Operationalizing GHI

The health priorities identified in Get Healthy Idaho represent the focus of the division over the next five years. With CY 2020 being the first year of the new initiative, the activities and measures included in the current plan emphasize establishing a foundation and beginning to build communication and infrastructure. Activities in CY 2020, include educating department staff and external partners about the basics of the social determinants of health and place-based initiatives; researching effective models used in other states or communities; identifying key partners for engagement; identifying opportunities for partnership; and, finally, identifying a funding model and funding sources to support this work both internally and for communities.

Because the Get Healthy Idaho initiative has limited designated staff or funding, the division’s first step towards implementation was to establish an operational structure to begin this cross-cutting work. Those involved in the various workgroups are laying the groundwork and building the internal infrastructure needed to support this long-range initiative.

Calendar years 2021-2024 will focus on implementation activities to include deployment of the first subgrant solicitation to a minimum of one local community in year two and potentially one new solicitation to a community in years three through five

Identifying Communities

DPH will use a data-informed approach to identify communities with poorer health outcomes where investments in upstream approaches will be most effective. To identify these communities, the division developed a data dashboard showing county-level health outcome measures (incidence, prevalence, mortality, etc.) combined with the health determinant indices. Indices are composite measures that combine multiple social determinant of health factors into one “score”.

Two health determinant indices (the Social Vulnerability Index (SVI) and the Concentrated Disadvantage Index (CDI)) were selected based on their ability to provide county-wide estimates, support and promotion by the Centers for Disease Control and Prevention and range of individual measures which are used to develop the index score.

The SVI has two composite groups focused on Socioeconomic Status (SES) and Housing.  The SVI-SES index considers poverty levels, unemployment, income and high-school graduation.  The SVI-Housing index considers multi-unit structures, mobile homes, crowding, access to vehicles and group living.
 

The CDI considers poverty, those receiving public assistance, female-headed households, unemployment and those younger than 18. When these indices, in combination with health outcome data, are applied to the state population, counties of highest risk are identified, as seen by the dark blue shading in the Diabetes Prevalence and SDOH Risk by County map.

 

The division’s data dashboard (here) allows the counties to be ranked from 1- 44 (the number of Idaho counties). As the division identifies the counties that will be funded through Get Healthy Idaho, social determinants and other resource data will be reviewed for the cities and towns located in those counties. This will allow for a more comprehensive, yet targeted assessment of each community’s highest needs.

Community Engagement  

Through Get Healthy Idaho, the division will sustain investments in statewide partnerships to connect resources and opportunities for authentic engagement with community members. This also reflects the department’s desire to ensure place-based initiatives are led and driven by communities. A fundamental component of this work is developing a model for authentic community engagement, led by a community leadership team, which will ensure open and ongoing dialogue with partners, residents, families, youth and community leaders. Authentic engagement, following the International Association for Public Participation (IAP2) spectrum, will build a foundation of partnership and trust and empower residents to take leadership roles, build social capital and identify resources to help the community collectively work toward impactful solutions.

A local agency will serve as the hub or community lead of this effort and will ensure a diverse representation of community members is engaged in the process and empowered to make decisions. Engagement will include capturing qualitative feedback through key informant interviews to gain a better understanding of the known assets, challenges and opportunities that exist in the community. By combining population-level health outcomes and qualitative feedback from residents, the community will be tasked with selecting evidence-based interventions that will promote the conditions needed to support health, safety and resilience in their community. Through this process, the division will gain a better understanding of what matters most to the community’s health and learn about their experiences and recommendations for improvement. 


Community members will have opportunities to engage throughout the process and contribute to the planning and implementation of solutions. Continual engagement and feedback of residents will be vital to ensure the work meets community needs.
 

Plans for policy and system level change

The department will provide technical assistance and knowledge to help community members and leaders advance their capacity and knowledge of practices that ensure implementation of meaningful solutions.  As this work develops, plans will be specific to individual communities based on their unique challenges, needs and opportunities.  Policy, system and environmental changes will be identified based on what is most critical to individual communities and will have the most impact on improving health outcomes.  It is anticipated that community priorities will be just as diverse as the communities themselves, given the variation in population-level health outcomes, culture, geography, sociopolitical climate, capacity and allocated resources across the state.  With the knowledge that health happens where people live, policy, system and environmental interventions that ensure healthy opportunities are accessible to everyone in a community will receive recommendations.

It is anticipated that community priorities will be just as diverse as the communities themselves, given the variation in population-level health outcomes, culture, geography, sociopolitical climate, capacity and allocated resources across the state.

Indicators of Health Improvement and Priorities for Action

Calendar year 2020 indicators focus on building and mobilizing the Get Healthy Idaho initiative. This work has no dedicated funding and limited dedicated staffing, so time is needed to lay the groundwork for engaging partners and communities in a way that will ultimately impact health improvement outcomes. The work began in calendar year 2019 through the department’s and division’s strategic plans; therefore, January 2020 through June 2020 of the health improvement plan indicators align with the metrics defined in those strategic plans:

1.       Develop a communication and education strategy

2.       Define and share the Get Healthy Idaho framework

3.       Develop a financial model framework

4.       Engage stakeholders and key partners in Get Healthy Idaho

 

From July 2020 through June 2021, the division will identify indicators that measure continued progress with establishing the infrastructure and implementation of Get Healthy Idaho community subgrants.

Publication of the Assessment and Plan

In calendar year 2020, this site was created to display the assessment and health improvement plan in an interactive format. It serves as the central location for all information related to this initiative.

At least annually, the division will convene the larger Get Healthy Idaho partner group to review the prior year implementation plan, present new data and modify the plan, as needed. Partnering agencies and the department team responsible for identified strategies will report progress. On a quarterly basis, strategy leads will meet to review progress, barriers and successes. Local agencies assigned to lead the work in their communities will also attend.
 

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