By MELINDA DESLATTE
BATON ROUGE, La. (AP) - In a poverty-ridden state plagued with dismal health outcomes, Louisiana's health department has set a big goal to improve citizens' health, trying to help people access services no matter their racial, economic or geographic backgrounds.
The agency last year created a health equity office, hired a deputy director to find ways to combat disparities, held listening tours around the state and recently completed a plan aimed at identifying and targeting inequities.
Next comes the hard part, executing the vision in day-to-day programs and service delivery.
Louisiana's health statistics tend to be grim, with high rates of chronic illness and the state ranked 49th in the latest annual state-by-state report card from the nonprofit United Health Foundation. But Louisiana has resources, spending billions each year on programs and services through a combination of state and federal financing.
Earl Benjamin-Robinson, deputy director of the health department's health equity office, said the agency needs to be smarter about how it spends those dollars. He said the department needs to think about patients in the context of their communities and hardships, rather than using the same approach everywhere.
"Typically what happens is we are just creating programs that are not necessarily informed by the experiences of the communities," Benjamin-Robinson said. He added: "Cookie cutter doesn't always make sense, and cookie cutter sometimes creates health disparities."
The vision of Louisiana's health equity plan - started under Rebekah Gee, a doctor who exited the state health secretary's job in January - is to have a road map that employees across the department can use to spot and respond to inequalities in health care access. (Gov. John Bel Edwards, a Democrat, hasn't announced a permanent replacement for Gee, who will decide how much or how little to continue investing in the plan for Edwards' second term.)
Among the most vulnerable populations to disparities, health officials say, are the poor, individuals with disabilities, African Americans, tribal communities, drug users and other minority groups. Benjamin-Robinson said Louisiana's health department had programs aimed at closing gaps in access, but he said the approach wasn't consistent.
To redirect its focus on combating health disparities, Louisiana looked to other states that have dedicated health equity initiatives and used two in particular as a model, Minnesota and California. Minnesota, ranked among the nation's healthiest states, created its health equity center in 2013, while California created its similar office a year earlier.
Under Louisiana's plan, the health department is creating Health Equity Action Teams across each of its offices to hold monthly meetings to assess data and strategize about ways to improve access to health services across geographic regions, economic backgrounds and racial groups. Those teams, Benjamin-Robinson said, should be in place by March.
More training initiatives also are planned around the state, to help draw attention to disparities. Training sessions about reducing the stigmas surrounding drug treatment already have been held, for example, according to the health department.
"There are areas of disparities that have and that will continue to jump out," Benjamin-Robinson said.
Benjamin-Robinson's four-person office - formally called the Office of Community Partnerships and Health Equity - has a budget in the current financial year of $319,000. But health department spokesman Kevin Litten said only the deputy director's job is new, while the costs for the other positions, travel and supplies were reshuffled from another office.
Louisiana's health equity initiative still is in early stages, but ideas already have emerged.
Litten said the department identified a need for additional outreach to black women and health providers about HIV prevention medication. The state's rates of HIV infection are higher in African American communities, but Litten said much of the information distributed by drug companies had focused heavily on black men alone.
In July, the state hired a handful of community health workers - paid through federal grant funds - to do HIV awareness and prevention outreach in Baton Rouge communities that have been hard hit by the virus. The workers don't just provide health resources, they also offer information about food stamps and housing programs.
"What research shows is that when programs are better engaged with communities, they are better informed with what's needed inside the communities," Benjamin-Robinson said.
EDITOR'S NOTE: Melinda Deslatte has covered Louisiana politics for The Associated Press since 2000. Follow her at http://twitter.com/melindadeslatte
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