Is there demonstrated community support from community groups?
Criteria for Health Equity Policy Proposals
1.
Does it impact a wide range of priority populations?
2.
Will it have a measurable impact on reducing chronic disease and health
disparities?
3.
Are there clear goals and objectives?
4.
Is it winnable in the next 5 years?
5.
Does it strengthen or build new partnerships between HOPE coalition members
and allies?
6.
Is there funding available?
Longer Edition (version 2/Nov 2011)
The HOPE Coalition has developed these policy criteria to help define and guide the
development of a five-year regional health equity plan. In evaluating a policy option,
the HOPE Coalition will take into consideration the following factors and key questions:
1. Reach. The HOPE Coalition will support policies that have a broad population impact
(wide
reach) on priority populations.
2. Effect. The HOPE Coalition will support policies, which have been shown to be
effective at reducing chronic diseases and health disparities.
What is the tangible benefit or harm of this policy to the priority populations?
If there are comparable policies elsewhere, are there data to map out that impact?
Is it administrative, legislative, executive, or other?
Have similar policies been passed in other jurisdictions?
How does this policy advance or inhibit equity principles?
DRAFT. SEPTEMBER 26, 2012
3. Political Feasibility. The HOPE Coalition aims to continually assess the political
landscape at the time the policy option is on the table to determine likelihood of
success. Political feasibility may not necessarily be a determining factor for support of
the policy but may be used in developing a political strategy that fits the political
landscape.
4. Timing:
Where does this issue fall in the policy life cycle?
Cultivation, emerging or mature?
Does the policy have a champion or champions? Who are they?
Is there active opposition?
Who are key supporters and opponents?
How does advocacy around this issue impact the HOPE Coalition’s relationship with
partners or allies?
How likely is it that the policy will get substantial community mobilization and
momentum from priority populations?
5. Community Values. The HOPE Coalition aims to prioritize community values in
developing policy priorities.
Is the policy consistent with community values?
What is the level of grassroots support? (Polling; word on the street)
Is there support at the grasstops level (i.e. does the policy count with the support of a
person(s) of influence?
Is there media support for the policy?
DRAFT. SEPTEMBER 26, 2012
APPENDIX B
HOPE COALITION HEALTH EQUITY QUESTIONNAIRE
A 240 N Broadway Suite 215, Portland, OR 97227 T 971-340-4861
Community Assessment and Data Collection
The HOPE Coalition is a regional partnership of communities of color, health advocates,
and policy-makers working to develop a five- year plan to increase health equity in
Clackamas, Marion, Multnomah, and Washington County.
The HOPE Coalition needs your organization’s support and perspective to ensure that
the five- year plan:
A) Reflects the most pressing needs of priority populations experiencing health
disparities in the region;
B) Prioritizes strategies and solutions that have the broadest reach, effect, and
political feasibility, while reflecting community values.
We strongly believe that a successful five-year plan will build on and promote the work
you are already doing, identify best practices and address gaps in health disparities
data and health promotion policies, and ultimately lift up and implement the coalition’s
collective priorities.
This questionnaire is our first step to find out what your organization’s health equity
priorities are.
Our hope is that you will contribute to our effort to collect and compile this critical data
by reviewing this questionnaire prior to our meeting, and engaging in a one-on-one
meeting and dialogue with members of the HOPE Coalition Steering Committee.
*Please note that we have included “Key Definitions” and “Policy Criteria” at the end of
the document.
DRAFT. SEPTEMBER 26, 2012
HOPE COALITION HEALTH EQUITY QUESTIONNAIRE
Organization Name:
Organization Mission:
Organization City and County:
Main Contact(s) (Name, Email, Phone):
Organization Priority Populations:
Health Equity Priorities
1) What are your organization’s primary health equity priorities? (Examples may
include nutrition, infant mortality, mental health issues, life expectancy,
chronic disease, alcohol, drug or tobacco abuse, physical activity, violence,
infectious disease, etc.)
2) Please describe the policy, system or environmental changes your
organization is promoting to address your health equity priorities (Example
may include jobs, education access, transportation access, safety, healthy
and affordable housing, access to healthy food, land use, community
empowerment, or other social determinants of health)
3) Please describe your organization’s SHORT TERM health equity priorities (by
2013), as well as their status (i.e. has the issue simply been identified, or has
the organization begun to take action? Have policies or changes been
explored, implemented, or are you already in the evaluation stage?)
4) Please describe your organizations MID TERM and LONG TERM health equity
priorities (by 2015 and by 2017, respectively), as well as their status.
Health Disparities and Health Equity Data Collection
5) Has your organization collected any health disparities or health equity
population data in the last 1-2 years? Please describe.
6) If yes, what methodology(ies) did you use to collect the data? (Examples
might include surveys, census data, focus groups, community forums, etc.)
7) What was the goal and range of your data collection?
DRAFT. SEPTEMBER 26, 2012
8) Has the data been analyzed? Is it informing any organizational programs or
priorities especially in terms of projects or programs?
9) Can you share the data-- either raw or analyzed-- with the HOPE Coalition? If
yes, can you share it with us by the end of December?
10)Is there anyone in your office who can act as liaison for data questions?
Final Questions
11)Ideally, what value could the HOPE Coalition bring to your work? Please be as
specific as you can.
12)Is there anything else you would like to add or any questions?
Key Definitions (adapted from DHS)
Health Disparities: Differences in the incidence and prevalence of health
conditions and status between groups.
Health Equity: When everyone has the opportunity to “attain their full health
potential” and no one is “disadvantaged from achieving this potential because of
their social position or other socially determined circumstance.”
Health Inequities: Differences in health status of individuals or groups that are
created by the unjust distribution of resources, power, and opportunities. These
inequities are rooted, determined by social conditions, and require different
public health approaches to be eliminated.
Priority Population: Communities of color; migrant populations, lesbian, gay,
bisexual, transgender, queer/questioning and intersex; people living with mental
illness; people with disabilities; and people living with fewer financial resources.
Social Determinants of Health: Life enhancing resources, such as food supply,
housing, economic and social relationships, transportation, education, and health
care whose distribution across populations effectively determines length and
quality of life.
HOPE Coalition Policy Criteria
The HOPE Coalition has developed these policy criteria to help define and guide the
development of a five-year regional health equity plan.
DRAFT. SEPTEMBER 26, 2012
Reach. The HOPE Coalition will support policies that have a broad population
impact (wide reach) on priority populations.
Effect. The HOPE Coalition will support policies which have been shown to be
effective at reducing chronic diseases and health disparities.
 What is the tangible benefit or harm of this policy to the priority
populations? If there are comparable policies elsewhere, are there
data to map out that impact?
 Is it administrative, legislative, executive, or other? Have similar
policies been passed in other jurisdictions? How does this policy
advance or inhibit equity principles?
Political Feasibility. The HOPE Coalition aims to continually assess the
political landscape at the time the policy option is on the table to determine
likelihood of success. Political feasibility may not necessarily be a determining
factor for support of the policy but may be used in developing a political strategy
that fits the political landscape.
In evaluating a policy option, the HOPE Coalition will take into consideration the
following factors:
 Timing: Where does this issue fall in the policy life cycle?
Cultivation, emerging or mature?
 Does the policy have a champion or champions? Who are they?
 Is there active opposition?
 Who are key supporters and opponents?
 How does advocacy around this issue impact the HOPE Coalition’s
relationship with partners or allies?
 How likely is it that the policy will get substantial community
mobilization and momentum from priority populations?
Community Values. The HOPE Coalition aims to prioritize community values in
developing policy priorities.
 Is the policy consistent with community values?
 What is the level of grassroots support? (Polling; word on the
street)
 Is there support at the grasstops level (i.e. does the policy count
with the support of a person(s) of influence?
 Is there media support for the policy?
DRAFT. SEPTEMBER 26, 2012
APPENDIX C
HOPE COALITION POLICY ISSUES AND STRATEGIES
Summary for HOPE Coalition 5.29.12
Priority Issues:
1) Cultural Competency and Workforce Diversity (CCWD)
a) CCWD.1 - Support and Expand Non-Traditional Workforce
b) CCWD.2 - Finance Community Health Worker Services
c) CCWD.3 - Cultural Competency for Health Professionals
2) Improved Data Collection and Analysis (IDCA)
a) IDCA.1 - Expand Data Collection
b) IDCA.2 - Data Collection Training
c) IDCA.3 - Expand Over-Sampling
3) Access to Health Care (AHC)
a) AHC.1 - Legislative sponsorship on basic health care as a human right
b) AHC.2 - Expand Health Care for All
c) AHC.3 – Expand Workforce Diversity
4) Chronic Disease and other Illness Factors (CDIF)
a) CDIF.1 - Limit Youth Access to Tobacco
b) CDIF.2 - Promote Healthy Food Financing initiatives
c) CDIF.3 – Reduce Obesity for Children and Families
5) Mental Health, Substance Abuse and Addictions (MHSAA)
a) MHSAA.1 - Standardize County Assessment and Screening Systems
b) MHSAA.2 - Increase Investment in Community Mental Health and Social Needs
programs
c) MHSAA.3 - Workforce Development
Policy Recommendation Detail by Priority Issue Area:
1. Cultural Competency and Workforce Diversity (CCWD)
Work Group Participants
Convener - Midge Purcell, Urban League of Portland
Laura Raymond, Coalition of Community Health Clinics
Sandra Hernandez, The TREE Institute
Valerie Palmer, OHSU
Sarah Petras, Josiah Jill Clinic
DRAFT. SEPTEMBER 26, 2012
Jean Yamamoto, SEIU 503
Rachael Banks, Multnomah County Health Department
Angela Gonzalez, Yakima Valley Farmworkers Clinic
Erin Moller Johnson, Yakima Valley Farmworkers Clinic
Callie Lambarth, Center for Improvement of Child and Family Service, PSU
Ty Schwoeffermann, Urban League of Portland
Tameka Brazile, Multnomah County Health Department
6 policy proposals were reviewed. The Working Group met one time, identified their
three top priority policies by way of a poll with follow up by email for those who were
unable to attend the meeting. Recommendations from Access to Health Care around
community health workers were incorporated into CCWD.1.
CCWD.1 - Support and Expand Non-Traditional Workforce
Standards in CCOs that support and expand Non-Traditional Workforce including
Community Health Workers, with strategic linkage to populations experiencing poverty
and/or homelessness. Require uniform collection and reporting of non-traditional
workforce information; requiring CCOs to develop a plan regarding non-traditional
workforce that links to appropriate programs and peer support structures; make the
plan publicly available.
CCWD.2 - Finance Community Health Worker Services
Establish sustainable financing for Community Health Worker services, especially
through payment for their services in Medicaid, CHIP and other major funding streams;
and ensure workforce development resources such as training, career progression,
standards for training and certification where appropriate and common guidelines for
evaluation. Establish state funding set-asides for diverse workforce development
through Community Health Worker training. Ensure that comprehensive payment
methodologies are created, as well as reimbursement guidelines for CHWs.
CCWD.3 - Cultural Competency for Health Professionals
Legislative and/or administrative mandatory cultural competency education for health
professionals. Source and expand available curriculum.
2. Improved Data Collection and Analysis (IDCA)
Work Group Participants
Convener - Joseph Santos-Lyons, Asian Pacific American Network of Oregon
Levi Herrera-Lopez, Mano-A-Mano Family Center
Janet Bauer, Oregon Center for Public Policy
Laura Raymond, Coalition of Community Health Clinics
Roberto Rivera, 211 info
Robert Brown, Metro Alliance for Common Good
DRAFT. SEPTEMBER 26, 2012
Kim Repp, Washington County Epidemiologist
Julia Meier, Coalition of Communities of Color
Reviewed 2 policy proposals, and developed 6 additional proposals. The Working Group
met one time and prioritized proposals through a group dialogue and follow-up by
email. Incorporated policy proposal from Mental Health, Substance Abuse and
Addictions around data collection into IDCA.1.
IDCA.1 - Expand Data Collection by Race, Ethnicity, Language, Sexual
Orientation, Gender, Housing Status, and Uninsured Status
Adopt Improved Uniform Data Collection and Analysis protocols at the county level that
provides for increased disaggregation by categories including, but not limited to Race,
Ethnicity, Housing Status, Language, Gender, Sexual Orientation, and Uninsured for all
patients, clients, etc., through integration in Electronic Medical Records and other
forms. Integrate data through backend connections for proprietary health systems for
dual-enrolled Medicaid/Medicare members, and integrate patient data for both mental
health and substance abuse treatment. Strive to implement the US HHS Ethnicity, Race
and Language Data Standard and Coalition of Communities of Color Data Protocol.
IDCA.2 - Data Collection Training
Develop and adopt Data Collection Training Program for service providers,
administrative and professional staff to improve accuracy and effectiveness of collection
methods at county, regional and/or state level.
IDCA.3 - Expand Over-Sampling
Develop and adopt Over-sampling Program integrated with existing surveys and data
collection to provide better data and analysis of community status at county region
and/or state level.
3. Access to Health Care (AHC)
Work Group Participants
Convener - Alberto Moreno, Oregon Latino Health Coalition
Sandra Hernandez, THE-TREE Institute
Michael Anderson-Nathe, Cascade AIDS Project
Suzanne Hansche, Elders in Action
Peter Shapiro, Jobs with Justice
Levi Herrera-Lopez, Mano-A-Mano Family Center
Valerie Palmer, OHSU/IRCO
Janet Bauer, Oregon Center for Public Policy
Danielle Sobel, Oregon Medical Association
Rebecca Schoon, Project Access Now
Josh Todd, Multnomah County Children and Families Commission
DRAFT. SEPTEMBER 26, 2012
Michael Moore, Sisters of the Road
Reviewed 12 policy proposals. The Working Group met two times and prioritized
proposals through a group dialogue and follow-up by email.
AHC.1 - Legislative sponsorship on basic health care as a human right
a.
Executive order.
b.
Legislative action.
AHC.2 - Expand Health Care for All
a. Expand prenatal care for all women in Oregon.
b. Provide state-funded health coverage for all, including currently categorically
ineligible children and families.
AHC.3 – Expand workforce diversification through support and codification of
community health workers in Oregon
a.
Implement strategies as represented in CCWD.1 and CCWD.2
4. Chronic Disease and other Illness Factors (CDIF)
Work Group Participants
Convener - Brett Hamilton, Tobacco Free Coalition of Oregon
Stephanie, Tama-Sweet, American Heart Association
Colleen Hermann-Franzen, American Lung Association
Katherine, McGuiness, Cascade AIDS Project
Laura Raymond, Coalition of Community Health Clinics
Alejandro Queral, NW Health Foundation
Deborah Turner, Portland Community Reinvestment Inc
Adriana Voss-Andreae, Portland Community Reinvestment Inc
Kelly Jurman, Washington County
Reviewed 14 strategies. The policy workgroup met once in-person, once via conference
call and extensively through email. The recommended policies were prioritized the
workgroup through votes. The final decision was made through a vote; the three
policies receiving the most votes advanced.
CDIF.1 - Limit Youth Access to Tobacco
Decrease youth initiation to tobacco by limiting access to and marketing of tobacco
products in the retail environment.
CDIF.2 - Promote healthy food financing initiatives
DRAFT. SEPTEMBER 26, 2012
Promote healthy food financing initiatives (e.g. Healthy Corner Store initiative and Fresh
Food Financing) with strategies (e.g. seed funding and capital) designed to promote
retailers that provide access to healthy food, and encourage food distribution systems
that do the same.
CDIF.3 – Reduce Obesity for Children and Families
Implement a model soda tax, through first targeting Multnomah County, with funds
being dedicated to obesity prevention. (PE requirements in schools, healthy food access
for low-income families, Farm to School programs, etc.)
5. Mental Health, Substance Abuse and Addictions (MHSAA)
Work Group Participants
Convener - Andrew Riley, Center for Intercultural Organizing
Chris Bonouff, NAMI-OR, Rachel Banks, Multnomah County Health Department
Sandra Hernandez, THE-TREE Institute,
Laura Raymond, Coalition of Community Health Clinics
Met once in person and by email.
MHSAA.1 - Standardize County Assessment and Screening Systems
The initiative to change intake and screening for the children’s mental health system
provides a useful comparative model: families have a greater satisfaction because
outcomes are more reliable and predictable. The state should develop standards for a
standardized screening and assessment process (for adult mental health and substance
abuse/addictions), and tie the implementation of that system to the disbursement of
funds to local mental health authorities.
MHSAA.2 - Increase Investment in Community Mental Health and Social
Needs programs
Treatment should be culturally competent and informed by a patient’s life
circumstances (including Trauma-Informed Care). Funding should be increased to an
adequate level, and funding systems should be re-designed to better integrate
substance abuse/addictions and mental health care, similar to the model provided by
Coordinated Care Organizations (CCOs). Funding should be allocated to allow for
relationship building rather than a simply medical model of treatment, in order to
improve patient outcomes, and should support the integration of treatment services
with social support programs. These programs would include, for example, housing
assistance, childcare, and transportation assistance.
MHSAA.3 - Workforce Development
DRAFT. SEPTEMBER 26, 2012
The state should develop and implement programs that promote cross-training and dual
credentialing in both mental health and substance abuse/addictions services, to provide
for a more robust workforce. The state should also take care to ensure that the mental
health systems workforce is culturally diverse and culturally competent (including peer
coaches). Finally, law enforcement professionals should receive comprehensive training
on working with individuals suffering from mental health crises.
We specifically hope to engage additional organizations in the development of these
strategies.
DRAFT. SEPTEMBER 26, 2012
Appendix D
Work Group Participants
Strategies
Cultural Competency and Workforce Diversity (CCWD)
a. CCWD.1 - Support and Expand Non-Traditional Workforce
b.
CCWD.2 - Finance Community Health Worker Services
c.
CCWD.3 - Cultural Competency for Health Professionals
Improved Data Collection and Analysis (IDCA)
a. IDCA.1 - Expand Data Collection
b.
IDCA.2 - Data Collection Training
c.
IDCA.3 - Expand Over-Sampling
Access to Health Care (AHC)
a. AHC.1 - Legislative sponsorship on basic health coverage as a human right
b.
AHC.2 - Expand Health Coverage for All
c.
AHC.3 – Expand Workforce Diversity
Chronic Disease and other Illness Factors (CDIF)
a. CDIF.1 - Limit Youth Access to Tobacco
b.
CDIF.2 - Promote Healthy Food Financing initiatives
c.
CDIF.3 – Reduce Obesity for Children and Families
Mental Health, Substance Abuse and Addictions (MHSAA)
a. MHSAA.1 - Standardize County Assessment and Screening Systems
b. MHSAA.2 - Increase Investment in Community Mental Health and Social
Needs programs
c. MHSAA.3 - Workforce Development
Work Group Participants
Urban League of Portland, Coalition of Community Health
Clinics, The TREE Institute, OHSU, Josiah Hill Clinic, SEIU
503, Multnomah County Health Department, Yakima Valley
Farmworkers Clinic, PSU Center for Improvement of Child
and Family Service
Asian Pacific American Network of Oregon, Mano-A-Mano
Family Center, Oregon Center for Public Policy, Coalition of
Community Health Clinics, 211 Info, Metro Alliance for
Common Good, Washington County Epidemiologist, Coalition
of Communities of Color
Oregon Latino Health Coalition, The TREE Institute, Cascade
AIDS Project, Elders in Action, Jobs with Justice, Mano-AMano Family Center, OHSU/IRCO, Oregon Center for Public
Policy, Oregon Medical Association, Project Access Now,
Multnomah County Children and Families Commission, Sisters
of the Road
Tobacco Free Coalition of Oregon, American Heart
Association, Cascade AIDS Project, Coalition of Community
Health Clinics, NW Health Foundation, Portland Community
Reinvestment Inc., Washington County
Center for Intercultural Organizing, Multnomah County
Health Department, The TREE Institute, Coalition of
Community Health Clinics
DRAFT. SEPTEMBER 26, 2012
APPENDIX E
ONE ON ONE INTERVIEW SUMMARIES
Organization:
Organizations Mission:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
211 Info
Communities are healthier when people can quickly and easily
access public, nonprofit and faith-based structures. The nonprofit
211info is like an air traffic controller directing families and
individuals to services that can help with personal or community
struggles.
Whether you’re in Oregon or Southwest Washington looking for
affordable housing, health care, food assistance or clinics, dial 211
or visit 211info.org to get connected to the nonprofit and public
services you need.
Roberto Rivera
Email: roberto.rivera@211info.org
Phone: 503-416-2637
Mailing Address:
Health; Nutrition; Housing Assistance; Providing multilingual services
Families in MultCo, Hispanic and Latino, Asian Pacific American,
African American, Native American.
Identify providers who are reliable, have free or sliding-scale
services, and build partnerships to continue the work
Assessment to provide greater return on investment; out reach to
providers; workforce development.
Yes or No: yes
Methodology: 211 maintains a comprehensive database of services
their refer callers to.
Goal:
Analyzed (Y/N):
Willing to share (Y/N): This is available on their website
Key Data Contact: Tim
211 could gain from increasing their understanding of diversity
A6 (African American AIDS Awareness Action Alliance)
Increase testing of African Americans for HIV/AIDS
Maurice Evans
Email: None Given
Sexual health; HIV/AIDS prevention; access to service and treatment
for people living with HIV; Encouraging people to know their
DRAFT. SEPTEMBER 26, 2012
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission Statement:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Population:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
HIV/AIDS status
African American Community (Greater Portland and
Multnomah/Clackamas counties)
Stigma reduction; Community Health Worker to connect people with
services; Collaboration between clinics and counties;
Stigma reduction; development of a community and faith-based
committee
TBD
Yes or No: Y
Methodology: Collected by MultCo and Survey’s from Survey
Monkey are being used
Goal:
Analyzed (Y/N): N
Willing to share (Y/N): Y
Key Data Contact: Ronnie Meyers
Partnerships that will help mobilize resources and advocacy; ensure
continued funding in light of current and future budget cuts
American Cancer Society
The American Cancer Society is the nationwide, community based,
voluntary health organization dedicated to eliminating cancer as a
major health problem by preventing cancer, saving lives, and
diminishing suffering from cancer, through research, education,
advocacy, and service.
Jason Parks
Email: jason.parks@cancer.org
Phone:
Mailing Address:
Statewide/At Risk population
Local breast and cervical screening program; Access to care;
Colorectal screening program: CCOs; Tobacco cessation
Work on ACA implementation; Tobacco cessation (Including: retail
licenses; law to regulate tobacco; regulation and advertising)
2015 Challenge:
Reduce the age-adjusted cancer mortality rate by 50%
Reduce the age-adjusted cancer incidence rate by 25%
Measurably improve quality of life from time of diagnosis through
balance of life for all cancer survivors
Yes or No: None Reported
Methodology:
Goal:
DRAFT. SEPTEMBER 26, 2012
What could HOPE bring
to your work?
Analyzed (Y/N):
Willing to share (Y/N):
Key Data Contact:
HOPE can help open doors to other organizations and provide
opportunities for networking. ACA also wants assistance bringing
disparities to the forefront
Comments:
Organization:
Mission Statement:
Representative
Name:
Rep. Contact Info:
Main Priority Issues:
Policy, System, Env.
Changes your
organization
supports:
Short Term Health
Equity Priorities:
Mid/Long Term
Health Equity
Priorities:
Health Equity Data
Collected in past 1-2
years?
American Lung Association
To save lives by improving lung health and preventing lung disease.
Colleen Hermann- Franzen, Advocacy & Outreach Manager
Email: chermann@lungoregon.org
Phone: 503.924.4094
Mailing Address: 7420 SW Bridgeport Rd Suite 200
Tigard, OR 97224
Tobacco use; Asthma and lung disease (asthma is a lung disease but
people still separate the two); Air quality (indoor and outdoor air
quality)
1. Tobacco use and prevention: Tobacco program funding; Higher
tobacco taxes; Strong smoke free work place laws; Looking at a new
bill for smoke free car for kids
2. Lung disease: Forming a COPD coalition in 7 state region. 90%
of COPD is caused by smoking. Based in Oregon; Expand flu shot
campaign
and work with large employers to bring fly
shots on site
3. Air quality: Annual State of the Air report includes soot and smog
level grades in each county.
See above. In addition:
Want to expand “better breathers” clubs, which are support groups for
adults living with lung disease. Currently have 20; Looking to expand
youth advocacy work, perhaps in the form of giving small grant to
youth groups to focus on tobacco prevention; Spreading lung disease
education and awareness on college campuses
At a national level: Maintain funding for Clean Air Act and Healthy Air
Campaign
Regional: Launch an outdoor air quality alert in 5 markets over the
next several years. Have State of the Air Campaigns (coming out with
an app for this)
Yes or No: Yes: Community Assessment and interviews with tobacco
prevention coordinators from Lane, Marion, and Multnomah county
health departments
Methodology: interviews
Goal: the county interviews informed their strategic plan
Analyzed (Y/N): unsure
DRAFT. SEPTEMBER 26, 2012
What could HOPE
bring to your work?
Willing to share (Y/N): TBD
Key Data Contact: Colleen Hermann- Franzen
It supports the work that we are trying to do with health equity,
especially identifying those health disparities in our communities. Also
we are a very white organization. By serving on HOPE Coalition we are
more tapped into the needs and issues of priority populations.
Comments:
Organization:
Mission Statement:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
CAUSA
Causa is Oregon’s statewide Latino immigrant rights organization.
Causa works to defend and advance immigrant rights by
coordinating with local, state, and national coalitions and allies. We
are the largest Latino civil and human rights organization in the
Pacific Northwest.
None given.
Email: None Given
Phone:
Mailing Address:
Link between immigration status and health equity; Health care
access for undocumented immigrants and children; Prenatal care for
all women; Support for the safety net clinics in Oregon
Health care access
No time line given. Projects include: Transportation; Driver’s license
issues; education; tuition equity; housing; migrant workers; and
residency as a barrier to education.
See above.
Yes or No: None reported
Methodology:
Goal:
Analyzed (Y/N):
Willing to share (Y/N):
Key Data Contact:
The HOPE Coalition could make available to CAUSA a broader social
justice lens that includes health equity that has more diverse
partners and provide more opportunities to access other
communities.
Comments:
Organization:
Representative Name:
Clackamas County Health Department
Scott France, Health Communities and Tobacco Prevention
DRAFT. SEPTEMBER 26, 2012
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Email: sfrance@co.clackamas.or.us
Phone: 503-742-5340
Mailing Address: 2051 Kaen Road, Oregon City, OR 98045
The urban/rural divide; Responding to a recent influx of
homelessness
Residents of Clackamas County
Health Improvement Plan
None given
Yes or No: Yes
Methodology:
Goal: Community Assessment/SWOT analysis
Analyzed (Y/N): Y
Willing to share (Y/N): Available through Clackamas County
online (“Road Map to Healthy Communities”)
Key Data Contact: Brett Hamilton
Clackamas County is engaged in learning more about health
disparities and there is support from the County Commissioners.
We would like to include HOPE in our discussions.
Comments:
Organization:
Mission Statement:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Coalition of Communities of Color
“The Coalition of Communities of Color addresses the socioeconomic
disparities, institutional racism, and inequity of services experienced
by our families, children, and communities. The Coalition organizes
our communities for collective action resulting in social change to
obtain self-determination, wellness, justice, and prosperity.”
Julia Meier
Email: juliam@nayapdx.org
Phone: 503-288-8177 x295
Mailing Address:
Advocacy; Partnership with organizations that effect public health
equity; Collection and utilization of culturally appropriate data and
research; Equity based funding
People of Color in Multnomah County
Please refer to the many publications available on their website:
coalitioncommunitiescolor.org
See above.
See above.
DRAFT. SEPTEMBER 26, 2012
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission Statement:
Yes or No: No, however CCC has compiled and published a variety
of reports on the conditions of the communities of color in
Multnomah County
Methodology:
Goal:
Analyzed (Y/N):
Willing to share (Y/N): Y
Key Data Contact: Julie Meier
CCC would like for the coalition to consider/advocate for a
community specific approach, rather than a race specific one (ie:
Burmese, African Immigrants vs. African Americans, etc.)
Healthy Birth Initiative
Improving birth outcomes for African American women and babies
Tameka Brazile
Email:
Phone:
Mailing Address:
Infant mortality prevention; Premature birth; Social determinants of
health; Childcare related to employment
African American Community (Greater Portland Area)
Reduction in number of premature births; support for pregnant
mothers and babies (0-2); Reimbursement for doulas
Expanding education for working mothers; supporting parents who’s
children are struggling in school; over-medication of African
American children; Disproportionate number of African American
children in special ed.
Yes or No: Yes (Collected by MultCo and Oregon Vital Stats)
Methodology:
Goal: Compare the outcomes of patients on HBI vs. those that are
not
Analyzed (Y/N):
Willing to share (Y/N): Available through MultCo
Key Data Contact:
Networking; Sharing information about reproductive health;
Increasing effectiveness in advocacy
Latino Network
Latino Network provides transformative opportunities, services, and
DRAFT. SEPTEMBER 26, 2012
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Population:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
advocacy for the education, leadership and civic engagement of our
youth, families and communities
Cynthia Gomez
Email: cynthia@latnet.org
Phone: 503-283-6881
Mailing Address:
Healthy food and built environment; Housing; Alcohol and Drug use;
Access to education; Immigration issues
Latino population in Multnomah county; Adjucated adolescent youth
and their families; Pre-K children and their families
Repeal inclusionary zoning ban by 2013; Cully Park improvements;
Hacienda’s Mercado; Office of Equity and Portland Plan (ensuring
Latino voice is represented and real)
Dream Act; Driver’s licenses; Undocumented children’s access to
health care
Yes or No: No
Methodology:
Goal:
Analyzed (Y/N):
Willing to share (Y/N):
Key Data Contact:
Networking and cross-pollination as well as access to data.
Marion County
None Given
Email: None Given
Phone:
Mailing Address:
No equity platform Is currently in place. Marion County is interested
in help forming a health equity platform.
All residents
None Given
None Given
None Given
Yes or No: None Given
Methodology:
DRAFT. SEPTEMBER 26, 2012
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Goal:
Analyzed (Y/N):
Willing to share (Y/N):
Key Data Contact:
Assistance in the formation of a health equity program.
There is an underserved Russian community in Marion County. This
is a gap.
Micronesian Islander Community
Organized for charitable, educational purpose and to promote
cultural awareness programs and events that provide social needs,
economic growth and racial justice to its MIC community members.
Cris Ogo
Email: kuriogo@gmail.com
Phone: 971-388-1794
Mailing Address:
None formalized yet (very new organization)
Micronesian Community (Chamorro [Guam/CNMI], Palauan,
Chuukese, Yapese, Kosraean, Pohnpeian, & Marshallese)
Establish a committee within MIC to address health issues.
N/A
Yes or No: N
Methodology:
Goal:
Analyzed (Y/N):
Willing to share (Y/N):
Key Data Contact:
HOPE could help strengthen MIC’s knowledge of the issues
surrounding health inequities for their community and others. This
could also strengthen their connections and ties to other
communities doing this work.
Comments:
Organization:
Representative Name:
Rep. Contact Info:
Multnomah County Commission on Children, Families and
Community
Joshua Todd
Email: joshua.l.todd@multco.us
Phone: 503-969-5862
Mailing Address:
DRAFT. SEPTEMBER 26, 2012
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
Community Capacity Building; Health Care Access; Transportation
Equity
Youth; Low income; Communities of color
By June 2012: Enroll 240 Families in OHK/OHP; Negotiate renewed
contract with State to continue providing service through 2013;
Continue YouthPASS program/negotiate long term funding
agreement between Portland, Mult Co, and Trimet; 6 year plan
(2008-2015) to improve health outcomes in children and families
(via improved academic success/high school completion rates and
decreasing poverty)
Expand YouthPASS to all middle and high school students in Mult Co
Yes or No: Yes. Qualitative data on access to transportation;
Quantitative and qualitative data on disproportionality in child
welfare involvement; Quantitative and qualitative data on education
success and impacts of exclusionary discipline
Methodology: Community stories/testimonies; community forums;
Data collection, disaggregation, and analysis; Surveys; Focus groups
Goal: To impact policy in our chosen issue area
Analyzed (Y/N): Y
Willing to share (Y/N): Some yes; child welfare data is unable to
be shared due to confidentiality issues.
Key Data Contact: Joshua Todd
What could HOPE bring
to your work?
Comments:
Organization:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Multnomah County Health Department
Rachel Banks
Email: Rachel.m.banks@multco.us
Phone:
Mailing Address:
Reproductive health, chronic disease disparities, mental
health/addiction, environmental health, STDs
HEAL coalition, Health Retail Initiative, Tobacco Retail Licensing
Project, SCHIEVE, Healthy Homes, etc
Projects involving: gentrification mitigation, legislative tracking,
influencing the Portland Plan and Comp Plan, Tobacco Retail
Licensing, Tobacco-Free Campus Initiatives, BPA ban;
implementation of an equity lens and framework
Develop a 5 and a 10-year plan in equity and health promotion;
DRAFT. SEPTEMBER 26, 2012
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
ensure that the Community Implementation Plan reflects community
priorities; Community Health Assessments; Develop systems level
policy priorities that track health dollars
Yes or No: Yes. Quarterly Racial and Ethnic Disparity Report Cards;
HBI Focus Group Report; Community Health Improvement Report;
Healthy Homes Report; Obesity Report; The Built Environment
Equity Atlas
Methodology: Collection of primary clinical and client data; focus
groups, surveys, etc.
Goal: To ensure that the result of the reports loop back to strategic
planning and budget allocations. Also, to identify health disparities,
create and implement programs and policies.
Analyzed (Y/N): Yes
Willing to share (Y/N): Yes - Available online
Key Data Contact: Sarah Tran (Early Childhood)
Chris Sorvari (Qualitative and Quantitative Data)
Maya Bhat – McCoy Bldg
Partnerships that will help mobilize resources and advocacy; ensure
continued funding in light of current and future budget cuts.
Northwest Health Foundation
To advance, support, and promote the health of the people of
Oregon and SW Washington
Alejandro Queral
Email: aqueral@nwhf.org
Phone: 971-230-1288
Mailing Address:
Public Health; Health Care Reform; Health Workforce
Underserved populations
A broad approach addressing notions of resources and power;
Systemic changes that provide people with more opportunities to be
healthy.
None given
None Given
Yes or No: None reported
Methodology:
Goal:
Analyzed (Y/N):
Willing to share (Y/N):
Key Data Contact:
NWHF is interested in a better integration of public health and the
DRAFT. SEPTEMBER 26, 2012
delivery system. Their strategies are to change to the direction of
the conversation versus making a big splash. Change the
conversation of preventative care to more upstream health
promotion efforts. For example, the CCO can benefit from
collaborating with public health, and one of the CCO’s greatest
challenge is meaningful outreach.
Alejandro is working with researchers from OSU that have identified
three consistent factors in health disparities:
1. proximity to an urban area? The closer the healthier.
2. childhood poverty
3. high school graduation
Organization:
Region:
Representative:
Priority Population:
Rep. Contact Info:
Main Priority Issues:
Policy, System, Env.
Changes your
organization supports:
Short Term (2013)
Health Equity Priorities:
Mid (2015)/Long
(2017) Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
Oregon Action
Multnomah County (also has an office in Jackson County)
Ron Williams
Email: ron@oregonaction.org
Phone: 503-282-6588
Mailing Address:
Health disparities
Cultural competency
Data collection
Workforce diversity
Heart disease
Hypertension/Blood pressure
Teen Pregnancy
Smoking
Violent death
Colorectal cancer
Land use (ex: brownfields)
Job creation
Income equality
Health insurance exchange
Community governance
Priority: CCO
Status: Launch June 2012
Priority: Oregon Health Equity Alliance Issues
Status: None Given
Priority: Community Health Workers
Status: None Given
Priority: Nothing finalized
Yes or No: No
Methodology:
DRAFT. SEPTEMBER 26, 2012
years?
What could HOPE bring
to your work?
Comments:
Organization:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission Statement:
Representative Name:
Rep. Contact Info:
Goal:
Particular interest in data collection
What data is out there, who is collecting
it, what is the rationale, what is the potential impact, who is required
to report
How to merge public and private data
Data should be disaggregated by
culture/ethnicity/language
How can we make the data and information we collect readily
accessible through a website like crowd-sourcing/open source?
Salem Keizer Equity Coalition
Eduardo
Email:
Phone:
Mailing Address:
Improving underperformance in Latino youth; Improved education
Latino Youth
Work towards new benchmarks for achievement; lower drop out
rates; Mentoring and tutoring gang-affected youth
None reported
Yes or No: No
Methodology:
Goal:
Analyzed (Y/N):
Willing to share (Y/N):
Key Data Contact:
Salem Keizer is interested in a full and meaningful relationship with
HOPE, but their main focus is on education.
Sisters of the Road Cafe
Sisters Of The Road exists to build authentic relationships and
alleviate the hunger of isolation in an atmosphere of nonviolence
and gentle personalism that nurtures the whole individual, while
seeking systemic solutions that reach the roots of homelessness and
poverty to end them forever.
Heather Ferco
Email: heather@sistersoftheroad.org
Phone: 503-222-5694 x.22
Mailing Address:
DRAFT. SEPTEMBER 26, 2012
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
What could HOPE bring
to your work?
Comments:
Organization:
Mission:
Representative Name:
Rep. Contact Info:
Main Priority Issues:
Priority Populations:
Policy, System, Env.
Changes your
organization supports:
Short Term Health
Equity Priorities:
Mid/Long Term Health
Equity Priorities:
Health Equity Data
Collected in past 1-2
years?
Preservation of safety nets for their populations; Ensuring
consistency of service; Access to quality, affordable care
People experiencing homelessness
Single-payer health care reform
Health Needs Assessment (underway)
Advocacy around single-payer health care; Analysis of potential
budget cuts impacting safety net programs
Yes or No: In process
Methodology: Interviews
Goal: To systematically document anecdotal evidence of health
disparities and concerns.
Analyzed (Y/N): Not yet
Willing to share (Y/N): Yes
Key Data Contact: Heather Fercho
Access to a different set of institutional actors, data collection and
analysis, and an opportunity to focus their four county advocacy.
Washington County Health Department
To impact policy, leverage resources, and make strategic
investments to build a thriving community.
Kelly Jurman (Health Promotion Supervisor Program)
Email: Kelly_jurman@co.washington.or.us
Phone: 503-846-4965
Mailing Address:
Childhood obesity; Improving data collection around obesity; School
gardens/farm to school; Moving Washington County’s campus to
smoke-free;
Chronic disease prevention program; built environment and physical
activity; Direct services; Migrant communities;
No timeline set. See below for priorities.
Childhood obesity prevention; Nursing programs for new moms;
Increasing rates of breastfeeding; Improved bicycle infrastructure;
Health Impact Assessments for land use initiatives; Focus on migrant
and Somali populations
Yes or No: Yes
Methodology: BRFFS/WIC/Census
Goal:
Analyzed (Y/N): N
Willing to share (Y/N): Available online
DRAFT. SEPTEMBER 26, 2012
What could HOPE bring
to your work?
Comments:
Key Data Contact: Kim Repp @
Kimberly_repp@co.washington.or.us
Collaboration and resource pooling; New networks/connections;
DRAFT. SEPTEMBER 26, 2012
APPENDIX F
HOPE COALITION DOCUMENT SOURCE LIST
Subject Key
DATA: collected data/reports
CC: Cultural Competency/Workforce Diversity
HC A: Health Care Access
ID: Improved Data
CD: Chronic Disease/Illness (specific disease is listed when report is highly focused)
MH/A: Mental health/Addiction/Substance Abuse
National Data and Reports:
1. 2010 Census Data www.census.gov (DATA)
2. America’s Health Rankings (2012)
http://statehealthstats.americashealthrankings.org/ (DATA)
3. CDC Chronic Disease and Health Promotion. Health Equity Publications
http://www.cdc.gov/chronicdisease/healthequity/index.htm (CD, DATA)
4. CDC Data Set Directory of SDOH at the local level: The directory contains an
extensive list of existing data sets that can be used to address social
determinants. The data sets are organized according to 12 dimensions, or broad
categories, of the social environment. Each dimension is subdivided into various
components. (2004) http://www.cdc.gov/dhdsp/docs/data_set_directory.pdf
(DATA)
5. CDC Obesity and Overweight Publications
http://www.cdc.gov/obesity/resources/reports.html (CD, obesity)
6. CDC Oral Health Publications (2011)
http://www.cdc.gov/chronicdisease/resources/publications/aag/doh.htm (CD,
oral health)
7. CDC: Morbidity and Mortality Weekly Report. Mental Illness Surveillance Among
Adults in the United States (Sept 2011)
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1.htm?s_cid=su6003a1_
DRAFT. SEPTEMBER 26, 2012
w (MH/A, DATA)
8. Center for Science in the Public Interest: Taxing Sugared Beverages Would Help
Trim State Budget Deficits, Consumers’ Bulging Waistlines, and Health Care
Costs http://cspinet.org/new/pdf/state_budget_report_-_sugar_tax.pdf (CD)
9. County Health Rankings (2012) countyhealthrankings.org (DATA)
10. F as in Fat: How Obesity Threatens America’s Future 2011
http://healthyamericans.org/assets/files/TFAH2011FasInFat10.pdf (CD obesity)
11. Health Affairs. Agenda for Fighting Disparities: Oct 2011
http://content.healthaffairs.org/content/30/10.toc (HC A, CC, DATA, ID, CD)
12. Health Affairs. Racial and Ethnic Disparities: The Action Plan From The
Department of Health and Human Services (2011)
http://content.healthaffairs.org/content/30/10/1822.abstract (CC, HC A, DATA)
13. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic
Disparities in Healthcare (2002) http://www.iom.edu/Reports/2002/UnequalTreatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx (HC A,
CC)
14. New England Journal of Medicine “Don’t Forget Tobacco” (2010)
http://www.nejm.org/doi/full/10.1056/NEJMx100045 (CD tobacco, CC)
15. News Article: “Why Do Hispanics Live Longer, on Average? They Smoke Less.”
(2011) http://news.yahoo.com/blogs/lookout/why-hispanics-live-longer-averagesmoke-less-181810154.html (CD tobacco, CC)
16. Office of Minority Health Reports (Table of Contents) (various reports; 2011)
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=10 (CC, HC A,
DATA)
17. OHSU. Mental Health Disorder Statistics. http://www.ohsu.edu/xd/health/health-
information/topic-by-id.cfm?ContentTypeId=85&ContentId=P00753 (MH/A)
DRAFT. SEPTEMBER 26, 2012
18. Racism, Health Equity and Community Health (2009)
http://www.bphc.org/chesj/resources/Documents/presentations/Center%20Prese
ntations/Racism,%20Health%20Equity%20and%20Community%20Health.pdf
(HC A, CD, MH/A DATA, ID, CC)
19. Substance Abuse and Mental Health Services Administration. 2010 Youth
Tobacco Sales.
http://www.samhsa.gov/prevention/2010_Annual_Synar_Report.pdf (CD
tobacco)
20. The Center for Health Equity and Social Justice (various reports; 2005)
http://www.bphc.org/chesj/Pages/default.aspx (HC A, CC)
21. The Common Wealth Fund http://www.commonwealthfund.org (CC, HC A)
22. The Food Trust. Supermarket Campaign
http://www.thefoodtrust.org/php/programs/super.market.campaign.php (CD)
23. U.S Surgeon General “Overweight and Obesity: Health Consequences”
http://www.surgeongeneral.gov/library/calls/obesity/fact_consequences.html
(CD obesity)
24. U.S. Department of Health and Human Services Implementation Guidance on
Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and
Disability Status http://aspe.hhs.gov/datacncl/standards/ACA/4302/index.shtml
(DC)
25. Wang, C.Y., Coxson, P., Shen, Y., Goldman, L., Bibbins-Domingo, K. (2012). A
penny-per-ounce tax on sugar-sweetened beverages would cut health and cost
burdens of diabetes. Health Affairs, 31.1, 199 - 207. (CD, obesity, diabetes)
26. Washington State's report on education and health: Research Review: School-
based Health Interventions and Academic Achievement provides important new
evidence that links students’ health and academic performance. It identifies
proven health interventions and practical resources that can positively affect both
student health and academic achievement. Julia Dilly mentioned that there is
more coming from Washington state on this topic in March, so we'll keep you
posted. (2009) http://here.doh.wa.gov/materials/research-review-school-based-
DRAFT. SEPTEMBER 26, 2012
health-interventions-and-academic-achievement/12_HealthAcademic_E09L.pdf
(DATA)
Oregon Data and Reports (statewide only):
27. 2010 Oregon Benchmark Race & Ethnicity Report: A Report on the Progress of
Oregon’s Racial and Ethnic Diverse Populations (November 2010)
http://www.oregon.gov/DAS/OPB/docs/2010Benchmark_RE_Report.pdf (DATA,
HC A, CC)
28. Cultural competency in Health Care: Evaluating the Outcomes of a Cultural
Competency training Among Health Care Professionals (OSU)/Author:
Sunil/Journal of the National Medical Association
http://oregonstate.edu/cla/anthropology/reproductive_lab/sites/default/files/Kha
nna_Cheyney_Engle_2009.pdf (CC, HCA)
29. DHS 2008 Tobacco Related and Other Chronic Diseases Community Assessment
http://public.health.oregon.gov/PreventionWellness/HealthyCommunities/Commu
nityPlanning/Documents/3/3presentation1.pdf (DATA, CD tobacco)
30. DHS’s Keeping Oregonians Healthy: Preventing Chronic Diseases by Reducing
Tobacco Use, Improving Diet, and Promoting Physical Activity and Preventive
Screenings (2007)
http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/Documents/h
ealthor.pdf (CD, DATA)
31. NACDD Diabetes Council's Act on Data Work Group Guidance Document to
Diabetes Prevention and Control Programs Effective Use of Indicators for
Exploring the Social Determinants of Health. Since social determinants that
cause/contribute to diabetes also contribute to other chronic illnesses, this is a
helpful resource for any health topic you may wish to look at. In addition, the
WG that created this document prioritized use of indicators that are available at a
level of granularity below statewide (i.e., at the county level). (2010)
http://www.nacddarchive.org/nacdd-initiatives/diabetes/professionaldevelopment/act-on-data/AODSDOHGuidanceDocFinal.pdf (DATA, CD diabetes,
HC A, CC)
DRAFT. SEPTEMBER 26, 2012
32. Office of Multicultural Health: 2009-2010 Report
http://www.oregon.gov/OHA/oei/docs/an-rpt-09-10.pdf (DATA, HC A, CC, CD,
ID, MH/A)
33. Oregon Department of Human Services “The Burden of Diabetes in Oregon:
Surveillance Report”
http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/Diabetes/Doc
uments/burdenreport2008.pdf
34. Oregon Department of Human Services: Public Health Division. “SB 931: Task
Force for a Comprehensive Obesity Prevention Initiative”
http://public.health.oregon.gov/PreventionWellness/ObesityPrevention/ObesityTa
skForce/Documents/sb931obesitytaskforce2009final.pdf
35. Oregon Health Authority Public Health Data and Statistics (has MULTIPLE data
sources, including WIC data, chronic disease and mortality, vital stats, tobacco
stats, all of which can be broken down by County) (Variety of reports, 2011)
http://public.health.oregon.gov/DataStatistics/Pages/index.aspx (DATA)
36. Oregon Health Fund Board. Health Equities Committee Recommendations (2008)
http://www.oregon.gov/OHA/OHPR/HFB/docs/HEC_Final_Report_.pdf?ga=t (HC
A, CC, DATA)
37. Oregon Public Health Authority “ Oregon Overweight: Obesity, Physical Activity
and Nutrition Facts”
http://public.health.oregon.gov/PreventionWellness/PhysicalActivity/Documents/
Oregon_PANfactst_2012.pdf (CD obesity)
38. Oregon’s Action Plan for Health, December 2010
http://www.oregon.gov/OHA/action-plan/rpt-2010.pdf?ga=t (CC, DATA, HCA)
39. State of Black Oregon Report (2009)
http://www.doj.state.or.us/victims/pdf/the_state_of_black_oregon.pdf (HC A,
DATA, CC, CD)
40. State of Equity Report, Summary of Findings, June 2011. Phase 1: DHS/OHA:
Key Performance Measures by Race and Ethnicity
http://www.oregon.gov/OHA/oei/soe/docs/state-of-equity-report.pdf?ga=t
DRAFT. SEPTEMBER 26, 2012
(DATA, CC, HC A, MH/A, CD, ID)
41. State of Oregon: Department of Human Services: 2010 Report of Abuse and
Neglect for Individuals who Receive Mental Health and Developmental Disabilities
Services http://www.oregon.gov/DHS/data/publications/oit-report10.pdf (MH/A,
CC, DATA)
42. The Kaiser Family Foundation. State Health Facts. Oregon: Mental Health.
http://www.statehealthfacts.org/profileind.jsp?cmprgn=1&cat=2&rgn=39&sub=
28 (MH/A)
43. The Kaiser Family Foundation. State Health Facts. Oregon: Percentage of Adults
Reporting Poor Mental Health by Race/Ethnicity 2010.
http://www.statehealthfacts.org/profileind.jsp?ind=95&cat=2&rgn=39&cmprgn
51 (MH/A)
44. Tobacco Free Coalition of Oregon. Facts and Stats.
http://tobaccofreeoregon.org/resources/facts_stats (CD tobacco)
Clackamas County:
45. 2011 Community Health Assessment (no link)
46. 2012 Clackamas County Community Health Improvement Plan (not electronic)
(no link)
47. Clackamas County Roadmap to Healthy Communities, Community Assessment
Report (2011/2012) http://www.clackamas.us/community_health/roadmap.jsp
(DATA)
48. Oregon Health Authority. Clackamas County Tobacco Fact Sheet 2011.
http://public.health.oregon.gov/PreventionWellness/TobaccoPrevention/Docume
nts/countyfacts/clackfac.pdf
Marion County:
DRAFT. SEPTEMBER 26, 2012
49. Marion County Community Health Improvement Partnership Report (2012)
http://www.co.marion.or.us/NR/rdonlyres/E3C733DE-5D0A-41E7-BBCAABE2A2AA8783/39747/CHIPWebBooklet.pdf (DATA, HC A, CC, CD)
Multnomah County:
50. 2011 Multnomah County Community Health Assessment
http://web.multco.us/sites/default/files/health/documents/mapp_healthstatus.pd
f (DATA, HC A, CC, CD)
51. Communities of Color in Multnomah County: An Unsettling Profile (2012)
http://www.coalitioncommunitiescolor.org/docs/AN%20UNSETTLING%20PROFIL
E.pdf (DATA, CC, HC A, ID, CD, MH/A)
52. Multnomah Commission on Children and Families has collected the following data
Exclusionary discipline and keeping students of color in school (2012)
http://web.multco.us/news/schools-community-focused-keeping-students-colorschool (DATA, CC)
53. Multnomah Commission on Children, Families and Community (2012)
Exclusionary Discipline in Multnomah County Schools: How suspensions and
expulsions impact students of color
http://web.multco.us/sites/default/files/ccfc/documents/exclusionary_discipline_1
-3-12.pdf (DATA, CC)
54. Multnomah County Health Department: Report Card on Racial and Ethnic Health
Disparities (March 2008)
http://web.multco.us/sites/default/files/health/documents/reportcard_health_dis
parities_2008.pdf (DATA, CD)
55. Multnomah County Health Reports (LIST OF REPORTS)
http://web.multco.us/health/reports (DATA, CC, HC A, ID, CD, MH/A)
56. Multnomah County Mental Health and Addiction Services. Early Assessment and
Support Alliance. http://web.multco.us/mhas/early-assessment-and-supportalliance (MH/A)
57. The Asian Pacific Islander Community in Multnomah County: An Unsettling Profile
(2012)
DRAFT. SEPTEMBER 26, 2012
http://www.coalitioncommunitiescolor.org/docs/API_UNSETTLING_PROFILE.pdf
(DATA, CC, HC A, ID, CD, MH/A)
58. The Latino Community in Multnomah County: An Unsettling Profile (2012)
http://www.coalitioncommunitiescolor.org/docs/LATINO_REPORT.pdf (DATA, CC,
HC A, ID, CD, MH/A)
59. The Native American Community in Multnomah County: An Unsettling Profile
(2012)
http://www.coalitioncommunitiescolor.org/docs/NATIVE_AMERICAN_REPORT.pdf
(DATA, CC, HC A, ID, CD, MH/A)
Washington County
60. Washington County Commission on Children and Families, “Together for
Children; A Comprehensive Community Plan for 2008-2014”
http://www.co.washington.or.us/HHS/CCF/upload/Comprehensive-CommunityPlan-2008-2.pdf (DATA, HC A, CD, ID, CC)
61. Washington County Commission on Children and Families. 2010 Plan Update:
http://www.co.washington.or.us/HHS/CCF/loader.cfm?csModule=security/getfile
&PageID=576754 (DATA, HC A, CD, ID, CC)
62. Washington County Health and Human services. Local Public Health Authority
Comprehensive Plan for FY 2010-2013 For Washington County
http://public.health.oregon.gov/ProviderPartnerResources/LocalHealthDepartmen
tResources/Documents/Annual%20Plans/AnnualPlans_20102011/WashingtonComp10_11.pdf (DATA, CD, HC A)
One on One Interviews:
211info
A6 (African American AIDS Awareness Action Alliance)
American Cancer Society
American Lung Association
CAUSA
Clackamas County Community Health
Clackamas Service Center
DRAFT. SEPTEMBER 26, 2012
Coalition of Communities of Color
Healthy Birth Initiative
Latino Network
Marion County
Micronesian Islander Community
Multnomah Commission on Children, Families & Community
Multnomah County Health Department
Northwest Health Foundation
Oregon Action
Salem Keizer Equity Coalition
Sisters of the Road
Washington County Department of Health & Human Services