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Addressing Health Disparities Linked to Climate Issues

Jacob BornsteinIn April, I had the pleasure of facilitating the Alliance of Nurses for Health Environments (ANHE) two-day strategic planning retreat. The goal was to chart a path forward that incorporated equity into their work, and we conducted interviews with members of the nursing community who were familiar with ANHE to understand how ANHE could best do this work. I walked away so impressed with the organization and the individual participants. They are all doing such amazing work. In particular, I was struck by the role nurses and other health professionals play in addressing health disparities related to climate issues and asked that ANHE author a blog for Spark to share with our network.

Jacob Bornstein, MS
Director of Consulting

By Monica Harmon, MSN, MPH, RN1; Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN2; Lillian Tom-Orme, PhD, MSPH, RN, FAAN3; and Ruth McDermott-Levy, PhD, MPH, MSN, RN4

Climate changes health. The influence of climate change on health affects nursing practice, as nurses are observing the health impacts upon the people, families, and communities in their care. The Alliance of Nurses for Healthy Environments (ANHE) is addressing the impact of climate change on the health of Americans by developing tools to educate and prepare nurses to respond and advocate for climate mitigation, adaptation, and resilience strategies. ANHE nurses are also researching climate-health impacts and nursing preparation related to climate change.

In March 2018, leaders within ANHE, as well as nurse leaders representing National Black Nurses Association, National League for Nursing, National Association of Hispanic Nurses, and the National Alaska Native American Indian Nurses Association, came together in Oracle, AZ to discuss the organization’s priorities with a focus on the specific needs of underrepresented nurses in the climate and health discussion. This meeting was particularly important because, although climate change is affecting the health of everyone, socially marginalized pockets of Black, Latino, and Native American populations have additional vulnerabilities related to the health impacts of climate change.

In the United States, people with higher poverty rates have fewer choices when it comes to housing, access to health care, employment, transportation, and food. People living in poverty also are less likely to have additional resources to mitigate effects of climate change and rebuild or relocate as needed after climate problems. Race/ethnicity and socioeconomic status are shown to be determinants of health compounding public health promotion and disease prevention activities. Due to the legacy of colonialism and structural racism, Black, Latino, and Native Americans are most frequently represented as marginalized groups living in poverty. Poverty influences a group’s ability to respond to the impacts of extreme weather events seen during climate change. During Hurricane Katrina, we saw residents of New Orleans’ 9th Ward, a low-income community, unable to evacuate as a result of limited resources. Many in the community did not have transportation to get away from the event, and they were at the epicenter of the disaster.

For Native American communities, the disruption of communities as a result of the changing climate leads to loss of culture, language, access to food sources, and health effects. Many villages in Alaska, for example, rely on subsistence food sources and with ice melts, their food from the sea is moved further out and not easily obtained. Village life disintegrates as communities are relocated, families might split up, some move to urban areas to find stability but lose access to cultural ties, language use, and support systems. Generally, Native Americans who move from rural reservation or communities find it difficult to access health care services in their new community.

These phenomena mean that marginalized populations are often disproportionally impacted by weather extremes from climate change such as flooding, extreme heat, and wildfires. Additionally, such populations have higher rates of chronic illnesses such as cardiovascular disease, diabetes, kidney disease, and asthma and COPD. For example, in 2006 severe flooding in El Paso Texas led to $200 million in damages to homes and businesses. Hispanic identity was most significant health risk after taking everything else into account. Language ability is another important factor that nurses must consider when addressing climate risk in underrepresented communities. Often the plan for what to do when a crisis happens is not provided in the language of the community most at risk or in a culturally appropriate manner. Those who are most vulnerable to climate impacts are left in a situation where they cannot move forward, get away, or have resiliency. This leads to greater health impacts including psychological problems such as PTSD following climate change events.

It is critically important that Black, Latino, and Native American nurses are included in the discussion and solutions to address climate change and health. Their perspectives inform best practices to address the unique needs of each community. ANHE will continue to make the inclusion of nurses who work in and identify with marginalized communities a priority in their work to address climate change and health in nursing research, education, advocacy, and practice.

1Chapter President, National Black Nurses Association of Southeastern Pennsylvania, Ph.D. candidate student at Villanova University
2President, National Association of Hispanic Nurses; Senior Vice President of Equity, Diversity and Inclusion at Equality Health
3Former President, National Alaska Native American Indian Nurses Association; Research Assistant Professor in the Division of Epidemiology and Adjunct Assistant Professor and Diversity Coordinator for the College of Nursing, University of Utah
4AHNE Education Workgroup co-chair; Associate Professor & Director, Center for Global and Public Health, M. Louise Fitzpatrick College of Nursing, Villanova University

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Our Diversity, Equity, and Inclusion Update

Alison McCarthyWe are committed to being open and transparent throughout our process of implementing Diversity, Equity, and Inclusion (DEI) at Spark. We have a lot of progress to share this month and hope it will be helpful to our staff, local community, peers, clients, and the people most affected by our work.

After announcing our DEI commitment and sharing our plan in January, we searched for and hired a DEI consultant, Maria Velasco from the Spring Institute. We feel lucky to have talked with so many incredible people; it’s heartening to see how many qualified folks are out there doing this work.

Here’s a list of names and contact information of the DEI consultants with whom we spoke. We are so excited to begin our work with Maria!

In preparation for our DEI “kickoff” with Maria, we conducted a literature review to identify tenets and measurements of organizational inclusiveness. Literature suggests that the essential components of inclusiveness are:

  • Fairness and opportunity
  • Belonging
  • Trust and respect

We then developed an internal staff survey that would incorporate these components and help us to better understand our baseline regarding diversity, equity, and inclusion. We adapted three commonly used instruments to ensure relevance to our organization. They include:

We have administered the survey to staff, and are hoping for a 100% response rate. We’ll work through the results with Maria at our next DEI staff training.

In the coming weeks, we’ll share our efforts at developing a DEI project and proposal checklist – serving as a prompt for incorporating DEI principles into all Spark projects. As always, we welcome your insights and questions as we move forward on this journey. Feel free to use the chat box below with any comments.

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Keeping Youth Out of the Juvenile Justice System: Creating Policy and System Change

By Lauren Gase, Spark Policy Institute and Taylor Schooley, Los Angeles County Department of Public Health

Each year, roughly one million young people are arrested in the United States. Contact with the justice system is not only a public safety issue – research shows that it can lead to a range of negative health and social outcomes, including damaging family functioning, decreasing high school graduation and employment rates, increasing the risk for involvement in violence, and worsening mental health outcomes.

Contact with the justice system is also an equity issue; persons of color are disproportionately represented at every stage of justice system processing. It should concern anyone interested in promoting health, educational achievement, and community and economic development.

The public health sector can be a strong leader in creating justice systems transformation because it has experience bringing together diverse stakeholders to facilitate meaningful dialogue and collaborative decision-making. Public health focuses on prevention, holistic wellbeing, and the root causes of poor outcomes. It is grounded in using data to drive decision-making to identify opportunities for improvement.

To illustrate this, we’ve gathered examples of several jurisdictions that have begun to advance promising solutions to justice reform in partnership with public health:

  • In Los Angeles County, California, the Board of Supervisors established a new division of Youth Diversion & Development within the integrated Health Agency. This division is tasked with coordinating and contracting community-based services in lieu of arrest or citation for youth countywide.
  • In King County, Washington, Executive Dow Constantine announced an executive order to place juvenile justice under the purview of the public health department. The order aims to change policies and system to “keep youth from returning to detention, or prevent them from becoming involved in the justice system in the first place.”
  • A recent analysis from Human Impact Partners examines the impacts of youth arrest on health and well-being in Michigan and identifies a number of recommendations, including diverting youth pre-arrest, training agency personnel to be trauma-informed, sealing youth records, and changing state sentencing laws.

To promote health, safety, and racial equity, we need to transform our current justice system to create the social, economic, and political conditions that allow individuals, families, and communities to thrive. Some jurisdictions have begun to advance public health solutions to justice reform, but there is more to be done. We need to think differently about the role of multiple partners – including law enforcement, courts, health, schools, social services, and community-based organizations – in creating opportunities for young people to avoid or minimize formal processing in the justice system.

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When Collective Impact Has an Impact: A Cross-Site Study of 25 Collective Impact Initiatives

When Collective Impact has an Impact
Executive Summary

Full Report

We at Spark Policy Institute and ORS Impact are excited to release the findings of a ground-breaking study in partnership with 25 collective impact sites in the US and Canada as part of the Collective Impact Research Study.

The study sought to shed light on a fundamental question:
To what extent and under what conditions does the collective impact approach contribute to systems and population changes?

The study findings can be a tool—for refining the collective impact approach, strengthening existing initiatives, supporting new initiatives, and evaluating collective impact more meaningfully.

Our study is intended to add to the body of knowledge related to collective impact, building a better understanding of when and where it has an impact. To solve the entrenched social problems that still plague too many people and communities, it is crucial to continue deepening the sector’s understanding of the results collective impact initiatives are achieving, the challenges they face, and the lessons they have learned.

Why this study?
In 2011, John Kania and Mark Kramer published in the Stanford Social Innovation Review, laying out “collective impact” as an approach for solving social problems at scale. For some, the introduction of a defined framework for cross-sector collaboration provided a useful way to focus new and existing partnerships toward a common goal and, hopefully, greater impact.

It has not, however, been without controversy. Some critiques from the field include a sense that collective impact is just new packaging for old concepts (without fully crediting the work that preceded it); that it is inherently a top-down approach to community problems; that it is too simplistic for solving the complex social problems it seeks to address; and that it replicates unjust power dynamics. There is also criticism that the approach has not been assessed rigorously enough to warrant the number of resources being directed toward it.

In early 2017, the Collective Impact Forum, an initiative of FSG and the Aspen Institute Forum for Community Solutions, hired ORS Impact and Spark Policy Institute to conduct a field-wide study of collective impact with funding from the Annie E. Casey Foundation, Bill & Melinda Gates Foundation, the Houston Endowment, the Robert R. McCormick Foundation, the Robert Wood Johnson Foundation, and the W.K. Kellogg Foundation. The partnership of ORS Impact and Spark Policy Institute brought, across the two organizations, both knowledge, and experience with collective impact (Spark) and experience with other community change models (both), as well as a healthy skepticism and more arm’s length relationship to the approach (ORS).

We encourage you to share any of your insights about collective impact in the comments section below. Questions or comments about the study may also be sent to Terri Akey at ORS Impact or Lauren Gase at Spark Policy Institute.

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Diversity, Equity, and Inclusion at Spark

“I raise my voice not so that I can shout, but so that those without a voice can be heard.”

― Malala Yousafzai

Dear partners and friends,

Spark Policy Institute was founded with a core belief that diverse perspectives are key to achieving meaningful change. Each of our conference rooms are named after leaders who made a difference because they spoke up and spoke out: Malala Yousafzai, Rodolpho “Corky” Gonzales, Hattie McDaniel, Maya Angelou, Dolores Huerta, and Sojourner Truth.

Our role as a bridge between nonprofits, communities, and funders brings with it a great responsibility to ensure all voices are heard in strategy design, implementation, research, evaluation, and interpretation. With the mark of the new year, we are committed to assessing how we are doing and where we need to improve. One of the ways we are doing that, is by renewing our focus on the issues of diversity, equity, and inclusion (DEI).

Our team is taking on the hard work to make this vision reality – we have assembled not just a committee, but a working group, whose key charges are to develop goals for improving our work and our internal culture to more truly and demonstrably respect diversity, value equity, and foster inclusion.

We are committed to sharing our journey with specifics about the steps we are taking to reach our goals. You can read an introduction to our reinforced effort in our latest blog post Journey to Diversity, Equity, and Inclusion, which includes a link to our DEI Commitment, and our 2018 DEI Plan. We will continue to update our website and newsletter with all of our efforts.

I am sincerely humbled by the skill and perseverance of my colleagues who continually seek to improve our work and challenge our assumptions. Together in this process we are capable of remarkable change.

As always, we at Spark welcome your questions, suggestions, or reactions. Please do not hesitate to reach out to me, or any of our staff as we move forward with this critical work.

Kyle Brost
Spark Policy Institute