FUTURE DIRECTIONS: Case Reports: Culture of Health Case Reports
In the next frontier of public health, health departments will have to foster positive community transformation to discover and create “upstream” health solutions. First steps in creating these relationships include meeting with local organizers to learn about the concerns of their community and utilizing others to diversify skills, tools, research, and reach. Additional steps include bringing partnering agencies as close as possible in terms of physical space and giving partnerships time to achieve long-term change. In the year 2000, the Kansas City, Missouri Health Department (KCMOHD) looked into life expectancy data by zip code and found that white residents lived an average of 6.5 years longer than black residents.1 It was undeniable that the city's long-standing geographic racial divide had created a significant health inequity across the community, resulting in deaths attributed to social factors such as poverty, violence, and a lack of education. With this information, an ambitious goal to increase life expectancy and reduce health inequities was built into the city business plan, and the director of health sought to find a collaborator with expertise in bridging the racial and economic divide.
When Kansas City, Missouri (KCMO), was awarded the Culture of Health Prize in 2015, KCMOHD and Communities Creating Opportunity (CCO) had been fostering a synergistic relationship for close to 10 years, developing a memorandum of understanding (MOU) and even sharing the same building in 2012. In fact, self-assessment in preparation for Public Health Accreditation Board (PHAB) accreditation was what encouraged KCMOHD to finalize our MOU with CCO as evidence of our community engagement and cross-sector collaboration objectives (Table). Joint activities were framed around the concept that when truth and power aligned, justice would prevail and health would be realized. KCMOHD provides the truth with health information and real-time data; CCO provides the power through motivation and mobilization of the community.
Together, KCMOHD and CCO have had many successes, including increasing the number of banking institutions willing to provide small loans at reasonable interest rates (2012), increasing employment opportunities for people with a criminal history by removing the mandatory disclosure on city job applications (2013), and ongoing work to increase the living wage in Kansas City; the city approved with a 12-1 vote; 68% voter approved but the state preempted (2017).
Over the past decade, life expectancy improved for everyone, and the gap between white and black residents was reduced from 6.5 to 5 years. Furthermore, geographic racial segregation among city residents has decreased by 7%. Progress has been observed in the newly released County Health Rankings where Jackson County, Missouri, which is home to most of KCMO, moved up from 96th to now 91st (out of 115 Missouri counties) in rankings for social and economic factors that impact health (ie, high school graduation, employment status, children in poverty, income inequity, violent crimes, etc).2
While all elements of the collaboration might have been achieved without the MOU process, it was through the MOU that KCMOHD and CCO moved beyond collaboration and into the realm of shared leadership.3 The commitment that each organization has to the other is a direct result of the accreditation process, where the MOU might not have been created if not for the illumination of gaps in KCMOHD's pursuit to reach PHAB standards. In addition, as a result of increasing focus on health equity and root causes, KCMOHD leadership has filled key positions with people who have a better understanding of health equity and are committed to working for cultural transformation. The 2 organizations will continue to work toward improving the overall health of Kansas City through community engagement around social justice and health equity issues.