CHE has three overall programmatic areas including: 1)  data analysis work group, 2) programmatic interventions to address structural determinants of health, and 3) education and training. To see an operational diagram of the Center for Health Equity click here (PDF).

Data Analysis Work Group
The Data Analysis Work Group is comprised of epidemiologists, demographers, policy analysts, and evaluation design researchers charged with developing and implementing strategies for elevating the standard of measures of health inequity that can support a practice that goes beyond the boundaries of traditional approaches to illustrate the connection between social inequalities and health.  Projects are meant to focus attention on measures that have not characteristically been within the scope of public health department epidemiology. It is thought that this work will ultimately strengthen the evidence base supporting new intervention strategies for eliminating health inequities.

 Structural Determinants

Enjoying good health is not just good luck.  Enjoying good health and well being means:

These influences are often referred to by the people working in the health sector as the “social determinants of health”:  that is those social, economic and environmental factors that can determine whether we are likely to enjoy good health. These basic social determinants of health are the living conditions that are shaped by public policy decisions on how to distribute economic and social resources. 

The economic status, education, housing and sanitation are a few of the social determinants of health that are the everyday concerns of local government. These conditions are controlled by public policies and regulations controlled by government.  Local government must understand how these living conditions affect the health and well-being of its community and identify what it can do proactively to create a healthier community. 

The basis for the Center’s operation is the idea that solving these determinants of health and living conditions requires a focus on public policy issues and their health and human development effects.  The CHE is dedicated to a civic process that builds social engagement, autonomy and movement to strengthen communities and influence public policy

To accomplish this CHE projects in this programmatic area utilize civic capacity building based upon community organizing as the basis for operations. The Center for Health Equity defines civic capacity building as efforts that increase the ability of individuals, organizations, networks of organizations and communities to work with, be in relationship with and impact the systems that influence quality of life. 

The Center’s definition of civic capacity is the ability of a community or any system to mobilize both horizontally and vertically the sectors needed to realize a common vision using the principles of community organizing. 

An example of this might be a community that wants fully funded daycare for children ages one to four.  A small group of residents would establish the interest in this issue on a larger scale in the community [horizontal mobilization].  The residents would study the issue and develop a set of policy recommendations.  Next, the community would begin to interact with, engage, and talk to those institutions, advocacy groups outside the community, policymakers, and government agencies that could move the issue forward in such a way that policy changes occurs [vertical mobilization]. 

CHE staff members are assigned to work with health department units to identify community concerns and conditions that may be public issues affecting health.  In this case a public issue is a measurable, concrete topic of great concern to many. 

For example, the problem might be unemployment for single mothers in the Healthy Start program.  The public issue might become creation of a job training program for employers needing skilled workers and the provision of subsidies to those employers that hire the women. 

Another example might be the availability of medicine for HIV clients.  The specific issue could be pooling the resources of providers to create increased purchasing power through a co-op thus eliminating shortages. 

CHE staff meet regularly with key departmental units serving clients to identify social and economic public problems related to the social determinants of health.  If a problem appears to be widespread CHE staff will begin the community organizing process by meeting with clients to discuss the problem. 

In some instances this begins with one-to one meetings building up to larger group meetings.  In other cases, where a group is already assembled CHE staff will meet with the larger group and conduct a series of one-to-one meetings.  One-to-one meetings are used in community organizing to increase the likelihood that community participation in the project will last over time.  The one-to-one meetings build relationships and ensure that the interests of each individual will be met by working on that project. 

 Education and Training

On of the core functions of the Center for Health Equity is to reeducate the public health workforce by fundamentally altering the programs, practices and services of the Louisville Metro Department of Public Health and Wellness (LMDPHW) to incorporate principles of health equity.  Equally as important is increasing knowledge and awareness about health equity in the greater Louisville population. 

The CHE is working with several researchers to design a health equity audit to be used internally on programs and services.  Along with this will be several core trainings designed to explore the departmental culture and practices around health as social justice, health equity and human rights, building civic capacity and community organizing. 

Many of the inequalities in health are due to inequalities in the social conditions in which people live and work.  Tackling these conditions- the social determinants health- which underlie causes of poor health can contribute to improving health and health equity.  Accordingly, if we are to improve these social conditions that contribute to health inequities it will require mutually agreed upon obligations from a community to redistribute social benefits and burdens more fairly and to treat all people equally. 

This is the reason that the CHE has launched a community-wide education and awareness campaign on health equity.  Called Health Equity- Civic Equity, the campaign is meant to increase awareness of and knowledge about the causes of health inequities and what can be done to address them.  Components of the campaign include: an online reading series, a speaker’s series featuring international researchers on the social determinants of health, and a media campaign.  To assess the assets and gaps in metro-wide efforts to address the social determinants of health, the Board of Health is also sponsoring a series of health equity hearings.