CCRS Partners with Division of Public Health to Promote Community Health

Delaware Voice Karyl T. Rattay 10:05 a.m. EST February 2, 2016

The mission at the Division of Public Health (DPH) is to protect and promote the health of all people in Delaware. Public health work is guided by a parable that says you can do your work downstream and pull drowning people from the river -- meaning to focus on treating the already sick.  Or you can focus upstream and work with people to keep them from falling into the river in the first place -- meaning prevent an illness before it starts.

Working with our many partners, Delaware is making progress as we can see population health measures improving in many areas. Yet even as our overall health improves, we have persistent health inequities in our state. In some cases, the gaps we see in health between different population groups or communities are getting worse, not better.

Individuals who are of low income or of color are more likely to have diabetes, suffer certain kinds of cancers and other serious chronic diseases, their life expectancy is often lower, and disability rates among these population often are higher.  For instance, Delawares black infant mortality rate was as high as 2.8 times that of the white rate for the most recent data available. Hispanic children in Delaware are four times as likely and non-Hispanic black children are nearly twice as likely to be in less than optimal health compared to non-Hispanic white children.  The number of Delaware children birth to age 5 living in poverty (a factor directly linked to poorer health outcomes)climbed from 12,481 (17 percent) in 2008-2010 to 16,417 (24.7 percent) in 2012-2014, according to Kids Count.

Persistent and growing inequities are certainly not unique to Delaware, however, it is time for a more concerted upstreaman effort focused on addressing those inequities.  Over the course of the past several years, DPH has worked with many community leaders, non-profit organizations, other governmental agencies and stakeholders to develop a strategy to reach our vision of health equity for all Delawareans where everyone will achieve their full health potential.

To help Delawareans understand our health inequities and how to reduce them, DPH, the Center for Community Research and Service at the University of Delaware, and other partners created the Health Equity Guide for Public Health Practitioners and Partners.  I am pleased to present this guide as a resource to support the efforts of DPH and our many partners, new and old. In this guide, you will find the evidence that supports the need to focus more of our attention and resources on underlying social conditions in our communities. The document shares evidence-based and promising strategies, and provides numerous references and web links for additional information.

As you will read, many of the factors that influence health are grounded in historical inequities, often beyond the reach of traditional public health efforts and beyond even the reach of state government. Health inequities result from a complex web of factors that span multiple sectors and disciplines. We all have a role to play in reducing such inequities, and this guide is meant to be a resource to promote and support a sustained, coordinated approach for moving upstream. Many individuals working outside of the health sector may not even realize the impact their work has on health and health equity. By raising awareness of the social determinants of health and sharing strategies and lessons learned for promoting healthier living and working conditions, we can mobilize our collective capacity to foster optimal health for all Delawareans.

I acknowledge that the concepts outlined in this guide represent a new way of doing business for DPH and our partners. Change is not always easy. But we also cannot afford to wait. According to the Centers for Medicare and Medicaid Services, per capita health care spending in Delaware is among highest in the country.

While there is a practical imperative for change that is difficult to ignore, there is also a moral imperative. It is simply not acceptable that Black infants in Delaware die at a rate that is more than twice that of White infants. It is unacceptable that in certain cases we may be able to predict how long someone will live based upon their ZIP code or income level. These are not naturally occurring or random phenomena.. Rather, they are systemic, structural, and predictable. At the same time they are not insurmountable. In fact, many efforts to improve social conditions are making a difference in the health of communities across the country. Many important initiatives are already making a difference in our state, for which I am grateful. Everyone regardless of race, ethnicity, ability, sexual orientation and economic or social condition has the right to attain their optimal health. I look forward to sharing this guide and working with you.