Oregon’s next health plan to tackle social factors
Oregon’s next State Health Improvement Plan will take on social factors that can affect people’s health, including exposure to racism, childhood trauma, living-wage jobs, food security and access to health care, the Oregon Health Authority said Friday.
The PartnerSHIP, a steering committee responsible for developing the 2020-2024 SHIP, determined the priorities during a meeting on Feb. 12. They include:
Institutional bias: This is defined as the systematic distribution of resources, power and opportunity in society to the benefit of people who are white and the exclusion of people of color, people with disabilities, people with low income and people who identify as LGBTQ+. This can have a significant effect on health. Adversity, trauma and toxic stress: These experiences can include abuse and neglect, living in poverty, incarceration, family separation, and exposure to racism and discrimination. These events have a lifelong effect on health and are correlated with things like substance use, suicide and even some cancers. Economic drivers of health, such as housing, living wage, food insecurity and transportation: Poverty is a strong predictor of poor health. Although Oregon’s economy is growing, many are struggling to get out of poverty despite having a job due to the high cost of living or raising a family. People living in poverty experience higher rates of premature death and increased rates of homelessness, mental distress and food insecurity. Access to equitable preventive health care: Despite an increasing number of people with health insurance, many are challenged to get to a health care provider or see a dentist due to provider shortages, transportation barriers, health care costs, or because they don’t feel comfortable with their provider due to language or other cultural difference. Behavioral health, including mental health and substance use: Oregon has one of the highest rates of mental illness in the country. Tobacco and substance use are the first and third leading causes of death, respectively, in Oregon. Mental distress can lead to lower quality of life, unemployment and increased rates of suicide. Use of alcohol, opioids, methamphetamine and other substances have a significant impact on many families.
According to the State Health Assessment that OHA published in July 2018, Oregon “lags far behind many other states in measures of the social determinants of health, which are social factors that influence health.” Oregon’s low standing in education, housing affordability and food insecurity have contributed to a decline in the state’s relative standing in national scorecards of health measures.
The 2018 United Health Foundation’s Annual Health Rankings found that Oregon has had the largest decrease in the country in national ranking. Oregon is the 21st healthiest state in the country, down from eighth in 2011. Persistent health inequities among people of color, people with disabilities, people with low income, and people who identify as LGBTQ+ remain high.
“The 2020-2024 SHIP priorities reflect where we need to focus our efforts and respond to the statewide health challenges uncovered in the State Health Assessment,” said Katrina Hedberg, MD, state health officer and epidemiologist at the OHA Public Health Division. “They take a more upstream approach to improve the health of everyone in Oregon in a more equitable way.”
The SHIP priorities were chosen from a list of health issues identified in the 2018 State Health Assessment. The priorities were further refined by feedback from more than 2,500 people who participated in online surveys and other efforts led by community-based organizations.
Subcommittees of the PartnerSHIP steering committee will soon begin meeting to identify strategies and metrics to measure progress. Strategies will address upstream changes needed in policies, systems and environments, and may include recommendations such as implicit bias training, providing paid family leave, increasing use of traditional health workers and raising the price of alcohol.
PartnerSHIP member Clarice Amorim Freitas, coordinator of the Linn Benton Health Equity Alliance, a program of Willamette Neighborhood Housing Services, said it’s important that the new SHIP priorities support health equity.
“Equity is not equality,” she said. “We need to acknowledge that not all communities across our state have historically had access to the same resources, and we must understand that additional focus must be given to disadvantaged communities in order to ensure that everyone has the opportunity to be healthy from now on.”
Given that much of this work will be carried out through the Community Health Improvement Plans implemented by local public health, hospitals and coordinated care organizations (CCOs), community members are also encouraged to learn more about the plans and priorities in their local area, which are available through the interactive map at https://www.arcgis.com/apps/MapSeries/index.html?appid=8568988df599486f9801edbff9433936
More information about the SHIP is at available on the SHIP webpage at http://www.healthoregon.org/2020ship. Sign up for the SHIP email list to receive updates and information about future opportunities to engage in the development of this plan.
