In November 2020, Governor Holcomb appointed Karrah Herring as Indiana’s first Chief Equity, Inclusion and Opportunity Officer (CEIOO). This position supports agencies across Indiana government to “build diversity and foster an inclusive environment.” Indiana joins a growing list of states, including Illinois, Michigan, New Jersey, Oregon, and Virginia, in committing to principles of equity and inclusion in their whole-of-government approach. Karrah Herring and Jennifer Sullivan, Former Secretary of Indiana’s Family and Social Services Administration (FSSA), recently spoke to the National Academy of State Health Policy’s Equity Workgroup about Herring’s role. Chief Officer Herring also presented at the NASHP annual conference in September 2021 and shared insights on Indiana’s journey in establishing this position and next steps in Indiana.

Background

Following the murder of George Floyd and the racial disparities illuminated by COVID-19, Governor Holcomb delivered an address on equity and inclusion in Indiana in August 2020. In his speech, Governor Holcomb discussed the common theme of “getting to the root causes of inequities and not just reacting to the symptoms” in his meetings with rural, urban, and suburban citizens across the state.

Two months before his address, Governor Holcomb formed an Executive Branch Task Force to identify gaps in state government and recommend actions to address disparities and inequities. The first action, identified in his address, was to create Indiana’s first Chief Equity, Inclusion and Opportunity Officer position to:

• “focus solely on improving equity, inclusion and opportunity across all state government operations as well as drive systemic change to remove hurdles in the government workplace and services we provide, and
• help them develop their own strategic plans to tactically remove all such barriers.”

Governor Holcomb identified other areas to address racial inequity and promote equal opportunity in the state. These initiatives include improving minority teacher recruitment, investing in Indiana’s workforce to fill job openings, mandating the use of body cameras for every state trooper, and a review of curriculum and training for the law enforcement academy. He also vowed to create a public disparity data portal to track progress towards health, public safety, social services, education, and workforce goals.

Indiana’s Family and Social Services Administration

Prior to Governor Holcomb’s address on equity, Indiana’s Family and Social Services Administration (FSSA) had begun to systematically address the social drivers of health, including the role of structural racism in overall well-being of Hoosiers. In 2018, Indiana FSSA created the Office of Healthy Opportunities to build out an integrated health and human services approach to address social determinants of health. The office implemented a data-driven strategy to identify both unmet social needs in the state and gaps in policies and programming, and subsequently launched an educational campaign for FSSA employees on social determinants of health and health disparities. In his address on equity, Governor Holcomb cited recent success in his priority to reduce infant mortality as the model for his approach to advancing equal opportunity, as Black women and children are disproportionately affected by infant mortality due to systemic barriers.

To help FSSA work to understand unmet social needs, Secretary Sullivan explained that it was necessary to identify structural barriers to care. This work culminated in the creation of the FSSA Equity Blueprint. The Blueprint contains important recommendations for the agency, including the creation of a Chief Health Equity and Americans with Disabilities Act (ADA) Officer for the FSSA agency. FSSA also recommended a cabinet level Chief Equity Inclusion and Opportunity Officer position to report to the Governor.

Chief Equity, Inclusion and Opportunity Officer

A team including Secretary Sullivan wrote the Chief Equity, Inclusion and Opportunity Officer position description. The position is funded through a public-private partnership with a financial contribution from the CenterPoint Energy Foundation. The Officer is a member of the Governor’s cabinet and reports directly to Governor Holcomb. Governor Holcomb’s office stated, “the officer will focus on improving state government operations as well as drive systemic change to remove hurdles in the government workplace and services the state provides. Herring will help agencies develop strategic plans to remove any barriers.”

Herring was appointed in November 2020 and started in the position in February 2021. In the first six months of her tenure, she met with over 200 stakeholders including mayors, community leaders, and chambers of commerce to better understand what equity looks like in different communities. According to Herring, contributors vary across the state; in rural Indiana inequities may be rooted in access to broadband while other parts of the state face high infant mortality rates, for example.

In response to Governor Holcomb’s goals for addressing equity, Herring’s office created an Equity Data Portal that tracks state efforts on closing equity gaps. Indiana’s Management Performance Hub worked with state agencies to create the portal that provides data dashboards on health, public safety, social services, education, and workforce. Herring emphasized that the data portal will drive her office’s strategy and outcome measures will be used to show the effectiveness of resources deployed toward strategic priorities.

Indiana’s COVID-19 Response

Herring’s office also played a key role in Indiana’s COVID-19 response, connecting Indiana’s Department of Health with key diverse stakeholders such as the Urban League, National Association for the Advancement of Colored People (NAACP) and other organizations serving communities of color. The state used data on vaccine uptake and the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI) to target vaccine outreach. According to Herring, each Indiana county was given an odds ratio based on gender, race, and age. In Gary, Indiana, low vaccine uptake and a high SVI led to the state partnering with the Federal Emergency Management Agency (FEMA) on an eight-week mass vaccination clinic that led to over 60,000 vaccinations. The state also created a messaging toolkit for providers to counsel patients about the COVID-19 vaccine.

Working with Organizations and Agencies on Diversity, Equity, and Inclusion (DEI) Initiatives

Following her conversations with organizations and agencies, Herring developed a DEI strategic communications toolkit, which she shared at a summit she hosted for DEI leaders from across the state. When asked, Herring has shared the toolkit with Chambers of Commerce and Boards of Directors across the state to guide their DEI efforts. The toolkit has also been shared internally with state agencies. The toolkit encourages organizations to:

• Define DEI for the organization. Consider how each organizations’ existing mission, vision and foundational values align with DEI.
• Start with civility and respect. Everyone enters the DEI space along a continuum and the State of Indiana Workforce’s goal is to meet people where they are through civility, constructive disagreement, and compassionate listening. Inclusive language can allow for more productive dialogues. The Office of the Chief Equity Inclusion and Opportunity Officer (CEIOO) offers a Supporting Next Level TEAMS training to prepare teams for ‘more in-depth discussions on equity, bias, consciousness, and allyship.’

The CEIOO office’s communications toolkit also outlines the importance of leadership buy-in and making the case to see DEI efforts incorporated into organizational culture and values. Key tactics include:

• Start with the data. Disaggregating available data points such as workforce by job level and classification, recruiting efforts, hiring data, promotions, and turnover can reveal organizational inequities and make the case for a DEI strategy.
• Define organizational needs. Tailor a DEI approach to the culture and needs of the organization.
• Go after low-hanging fruit. Implementing inexpensive efforts like monthly DEI talks, employee resource groups, or a calendar of cultural events can demonstrate organizational commitment early.
• Demonstrate return on investment. Show how staffing and financial resources can yield financial returns. Expanding recruiting to diversify applicant pools is an inexpensive practice to diversify teams. Companies that embrace diversity and inclusion report a culture of innovation, higher engagement, lower turnover, and increased profits.

Moving Forward

In September 2021, Herring joined NASHP’s annual conference to discuss her work as Indiana’s first Chief Equity, Inclusion and Opportunity Officer. She was joined by Dr. Janice Underwood, Virginia’s Chief Diversity, Equity and Inclusion Officer, and Michigan’s Lt. Gov. Garlin Gilchrist II, who is leading Michigan’s work on racism as a public health crisis. During the session, Herring credited Dr. Underwood for her guidance during the creation of Indiana’s office. She emphasized the importance of codifying the position so that Indiana’s equity work can continue as a whole-of-government approach past the current administration.