applying a health equity lens when completing bill analyses gail brandt, bs, mph, edd washington...
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Applying a Health Equity Lens When Completing Bill Analyses
Gail Brandt, BS, MPH, EdDWashington State Department of Health | Heath Equity Manager
Kristin Villas MPAcEvans School of Public Policy and Governance | University of Washington
Background
• Standard bill analysis template• Two new questions added in 2015• No staff preparation to answer new
questions
New Questions for 2015 Legislative Session
Purpose and Scope of Project
Identify Resources and Training Needs on Health Equity and Tribal Health
Four Phases1. Contact other states2. Review responses on two new questions3. Meet with legislative coordinators and liaisons 4. Interview sample of analysts (n =21 )
Analyst Responses: Health Equity180 bills received a hearing
70 different analysts
15%
33%52%
Response TrendsBlank None/NA/UnknownUnique Response
Bill Analysis – Health Equity example
Populations near major roadways are exposed to
more air pollution and suffer health impacts of
poor air quality. These populations near major
roadways are lower income and composed of more
minorities than state. They will benefit more from
improved air quality as a result of this legislation.
Analyst Responses: Tribal Health
14%
55%
31%
Response TrendsBlank None/NA/UnknownUnique Response
Bill Analysis – Tribal Health example
Data indicates that Native Americans and Alaska
natives have the highest rate of suicide out of all
population groups in the state; however, tribal health
concerns are not addressed in this bill and the bill does
not include tribal colleges (such as Northwest Indian
College). The tribes are stakeholders in the
department’s state plan efforts.
Meet with Legislative Liaisons and Coordinators
1. Inform about project2. Obtain names of analysts to interview3. Gather suggestions for training and resources4. Meet with Workforce Development Manager
to prepare for training needs
A Few Interview Questions• Briefly describe what the term health equity
means to you.
• What factors do you consider when deciding how a bill would impact health equity?
• If you were unsure of how to answer either the tribal health or health equity question, what did you do?
• What training and resources would be helpful?
Interview Findings• Understanding of Health Equity varies
• Confusion with the Tribal Question
• Some difficulty identifying how bills impact tribal health and health equity
• Analysts used a diversity of resources
• What’s behind “N/A”?
• Want rationale/goals/evaluation
Training Recommendations• Incorporate into existing Bill Analyses training
• Clear definition of health equity
• Include relevant examples of good answers and answers needing development
• Communicate expectations for citations, research time, and order of impact
• Short video explaining rationale from leadership
Training Recommendations• Develop a matrix of social and economic factors and
their link to health outcomes (e.g. non-graduation leads to lower lifetime earnings and shorter life expectancy)
• Provide key health trends by race/sexual orientation/age
• Tribal member to give overview of tribal law and governments
• All training information posted to intranet
• Resource list on intranet
Related Suggestions
• Add “please explain” to both questions
• Revise tribal health to specify both legal and health considerations
• Help “in my backyard” list
What should we do with the answers?
• Discuss during agency level bill reviews
• Recommend amended language to bill
• Determine position on legislation
• Develop talking points for testimony
• Explore future training and resource needs
What should we do with the answers?
• Assess impact on tribes to comply with Consultation Requirements
• Meet legal and agency requirement to consult with tribes on issues with significant impact
• Know who is most impacted to make policy/work relevant to tribes
Next Steps
Recommend to
leadership
Develop training
and resources
Test
Apply
Evaluate
