Root Causes of Health Initiative: Enhancing Organizational Capacity to Address Root Causes of Health

In 2020, NACDD’s Center for Public Health Leadership launched the Root Causes of Health Initiative (RoCHI) in collaboration with the Institute for Healthcare Improvement (IHI). Using IHI’s Psychology of Change Framework, this initiative helped state health departments implement improvement plans to create meaningful changes addressing the root causes of health disparities in their states. The Framework is an approach to advancing and sustaining improvement together with the people directly and indirectly affected by that improvement including those with lived experience.

In 2022, chronic disease teams from Maryland, Utah, Montana, and Pennsylvania attended an eight-week virtual training designed to deepen their understanding of the root causes and the social determinants of health. Participants were encouraged to discuss what motivates them to do health equity work and how they can come together as a team to create policy, systems, and environment changes to advance health equity. RoCHI teams created a strategic action plan to incorporate health equity into their work and carry out an Equity Action Lab – an event that engaged a wide network of key multi-sector partners (including those with lived experience) to address root causes that prevent the achievement of health equity. The teams participated in monthly coaching sessions while they were implementing their action plans.

“The RoCHI sessions have been extremely helpful and pushed our team to take action that will allow us to standardize health equity efforts across our administration within the health department.”

As a result of participating in the RoCHI learning and coaching sessions, 85% of the participants report improved understanding of the root causes of health; 85% report that they identified actions they will take to apply information they learned in their work; and, 80% report satisfaction with the sessions overall.  The participants also report improved capacity in the team’s ability to adapt to changing environments and work experiences (from 54% on pre-assessment to 73% on final evaluation); the organization’s ability to convene multi-stakeholder groups (from 54% on pre-assessment to 73% on final evaluation); the team’s ability to implement an improvement plan (from 65% on pre-assessment to 80% on final evaluation); and, finally, the ability to work with power dynamics within the organization and community (from 35% on pre-assessment to 67% on final evaluation).

RoCHI teams have tackled a variety of challenges, such as changing organizational structures to better incorporate the voices of the communities in decisions and funding allocations; implementing professional development opportunities designed to increase staff capacity to consciously integrate health equity principles in standard procedures and work deliverables; and, improving the State Health Assessment process to make it more representative of statewide interests and needs. 

“The RoCHI project helped improve PHSD’s organizational capacity by strengthening interorganizational relationships. It also helped us prioritize this project in our workflows.” ​

For example, the Public Health and Safety Division from the Montana Department of Public Health and Human Services is co-designing the State Health Assessment with local and Tribal health departments and other cross-sector partners such as veteran-servicing organizations, the Department of Labor and Industry, and the Department of Commerce. To date, the Division has engaged partners in eight listening sessions with about 300+ people participating in the sessions and providing feedback. Staff are committed to increasing equitable representation of voices contributing to the Assessment and using equitable data communication techniques.

As a result of these new approaches, Montana’s Public Health and Safety Division is expecting a State Health Assessment that is more useful to statewide partners in strategic planning, more representative of statewide interests and needs, and more focused and actionable than ever before.

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