NACCHO is pleased to recognize the Kansas City (MO) Health Department as a recipient of the 2016 Local Health Department of the Year Award. This award recognizes and honors outstanding accomplishments of local health departments (LHDs) across the country for their innovation, creativity, and impact on communities.
Kansas City, MO, is a diverse urban community in the heart of the Midwest with a population of 459,787 people. The Kansas City Missouri Health Department (KCMOHD) has protected the population’s health for 150 years and operates with a mission to promote, preserve, and protect the health of Kansas City residents and visitors. KCMOHD employs 200 staff through various programs, some which are active in both Missouri and Kansas. Programs and services strive to prevent illness and injuries, improve health services, enforce public health laws, and support policy development to build a healthier community.
An innovative steward of health, KCMOHD has adopted a keen focus on the root causes of health inequity. Their approach was recognized by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute as a 2015 Culture of Health Prize recipient. The intensive year-long process included evaluation through written proposals and a multi-day site visit. Further, KCMOHD is accredited by the Public Health Accreditation Board, requiring a site visit and documented measures of community engagement. In 2013, the Director of KCMOHD was the recipient of the American Public Health Association Milton and Ruth Roemer Prize, recognizing outstanding creative and innovative public health equity and social justice work.
KCMOHD’s Executive Director Dr. Rex Archer spoke with NACCHO Voice to share his department’s path to achieve health equity, describe the challenges and successes it has encountered, and advise other LHD’s embarking on the same journey.
NACCHO: Please describe the challenge or issue that led your LHD to embark on a journey of health equity.
Rex Archer: After reviewing our population health statistics, I was surprised and horrified to discover a 6.5-year difference in life expectancy between blacks and whites in our city. Following this discovery, we approached our mayor stating the need to release this data. The mayor understood the importance of this report and what it meant for the health of our citizens and the future of our city. Our mayor supported us in the creation of a task force comprised of a well-respected, diverse representation of our community. This task force was charged with developing recommendations to address the life expectancy gap through a public health lens. After meeting for a year, the committee developed recommendations that addressed many health inequities, but understood that the history of our city and our country, including over 400 years of slavery and racial segregation, was too large to tackle in one year. We needed an ongoing health commission to be a monitoring and advocacy group for improving the health of the city. This group started off as a resolution that is not binding with an ordinance. Eventually we modified our city charter so the health commission is now a chartered commission, requiring a vote of the citizens to dissolve. Our commission and their advocacy work has been a critical part of elevating the importance of health in everything we do.
Our department has always made use of peer review and peer challenges to make us better. We were one of the first two city health departments to become nationally accredited under the Public Health Accreditation Board in 2013. We are also one of the first few cities that utilized the power of partners and community organizers to win the Robert Wood Johnson Culture of Health Prize. Our community partnerships are very strong and we share a lot of resources across organizations. One of the outcomes of strategic partnerships is the life expectancy gap between whites and blacks in our city is reduced from that 6.5 years down to five years.
NACCHO: What was your plan to address health equity? What were your initial goals? How did you plan on measuring success?
Archer: We are working to address health equity across several areas. Somewhere between one-third and one-half of the deaths in our city are directly or indirectly attributed six factors. These factors included (1) people not graduating from high school; (2) our racial segregation practices of the past and in some cases the present, including red-lining; (3) block-busting and other types of mechanisms that forced a racial divide in our city; (4) our individual poverty levels; (5) income inequality; and (6) area poverty. We understood that the best predictor in the difference of life expectancy in the top 50 countries with the best economic development in the world is income inequality. Residents in countries with low income inequality live much longer than those in the United States. This would be one of the areas we choose to address. In 2015, our city council and mayor decided in a 12-1 vote to raise the living wage in Kansas City. Unfortunately, our state legislator decided that we couldn’t protect the health of our population that way and preempted those plans. We also noted that we were one of only 10 states that still banned former felons from access to food stamps. We understood that felons’ difficulty re-entering the work force and ultimately having the ability to feed themselves and their families could result in their turning to crime. We were able to get the state legislator to lift the ban on former felons getting access to food stamps.
We are working on several of these issues and support those that gain momentum by utilizing our data to activate various community organizing groups that champion health equity.
In our city’s five-year business plan, the objective of increasing life expectancy and reducing the inequities between zip codes is an important goal. We are using the information provided across city departments and our own data to measure the success of our efforts in relation to this business plan. Our department analyzed life expectancy by zip code and pinpointed the 28 zip codes that have the largest populations and stable life expectancy rates. From here we were able to look at the first quartile that’s had the most improvement and the last quartile that’s been stagnant or have gone down in life expectancy. Those two groups were analyzed to understand what factors are driving the life expectancy changes within our city.
NACCHO: How did your LHD implement this plan? What resources and activities were involved?
Archer: We implemented our plan using our health commission, mayoral appointed volunteer leaders from our community, and a large committee structure. We updated our community health improvement plan called KC-CHIP that outlines our top five focus areas. Our top priority is ensuring high school graduation. We were armed with the knowledge that if you are not reading at grade level by third grade, your odds of graduating decreases, and this is a vital part of community health. Additionally, we are targeting absenteeism and moving down that gradient of years to look at what prevention activities to put in place. We are also posing questions like, “Are we preventing kids from being exposed to lead?” All those factors are part of an integrated approach.
Our second issue is violence prevention and reducing community violence. It is difficult to build strong, healthy communities if community violence is an issue. Violence prevents the growth of business, grocery stores, and safe places for children to play. We are working aggressively on mediating and reducing violence via a public health model.
Our third measure is economic prosperity, specifically the issue of predatory lending. We have the dubious distinction of having a 1,950% allowable interest rate on short-term loans. This creates a mechanism by which people get trapped (enslaved) in that system. We are working on several measures that would cap the interest rate at 36% instead of 1,950%.
NACCHO: What challenges or barriers did you encounter during implementation and how did you overcome them?
Archer: In many parts of the county, including Kansas City, there is often a mistrust of government. We constantly have to work to develop relationships, network with people, listen, and work on issues the community sees as high priority. Once we developed community relationships, we had the ability to bring up other important issues, and assisted the community in understanding how these issues affect community health.
NACCHO: What advice would you give to other LHDs seeking to embark on a similar journey?
Archer: I always think of the old saying, “If you continue to do things as you’ve always done them and expect different results, you may be insane.” Acknowledging that what you are doing isn’t enough and isn’t working can be scary and difficult. We have found that our partnerships with community organizers is key. If there are organizations that understand how to organize the community and are effective, partner with them! Why build a new division in your department if you can partner with, and support those organizations? Partnering with an organization external to your department can be very powerful. If you can find a great community organizing group, bring them in so they can collocate with you. There’s an old rule I learned when I was at the Ford Motor Company; it’s the “25-foot rule.” Every 25 feet you get further away from somebody’s office, communication drops in half. If you can, embed a community organizing group in your department.
Martin Luther King said, “If you can’t fly, then run. If you can’t run, then walk. If you can’t walk, then crawl. But whatever you do, keep moving.” It is important to fine-tune how fast you can move your community forward, understanding that even if you can’t see change in your tenure, you’ll make progress and pass it along to the next person who inherits your position. To me, this is what the work for health equity is about. Do not give up. Some years you’ll be able to run, some years you’ll be crawling, but you’ll know that whatever happens, you will keep moving forward.