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Collaboration and Health Equity: Drivers, Success, and Strategies of Local Health Partnerships
Swenson, Margaret Hope
Swenson, Margaret Hope
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Abstract
Growing evidence indicates that factors outside of health care profoundly shape health and wellbeing. The Social Determinants of Health framework (SDoH) emphasizes how the conditions where people live, work, play, learn, and age influence health; these include neighborhood and community conditions, economic well-being, and social support, to name a few (Braveman & Gottlieb, 2014). There are persistent and preventable racial and economic health disparities in the United States, and these health outcomes mirror patterns evident in education, occupation, and housing. Because of the multiple upstream causes of health disparities, public health experts recommend collaboration across sectors to advance health equity. Local health departments increasingly partner with other organizations, but not enough is known about how these partnerships form, their outcomes, or their operations. Public administration propositions and frameworks explore collaborations' drivers, success, and strategies. However, collaboration frameworks have rarely been extensively empirically tested, particularly in equity contexts. This dissertation investigates how collaboration frameworks apply to local health collaborations across the SDoH. Chapter One explores potential drivers of local health collaborations, including organizational and community factors. Using evidence from 445 health departments and the counties they serve, I find that financial resources and problem understanding are associated with local health departments collaborating with organizations across the SDoH. Better funding mechanisms and updated data collection standards for health assessments may spur equity collaborations. Chapter Two examines the success of local health collaborations. I analyze how different collaboration characteristics are associated with health care utilization across racial groups. I find that interdependent collaborations are associated with Black and White flu vaccination and mammography screenings. However, White flu vaccination rates are significantly more positively associated with collaboration than Black flu vaccination rates. This suggests sharing personnel and resources benefits White health care utilization more than Black health care utilization. In high disparity health outcomes, collaborations may benefit advantaged groups more; thus, rethinking how public health agencies collaborate may be necessary to address the most pressing health equity challenges. Chapter Three explores local health department leaders’ perceptions of strategies facilitating success in health equity collaborations. Specifically, interviews focus on how shared understanding is created among partners. Local health leaders create shared understanding by establishing agreement around equity, leveraging data and community input, identifying critical problem drivers, and conducting internal and external training and education on equity and biases. This research provides actionable evidence on how leaders and decision-makers can support local partnerships across the SDoH to promote health equity.
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Date
2024-01-01
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University of Kansas
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This item contains archived web content.
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1064687_1.pdf
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- Embargoed until 2174-05-31
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Keywords
Public administration, Public health, Collaboration, Health Equity, Local Government, Social Equity