Click on the policy priorities below to find recent studies, research and reports on each topic:

General Resources Provide Health Homes for All Healthy Eating and Active Living Next Steps toward Closing the Health Disparities Gap

Washington State Board of Health

The State Board of Health’s (SBOH) “For Your Information” web page has excellent health-related information updated on a regular basis and should be considered the go-to source for current information on correspondence to and from the Board, a selection of health publications, media articles that relate to the Board's authority or strategic goals, health-related conferences, and available public health positions.

www.sboh.wa.gov/FYI/FYI.htm

CDC Div. of Adolescent & School Health (DASH) website

Find tools, publications, and 'how-to' program evaluations on health topics such as asthma, childhood overweight, crisis preparedness, injury & violence (including suicide), physical activity, nutrition, sexual risk behaviors and tobacco use. This website is also a resource for strategies, best-practice models at the federal, state and local level, as well as data (YRBSS, Profiles, SHPPS, by state) and recent articles.

www.cdc.gov/HealthyYouth

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Closing the Divide: How Medical Health Homes Promote Equity in Health Care

The Commonwealth Fund 2006 Health Care Quality Survey finds that when adults have health insurance coverage and a medical home—defined as a health care setting that provides patients with timely, well-organized care, and enhanced access to providers—racial and ethnic disparities in access and quality are reduced or even eliminated.

http://www.commonwealthfund.org/usr_doc/1035_Beal_closing_divide_medical_homes.pdf?section=4039.

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Health and Economic Benefits of Reducing the Number of Students per Classroom in US Primary Schools
American Journal of Public Health; Nov2007, Vol. 97 Issue 11
Smaller class sizes in grades kindergarten through third grade are causally linked to greater high school graduation rates. Investment of smaller class sizes would generate a net cost savings of approximately $168,000 and a net gain of 1.7 quality-adjusted life-years for each high school graduate. Policy implications to enforce smaller class sizes is estimated to generate 72,000 to 140,000 additional graduates each year.

www.pceo.org/pubs/AJPH%20Education%20Small%20Class%20Size.pdf

Healthy Youth! Student Health and Academic Achievement
This link reinforces the strong relationship between academic achievement and health in advocating for school health programs and education interventions. Health problems, such as hunger and abuse, are barriers to academic achievement. Academic failure, in turn, is strongly linked to substance abuse, violence and physical inactivity. School health programs and smaller class sizes are empirically supported in raising academic achievement and health.

www.cdc.gov/healthyyouth/health_and_academics/index.htm

Childhood Obesity in Rural Pennsylvania presentation
Kelly Loomis, MS, RD, LDN, Project Coordinator for Steps to a Healthier PA-Fayette County
The Fayette County School District refers children ages 6-14 with a high Body Mass Index to the Steps KidShape program, a 9-week program that requires parental participation. Approximately 50 percent of the children lowered their BMI after 9-weeks (the program focuses on weight maintenance, not weight loss). A major factor in their success was rotating the classes throughout the county rather than holding them in one central location. KidShape conducted a 12-month follow up with all participants. Another important finding was the need to address culture and environment. A Family Steps Support Group was created to keep program graduates motivated, and an adolescent program model is being designed.

www.stepstoahealthierfayettecounty.org/index.html

Each Student Successful Summit Report
The report includes speaker presentation summaries, results from break-out sessions, and a discussion of Next Steps. Topics include an inventory of best or most promising practices, information on conducting needs assessments at the community level, and information on the link between health and education. The report concludes that system-wide change is needed in both health and education (such as implementing the Coordinated School Health Program, curriculum changes, a population-based model for wellness in health care, and working to get kids 'into health'), as well as policy strategies (such as promoting the term “equity” instead of “disparities”, finding health champions and closing the achievement gap, designating funding for collaboration and implementing programs, and providing incentives for health care providers and math/science professionals to help build a healthy education system).

www.sboh.wa.gov/ess/documents/FinalReport.pdf

National Association of State Boards of Education
This site offers a practical look at how education systems work at the school, district, state and national levels, including tips for how to work with educators, administrators and policymakers. Resources include reports, publications and articles, a state level school health policy database, a best practice database, healthy eating, HIV prevention, and information about its projects (Center for Safe & Healthy Schools, Early Childhood Education Network, High School Redesign Initiative, State Adolescent Literacy Network, Student Leadership Initiative, Study Group on English Proficiency & Language Preservation).

www.nasbe.org

Successful Students Web Site: Supporting School Health in Washington
The Washington State Department of Health, Office of Superintendent of Public Instruction, University of Washington Center for Public Health Nutrition and partner organizations developed this website to increase access to existing school health resources. The website provides information for schools developing or implementing the Coordinated School Health model. It also provides access to wellness policy resources and a catalog of policies from school districts across Washington state.

www.healthyschoolswa.org

Giving Everyone the Health of the Educated: An Examination of Whether Social Change Would Save More Lives Than Medical Advances
Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to elimination disparities, but the changes would save more lives than would society's current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health.

http://www.whf.org/documents/health&education.pdf [4.91 MB]

School Nutrition Association Report
School boards nationwide have approved student wellness policies that include such key characteristics as more nutrition education, mandatory recess and additional nutrition standards for foods and beverages available outside the school cafeteria, according to "A Foundation for the Future II," a new study by the School Nutrition Association (SNA). SNA analyzed the local wellness policies approved by 140 school districts in 49 states.

http://www.schoolnutrition.org/uploadedFiles/SchoolNutrition.org/
News_&_Publications/School_Foodservice_News/ New_Folder/Regional LWP Report.pdf

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A Conceptual Framework for Action on the Social Determinants of Health Report
Commission on Social Determinants of Health, April 2007 World Health Organization Director-General Lee Jong-wook created the Commission on Social Determinants of Health as part of a comprehensive effort to promote greater equity in global health. The Commission’s goal is to advance health equity, and to reduce health differences among social groups within and between countries.

www.sboh.wa.gov/hdcouncil/Meetings/2007/2007-09-20/documents/Tab07c-CSDHReport.pdf

Governor's Interagency Council on Health Disparities website
The Governor's Interagency Council on Health Disparities was established by the Washington State Legislature in 2006 to eliminate health disparities. This website contains updates on Council priorities, detailed materials, reports and information from Council meetings, and information on how to join the mailing list and how to attend Council meetings.

www.sboh.wa.gov/hdcouncil/default.htm

Logic Model: Social Determinants of Health and Health Disparities
Governor’s Interagency Council on Health Disparities
This logic model demonstrates how social, economic and political mechanisms result in the stratification of populations by socio-economic status, power and prestige for which race/ethnicity, gender, social class, education, occupation, and income are often proxy indicators. The model assumes that those with lower socio-economic position have less favorable material circumstances, health behaviors, psychosocial factors, and experiences with the health system. The unequal distribution of these intermediary social determinants of health constitutes the mechanism by which socio-economic position generates health disparities.

www.sboh.wa.gov/hdcouncil/Meetings/2007/2007-09-20/documents/Tab07b-LogicModel.pdf

Making A Difference In Differences For The Health Inequalities Of Individuals
Health Affairs, Vol. 26, No. 5, September/October 2007
This article states that policy interventions should focus on the degree to which health conditions are persistent, avoidable and treatable. Assistance should be targeted to people who are at greater risk for such conditions. The highest-yield interventions should address prenatal and early childhood care and reformation of destructive lifestyle practices. It states that improving outreach, education, access and service delivery represent a more important factor in health outcomes than expanding the level and scope of insurance coverage.

http://content.healthaffairs.org/cgi/content/abstract/26/5/1235

Overweight and Physical Inactivity among Rural Children Aged 10-17: A National and State Portrait
South Carolina Rural Health Research Center, May 2007
The South Carolina Rural Health Research Center used the National Survey of Children's Health to compare rural and urban children for obesity and physical inactivity, with children ages 10-17 broken ethnicities of African-American, Hispanic, Caucasian, and other. The rural or urban designation was made at the county level. They found that while rural children were more active and spent less time on non-educational electronic media, they had higher levels of obesity. It found children of color were at substantially higher risk for obesity than rural or urban Caucasians, with African-American children much higher, even though Hispanic children were more inactive than African-American children. The biggest risk factors they found were being male, being a minority, living in unsafe neighborhoods, having poor health as a child, and inactive parents. Executive Summary available at:

http://rhr.sph.sc.edu/report/SCRHRC_ObesityChartbook_Exec_Sum_10.15.07.pdf

Racial & Ethnic Health Disparities: Influences, Actors, and Policy Opportunities
While most action has focused on individual sectors of health or social policy, such as coverage for the uninsured, linguistically appropriate care, or neighborhood changes to support healthy eating and active living, this paper aims to equip multi-sectoral actors with a shared language and model to consider the problem of health disparities, as well as potential solutions. It provides a basis for dialogue and strategy development and implementation. The Kaiser Permanente Institute for Health Policy supports policy action around individual socioeconomic circumstances, the physical and cultural community environment, personal management of health and health care financing and delivery.

www.kpihp.org/publications/docs/disparities.pdf

What Influences Our Health
A presentation by Washington State Health Officer Maxine Hayes at the Each Student Successful Summit (May 18, 2007) that outlines policies to improve community health and strategies to eliminate health disparities. This includes using the term health “equity” instead of “disparities”, educating policymakers and communities on the consequences of disparities, illustrating to policy makers as well as health and education professionals the impact of social determinants on health and academic achievement, and partnering to take action.

www.sboh.wa.gov/ess/presentations/hayes.pdf

Washington State DOH: Barriers to Health and Effective Utilization of Existing Resources
Sita DeGiulio Das, Cross Cultural Health Care Program
The Cross Cultural Health Care Program was chosen by the Washington State Department of Health to report on select findings from research conducted for its Cultural Navigator Program. This identifies barriers to health and effective utilization of existing resources for patients using health systems that target populations with limited access to care.

www.sboh.wa.gov/hdcouncil/Meetings/2007/2007-09-20/documents/Tab04f-CCHCPFocusGroupReport.pdf

Culturally and Linguistically Appropriate Health Education Materials: Access, Networks, and Initiatives for the Future
Alyssa Sampson, MLIS, Cross Cultural Health Care Program
In response to four bills passed by the Washington State Legislature in 2006 that deal with health disparities, the State Board of Health requested proposals for assessments regarding language access to health care in Washington, addressing either interpreter services, culturally and linguistically appropriate health information, or both. The Cross Cultural Health Care Program received a contract to explore and assess culturally and linguistically appropriate health information and ways to improve access to such materials.

www.sboh.wa.gov/hdcouncil/Meetings/2007/2007-09-20/documents/Tab04e-CCHCPAssessment.pdf

Disparities in Health: Perspectives Of A Multi-Ethnic, Multi-Racial America
Health Affairs, Vol. 26, No. 5, September/October 2007
This 2006 survey of 4,157 randomly selected U.S. adults and compared perceptions of health care disparities among fourteen racial and ethnic groups to those of whites. Findings suggest that many ethnic minority groups view their health care situations differently and, often, more negatively than whites. A substantial proportion perceived discrimination in receiving health care, and many felt that they would not receive the best care if they were sick. The report concludes that these responses demonstrate the importance of examining ethnic subgroups separately rather than combined into a single category.

http://content.healthaffairs.org/cgi/content/abstract/26/5/1437

Racial and Ethnic Disparities in Access to and Quality of Health Care
This Robert Wood Johnson Foundation Synthesis Project report presents findings on the size and causes of racial and ethnic disparities in health care access, as well as disparities in quality of care. It finds that disparities in access to, and quality of, care are pervasive although not universal. The largest access disparities are found among Spanish-speaking Hispanics. Insurance coverage, income and other factors explain a portion of the disparities, but racial and ethnic gaps in access and quality remain after accounting for these factors, and after adjusting for other factors, disparities in recommended processes of care—the appropriate use of screening tests, medications, and laboratory tests—tend to be small or non-existent.

www.rwjf.org/pr/synthesis/reports_and_briefs/issue12.html?c=EMC-CA142

Health Disparities across the Lifespan:
Selected Medical Conditions and Risk Factors in Washington State
In 2006, the FSDB (First Steps Database) found that African American infants have the highest rate of low birth weight at 9.l%, which is more than double that of white infants (4.1%). African Americans and Asian/Pacific Islanders also have the highest rates of Infant Mortality, with 10.9% and 11.4% respectively. This is more than triple that of Asian Americans (3.3%) and double that of White and Hispanic infants (5.2% and 5.0%, respectively). To read more about infant, childhood, and adult outcomes, click on the PDF below.

Disparities by Disease

Infant Mortality and SIDS
The First Steps Database (FSDB) found that enhancing prenatal services for mothers and infants has reduced rates of Infant Mortality and SIDS in Washington State 1990s for all racial groups except Infant Mortality rates American Indians. Regardless, the death rates among African Americans and American Indians remain higher than rates for white infants, though the gap has narrowed since the 1980s. However, for Medicaid infants, disparities between whites and African Americans have been eliminated, though only reduced between whites and American Indians. http://www1.dshs.wa.gov/pdf/ms/rda/research/9/81.pdf.

Key Health and Health Care Indicators by Race/Ethnicity and State
In April 2007, the Kaiser Family Foundation compared national and state rates of six different health and health care indicators: Infant Mortality, Diabetes-Related Mortality, Annual AIDS cases, those living in poverty, those with Medicaid, and those uninsured. These measures were compared among Whites, African Americans, and Hispanics/Other. http://www.kff.org/minorityhealth/upload/7633.pdf.

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