Policymakers are exploring ways to expand access to doula care to address persistent inequities i... more Policymakers are exploring ways to expand access to doula care to address persistent inequities in maternal and infant health across the United States. Doulas are non-medical professionals who provide physical, emotional, and informational support to birthing people before, during and after childbirth. Growing evidence supports the role of doulas in improved birth outcomes. Delaware is among several states moving towards Medicaid reimbursement for doula care to serve those most at risk. Objective: To gain an in-depth understanding of key stakeholders' knowledge, attitudes, beliefs and experiences regarding doula training and certification, relationships among providers, and other potential needs related to infrastructure to identify areas of agreement and inform policy change in the state of Delaware. Methods: We conducted focus groups with 11 doulas and key-informant interviews with 12 licensed providers practicing in Delaware, including six nurses, four physicians and two certified nurse midwives. Qualitative data was collected via Zoom (video conferencing) between September 2022 and April 2023. Results: Analysis revealed themes related to training, credentials and competencies of doulas, including cultural competence; logistical, administrative, and financial considerations for policy and practice change; and the whole care team-relationships between doulas and medical partners, and opportunities for growth. Conclusions: Doulas and licensed providers agree on key elements of doula training, the value of certification, the need for financial support, and the importance of relationship-building across the care team. Policy implications: Areas of agreement among stakeholders provide a foundation for state leaders to move forward to ensure the delivery of the most accessible, high quality, and culturally competent doula care for birthing people in Delaware.
In the fall of 2017, the University of Delaware (UD) launched the Partnership for Healthy Communi... more In the fall of 2017, the University of Delaware (UD) launched the Partnership for Healthy Communities (PHC) as part of UD's Community Engagement Initiative, which is designed to strengthen the contributions of UD as an engaged research university. Our mission at the Partnership for Healthy Communities is to align and strengthen UD research, educational and service capabilities to improve the health and well-being of Delaware communities and beyond through effective community partnerships.
Delaware Contraceptive Access Now was a statewide contraceptive access program implemented in Del... more Delaware Contraceptive Access Now was a statewide contraceptive access program implemented in Delaware between 2015 and 2020. We evaluated the association of the program with contraceptive initiation in Delaware’s Medicaid program using a difference-in-differences design that compared changes in Delaware to changes in Maryland. Results suggest that program implementation was associated with increased initiation of long-acting reversible methods, particularly among adolescent patients aged 15 to 18 years. We found less-consistent evidence for changes to any contraceptive method. (Am J Public Health. 2022;112(S5):S537–S540. https://doi.org/10.2105/AJPH.2022.306938 )
In December 2014, Nemours engaged the services of the University of Delaware, Center for Communit... more In December 2014, Nemours engaged the services of the University of Delaware, Center for Community Research and Service, to conduct an analysis of the health services utilization among children enrolled in Medicaid that are served by the Nemours health system in order to help evaluate the asthma intervention.
Given that the health of a woman is directly linked to the health of her baby and that prenatal c... more Given that the health of a woman is directly linked to the health of her baby and that prenatal care is often too late to address conditions that could potentially impact the healthy development of a fetus, preconception care has emerged as a critical area of women’s health care over the past several years.
Реферат. Стрессовое недержание мочи и пролапс тазовых органов является мировой проблемой, которая... more Реферат. Стрессовое недержание мочи и пролапс тазовых органов является мировой проблемой, которая пагубно влияет на качество жизни женщин в различных возрастных группах. Данная статья представляет собой анализ методов коррекции этих нарушений при различных дефектах тазового дна. Цель исследования-анализ и оценка различных биологических материалов, используемых при несостоятельности тазового дна и стрессового недержания мочи, таких как уретральные слинги, биологические трансплантаты, стволовые клетки, исходя из данных мировой литературы. Материал и методы. Для оценки и сравнения использовались работы многих зарубежных и отечественных авторов. Рассмотрены механизмы действия стволовых клеток, сравнительная их характеристика по данным результатов проведенных исследований. Проанализированы достижения в тканевой инженерии и изучено значение собственных стволовых клеток, полученных из мышечной, жировой, мезенхимальной тканей, костного мозга и эндометрия. Оценены преимущества и недостатки синтетических и биологических материалов. Результаты и их обсуждение. Несмотря на большое количество отечественных и зарубежных публикаций по проблеме несостоятельности мышц тазового дна и обширных исследований по проблеме недержания мочи, в данное время отсутствует дифференцированный подход к выбору методов хирургического и консервативного лечения при различных дефектах тазового дна, что позволило бы существенно улучшить результаты лечения. Выводы. Ряд литературных данных указывает на относительно высокую эффективность использования собственных стволовых клеток. На современном этапе научные исследования в данном направлении представляются крайне перспективными. Ключевые слова: пролапс органов малого таза, биологические материалы, недержание мочи, стволовые клетки. Для ссылки: Сравнительная эффективность некоторых видов биологически материалов при различных дефектах тазового дна / А.Г. Ящук, И.И. Мусин, Р.А. Нафтулович [и др.] // Вестник современной клинической медицины.-2018.-Т. 11, вып. 3.-С.82-88.
This policy brief describes the role of racism in creating and perpetuating inequities in health ... more This policy brief describes the role of racism in creating and perpetuating inequities in health among Black communities in the United States. It defines structural racism within a social determinants of health framework and highlights ways in which residential segregation is connected with poor living, working, and social conditions that threaten good health. This brief concludes with recommendations for advancing health equity through more concerted attention to structural racism. Health and Health Inequities in the United States (US) Despite being one of the wealthiest countries in the world with an abundance of health-related resources, the US has poor health compared to other countries. Life expectancy and infant mortality are two important measures used to describe the health and well-being of a community or population. On both indicators, the US ranks poorly: 45 th in life expectancy and 170 th in infant mortality. 1 Notably, these indicators are also generally moving in the wrong direction, with the US falling in the rankings in recent years. Differences in health among different groups of people, often referred to as health inequities, are well documented, persistent, and even increasing for some health conditions across the US. Health inequities may be viewed in the context of race, gender, sexual orientation, income, education level, disability status, or geographic location, among others. For example, sexual minorities tend to have poorer physical and mental health than heterosexual men and women 2 and individuals with disabilities are likely to have higher rates of chronic diseases, unrelated to their disability, compared to individuals without disabilities 3. We also see persistent health inequities by socioeconomic status (e.g., income, occupation, and education level) and research documents a social gradient in health, such that as socioeconomic status improves, so does health status. For example, the gap in life expectancy between individuals in the top and bottom 1% of the income distribution in the US is 15 years for men and 10 years for women. 4 The social gradient in health means that inequities affect virtually everyone. 5 Further, when it comes to health, people are often disadvantaged by more than one type of oppression based on their identity or class (e.g., "black" and "gay"). This concept of intersectionality, originally described by Crenshaw 6 , is important for understanding how groups of people with overlapping identities and experiences may be discriminated against in many ways. Because these are socially constructed categories related to social hierarchy, and related differences in health do not derive from biology or genetics, experts consider such health sites.udel.edu/healthycommunities |
The COVID-19 pandemic has illuminated the critical need to make greater investments in public hea... more The COVID-19 pandemic has illuminated the critical need to make greater investments in public health and build the capacity of the public health workforce. Among the professional competencies needed to address the ongoing morbidity and mortality associated with COVID-19, as well as other current and future public health challenges, is the ability to effectively engage in the political process. While we acknowledge that public health institutions and workers are under-resourced and are grateful for their tireless efforts to control the pandemic, we argue that their efforts have been severely hampered by a notable absence from politics. We argue that our ability to protect and promote public health has been further challenged by divisive political rhetoric from the former presidential administration, which has amplified a culture of selfinterest and individualism. Such values are counter to public health and threaten our ability to address the disproportionate impacts of COVID-19 on low-income communities and communities of color, along with the myriad of health inequities experienced by marginalized communities in the US. We assert that public health professionals must be better equipped and supported in their efforts to challenge powerful majorities that have generated such unhealthy and unequal social and environmental conditions. Policy change related to social determinants of health should be an integral component of our intervention strategies and political advocacy should be considered a core competency for training future public health professionals. The field needs professionals comfortable and adept at working within the political sphere; students are eager for skills that allow them to translate their passion for social justice in health; and the persistent and pervasive health inequities experienced by marginalized communities demand such action.
According to the American Academy of Pediatrics, children in foster care have poorer health than ... more According to the American Academy of Pediatrics, children in foster care have poorer health than any other group of children. Their higher prevalence of a range of physical, mental and behavioral health problems can lead to greater healthcare utilization and higher costs. However, many children in foster care have undiagnosed and under-treated medical conditions, and persistent unmet health needs.
How Healthy are Delawareans? Health is often defined as a state of physical, mental and social we... more How Healthy are Delawareans? Health is often defined as a state of physical, mental and social wellbeing and not merely the absence of disease. It is a positive concept emphasizing resources and capabilities1 and at a population level, is only marginally impacted by the delivery of healthcare2. Rather, experts agree that social circumstances and our living and working conditions—referred to as social determinants of health (SDH)—are the most important drivers of health.
This report documents a preliminary evaluation of Planned Parenthood of Delaware (PPDE) preconcep... more This report documents a preliminary evaluation of Planned Parenthood of Delaware (PPDE) preconception services.
the present study utilizes seventeen maternal and child health indicators that have been reported... more the present study utilizes seventeen maternal and child health indicators that have been reported annually for each state through KIDS COUNT which is sponsored by the Annie E. Casey Foundation. In addition to social and demographic independent variables, economic and policy variables thought to be related to maternal and child health are included in the statistical models.
In the United States, substantial justification exists for considering teen pregnancy prevention ... more In the United States, substantial justification exists for considering teen pregnancy prevention programs. First, the prevalence of teen pregnancy and birth rates among female teenagers has been at high levels. Second, teen pregnancies have produced considerable social costs to the America population.
Abstract Persistent challenges to public health and well-being are being addressed though complex... more Abstract Persistent challenges to public health and well-being are being addressed though complex interventions. Complex interventions are intentional processes designed to shift and realign the form and function of targeted system patterns by changing underlying system dynamics, structures, and conditions. The IM40 initiative was a complex health promotion intervention designed to address adolescent health and well-being through a developmental assets approach. The initiative sought to influence several levels simultaneously (e.g. individual, professional, procedural, and policy), compounding the complexity for implementation and evaluation. The purpose of this case study is to present the development and initiation of an evaluation approach based on systems thinking and complexity science principles, concepts, and methods. We used three systems methods, Group Model Building (GMB), viable systems model (VSM) assessment, and Social Network Analysis (SNA) to identify and examine underlying patterns and structures that influenced system-wide behaviors. Each method focused on a general systems-oriented question and illuminated stakeholder views of the IM40 theory of change, adaptive organization of multiple independent institutions, and relational ties among system actors. Collectively, the methods enabled us to describe systems change over time and examine shifts in boundaries, relationships, perspectives, and dynamics. The implications of this approach relative to typical evaluation activities in public health practice are contrasted and discussed.
The purpose of this guide is to provide a resource to assist the Delaware Division of Public Heal... more The purpose of this guide is to provide a resource to assist the Delaware Division of Public Health (DPH) and its partners in moving farther upstream to address the underlying causes of health inequities in Delaware’s communities.
The Health Services Policy Research Group (HSPRG) expresses its appreciation to a number of indiv... more The Health Services Policy Research Group (HSPRG) expresses its appreciation to a number of individuals for their contribution that facilitated the completion of this evaluation and its report. The following individuals provided assistance and cooperation in either data collection and/or the facilitation of the site audits.
ABSTRACT One of the overarching goals of Healthy People 2020 is to Achieve health equity, elimina... more ABSTRACT One of the overarching goals of Healthy People 2020 is to Achieve health equity, eliminate disparities, and improve the health of all groups. Public health agencies across the country are working to operationalize this goal within their organizations. However, they face many challenges in translating the evidence base regarding the social determinants of health and the causes of health inequities into public health practice that advances health equity. In 2011, the Delaware Division of Public Health identified health equity as one of its strategic priorities and launched an organization-wide planning effort for its implementation. A consulting firm, the Results that Matter Team, provided technical assistance on strategy map development through the Association of State and Territorial Health Officials. Over the course of 18 months, individuals from across the agency met to develop strategic cross-cutting objectives, and related activities and performance measures. Refinement of the health equity strategy map is ongoing, and will eventually link the Division's comprehensive strategy with a performance management system for tracking progress and improving quality. This presentation will describe the strategy mapping process that was used, highlighting the value of such a planning framework, as well as some of the challenges faced. We believe that sharing early lessons learned from Delaware's experience may benefit other public health agencies as they work to integrate health equity efforts into more traditional public health practice and contribute to the achievement the national Healthy People goal.
Policymakers are exploring ways to expand access to doula care to address persistent inequities i... more Policymakers are exploring ways to expand access to doula care to address persistent inequities in maternal and infant health across the United States. Doulas are non-medical professionals who provide physical, emotional, and informational support to birthing people before, during and after childbirth. Growing evidence supports the role of doulas in improved birth outcomes. Delaware is among several states moving towards Medicaid reimbursement for doula care to serve those most at risk. Objective: To gain an in-depth understanding of key stakeholders' knowledge, attitudes, beliefs and experiences regarding doula training and certification, relationships among providers, and other potential needs related to infrastructure to identify areas of agreement and inform policy change in the state of Delaware. Methods: We conducted focus groups with 11 doulas and key-informant interviews with 12 licensed providers practicing in Delaware, including six nurses, four physicians and two certified nurse midwives. Qualitative data was collected via Zoom (video conferencing) between September 2022 and April 2023. Results: Analysis revealed themes related to training, credentials and competencies of doulas, including cultural competence; logistical, administrative, and financial considerations for policy and practice change; and the whole care team-relationships between doulas and medical partners, and opportunities for growth. Conclusions: Doulas and licensed providers agree on key elements of doula training, the value of certification, the need for financial support, and the importance of relationship-building across the care team. Policy implications: Areas of agreement among stakeholders provide a foundation for state leaders to move forward to ensure the delivery of the most accessible, high quality, and culturally competent doula care for birthing people in Delaware.
In the fall of 2017, the University of Delaware (UD) launched the Partnership for Healthy Communi... more In the fall of 2017, the University of Delaware (UD) launched the Partnership for Healthy Communities (PHC) as part of UD's Community Engagement Initiative, which is designed to strengthen the contributions of UD as an engaged research university. Our mission at the Partnership for Healthy Communities is to align and strengthen UD research, educational and service capabilities to improve the health and well-being of Delaware communities and beyond through effective community partnerships.
Delaware Contraceptive Access Now was a statewide contraceptive access program implemented in Del... more Delaware Contraceptive Access Now was a statewide contraceptive access program implemented in Delaware between 2015 and 2020. We evaluated the association of the program with contraceptive initiation in Delaware’s Medicaid program using a difference-in-differences design that compared changes in Delaware to changes in Maryland. Results suggest that program implementation was associated with increased initiation of long-acting reversible methods, particularly among adolescent patients aged 15 to 18 years. We found less-consistent evidence for changes to any contraceptive method. (Am J Public Health. 2022;112(S5):S537–S540. https://doi.org/10.2105/AJPH.2022.306938 )
In December 2014, Nemours engaged the services of the University of Delaware, Center for Communit... more In December 2014, Nemours engaged the services of the University of Delaware, Center for Community Research and Service, to conduct an analysis of the health services utilization among children enrolled in Medicaid that are served by the Nemours health system in order to help evaluate the asthma intervention.
Given that the health of a woman is directly linked to the health of her baby and that prenatal c... more Given that the health of a woman is directly linked to the health of her baby and that prenatal care is often too late to address conditions that could potentially impact the healthy development of a fetus, preconception care has emerged as a critical area of women’s health care over the past several years.
Реферат. Стрессовое недержание мочи и пролапс тазовых органов является мировой проблемой, которая... more Реферат. Стрессовое недержание мочи и пролапс тазовых органов является мировой проблемой, которая пагубно влияет на качество жизни женщин в различных возрастных группах. Данная статья представляет собой анализ методов коррекции этих нарушений при различных дефектах тазового дна. Цель исследования-анализ и оценка различных биологических материалов, используемых при несостоятельности тазового дна и стрессового недержания мочи, таких как уретральные слинги, биологические трансплантаты, стволовые клетки, исходя из данных мировой литературы. Материал и методы. Для оценки и сравнения использовались работы многих зарубежных и отечественных авторов. Рассмотрены механизмы действия стволовых клеток, сравнительная их характеристика по данным результатов проведенных исследований. Проанализированы достижения в тканевой инженерии и изучено значение собственных стволовых клеток, полученных из мышечной, жировой, мезенхимальной тканей, костного мозга и эндометрия. Оценены преимущества и недостатки синтетических и биологических материалов. Результаты и их обсуждение. Несмотря на большое количество отечественных и зарубежных публикаций по проблеме несостоятельности мышц тазового дна и обширных исследований по проблеме недержания мочи, в данное время отсутствует дифференцированный подход к выбору методов хирургического и консервативного лечения при различных дефектах тазового дна, что позволило бы существенно улучшить результаты лечения. Выводы. Ряд литературных данных указывает на относительно высокую эффективность использования собственных стволовых клеток. На современном этапе научные исследования в данном направлении представляются крайне перспективными. Ключевые слова: пролапс органов малого таза, биологические материалы, недержание мочи, стволовые клетки. Для ссылки: Сравнительная эффективность некоторых видов биологически материалов при различных дефектах тазового дна / А.Г. Ящук, И.И. Мусин, Р.А. Нафтулович [и др.] // Вестник современной клинической медицины.-2018.-Т. 11, вып. 3.-С.82-88.
This policy brief describes the role of racism in creating and perpetuating inequities in health ... more This policy brief describes the role of racism in creating and perpetuating inequities in health among Black communities in the United States. It defines structural racism within a social determinants of health framework and highlights ways in which residential segregation is connected with poor living, working, and social conditions that threaten good health. This brief concludes with recommendations for advancing health equity through more concerted attention to structural racism. Health and Health Inequities in the United States (US) Despite being one of the wealthiest countries in the world with an abundance of health-related resources, the US has poor health compared to other countries. Life expectancy and infant mortality are two important measures used to describe the health and well-being of a community or population. On both indicators, the US ranks poorly: 45 th in life expectancy and 170 th in infant mortality. 1 Notably, these indicators are also generally moving in the wrong direction, with the US falling in the rankings in recent years. Differences in health among different groups of people, often referred to as health inequities, are well documented, persistent, and even increasing for some health conditions across the US. Health inequities may be viewed in the context of race, gender, sexual orientation, income, education level, disability status, or geographic location, among others. For example, sexual minorities tend to have poorer physical and mental health than heterosexual men and women 2 and individuals with disabilities are likely to have higher rates of chronic diseases, unrelated to their disability, compared to individuals without disabilities 3. We also see persistent health inequities by socioeconomic status (e.g., income, occupation, and education level) and research documents a social gradient in health, such that as socioeconomic status improves, so does health status. For example, the gap in life expectancy between individuals in the top and bottom 1% of the income distribution in the US is 15 years for men and 10 years for women. 4 The social gradient in health means that inequities affect virtually everyone. 5 Further, when it comes to health, people are often disadvantaged by more than one type of oppression based on their identity or class (e.g., "black" and "gay"). This concept of intersectionality, originally described by Crenshaw 6 , is important for understanding how groups of people with overlapping identities and experiences may be discriminated against in many ways. Because these are socially constructed categories related to social hierarchy, and related differences in health do not derive from biology or genetics, experts consider such health sites.udel.edu/healthycommunities |
The COVID-19 pandemic has illuminated the critical need to make greater investments in public hea... more The COVID-19 pandemic has illuminated the critical need to make greater investments in public health and build the capacity of the public health workforce. Among the professional competencies needed to address the ongoing morbidity and mortality associated with COVID-19, as well as other current and future public health challenges, is the ability to effectively engage in the political process. While we acknowledge that public health institutions and workers are under-resourced and are grateful for their tireless efforts to control the pandemic, we argue that their efforts have been severely hampered by a notable absence from politics. We argue that our ability to protect and promote public health has been further challenged by divisive political rhetoric from the former presidential administration, which has amplified a culture of selfinterest and individualism. Such values are counter to public health and threaten our ability to address the disproportionate impacts of COVID-19 on low-income communities and communities of color, along with the myriad of health inequities experienced by marginalized communities in the US. We assert that public health professionals must be better equipped and supported in their efforts to challenge powerful majorities that have generated such unhealthy and unequal social and environmental conditions. Policy change related to social determinants of health should be an integral component of our intervention strategies and political advocacy should be considered a core competency for training future public health professionals. The field needs professionals comfortable and adept at working within the political sphere; students are eager for skills that allow them to translate their passion for social justice in health; and the persistent and pervasive health inequities experienced by marginalized communities demand such action.
According to the American Academy of Pediatrics, children in foster care have poorer health than ... more According to the American Academy of Pediatrics, children in foster care have poorer health than any other group of children. Their higher prevalence of a range of physical, mental and behavioral health problems can lead to greater healthcare utilization and higher costs. However, many children in foster care have undiagnosed and under-treated medical conditions, and persistent unmet health needs.
How Healthy are Delawareans? Health is often defined as a state of physical, mental and social we... more How Healthy are Delawareans? Health is often defined as a state of physical, mental and social wellbeing and not merely the absence of disease. It is a positive concept emphasizing resources and capabilities1 and at a population level, is only marginally impacted by the delivery of healthcare2. Rather, experts agree that social circumstances and our living and working conditions—referred to as social determinants of health (SDH)—are the most important drivers of health.
This report documents a preliminary evaluation of Planned Parenthood of Delaware (PPDE) preconcep... more This report documents a preliminary evaluation of Planned Parenthood of Delaware (PPDE) preconception services.
the present study utilizes seventeen maternal and child health indicators that have been reported... more the present study utilizes seventeen maternal and child health indicators that have been reported annually for each state through KIDS COUNT which is sponsored by the Annie E. Casey Foundation. In addition to social and demographic independent variables, economic and policy variables thought to be related to maternal and child health are included in the statistical models.
In the United States, substantial justification exists for considering teen pregnancy prevention ... more In the United States, substantial justification exists for considering teen pregnancy prevention programs. First, the prevalence of teen pregnancy and birth rates among female teenagers has been at high levels. Second, teen pregnancies have produced considerable social costs to the America population.
Abstract Persistent challenges to public health and well-being are being addressed though complex... more Abstract Persistent challenges to public health and well-being are being addressed though complex interventions. Complex interventions are intentional processes designed to shift and realign the form and function of targeted system patterns by changing underlying system dynamics, structures, and conditions. The IM40 initiative was a complex health promotion intervention designed to address adolescent health and well-being through a developmental assets approach. The initiative sought to influence several levels simultaneously (e.g. individual, professional, procedural, and policy), compounding the complexity for implementation and evaluation. The purpose of this case study is to present the development and initiation of an evaluation approach based on systems thinking and complexity science principles, concepts, and methods. We used three systems methods, Group Model Building (GMB), viable systems model (VSM) assessment, and Social Network Analysis (SNA) to identify and examine underlying patterns and structures that influenced system-wide behaviors. Each method focused on a general systems-oriented question and illuminated stakeholder views of the IM40 theory of change, adaptive organization of multiple independent institutions, and relational ties among system actors. Collectively, the methods enabled us to describe systems change over time and examine shifts in boundaries, relationships, perspectives, and dynamics. The implications of this approach relative to typical evaluation activities in public health practice are contrasted and discussed.
The purpose of this guide is to provide a resource to assist the Delaware Division of Public Heal... more The purpose of this guide is to provide a resource to assist the Delaware Division of Public Health (DPH) and its partners in moving farther upstream to address the underlying causes of health inequities in Delaware’s communities.
The Health Services Policy Research Group (HSPRG) expresses its appreciation to a number of indiv... more The Health Services Policy Research Group (HSPRG) expresses its appreciation to a number of individuals for their contribution that facilitated the completion of this evaluation and its report. The following individuals provided assistance and cooperation in either data collection and/or the facilitation of the site audits.
ABSTRACT One of the overarching goals of Healthy People 2020 is to Achieve health equity, elimina... more ABSTRACT One of the overarching goals of Healthy People 2020 is to Achieve health equity, eliminate disparities, and improve the health of all groups. Public health agencies across the country are working to operationalize this goal within their organizations. However, they face many challenges in translating the evidence base regarding the social determinants of health and the causes of health inequities into public health practice that advances health equity. In 2011, the Delaware Division of Public Health identified health equity as one of its strategic priorities and launched an organization-wide planning effort for its implementation. A consulting firm, the Results that Matter Team, provided technical assistance on strategy map development through the Association of State and Territorial Health Officials. Over the course of 18 months, individuals from across the agency met to develop strategic cross-cutting objectives, and related activities and performance measures. Refinement of the health equity strategy map is ongoing, and will eventually link the Division's comprehensive strategy with a performance management system for tracking progress and improving quality. This presentation will describe the strategy mapping process that was used, highlighting the value of such a planning framework, as well as some of the challenges faced. We believe that sharing early lessons learned from Delaware's experience may benefit other public health agencies as they work to integrate health equity efforts into more traditional public health practice and contribute to the achievement the national Healthy People goal.
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