Identifying Public Health Competencies and Standards for Eliminating Health Inequities

Public Health Departments face many problems in seeking to address the increasing level of Health Inequities. Three has been a significant increase in public understanding of the underlying social causes of health inequities, yet the capacity of Health Departments to act on these social causes has been limited. Institutional policies and categorical funding often limit the range of practice, leading many departments to believe that action on the social determinants that lead to health inequities is not within their purview. Yet Healthy People 2010 recognizes the "need to take a multidisciplinary approach to achieving health equity" that involves improving health, education, housing, labor, justice, transportation, agriculture, and the environment. It is essential to rethink Public Health Practice to facilitate such an approach.

Since the 2002 Institute of Medicine's report that called on the public health community to consider how accreditation could improve the nation's health, several organizations have partnered on exploratory discussions of a national accreditation system. This is an opportune time to define concrete standards and competencies for achieving health equity, enabling public health departments to understand and address health inequities in practice and advance thinking in the field.

Over the past year BARHII has been spearheading a regional initiative to think critically about competencies, policies and standards that are essential for eliminating health inequities. Representatives from seven county public health departments participated in a series of consensus-building discussions during which time they sought to define the most critical elements of Public Health Departments as social change organizations. The group ultimately categorized their outcomes into a "matrix" of 9 Workforce Competencies and 9 Organizational Standards and Policies.

1. Specific Personal Attributes
2. Knowledge of Public Health Framework
3. Understand the social, environmental and structural determinants of health
4. Community Knowledge
5. Leadership Skills
6. Collaboration Skills*
7. Community Organizing Skills
8. Problem Solving Ability
9. Cultural Competency/ Cultural Humility

1. Institutional Commitment to Address Health Inequities
2. Hiring to Address Health Inequities
3. Structure that supports true community partnerships
4. Support Staff to Address Health Inequities
5. Transparent & Inclusive Communication (community, staff, partners etc.)
6. Institutional support for innovation
7. Creative use of categorical funds
8. Community Accessible Data & Planning
9. Streamlined administrative process

In developing the matrix, committee members admitted that there were many dimensions where their respective health departments were already making headway in addressing health inequities and others where there was room for improvement. Organizational self assessment would be an effective tool for gauging these areas and a necessary first step for identifying specific methods of enhancing institutional capacity. The committee has retained La France and Associates to weave together local public health community knowledge as well as public health and organizational development theory into a comprehensive Self Assessment Tool. This tool scheduled for completion October 2007 will be piloted in one of BARHII's member departments and available for public use in 2008.