Community Partnership Fund Community Health Grant Technical Assistance

Community Partnership Fund: Community Health Grant Technical Assistance Workshop February 22, 2019

Page 2 Agenda Ø Background and Overview Ø Goals and Funding Priorities Ø Policy, Systems and Environmental Change Strategies Ø Equity Ø Q and A

3 Overview ØThe Metro Public Health Department (MPHD) seeks grant applications that align with the community’s priority health needs as defined in the Healthy Nashville Community Health Improvement Plan (CHIP). CHIP Priorities ØProposal must address: • One or more of the CHIP priority area goals, • Advance health equity, • Incorporate a Policy, Systems or Environmental (PSE) change strategy

4 CHIP Priority Goals Ø Maximize the Built and Natural Environment Goals: • Increase active transportation, i. e. , walking or biking options and utilization. • Improve and protect the quality of air, land water Ø Support Mental and Emotional Health Goals: • Provide individuals and families with the support necessary to maintain positive mental well-being • Promote positive parenting and violence free homes

5 Policy, System and Environmental (PSE) Strategies Ø Approaches that seek to go beyond programming and into the systems that create the structures in which we work, live and play.

6 Event/Program vs. PSE Change Characteristics of Event or Program Characteristics of PSE Change One time Ongoing Additive: often results in only short‐term behavior change Foundational: often produces behavior change over time Individual level Community/Population level Not part of ongoing plan Part of an ongoing plan Short term Long term Non‐sustaining Sustaining

7 Policy Change Ø Creating or changing a written statement of an organizational position, decision, or course of action. Ø Can be made in public, non-profit, and business sectors. Ø Can be at various levels – organizational, professional, government.

8 Policy Examples: • Workplace rules, agreements, decisions, agreed upon ways of doing business, standards

9 Metro Paid Family Leave 5. 17 PAID FAMILY LEAVE Full-time employees who have been employed with Metro for at least six (6) months are eligible for up to thirty (30) work days of Paid Family Leave (approximately six business weeks) for the birth or adoption of a child and/or to provide care for a spouse, parent, or child as defined by the Federal Family and Medical Leave Act (FMLA). The Paid Family Leave program will be administered within the guidelines of the FMLA Policy Handbook maintained by Human Resources and publicly available to all employees. Paid Family Leave time will run concurrently with time designated as FMLA leave.

10 MPHD Wise Moves Policy Summary The Metro Public Health Department (MPHD) understands and acknowledges that health is a state of physical, mental, and social wellbeing. Modifiable lifestyle changes such as nutrition, stress management, weight control, tobacco use and sleep habits are significant influences on health. Improving employees’ health requires a broader view of wellness. Mental health is an important part of health, as it influences how people handle stress, relate to others, and make choices. Mindfulness and meditation are practices that use breathing, quiet contemplation or sustained focus on something to reduce stress and anxiety, lower blood pressure, manage depression, improve cognition and reduce distractions. Regular physical activity increases quality of life through improved endurance, strength, flexibility and balance. Healthy employees reportedly incur fewer medical expenses, have increased productivity, improved morale, use fewer sick days, and have fewer health risks and work-related injuries. By taking a holistic approach to wellness, employees will have more opportunities to improve their overall health and well-being. Policy When MPHD employees engage in wellness activities, they act to model and achieve the mission of MPHD to “protect, improve and sustain the health and well-being of all people in Metropolitan Nashville. ” Therefore, MPHD adopts the following Wise Moves Wellness Time policy to encourage and support employees to practice wellness during the workday.

11 Systems Change Ø A group of interrelated and interacting entities, processes or people (social systems). • Defining what is included in the beginning and the relationships between the parts and how each affects the other. Ø Focuses on changing infrastructure within or between a setting(s) or organization(s) that institutes processes or procedures at the system level. Ø Unwritten, ongoing, decisions or changes that result in new activities reaching large proportions of people. Can alter how business is conducted.

12 Systems Examples: Ø Procedures between or within organizations such as personnel, resource allocation, programs, processes. Ø Can occur in settings such as schools, parks, worksites or healthcare.

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14 Fall Hamilton Elementary

15 Environmental Change Ø A change made to the environment through physical, social, and economic factors that influence people’s practices and behaviors. Ø Not necessary to pass a policy

16 Environmental Examples: Ø Physical - Structural changes or programs or service. Ø Social - A positive change in attitudes or behavior about policies that promote health or an increase in supportive attitudes regarding a health practice. Ø Economic - Presence of financial disincentives or incentives to encourage a desired behavior.

17 Historical Example: Ø John Snow couldn’t persuade others that contaminated water caused cholera Ø Epidemic killed 616 people; 500 fatal attacks in 10 days near the Broad Street Pump Ø September 7, 1854: Took research to town officials, who took the handle off the pump Ø Outbreak stopped almost immediately

18 Nashville B-Cycle

19 Examples of PSE Change in Different Settings

20 PSE Overlap Ø PSE strategies may overlap across all three categories: policy, systems, and environment. Example: • California’s smoking ban is a policy change that led to a systems change for workplaces and restaurants. • Prohibiting smoking created an environmental change that allowed for a general smoke free environment, making it a social norm. Ø PSE strategies may also overlap across health sectors or programs.

21 Question 1 Which is an example of a PSE Approach? a. Doing food demonstrations at a grocery store. b. Working with local chefs on menus using WIC approved foods and with grocery store chain to schedule those chefs to do food demonstrations on a regular basis.

22 Question 2 Which is an example of a PSE Approach? a. Getting local health insurance group to pay for smoking cessation programs. b. Providing counseling to pregnant women in OB offices about the dangers of smoking.

23 Question 3 Which is an example of a PSE Approach? a. Offering and promoting a Zumba class at work. b. Turning an unused space into a locker room and fitness facility.

24 Advance Health Equity Proposals should describe how the project incorporates equity in practices and processes and the social determinants of health. Definitions: The societal and systematic understanding and appreciation of differences among individuals and populations; where everyone is valued and has the opportunity to achieve optimal health and well-being (2015 Health Equity Recommendations Report). Both the absence of systemic obstacles and the creation of opportunities for all to be healthy. (MPHD)

Health Equity Everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care. Source: Robert Wood Johnson Foundation’s “What Is Health Equity? And What Difference Does a Definition Make? , ” 2017.

26 Health Inequities Exist and Persist: Ø Inequity has been most commonly associated with those that have suffered from discrimination related to their: • Race • Religion • Ethnicity • Neighborhood • Gender • Education • Sexual Orientation • Income • Nationality • Ability Level • Language Ø The unequal distribution of power, money and resources has led to fundamental inequalities in the distribution of social determinants of health.

27 Advance Health Equity Ø Social Determinants of Health (SDOH) • The conditions in the places where people live, learn, work, worship and play, affect a wide range of health risks and outcomes. • Addressing SDOH removes barriers and create opportunities to advance health equity for all. • They can be influenced and changed

28 Social Determinants of Health

29 Levels of Equity/Inequity

STEP 1 STEP 3 STEP 5 STEP 7 continuously evaluate effectiveness and adapt strategies conduct equity impact assessment for all policies & decision making STEP 6 identify strategies & target resources to address root causes of inequities conduct systems analysis of root causes of inequities STEP 4 gather and analyze disaggregated data engage affected populations and stakeholders STEP 2 establish an understanding of equity and inclusion principles Source: Embracing Equity: 7 Steps to Advance and Embed Race Equity and Inclusion Within Your Organization, by the Annie E. Casey Foundation (2014).

31 Equity in Practice Ø Community/stakeholder engagement Ø Use data to select a community/population that is Ø Ø experiencing inequities Focus on root causes of inequities (racism, sexism, classism, etc. ) within policies and practices Sharing power and resources with communities most affected by issue Partner with community members and organizations that are of and from affected community Examine which SDOH are most connected to particular community’s health inequities

32 Equity in Policy Ø Nashville Metro Arts Commission – Historically, only major arts institutions were able to obtain funding from their grants program Ø Policy change allowed for individual artists to receive grant funding from Metro Arts Created equity by reallocating resources from large arts institutions to individual artists through a policy change

33 Equity in the Environment Ø Construction of I-40 interstate isolated North Nashville Ø Construction of 28 th /31 st Avenue Connector reconnected North Nashville and West Nashville Created equity by allocating funds and resources to build an environmental change

34 Equity in Systems Ø Requires a combination of equitable practices, policies and environments Ø Also requires cross-sector and community collaboration, sustainability and cultural humility/competency

35 Additional Project Priorities Ø Cross-sector Collaboration Ø Sustainability Ø Culturally Competent

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