Promoting health equity – how Columbus, OH, is improving health for African-American women

Earlier this year, Dr. Mysheika Roberts, Health Commissioner at Columbus Public Health (CPH), gave an interview to the National Association of County and City Health Officials (NACCHO) to discuss issues that negatively affect African-American women’s health.

1. Can you discuss the societal issues that negatively impact African-American women’s health, such as low-income related issues, access to preventative healthcare, etc.?

A person’s health depends on more than just his or her individual decisions and genetic makeup. The circumstances and conditions in which we are born, grow, live, work and age all influence how healthy we are and have the chance to be. We call these influences—which are often shaped by social and economic factors beyond a person’s control—the social determinants of health. These determinants include many things – such as the availability of safe and reliable housing, or healthy and affordable food – but unfortunately, not everyone has the same access to these opportunities to be healthy.

Social determinants of health greatly contribute to unfair and avoidable differences in health status that affect both length and quality of life. Across the country, including in Columbus and Franklin County, we see differences in health based on race, ethnicity, sex, neighborhood, income, education, sexual orientation, gender identity and more. Unfortunately, some areas and groups also have experienced generations of isolation from opportunity, and African American women are among those most at risk for experiencing health inequities.

For instance, some of the issues we see that are of particular concern for African American women (and that CPH is working to address) include:

• Infant mortality: Franklin County has one of the highest infant mortality rates in the country. One hundred thirty-six babies die before their first birthday every year in our community, and African American babies are nearly 2.5 times as likely to die as white babies.
• Cancer: African American women in Franklin County have a 35 percent higher breast cancer mortality rate than white women. The late-stage breast cancer diagnosis rate among African American women also is 22 percent higher than white women.
• Sexually transmitted infections (STIs): The rates of gonorrhea, HIV and primary and secondary syphilis are higher among African Americans compared to whites. In particular, African American women are disproportionately at risk of chlamydia compared to men or whites.
• Chronic disease: Issues like smoking and tobacco use, as well as obesity, contribute significantly to chronic disease. Lack of access to smoke-free housing options and affordable, healthy food disproportionately burdens at-risk groups, including African American women.

2. How can local health departments like yours help African-American stay healthy? How can local health departments fill the gaps in care?

One of the most important things health departments can do to help African Americans and other groups stay healthy is to promote health equity so that everyone has access to the opportunities and resources they need to lead a healthy life—no matter who they are, where they live or how much money they make.

At CPH, we’re prioritizing this work by addressing the root causes of health inequities, and creating opportunities for all people to be healthy. Examples of this work include:

• Training staff to understand and recognize the factors that contribute to gaps in health for minority groups and vulnerable populations, including involving staff in community outreach and engagement.
• Providing evidence-based resources, presentations and trainings, to the community so people can make choices that help them live long, healthy lives.
• Working with community volunteers to help them educate, organize and mobilize their neighborhoods for healthy changes.
• Leading a diversity and equity committee that ensures all CPH activities and resources promote and advance health equity—for instance, by proposing related programs and events.

CPH also leads other targeted programs and efforts to address priority health concerns in the African American community. Some of this work includes:

• Linking people to quality care through neighborhood social work and outreach: We help community members improve their health by linking them to resources, health assessments and screenings available in their area. Our new Neighborhood Health Ambassadors help spread important health information in priority neighborhoods, while also relaying community concerns back to CPH. 
• Ending infant mortality by providing support for pregnant women: In addition to providing pregnancy education, support and smoking cessation and linking expectant mothers to doctors and social services, our evidence-based home visiting program provides in-home, family-centered services both before and after delivery.
• Tackling chronic disease by promoting healthy homes: We provide in-home assessments and support to protect children against hazards such as asthma triggers and lead poisoning. We also promote smoke-free housing as a part of our tobacco cessation and prevention programming by educating the community about the dangers of secondhand smoke, and coordinating smoking cessation services to the public.
• Tackling chronic disease by improving access to healthy, local foods: The joint work of the City of Columbus and Franklin County on the Local Food Action Plan helps connect residents in low-food access communities to nutritious, affordable food in underserved neighborhoods.

3. If you had an unlimited budget and could tackle any public health issue affecting African-American women, what would that issue be? 

With an unlimited budget, I would focus on addressing the social determinants of health in order to improve the health outcomes of African American women – and all residents. Improving the conditions in which people are born and live are the foundation from which we must all work to improve health. In fact, it is difficult for us to eliminate any specific health issues concerning African American woman without seriously addressing the underlying social determinants of health, many of which are shaped and perpetuated by bias, injustice and inequality.

We all must work together to ensure that African American women have access to the things that they and their families need in order to be healthy. So to improve their health, I would focus on building more safe and affordable housing, increasing transportation options, improving access to quality health care, making sure families can get healthy, local foods in their own neighborhoods, improving schools, providing job training and child care so women can earn a living wage, testing all children for lead poisoning, and reducing trauma and violence in neighborhoods. When we can address – and improve – these conditions, African American women will have the opportunity to lead healthier and safer lives.