The Utah Office of Health Equity (OHE) is currently in the process of revising its 2021-2023 Strategic Plan for closing health disparities. The existing plan is focused largely on the impacts of the COVID-19 pandemic, as well as coordinating public health responses within communities including the equitable distribution of vaccines and social resources.
The OHE operates under the Utah Department of Health and Human Services (DHHS). The revised plan will be part of the department’s overall strategic plan, which it outlined last year and of which health equity is a significant part.
Speaking to State of Reform, OHE Director Dulce Diez outlined how her office is coordinating with state and local health agencies on unifying that vision and embedding health equity in their respective strategic plans.
“One of [our strategies] is to create a high-quality and efficient DHHS. And one of the processes that the Office of Health Equity is part of is embedding fairness in all the processes of the [department]—that cannot be done in one month or in one week, or even a year. It is going to be a long process, but we are heading in the right direction.
Our different units or different divisions can start operating with a health equity mindset. This is not just a matter of doing one activity or measuring one activity; this is a matter of working with our different programs, divisions, [and] offices in a way that we can improve the current processes that they have so we can provide better services to all individuals in Utah.”
Part of improving those processes involves improving data collection. OHE is working on a project in collaboration with the University of Utah/Intermountain Healthcare health systems and community groups that aims to standardize the collection of demographic data so they are uniform, relevant, and reliable.
OHE issued the draft guidelines for race/ethnicity data and is in the process of developing data standards for the collection of other demographic indicators as part of the data modernization project to better represent the population throughout more than 1,000 different departmental data collection systems.
These efforts to improve data collection are part of the state’s larger efforts to modernize its databases and surveillance systems in a way that will safely and more accurately inform policies and processes for addressing health disparities, Diez said.
The University of Utah Health (U of U Health) told State of Reform it worked with DHHS and community partners to identify best practices for collecting race and ethnicity data, noting accurate data is necessary for identifying and addressing health disparities.
“In spring of 2023, U of U Health patients will have the opportunity to voluntarily answer race and ethnicity questions that will enable our providers to care for patients in a culturally responsive way,” U of U Health said.
“U of U Health believes that our community cannot truly thrive until every Utahn has equal access to the essential elements of living a healthy life. Our commitment is to provide patient-centered, culturally respectful care to every patient and their family.“
The state has already mapped out areas where disparities exist through the Health Improvement Index (HII), a composite measure of social determinants of health (SDOH) by geographic area. It includes nine SDOH indicators including demographics, socioeconomic deprivation, economic inequality, resource availability, and opportunity structure.
HII was launched in 2018 and updated in September of last year. Diez says the index differs from the US Census tract because it maps 99 small areas in Utah, which are defined by the neighborhood’s population, socioeconomic status, traditions, and culture.
OHE could then take health equity-focused approaches to policies and interventions for the areas that receive high indications of SDOH challenges through HII.
The Area Deprivation Index (ADI) (which measures the rate of socioeconomic disadvantage in certain areas) for the Salt Lake City communities of Glendale (150.6), predominantly Hispanic, and the Avenues (87.1), an affluent neighborhood, reveal the disparities that exist between these adjacent areas. They are also notably disparate in HII’s health insurance coverage ranking, with Glendale receiving a score of 21.2 compared to 8.5 in the Avenues.
Diez said the state’s strategies on health equity must continue to be aimed at lowering the number of uninsured Utahns.
“The main issue that many underserved, underrepresented communities face is access to healthcare,” Diez said. “And the main reason for that is the cost of healthcare. We know that many individuals do not have insurance or even though they have health insurance, they are underinsured. So before the pandemic, during the pandemic, and after the pandemic, cost is one of the main barriers to accessing healthcare for our underserved and underrepresented communities.”
While the Utah Legislature passed several measures to expand access to healthcare for vulnerable communities this session, including expanding Medicaid coverage for postpartum care, recreational therapies, dental care, and doula services, concerns persist as DHHS continues its renewal process for Medicaid eligibility and will begin disenrolling members who are no longer eligible in May. Reports estimate thousands could lose coverage during the process.
Diez emphasized that advancing health equity is not a sprint, but a marathon, and something the entire state must be part of.
“In order to advance health equity, we need to reduce health disparities,” she said. “And in order to reduce health disparities, we need to address health inequities. Health disparities [reflect] health outcomes. Health inequities are the processes in society that create those disparities. So in order to have good health outcomes, we need to have processes in society that promote health equity.”
Diez will be speaking on the “Efforts to Ensure Health Equity Across the Continuum of Care” panel at the 2023 Utah State of Reform Health Policy Conference on April 26th. You can register for the event here if you haven’t already!