“…the moral growth of a great nation requires reflection…” - Frederick Douglas Reflections on Public Health Practice
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“…the moral growth
of a great nation
requires reflection…”
- Frederick Douglas
Reflections on Public Health Practice
Source: Nebraska DHHS Vital Statistics Report 2014
• Reflection 1: How equity minded is your practice?
• Reflection 2: How evidence basedis your practice?
• Reflection 3: How community integrated is your practice?
Reflections on Public Health Practice
Reflection 1:
How equity minded is your practice?
Mission:
Strengthen public health leaders and
organizations to promote equity and
improve the health of urban women,
families, and communities.
Abresch, C. & Lee, J. (2015). Representative bureaucracy in local public health
agencies: Do top bureaucrats represent women and minorities?. Unpublished
manuscript, School of Public Administration, University of Nebraska, Omaha.
Abresch (2015). Social equity and urban health disparities: A mixed methods
investigation. Unpublished manuscript, School of Public Administration, University of
Nebraska, Omaha.
Abresch (2015). Social equity and bureaucratic identity: A discursive analysis.
Unpublished manuscript, School of Public Administration, University of Nebraska,
Omaha.
Chad: This is a personal
question: so why is it
important for you
personally to be
addressing health
disparities?
Ivy: “For me personally, well part of it is
that again as I highlighted, I come from a
background of non wealth, but still being
born and raised white and in a white—
predominately white—community.”
Ivy: “But then in adulthood have married an African
man—black man—and I now have a mixed race son and
so coming to terms with the reality that my son is going to
have to face is heartbreaking at times” ((crying))
Ivy: “… ” “and seeing the reality that I brought my husband
into being that he was an immigrant and I brought him to
this country and the challenges that he has to face living
here is ridiculous” ((crying again)) “so yeah pretty personal.”
Chad: “final question; this is a
personal one: you’ve talked a
lot about the justification for
working on health disparities
and the reason for the health
department but would you
mind talking just a little bit
about why it’s important for
you?
Robin: “Okay, yes because my
story is not unlike a whole lot of
African American people. I was
raised by a single mother and
there was six children so needless
to say we were poor; however, we
didn’t know that because we had
what we needed and we had love”
Robin: “And my mother was a prime
example for me as to what community
engagement is because even before there
were food pantries with these official
titles, my mother, we lived in a project (I
mean we lived in a community that people
called the projects) but she was always
helping her neighbors her community our
people…”
Robin: “…she just felt that compassion to do
something and I’d say she’s the first that I saw
that actually embellished what community is and
what we need to do. And we saw her do that—
all of us children—so we just kind of fell in line
you know we have to step up to the plate and
we have to speak up for what we see is
injustice…so for me it’s just carrying on the
tradition of family”
• Equity practice is often based in personal historical narrative.
• Regardless of minority status, public sector employees can hold personal rationales that lead to equally high levels of social equity activity.
• Know your narrative! And, consider helping others on your team to articulate and embrace their own story.
Application
Reflection 1:
How equity minded is your practice?
How personal is my equity practice?
Reflection 2:
How evidence-based is your practice?
• Evidence-based programming is important
and holds promise for improving outcomes.
• ‘Evidence-based’ is not always ‘real-world
based’ (i.e., implementation science)
• Innovation is equally important!
What we know…
Given this…
Balance is called for… between evidence
and innovation… between perfect
fidelity and local tailoring.
Downstream
Strategies
Upstream
Strategies
Preventio
n Vehicles
racism
Equity Institute Training
Upstream Strategies
Education, Racism, housing, labor,
justice, transportation, agriculture,
environment, etc.
Prevention
Vehicles
Home Visiting,
Medical Homes
and Neighborhoods,
Case Management,
WIC, Centering,
Baby-friendly Hospitals and
Birthing Clinics, Doula Care,
etc.
Downstream
Strategies
Family Planning,
Maternal Stress
Prevention and
Management,
Tobacco, Alcohol, other
Drug Cessation,
Progesterone, Kangaroo
Care, Safe Sleep, etc.
Equity Institute Training
Equity Institute Training
• Ready, Set, Go!
– READY phase: It’s about data and community.
Assessments and activities to ensure community
readiness and a thorough understanding of the
disparity.
– SET phase: It’s about developing the logic model,
evaluation plan and all other local components
needed for successful intervention.
– Go phase: It’s about implementation and ongoing
monitoring and evaluation.
Reflection 2:
How evidence-based is your practice?
and innovative
Reflection 3:
How community integrated is your
practice?
Old Model
- Bureaucratic
- Inefficient
- One Service (No Choice)
New Model
- Market-oriented
- Customers not Citizens
- Contracts and Collaboration
- Old and new coexist
- Both Models have strengths
and limitations
- Opportunity! Realize greater
democratic participation in
addressing society’s “Wicked
Problems”. Collective Impact
Collective Impact
Collective impact initiatives are long-term
commitments by a group of important actors from
different sectors to a common agenda for solving a
specific social problem. Their actions are
supported by:
• A shared measurement system
• Mutually reinforcing activities
• Ongoing communication,
• And are staffed by an independent backbone
organization (p. 39)
Source: Kania, J., & Kramer, M. (2011). Collective impact.
Collective Impact
“If successful, it presages the spread of a new
approach that will enable us to solve today’s
most serious social problems with the resources
we already have at our disposal” (p. 41)
Apart from ‘solving’ social ills, there is an
inherent democratic value—with social capital
investments—derived from approaching the
administrative work of state as collective impact
initiatives.Source: Kania, J., & Kramer, M. (2011). Collective impact.
CityMatCH Collective Impact
Learning Collaborative
• Funded by MCHB
• Partners Tamarack Institute and FSG
• 10 Teams Per Year, Next 3 Years
• 1-Year Training, Planning, and Peer Exchange, Then
Implementation
• Teams Choose Local Projects
• Ongoing Support and Evaluation of Effort
Collective Impact
CILC Cohort 1Teams
1. San Luis Obispo, CA 6. Nashville, TN
2. Salt Lake City, UT 7. Peoria, IL
3. Fort Collins, CO 8. Little Rock, AR
4. Fort Worth, TX 9. Rhode Island
5. Milwaukee, WI 10. Tallahassee, FL
Collective Impact
1. Los Angeles
2. Portland
3. Everett, WA
4. St. Paul, MN
5. Phoenix, AZ
6. Pinellas County, FL (St.
Petersburg/Clearwater)
7. Detroit
8. Atlanta
9. Indianapolis
10. Philadelphia
11. Chicago
12. NYC
CILC Cohort 2 Teams
Year-3 Applications Coming Soon!
• Establish and promote a personal narrative
and an agency vision for equity (in every
form)
• Balance programming between evidence-
based and innovative; build stronger
capacity for doing both; and, think
upstream and down
• Work with (not only for) community,
striving to make a collective impact
Final Thoughts
Chad Abresch (and daughter Isla)
CityMatCH Executive Director
Special thanks to Shabana Sidhu for being awesome smart and helping with this presentation!
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