In King County, the Place Matters is organized into 3 tiers.  A King County Place Matters Team functions as a small planning group and includes 8 representatives of Public Health – Seattle & King County and the King County Executive’s Office.  A larger Community Planning Group consists of individuals who are interested in this work, and representing 20 community-based organizations, social service and public health agencies, and the University of Washington.  The broad inclusion of multi-sector agencies & professionals ensures the inclusion of all the social determinant factors that fully represent the issues that impact health outcomes. A third group of community members paired with agency representatives will be trained to facilitate community dialog sessions to provide input to various parts of the King County Place Matters initiative.

Statement of the Problem:
In King County, there are racial disparities in well-being that are influenced by such factors as income and access to living-wage jobs, educational attainment and access to resource-rich schools, neighborhoods and access to safe, affordable housing, criminal justice involvement and institutionalized racism.  These disparities in income, educational attainment, housing, and criminal justice involvement result in health inequities, as illustrated in this diagram adopted from the Bay Area Regional Health Inequities Initiative:

 

Social inequalities of race, gender and class interacts with inequalities of institutional power to create neighborhood conditions, both physical and social environments that contribute to individual risky behaviors.  These neighborhood conditions and risky behaviors, directly and indirectly through chronically elevated stress,  result in unequal distribution of disease and mortality. 

Inequities exist in almost every social issue of concern to the residents of King County. Young black men are disproportionately represented in King County’s juvenile justice system.  Minority youth are 5.6 times more likely to be in jail or prison.  Children of color are disproportionately represented in the child welfare system.  African American youth are over 4 times more likely to be placed in foster care in King County.  Rates of college education among people of color are much lower than their white counterparts.  23% of African American males have a Bachelor’s degree compared with 50% of while males in King County.  Children and adults of color are more likely to be living in poverty than whites.  The median income of white households is almost twice that of African American households.  The unemployment rate for white males ages 16 – 24 is 13%, compared to African American males at 26% and Native American males at 27%.  African American babies are 3 times as likely and Native American babies are 4 times more likely to die before their first birthdays than white, Latino and Asian babies.  African Americans die as a result of diabetes at 3.3 times the rate and Native Americans at 2.3 times the rate of whites in King County.

In addition to the basic tenet of social justice that everyone should have equal opportunity for health and well-being, the burden of poor health is borne by the whole community.  The economy is impacted by health inequity through reduced productivity, increased health care costs, and the shift of health care costs from the uninsured to the insured, resulting in a greater burden on business which bears the costs of health care for the insured.  Communities and countries with large gaps between rich and poor have worse health outcomes for both groups than communities and countries where the gap is smaller.  Health inequities are both influenced by and contribute to economic disparities, so impact the health of the whole community, not just those populations with disparate health outcomes.

King County’s Place Matters initiative will impact health inequity in two ways.  King County’s program investments and policy decision-making processes can impact the root causes of inequity by consciously evaluating new and current programs and policies through the lens of their impact on people of color and people in poverty.  In addition, the King County Place Matters Team, understanding that racism is a result of unequal distributions of power and privilege, seeks to change the process to give communities more voice in King County program and policy decisions. 

Targeted Actions (Objectives):
The King County Place Matters Team proposes to accomplish the following:

1. Increase the capacity of King County departments to identify actions that will increase health & well-being and decrease health inequities by developing a Health Equity Impact Assessment (HEIA) process by which new and existing King County programs, initiatives and policies will be assessed by King County departments for their impact on health equity.
1. A draft tool for Health Equity Impact Assessment (HEIA) will be developed by the Place Matters Team, and introduced to the Community Planning Group in order to gather community input into its development. 
2. The draft tool will be presented for Executive review and application of a pilot process to test it among selected King County departments.
3. The tool will be piloted with staff from selected King County departments, to be used in their planning decisions for developing the 2009 Budget.
2. Give communities more voice in decision making, to increase their power and reduce power inequity within the County by conducting community dialogs facilitated by community members paired with King County staff, to provide community members with a forum in which to give input on proposed programs & policies, and to represent their communities on issues of concern to them.
1. A core group of community members and King County staff will be trained in Technologies of Participation (ToP), a facilitation method which encourages participation by all members of a dialog group, and which results in identification of priorities truly reflective of the group.
2. Using the ToP facilitation method, community dialogs will be conducted throughout the County, among targeted communities, for the purpose of raising community awareness about the social determinants of health and beginning an input process for policy development and implementation, and for obtaining community input on the piloted HEIA.

Anticipated Results & Outcomes
Community dialogs are our intervention on social inequalities by educating people and giving them a voice.  A Health Equity Impact Analysis tool is our intervention on institutional power.  The combination of these two strategies will result in improved neighborhood conditions and reduced risky behaviors, which will improve health outcomes.  Once the process has been piloted, it will move to full implementation.   The HEIA process will be adopted in an Executive Order, and all King County Departments will use the tool for assessing new and current programs and policies.  This will begin a culture change that becomes self-sustaining as this process becomes the normal way of doing business for King County departments.

1. Tool:
1. A draft HEIA tool will be developed, by October, 2007
2. The draft HEIA tool will be reviewed by the Community Planning Team by November, 2007.
3. The draft HEIA tool will be introduced to the King County Executive and Department Directors by January, 2008.
4. A pilot process for using the tool will be launched in March, 2008.
2. Community Dialog:
1. Department Directors will participate in a ½-day retreat hosted by the Director of the Health Dept. to learn about social determinants of health and the Place Matters initiative in September, 2007.
2. Community and agency staff to be trained as facilitators of community dialogs will be identified by September, 2007.
3. Community members & agency staff will be trained in ToP facilitation in October/November, 2007.
4. Community dialogs will begin in early 2008.