UD Partnership for Healthy Communities:

About the UD Partnership for Healthy Communities

In the fall of 2017, the University of Delaware (UD) launched the Partnership for Healthy Communities (PHC) as part of UD’s Community Engagement Initiative, which is designed to strengthen the contributions of UD as an engaged research university. Our mission at the Partnership for Healthy Communities is to align and strengthen UD research, educational and service capabilities to improve the health and well-being of Delaware communities and beyond through effective community partnerships.

This strategic focus on healthy communities underscores growing evidence that health is affected by more than what happens in the doctor’s office, and is reflected in the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. We seek to improve the health and well-being of Delaware residents, especially those living in communities that experience social, environmental and economic disadvantages. We know that many of our residents live in communities that lack the resources needed for good health and often shoulder a disproportionate share of threats or risks to health.¹ PHC Graduate Research Assistant, Kalyn McDonough, conducted research on life expectancy and the relationship with race, education and poverty in Delaware that is further highlighted in this journal issue. We also know that thriving communities with affordable, high quality housing, well-paying jobs, good schools, safe parks and welcoming community spaces, as well as affordable and high-quality healthcare, translate into positive health outcomes for their residents.² We are inspired by the possibility of this reality for all Delaware communities, as well as being inspired by a vision of equity in health where everyone has the opportunity to reach optimal health and well-being.

The focus on how the university engages in this work is also vital. PHC seeks to do this work in authentic partnership by facilitating and enhancing connections between UD (i.e. Colleges of Health Sciences, Agriculture, Arts and Sciences, Business and Economics, Earth, Ocean and Environment, Education and Human Development, and Engineering) and the community (i.e. community-based organizations, state and local agencies and communities themselves, including those impacted first hand by inequities). We consider partnerships to be long-term, two-way mutually beneficial collaborations (with potential for scale); designed to leverage collective resources toward a shared goal; and, guided by jointly defined vision, roles and strategies for achieving that goal. We seek out collective, inter-disciplinary, multi-sector efforts with partners dedicated to learning from each other, embracing strengths and assets, aligning around shared impact, and advancing collaboration in place of unnecessary duplication.

A UD campus-wide survey in fall 2017 that focused on assessing health-related partnerships confirmed that there is much work to build upon. Seventy-three respondents reported that they were currently engaged in 91 health-related partnerships, with some active for over 25 years. Some of the top focus areas of such partnerships included inequities, health care transformation, population health, and health policy. PHC aims to support, sustain and strengthen these efforts in a collective framework that cultivates meaningful engagement to promote equity and drive healthier outcomes.

Alignment with SHIP System-wide Recommendations

PHC’s work in advancing “upstream” thinking for building healthy communities and addressing the social determinants of health is fundamental for improving global and national health, and is a priority for Delaware stakeholders.³ Specifically, PHC’s mission and goals aim to align with the Delaware Division of Public Health’s 2018-2023 Delaware State Health Assessment and State Health Improvement Plan, which emphasizes a system-wide approach that promotes health in all policies, incorporates a social marketing approach, and addresses the social determinants of health. For example, PHC connected public policy students in the Biden School to work alongside a local Blueprints Community who wanted to understand not only how their neighborhood redevelopment plans might impact the environment, but also have an impact on residents’ health. Students conducted a literature review, assessed existing conditions, and predicted the health impact of the community’s plan across 12 social determinants of health.⁴ For more information on Health Impact Assessments, see UD’s Institute for Public Administration’s Complete Communities Toolkit (www.completecommunitiesde.org).

To guide and inform the work of PHC, and potentially support Delaware’s SHIP in addressing gaps and opportunities for improvement, another group of students conducted research this fall to provide an overview of the current state of Health in All Policies (HiAP) approaches taken by various cities, states, and countries. Based on findings from a comprehensive, semester-long literature review, this report mapped out what HiAP might look like in Delaware, including recommendations for a policy alternative to a Delaware-specific HiAP approach.⁵

Through multi-year, donor-funded projects initiated in the summer of 2018, PHC began placing students in a federally-qualified healthcare centers (FQHC) to support clinics in addressing the social determinants of health impacting their patients. Students conducted research on food access initiatives that could help identify and advance potential models for Delaware and developed resource guides to support each clinic in making referrals tailored to their community and patients. The student fellows also worked extensively to plan, coordinate and implement community outreach events in Wilmington and Dover that yielded the highest participation rates since the event’s inception.

Alignment with SHIP Priority Areas

PHC’s alignment with Delaware SHIP system-wide goals has also facilitated our work on Delaware SHIP priority focus areas: chronic disease, maternal and child health, substance use/misuse, and mental health.⁶ One example is PHC’s support of Delaware’s Healthy Neighborhood strategies. As part of Delaware’s healthcare transformation efforts through the federal State Innovation Model program, the Healthy Neighborhoods population health strategy has helped establish local-level councils and task forces across the state that integrate community and health system efforts and target parallel priority focus areas.⁷ PHC has been working extensively with Healthy Neighborhoods, and has helped mobilize several teams of cross-college faculty and students from our Wilmington, Newark and Dover campuses to assist with implementation and evaluation. Internally, PHC also coordinated with UD’s Cooperative Extension leadership and staff, who have been supporting Healthy Neighborhoods across the state with planning and logistics since their inception. These plans are laying the groundwork for systems to work across sectors and engage in more “upstream” strategies as part of healthcare transformation’s shift to value-based care and greater return on investments. Moving ahead, PHC is excited to play a role in helping sustain efforts to align for better health in DE. These efforts are now being led by Healthy Communities Delaware, a consortium of public, nonprofit and private organizations aligning efforts and investing in projects, programs and policies aimed at improving the health of people in low-wealth communities in the state.

Plans and Considerations for the Future

In spring 2018, PHC, in partnership with the Delaware Academy of Medicine/Delaware Public Health Association and 12 campus and community partners, planned and hosted 15 events as part of National Public Health Week. The week culminated in a presentation from Joseph Telfair, DrPH, MSW, MPH, President of the American Public Health Association (APHA). Dr. Telfair underscored the need to build infrastructure and develop our workforce as essential means to assuring the public's health.⁸ Dr. Telfair outlined gaps in training, stressed the need for skill development among workers to better understand and influence policy, and described looming workforce capacity challenges. It is estimated that 250,000 more public health workers will be needed by 2020 to maintain capacity.⁹ These remarks further bolstered PHC goals to expand public health-related educational opportunities through new and expanded instructional programs and enhanced experiential learning. In addition to a new “Public Health in Practice” course taught in 2018 by PHC Director, Rita Landgraf, Professor of Practice and Distinguished Health & Social Services Administrator in Residence, PHC is working to develop and advance a Masters of Public Health program. While UD’s current Public Health minor continues to generate interest with student enrollment over 180, an MPH would help DE provide the educational and training capital needed to support public health professionals in gaining accredited, innovative and rigorous public health workforce development.

Dr. Telfair also focused on the role policies played in some of the greatest public health achievements of the 20th century, where the results had an outsize impact over time (i.e, fluoridating our water, mandating seatbelts, and improving access to family planning services). In the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), three quarters of respondents agreed that it is important to have the skills to influence policy and understand the relationship between public health policy and public health problems. However, one-third of that group reported either beginner-level ability or no ability at all in these areas.

This April, PHC will launch our first Policy Academy for faculty, students, staff, state and local government leaders and representatives, advocates, community partners and residents. This inaugural academy, “Reducing Health Inequities by Addressing Structural Racism,” will cultivate awareness of how policy and resource allocation often create or perpetuate health inequities and racial injustice. We are working to ensure that participants leave with new and deepened insights, grounded in the best possible evidence, to evoke compassion and shared responsibility for dismantling structural racism and promoting equitable policies and practices. As a long-term strategy, PHC Policy Academies will have several aims: increase our collective understanding of key issues that impact the health of communities, give voice and clarity to why certain communities are most impacted by health inequities, facilitate authentic partnerships, and advance informed decision-making related to the complex nature of health inequities and the policies that impact them.

As PHC progresses through its second year, we are excited to advance research and policy, expand educational opportunities, and enhance our service capabilities. Ensuring that our goals are aligned with Delaware’s SHIP is not only an ironclad strategy to improve and protect the health of Delawareans, it is a partnership we are honored and proud to be a part of with the Delaware Division of Public Health and our partners across the First State.