November 18, 2022
Louisiana Department of Health

Introduction

The report Public Health Forward: Modernizing the U.S. Public Health System highlights the need for readily available data to support public health programs, and specifically calls on public health agencies to consistently collect data needed to identify, document, and address health inequities in local communities. Data must include indicators that characterize populations experiencing health inequities, health disparities present within these populations, and socioeconomic conditions. These data are foundational to public health programs and other community efforts to advance health equity.

Context

The Louisiana Department of Health (LDH) uses a health equity lens for its data collection and reporting. While LDH serves all Louisianans, they maintain a focus on communities experiencing poorer health outcomes due to structural factors. LDH is developing a two-phase health equity plan that adopts and supports a new approach to operationalize health equity practices and protocols across all its offices, divisions, and bureaus. In alignment with this plan, the most recent State Health Assessment (SHA) focuses on health equity in a new and compelling way: by including data indicators that underlie health inequities (e.g., housing and education) as opposed to solely using health condition-based indicators. LDH displays all its SHA data on a new dashboard that is updated annually, providing a robust resource for all who are working to advance health equity.

Key Actions

Identify a framework for health equity.

A specific framework for health equity data collection efforts provides important context and sets a foundation for the health department and its partners.

  • The Prevention Institute’s framework for health equity appealed to LDH because it shifts the focus from health outcomes to all levels of social determinants of health, emphasizing the underlying problems that drive health inequities. LDH adapted this framework for its SHA to reflect its context.

Because health equity data will be used by health department staff and external partners, it is important to include perspectives from various users in these efforts.

  • LDH convened an advisory board of 30 members representing all nine regions of the state. LDH used their networks to solicit applicants for one- to three-year terms, through a rigorous selection process that included individual interviews. The advisory group includes people from government offices, academia, and non-profit organizations, and has members who represent different races, ethnicities, and gender identities.

There are many data to choose from, and a robust process is needed to determine which indicators will best support the health equity work of the health department nd its partners.

  • LDH engaged in a rigorous, iterative process to identify equitable indicators for its SHA.
    • A vendor provided 120 health-related indicators as a starting point. Health department staff then mapped the suggested indicators directly related to their health equity framework and identified the indicators representing inequities between the Black and white populations in Louisiana (using bivariate analyses, a method that identifies statistically significant differences between two variables).
    • Staff ranked the indicators that were statistically significant to prioritize some for follow-up in focus groups, interviews, and the dashboard.
    • The resulting list of 50 indicators was shared with the internal SHA team and the advisory board.

While examination of data is critical for understanding the health status of Louisianans, direct feedback from a wide variety of partners and community members provides important context to understanding the data. Methods can include one-on-one interviews, focus groups, and surveys.

  • LDH invested in numerous focus groups and interviews in the community to capture lived experiences and compensated individuals for their time.
  • Interviewees represented or served demographic groups that were underrepresented in the statewide survey, including individuals who are Black, Asian, Latino/Hispanic, Native American/Indigenous, members of the LGBTQ+ community, and youth and young adults.
  • Lead interviewers were formally trained on cultural competency and had previous experience working with communities in Louisiana. Additionally, two of the team leads on this project provided cultural and geographic context to the lead interviewers prior to the interview process.
  • Although LDH would have preferred in-person meetings, that was not possible during the pandemic. Instead, LDH designed interactive and engaging virtual meetings that earned high ratings from the participants.

Data will be used in a variety of ways by different partners (e.g., grant applications, program planning and evaluation, and presentations to collaborators and the community), and therefore it is helpful to offer different means of accessing and visualizing them.

  • LDH’s SHA dashboard data are provided at the regional, parish (county), and census-tract levels, in formats that can be combined and viewed to highlight the most significant inequities. Options for downloading data from charts and maps include CSV, GeoJSON, SVG, and PNG.

Keeping data current ensures that they are a consistent and reliable resource for grant writing, research, and other efforts that support the advancement of health equity. In addition, it is important to grow the data as they become available, as new partners become engaged, and as additional priority areas emerge. Moreover, having an online SHA platform keeps the data “alive” and facilitates an ongoing evolution of information.

  • LDH’s SHA dashboard is updated annually.
  • LDH plans to engage more partners and expand the data indicators over time. For example, two additional priority areas identified by LDH and its partners are maternal health outcomes and incarceration.

Recommendations

Workforce

Involve other groups working on health equity.

Other entities can potentially provide data, offer insights into data collection and visualization efforts, and assist with community engagement.

  • LDH’s Bureau of Community Partnerships and Health Equity assisted the SHA project team with identifying members for their advisory board and facilitated a collaboration with the Governor’s COVID-19 Health Equity Task Force.

Primary data are needed to have a comprehensive picture of health inequities. It takes a great deal of time and effort to elicit authentic and comprehensive community feedback.

  • LDH recommends the following strategies to enhance efforts to elicit feedback from the Hispanic/Latinx community: spending time on the front end identifying and nurturing partnerships with organizations and individuals from the community, listening to them to best ensure their voices are heard in the assessment; making the data collection a collaborative process; ensuring outreach is done by trusted partners from that community; investing in developing communications throughout the SHA process that are in Spanish and tailored to reaching the Hispanic/Latinx community; and including additional funding for outreach, translation, and interpretation in the project budget.
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Financial

Budget sufficient resources for technology.

Health equity data are most valuable when accessible, convenient, and used by the health department and its partners. Therefore, it’s important to secure the technology necessary to support the data platform.

Anticipated Impacts For Public Health Departments

Tackle self-identified health concerns and provide interested parties the ability to work collaboratively.
  • Providing actionable health-related data, aligning partners around common goals, and creating a framework that can be used across populations and sectors allows communities to tackle self-identified health concerns and provides interested parties the ability to work collaboratively.
    • While communities can use these data now to plan health improvement efforts, LDH and its partners are also using this data to inform the State Health Improvement Plan, currently under development.

Potential Challenges To Implementation

Lack of a centralized partner list.

Community engagement efforts rely on an established contact list of partners. Without such a list, community engagement efforts can be delayed and disjointed, adding time and frustration to the process.

  • Before this initiative, LDH was engaged with partners in a siloed manner. The relatively new SHA team had to rely on a patchwork of different lists to engage community members in this work. Building a partners list first would have made the entire process easier, from inviting participants to meetings to disseminating the statewide survey.

Focusing on partnership building can facilitate engagement among groups that traditionally have lower representation in these types of assessments.

  • LDH developed their electronic survey in three languages, but response rates to the Spanish and Vietnamese surveys were very low. Engaging a Spanish-language media outlet helped, but it did not result in a high level of participation from the Hispanic and Latinx populations.

Electronic surveys are an inexpensive way to reach more of the general population, but there are communities and low-income populations for which this is not an option. For this reason, health departments must plan alternative methods to solicit input.

Sustainability

Include key partners from the outset of health equity data collection efforts.

Co-create this body of work to get it right the first time, and in the process, create buy-in and shared ownership from partners and the community.

  • The Louisiana governor established a COVID-19 Health Equity Task Force, which recommended the creation of a statewide health equity dashboard and became a key partner in the effort to provide equity data to the community.

Demonstrate the benefit of data to partners who finance data collection and those who use it.

  • LDH staff have presented on the dashboard to task force members on multiple occasions, including their final meeting in April 2022. LDH has included information about the dashboard in briefings to the Governor and State Legislature. The Secretary of the Department of Health has spoken of the dashboard at a variety of public speaking engagements.
  • LDH’s efforts to make the data easily accessible and digestible has facilitated non-profit organizations’ use of the data to conduct local assessments, plan activities, and write grants.

Even during lean fiscal times, there are affordable tools to help gather perspectives from partners and others in the community.

  • LDH used Google Drive, Jamboard, Mentimeter, and SurveyMonkey to support their data collection efforts.

Check back in with partners and the community about the data, including new data that would be helpful and ways to improve its accessibility and usability. Doing so not only keeps the data relevant and top of mind to external partners but also helps to build trust and solidify support for continued data collection.

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