Health Equity

There's no reason why someone's health should be determined by their zip code – but it is.  Historical social injustices have led to higher rates of poverty, segregation, unsafe neighborhoods, and poor education outcomes for certain populations. As a result, people of color and those experiencing poverty have lower life expectancies, poorer birth outcomes, and higher risk for chronic diseases.

We know that everyone deserves an equal chance to be healthy and thrive.


Why It Matters

In Oregon, as well as across the nation, communities of color and under resourced communities have worse overall health outcomes than almost every other group. These health inequities are rooted in social injustices that make some population groups more vulnerable to poor health than others. We know, for example, that too many people lack access to nutritious food, sidewalks and parks, smoke-free air and other healthy options. This is particularly true for African Americans, Asian Pacific Islanders, Latinos, Native Americans, low-income individuals, people with disabilities, immigrants, refugees, and other underserved populations. As a result, these communities suffer from chronic diseases at much higher rates than the rest of the population.

At Upstream Public Health, we are working to ensure every Oregonian has the chance to achieve their full health potential. We believe that no one should be disadvantaged from achieving this potential because of social position, race, ability or any other socially determined circumstance. Achieving health equity requires valuing everyone equally with focused and ongoing efforts to address avoidable inequalities, historical and contemporary injustices, and the ultimate elimination of health and health care disparities.

What We’re Doing

Health equity is a priority in all the work we do. We continually work to improve our understanding of how social injustices, including racism, impact health. Below are projects where health equity is the primary focus.

The Oregon Health Equity Alliance (previously the HOPE Coalition)

Upstream Public Health is one of the steering committee members of the Oregon Health Equity Alliance (OHEA), previously the Healthy Oregon Partnerships for Equity (HOPE) Coalition. OHEA is a regional partnership of communities of color, health advocates, and policy-makers working together to create and implement a five year plan to increase health equity. For the community, by the community, the alliance seeks to engage on-the-ground partners and people in Clackamas, Marion, Multnomah, and Washington Counties who face significant barriers to better health.

OHEA's 2015 Legislative Work resulted in passage of five out of seven priorities:    

HB 2934 Basic Health Plan (Signed into Law): Continues discussions in Oregon to establish a Basic Health Program.

HB 3025 Ban the Box (Signed into Law):  Requires employers wait to ask the question about criminal history until after making a job offer, in order to give people and families a chance to rebuild after criminal convictions.

SB 454 Paid Sick Time (Signed into Law):  Creates a statewide standard that allows all Oregonians to earn sick time while working. 

HB 2002 End Profiling (Signed into Law):  Defines and bans profiling based on certain characteristics, collects data on stops and arrests to identify patterns or practices of profiling, give the Law Enforcement Contacts Policy and Review Data Review Committee (LECC) the authority to collect and house complaints.

HB 3517 Cover all Kids (Budget Allocation):  Attempted to fix an Oregon statute that excludes some children from health coverage. The bill did not pass, but SB 5507 allocated $10 million to Safety Net Capacity Grants to ensure that children will have access to the primary care services they need.

SB 894 Comprehensive Women's Health Package (Died in Committee):  Would have required that all insurance, whether paid for by individuals, employers or with government funds, cover contraception, abortion, prenatal care, childbirth and post-partum care.

HB 3363 Junk Food Marketing in Schools (Died in Committee):  Would have prevented schools from allowing marketing for food products that do not meet school nutrition standards. (led by Upstream)

What You Can Do

Interested in learning more about ongoing ways to get involved in these issues? Contact Claudia, Upstream's Health Equity Coordinator.

Our Successes So Far

OHEA/HOPE 2014 Work:  In 2014, OHEA and HOPE formally merged.  Prior to that, the HOPE Coalition focused on policy and rule opportunities at the local level to implement our 5 Year Plan, continue coalition building, community education and fundraising, especially for our unfunded priorities. In particular the HOPE Coalition worked to:

  • Ensure CCOs success and accountability in implementing health equity strategies and outcomes
  • Track and assist implementation of cultural competency and data collection legislation
  • Expand tobacco prevention and cessation, including curbing youth access through the retail environment (retail licensure)
  • Mitigate Health and Obesity Impacts of Sugary Beverages
  • Increase focus on improved mental health interventions
  • Promote a Healthy Food Financing Initiative
  • Advance Health Care for All
  • Expand workforce diversity and use of traditional health workers


HOPE 2013 Legislative Accomplishments

The HOPE Coalition developed 13 policy recommendations across the 5 key policy areas that make up our health equity plan.  During Year 2, the Coalition used the Legislative process to advance its goals, continued coalition-building, and community education. The HOPE Coalition was funded to implement 4 of our policy recommendations, and is leveraging its collective strength to make progress on a total of 6 of our 13 policy recommendations. We are developing a fundraising strategy to fund the remaining priorities. 

  • Traditional Community Health Workers
    • As a result of policy work done by  OEI, OLHC and ORCHWA, services provided by these vital workers is now reimbursable by CMS in Oregon
  • Pre-Natal Health Care Expansion (CAWEM)
    • Every year, 5,000+ women in Oregon are unable to access prenatal care services
    • OLHC developed a successful prenatal expansion program now active in 14 counties
    • OLHC is presently engaged in highly confidential conversations with legislators and partners
    • We have reason to hope that by the end of session, all women will have access to prenatal care services in Oregon
  • The Transformation Center
    • A meeting with the Innovation Agents has been set to discuss tobacco control interventions later this month.
  • Soda Tax as a tool for combating obesity and overweight
    • Feasibility study, legal analysis and extensive background  research is underway
    • Educational forum on health impacts of sugary beverages in late June

HOPE helped pass the following bills during the 2013 legislative session:

  • Oregon Safe Roads Act, SB 833- Passed into law
    • Enables undocumented immigrants in Oregon to access an Oregon Driver’s Card
  • Tuition Equity Bill, HB 2787-Passed into law
    • Provides undocumented students an exemption from paying nonresident tuition and fees at public universities, thus removing a critical barrier to higher education.
  • Cultural competency bill, HB 2611-Passed into law
    •  Establishes tracking and reporting of cultural competency education for healthcare professionals and workers.
  • Data Collection bill, HB 2134- Passed into law
    • Establishes culturally appropriate data collection practices within OHA and the Department of Human Services
  • Tobacco Master Settlement Agreement, HB 2136 (Passed into law)
    • Directs that moneys received under Master Settlement Agreement be distributed to Oregon Health Authority Fund and to Tobacco Use Reduction Account.
  • Traditional Health Worker Commission, HB 3407 (Passed into law)
    • Establishes commission within OHA to adopt criteria for CCOs to use with respect to health workers who are not licensed by this state and training and education requirements for those workers.

HOPE 2012 Accomplishments

From 2011-2012, the HOPE Coalition completed its first full year of outreach, engagement, research and action to build a strong coalition and develop a 5-Year Plan. In the first year the HOPE Coalition:

  • Held four community forums to reach consensus on top issue priorities, reaching out to over 100 community-based organizations, advocates, and private health institutions in the consensus-building process
  • Collected local, state, and nationwide health equity data, reviewed over 60 reports and studies, conducted key stakeholder interview and performed health equity data and literature review of the 4 county region
  • Adopted a 5-year plan focused on 5 key policy areas:
  1. Improved Data Collection & Analysis
  2. Workforce Diversity & Cultural Competency
  3. Access to Health Care
  4. Chronic Disease and Other Illness Factors
  5. Mental Health / Substance Abuse / Addictions


Equity Working Group

As a way to ensure that our work at Upstream is consistent with our health equity goals, in 2011 we created a Health Equity Working Group. The Health Equity Working Group is made of up staff and board members. To date, the Working Group has:

  • Completed an internal race equity audit
  • Hosted a race equity training for Upstream's board and staff
  • Developed outreach goals for individual staff to enhance relationships with underserved communities in our region
  • Hired a health equity intern to help reach our health equity goals
  • Developed a race equity analysis tool