Health Im Impact Assessment: : In Indian Health Services Budget - PowerPoint PPT Presentation

Health Im Impact Assessment: : In Indian Health Services Budget and Urban In Indian Budgeting Decisions http://nmhep.org/resources/hia-reports/ihs/ Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Acknowledgements • HIA Team • Emily Haozous • Valerie Rangel • Shandra Burton • NM Health Equity Partnership Technical Support Team • David Gaussoin • Jinelle Scully • Richard Wright • Jessica Jensen • Community Advisory Board • Kathryn Harris Tijerina • Delight Talawepi • Anne Wheelock Gonzales • David Sloan • Nancy Davis • Cyndi Woodall-Hall • Edie Brycelea • Santa Fe IHS Hospital Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

What is an HIA? The value of HIAs is that they: • Engage the public and other Health Impact stakeholders throughout the Assessments (HIAs): process • Evaluate the impact of a • Consider the many layers that public policy with the goal influence health of promoting health, health (from individual uncontrollable risk factors like age, genetics, and gender, to equity, and social justice controllable risk factors like diet, exercise, and coping) • Can be used to inform recommendations on a specific policy Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Screening Determines the need and value of an HIA. 6 Steps to an HIA Scoping Determines which health impacts to evaluate, methods for analysis, and a work plan. Assessment Provides a profile of existing health conditions and an evaluation of potential health impacts. Recommendations Provides strategies to manage identified adverse health impacts. Reporting Develops the HIA report and communicates findings and recommendations. Monitoring Tracks impacts on decision-making processes and the decision itself, and impacts of the decision on health determinants. Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Purpose Examine the impact of federal underfunding of the Santa Fe Indian Health Service Hospital on the inter- tribal community of American Indian and Alaska Natives in the metropolitan Santa Fe area Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Background • Urban American Indians/Alaska Natives • Off-reservation population • Causes: • Federal Relocation policies • Boarding schools • Economy/ unemployment/ poverty • Unfriendly political climate • Personal reasons • Indian Health Service - Treaty obligation Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Background Data Sources • NM Department of Health​ • Indian Health Service • CDC​ • Annie E. Casey Kids Count! Annual Report​ • Surveillance, Epidemiology, End Results (SEER) Tumor Registry​ • The Joint Commission Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

AIAN Child Health in NM % Hispanic or Latinx children with no health insurance % NHW children with no health insurance % AIAN children with no health insurance All family income (in thousands) AIAN family income (in thousands) % All Families with no parent in workforce %AIAN Families with no parent in workforce % All Families living in poverty % AIAN Families Living in Poverty 0 5 10 15 20 25 30 35 40 45 50 Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

AIAN females have shorter Vital Statistics- Santa Fe County life span than NHW females Life Expectancy- Average Number of Years Remaining 90 AIAN males 80 have shorter 70 60 life span than 50 NHW males 40 30 20 10 0 0 Age 45-49 Age 50-54 Age 55-59 Age 60-64 Age 65-69 Age 70-74 Age 80-84 Age 85+ Male AIAN Male NHW Female AIAN Female NHW Source: NM Dept of Health Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Malignant Neoplasms AIAN are diagnosed at lower rates as Incidence and Mortality, Santa Fe County, Both NHW, but die at Sexes, All Ages, 2008-2012, Age Adjusted (95% the same rates as CI) NHW 450 400 350 300 250 200 150 100 50 0 AIAN Incidence AIAN Mortality NHW Incidence NHW Mortality Incidence Mortality AIAN (includes Hispanic) 277.2 (208.4, 360.2) 91.6 (50.0, 150.4) NHW 391.8 (371, 427.9) 125.7 (115.8, 136.5) Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Source: SEER Registry Jinelle Scully; Jessica Jensen

Methods • Community Advisory Board • Members of the Urban AI/AN community • Professionals- • Lawyer • Policy expert • Public education • Art retail • Artist • Art education • Healthcare • Mental health • Consulted at all key decision-making points Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Methods • Data Collection • Community Survey • Drawn from larger needs assessment question bank • Amended to meet project needs • Focused based on Community Advisory Board priorities • Qualitative Interviews • Analysis • Quantitative Data: Descriptive statistics and overall data trends • Qualitative Data: Thematic analysis • Total sample • 165 anonymous surveys completed • pencil/paper and online survey • 17 confidential qualitative interviews Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Table 1. Demographic Characteristics Characteristics Characteristics % (N=165) % (N=165) Gender Income < $10,000 17.91 24 Male 29.71 41 $10,000-$19,999 11.94 16 Female 69.57 96 $20,000-$29,999 13.43 18 Other 0.72 1 $30,000-$49,999 19.40 26 Age $50,000-$74,999 9.7 13 18-24 9.45 12 More than $75,000 9.7 13 25-34 17.32 22 I prefer not to answer 17.91 24 Number of Children 35-44 23.62 30 45-54 18.9 24 0 47.15 58 55-64 19.69 25 1 13.82 17 65+ 11.02 14 2 19.51 24 Education Attained 3 15.45 19 11th Grade 3.05 4 4 4.07 5 High School Diploma or GED 39.42 54 Associates Degree 23.36 32 Bachelors Degree 24.09 33 Masters Degree 3.65 5 Professional Degree 2.92 4 Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; I prefer not to answer 2.65 5 Jinelle Scully; Jessica Jensen

Survey Demographics: Age Age 65+ 55-64 45-54 35-44 25-34 18-24 0 5 10 15 20 25 % Response Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen

Survey Demographics: Education Completed 45 40 35 30 25 20 15 10 5 0 11th Grade High School Associates Degree Bachelors Degree Masters Degree Professional I prefer not to Diploma or GED Degree answer Research Team: Emily A. Haozous, PhD, RN, FAAN (Chiricahua Warm Springs Fort Sill Apache); Valerie Rangel, MCRP; Shandra Burton, MSN, RN New Mexico Health Equity Partnership Technical Support Team: Richard Wright, MPH; David Gaussoin; Jinelle Scully; Jessica Jensen