“…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 Unpublished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 Unpublished manuscript, School of Public Administration, University of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Unpublished manuscript, School of Public Administration, University of Nebraska,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

cabresch@unmc.edu

Special thanks to Shabana Sidhu for being awesome smart and helping with this presentation!