D.C. Mun. Regs. tit. 10-A, § 1106
1106.1 Health equity is defined as the commitment to ensuring that everyone has a fair and just opportunity to be healthier. Many of the determinants of health and health inequities in populations have social, environmental, and economic origins that extend beyond the direct influence of the health sector and health policies. Thus, public policies in all sectors and at different levels of governance can have a significant impact on population health and health equity. Washington, DC is moving toward a Health in All Policies (HiAP) approach, a systems-wide, cross-sector consideration of health in government decision-making. This HiAP approach seeks to advance accountability, transparency, and access to information through cross-sector and multilevel collaboration in government.
1106.2 Access to affordable, equitable, quality clinical care and health behaviors are crucial for improving health outcomes. DC Health has advanced this framework through several strategic plans, including DC Healthy People 2020 (DC HP2020), the DC Health Systems Plan (HSP), and the DC State Health Innovation Plan (SHIP), and by continually developing and deploying innovative tools that help track and improve health outcomes.
1106.3 Further, Sustainable DC 2.0, a multi-agency initiative led by OP and the Department of Energy and Environment (DOEE), includes the goal of improving population health by systematically addressing the link between community health and place, including where people are born, live, learn, work, play, worship, and age. Sustainable DC 2.0 sets a target of reducing racial disparities in the life expectancy of residents by 50 percent by 2032.
1106.4 The District has adopted an overarching framework of health equity. Achieving health equity requires an explicit focus on and targeting of societal structures and systems that prevent all people from achieving their best possible health, including poverty, discrimination, and lack of access to economic opportunities.
1106.5 Figure 11.7. Leading Health Indicator Chart, District of Columbia District of Columbia Healthy People 2020, Annual Report and Action Plan 2017-2019
| Number | Leading Health Indicator | Baseline (Year) | Recent (Year) | Target (2020) | Status |
|---|---|---|---|---|---|
| 1. Mental Health and Mental Disorders | |||||
| MHMD-2 | Reduce the proportion of adolescents aged 12 to 17 years who experience major depressive episodes (MDEs) | 6.9% (2010) | 10.0% (2015) | 5.8% | ● |
| 2. Injury and Violence Prevention | |||||
| AH-11 | Reduce homicide rate among 20-24 year olds (per 100,000) | 46.9 (2012) | 49.3 (2016) | 32.7 | ● |
| IVP-2 | Reduce fatal injuries (per 100,000) | 49.4 (2012) | 83.9 (2016) | 46.3 | ● |
| 3. Access to Health Services | |||||
| AHS-2 | Increase percentage of residents who receive preventive care | 74.6% (2011) | 76.2% (2015) | 80.3% | ● |
| 4. Nutrition, Weight Status and Physical Activity | |||||
| NWP-2 | Decrease the number of food deserts | 9 (2014) | 6 (2015) | 0 | ● |
| NWP-4.1 | Reduce the proportion of children and adolescents who are considered obese | 20.6% (11/12) | 19.5% (16/17) | 14.5% | ● |
| Number | Leading Health Indicator | Baseline (Year) | Recent (Year) | Target (2020) | Status |
|---|---|---|---|---|---|
| 5. Clinical Preventive Services | |||||
| C-5 | Increase early detection for cancer (% in situ or local) | 48.4% (2010) | 55.2% (2014) | 57.0% | ● |
| D-4 | Reduce the proportion of persons with poor control of diabetes | 37.1% (2013) | 33.8% (2015) | 27.2% | ● |
| HDS-4.1 | Increase the proportion of adults with hypertension whose blood pressure is under control | 55.7% (2013) | 61.9% (2015) | 77.4% | ● |
| IID-2.2 | Increase the percentage of children aged 19 to 35 months who receive the recommended doses of vaccinations | 66.2% (2010) | 76.3% (2015) | 80.7% | ● |
| 6. Social Determinants of Health | |||||
| AH-2.1 | Increase the 4-year high school graduation rate | 59% (10/11) | 72.4% (16/17) | 80% | ● |
| SDH-4 | Decrease proportion of persons living in poverty | 18.5% (2010) | 18.0% (2015) | 16.7% | ● |
| 7. Substance Use | |||||
| MHMD-4 | Increase the proportion of persons with co-occurring substance use and mental disorders who receive treatment for both disorders | N/A | N/A | TBD | ○ |
| 8. Oral Health | |||||
| OH-2 | Increase percentage of residents who receive preventive dental care | 71.1% (2012) | 72.5% (2015) | 78.2% | ● |
| Number | Leading Health Indicator | Baseline (Year) | Recent (Year) | Target (2020) | Status |
|---|---|---|---|---|---|
| 9. HIV | |||||
| HIV-2 | Reduce the number of new annual HIV infections in all ages | 889 (2010) | 347 (2016) | 196 | ● |
| 10. Maternal, Infant and Child Health/Perinatal Health | |||||
| MICH-1 | Decrease infant mortality rate (per 1,000 live births) | 8.0 (2010) | 7.1 (2016) | 6.0 | ● |
| MICH-2.1 | Decrease total preterm births | 11.0% (2011) | 10.8% (2016) | 6.5% | ● |
| 11. Tobacco Use | |||||
| TU-4 | Reduce the early initiation of the use of tobacco products among children and adolescents in grades 9-12 | 8.3% (2010) | 7.0% (2015) | 7.5% | ● |
| 12. Older Adults | |||||
| OA-1 | Improve overall health of older adults (50+) | 73.6% (2011) | 78.5% (2015) | 90% | ● |
| 13. LGBTQ Health | |||||
| LGBTH-3 | Decrease the percentage of youth in grades 9-12 who were threatened or hurt because someone thought they were gay, lesbian, or bisexual | 10.7% (2010) | 16.5% (2015) | 4.2% | ● |
(Source: Annual Report & Action Plan, 2017-2019, DC Healthy People 2020, DC Health)
1106.5a Text box: Strategic Planning and Implementation Frameworks for Improving Community Health
The approach of DC Health to population health improvement consists of cross-cutting plans and implementation frameworks that include DC HP2020, SHIP, and HSP.
1106.5b DC HP2020, adopted in 2016, sets goals and targets for health outcomes for the year 2020 (the District's leading health indicators are shown in Figure 11.7) and provides evidence-based strategies to improve them. As of 2017, five percent of the leading health indicators in HP2020 were met, 50 percent improved, 25 percent had no change, and 20 percent worsened. SHIP, released in 2016, seeks to improve primary health care, better coordinate care for vulnerable residents, enhance patient care experience, and reduce costs. Finally, HSP, released in 2017, serves as the District's roadmap for developing a comprehensive, accessible, equitable health care system through comprehensive assessment of community needs, provider capacity, and service gaps and strategies for strengthening health services.
1106.5c Together, these three plans identify the strategic needs and priorities essential to Washington, DC's community health improvement agenda and advancing social and structural determinants of health for all residents. These plans are all informed by an equity lens, recognizing the importance of social and structural determinants in population health outcomes.
1106.5a1 Text box: Person-Centered Thinking and Cultural and Linguistic Competence
The District recognizes that person-centered thinking, cultural competence, and linguistic competence are keys to promoting equity in health. Person-centered thinking is a philosophy that encourages positive control and self-direction of people's own lives. Cultural competency is the ability of District agencies to deliver services in a manner that affirms worth, preserves dignity, and honors the preferences and choices of people of all cultures and human identities in accordance with the DC Human Rights Act, which makes discrimination illegal based on 19 protected traits. Cultural competency also incorporates a person's cultural values, beliefs, practices, mode of communication, and economic status, including sensitivity to the environment from which the person comes and to which the person may ultimately return, in all aspects of service delivery. Linguistic competence involves the District's ability to communicate in a manner and through modes that can be easily understood by diverse groups, including but not exclusive to persons who have low literacy skills or are not literate, persons with disabilities, and persons who have limited and non-English proficiency.
1106.6 Policy CSF-2.1.1: Enhance Health Systems and Equity
Support the Strategic Framework for Improving Community Health, which seeks to improve public health outcomes while promoting equity across a range of social determinants that include health, race, gender, income, age and geography.
Promote person-centered thinking as well as linguistic and cultural competence across District agencies, especially those that deliver long-term services and supports. Inclusion can also be enhanced by improved cross-agency communications and coordination of service delivery to all residents.
Advance a health-forward approach that incorporates health considerations early in the District’s government planning processes.
Continue efforts to set public health goals and track and evaluate key health indicators and outcomes.
Intensify efforts to improve primary health care and enhance coordination of care for the District’s most vulnerable residents to improve health, enhance patient experience of care, and reduce health care costs.
Continue refining and implementing the District’s health care system roadmap for a more comprehensive, accessible, equitable system that provides the highest quality services in a cost-effective manner to those who live and work in the District.
Enhance and expand training of District agency employees regarding people-centered thinking and cultural and linguistic competency.
Explore tools that can help decision-makers, practitioners, and Washington, DC residents to better understand how changes in the built environment can affect human health. Such tools can include Health Impact Assessments (HIAs).
Enhance healthy food access, address diet-related health disparities, and generate economic and social resilience by supporting the development of locally owned, community-driven grocery stores in areas with low access to healthy food options. Such support should include targeted financing, technical assistance, and co-
location with new mixed-use developments.
SOURCE: District of Columbia Comprehensive Plan Act of 1984, effective April 10, 1984 (D.C. Law 5-76; 31 DCR 1049 (March 9, 1984)); as amended by District of Columbia Comprehensive Plan Act of 1984 Land Use Element Amendment Act of 1984, effective March 16, 1985 (D.C. Law 5-187; 32 DCR 873 (February 15, 1985)); as amended by District of Columbia Comprehensive Plan Amendments Act of 1989, effective May 23, 1990 (D.C. Law 8-129; 37 DCR 55 (January 5, 1990)); as amended by District of Columbia Comprehensive Plan Amendments Act of 1989 NCPC-Recommended Amendments, and Closing of Public Alleys in Square 669, S.O. 88-452, Act of 1990, effective May 23, 1990 (D.C. Law 8-132; 37 DCR 2213 (April 6, 1990)); as amended by District Government Land Use Temporary Amendment Act of 1994, effective October 1, 1994 (D.C. Law 10-190; 41 DCR 5360 (August 12, 1994)); as amended by Comprehensive Plan Amendments Act of 1994, effective October 6, 1994 (D.C. Law 10-193; 41 DCR 5536 (August 19, 1994)); as amended by District of Columbia Comprehensive Plan Act of 1984 Land Use Amendment Act of 1994, effective March 21, 1995 (D.C. Law 10-235; 42 DCR 30 (January 6, 1995)); as amended by Technical Amendments Act of 1996, effective April 18, 1996 (D.C. Law 11-110; 43 DCR 530 (February 9, 1996)); as amended by Second Technical Amendments Act of 1996, effective April 9, 1997 (D.C. Law 11-255; 44 DCR 1271 (March 7, 1997)); as amended by Comprehensive Plan Amendment Act of 1998, effective April 27, 1999 (D.C. Law 12-275; 46 DCR 1441 (February 19, 1999)); as amended by Technical Amendments Act of 1999, effective April 12, 2000 (D.C. Law 13-91; 47 DCR 520 (January 28, 2000)); as amended by Comprehensive Plan Amendment Act of 2006, effective March 8, 2007 (D.C. Law 16-300; 54 DCR 924 (February 2, 2007)); as amended by Technical Amendments Act of 2008, effective March 25, 2009 (D.C. Law 17-353; 56 DCR 1117 (February 6, 2009)); as amended by Comprehensive Plan Amendment Act of 2010, effective April 8, 2011 (D.C. Law 18-361; 58 DCR 908 (February 4, 2011)); as amended by Comprehensive Plan Amendment Act of 2021, effective August 21, 2021 (D.C. Law 24-20; 68 DCR 006918 (July 16, 2021)).