Addressing Health Equity
Ranking and roadmaps (Tool for Social Determinants of Health)
help communities promote healthy behaviors for people within their own communities, focusing on specific factors that are known to affect health, such as education and income
three preventable conditions that cause a cost burden
high blood pressure, diabetes and stroke
increased rates in the number of people who are overweight or obese have contributed to:
higher rates of chronic illness and increased amounts of spending on health care in the U.S.
According to the CDC, HIAs have three primary differences from other measurements. HIAs...
- Are intended to inform arguments on proposed legislation, such as project permits - Systematically assess the various influences on health that can occur as a result of social, economic, and environmental changes. - Use a broad definition of health that includes physical and psychological health and general well-being.
The infant mortality rate in the U.S. in 2009 (the most recent data available) was 6.4 per 1000 live births
34 countries surveyed = The average infant mortality rate was 4.3 per 1,000 live births. preterm delivery plays a key role in the rate of infant death Healthy People 2020, social, environmental, and physical factors have been linked to maternal, infant, and child health outcomes. These factors include race and ethnicity, age, and socioeconomic factors, such as income level, educational attainment, medical insurance coverage, access to medical care, prenatal health, and overall health status.
The Legacy of the Tuskegee Experiment
400 poor black men with syphilis from Macon County, Alabama - never told they had Syphilis, nor were they ever treated for it so they could study the effects of it
Health Equity
Absence of socially unjust health disparities. It implies that ideally, everyone could attain their full health potential.
Social Determinants of Health
Acting on the social determinants of health must include building strong community partnerships and shaping policies for sustainable environments that promote health and address the root causes of health disparities. actions: -Monitoring and reporting -Developing and promoting awareness -Understanding effective communication strategies
Forty years after the Civil Rights Movement African Americans and other minority groups continue to be disproportionately impacted by health disparities today. Which of the following is a true statement related to health disparities? a. Today, schools and neighborhoods remain deeply segregated and people of color are overrepresented in low income areas. b. Low income neighborhoods are more likely to be exposed to environmental hazards. c. Poor and minority communities not only lack access to green space, full service supermarkets and clean parks, but also they are dominated by liquor stores, fast food outlets and advertising for alcohol and tobacco products. d. All of the above
All of the above
Hepatitis Studies
Children with Mental Retardation were fed live local hepatitis strains to aid in vaccine development.
Economic Environment
It could mean living-wage jobs with health benefits; safe workplaces and home ownership providing economic stability or numbers of community residents with low-wage jobs with no benefits and unsafe working conditions, and disinvestment in community and decline in property values
How can we promote healthy behaviors? Current or Social Justice perspective?
Current Frame
What are the biological and behavioral reasons behind some people being more predisposed to illness and death? Current or Social Justice perspective?
Current Frame
Diabetes
Diabetes is much greater a burden for minority populations than the white population. higher rates of diabetes-related complications and death
Health Inequity
Disparities in health that are systemic and avoidable; therefore, considered unfair or unjust.
Health Disparity vs. Health Inequity
Disparity is a dimensional concept referring to measurable quantities. Inequity is a political concept expressing a commitment to social justice.
Healthcare Disparity
Disparity is a dimensional concept referring to measurable quantities. Inequity is a political concept expressing a commitment to social justice.
Building Partnerships
Engaging multiple partners to harness existing resources in a community is central to a strategic and powerful approach for eliminating inequities.
Place is a key determinant of health because it can impact which of the following?
Environmental exposure Access to green space and healthy foods Neighborhood quality and social networks
Health Disparity
Health Disparities are variations or differences in health status among certain groups of people.
Which of the following most accurately describes the term health disparities?
Health Disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.
Cancer
Hispanic women are twice as likely as non-Hispanic white women to be diagnosed with cervical cancer. Additionally, Vietnamese American women have a cervical cancer rate nearly 5 times that of white women. African American women are 34% more likely to die of breast cancer.
What is REACH?
REACH is a national program that serves as the cornerstone of CDC's efforts to eliminate racial and ethnic disparities in health
Health status cannot be improved through individual behavior change alone.
Rather any solution to improve health must focus on changes in social systems.
Are there governmental or commercial policies in place that discourage access to transportation, recreational resources, and nutritious food in neighborhoods where health is poorest? Current or Social Justice perspective?
Social Justice Frame
Which of the following statements is correct regarding the healthcare system in the United States? a. The United States spends more money per capita on health care expenses than any other developed nation. b. According to the World Health Organization (WHO), the United States ranks among the top ten countries based upon their health system. c. WHO predicts that the United States will continue to rank among the top countries for at least the next ten years. d. Both A and B
The United States spends more money per capita on health care expenses than any other developed nation.
Social Determinants of Health Inequity
The economic and social conditions in which people are born, grow, live, work and age.
Physical Environment
The physical environment includes environmental quality, built environment and infrastructure and geographic access"
Social Environment
The social environment includes cultural characteristics, support and networks, and community leadership and organization
Public health services have an important role in leading and supporting collaboration and community actions to improve population health and well being to address health disparities.
These roles include: -Examining current work through health equity lens -Increasing awareness of health inequities and social determinants of health -Empowering communities -Increasing collaborative partnerships -Coordinating and utilizing research effectively -Completing health impact assessments and advocating for progressive policy initiatives
Asthma
While asthma is a prevalent disease among all children, it disproportionately affects minority and low-income groups.
what does the World Health Organization (WHO) do?
ranks countries according to the quality of their healthcare system. -France ranks 1st -Japan ranks 10th -Columbia ranks 22nd -U.S ranks 37th
According to the Agency for Healthcare Research and Quality, 2010 National Healthcare Quality Report and several studies:
-Racial and ethnic minorities were less likely to receive routine medical procedures -Minorities were less likely to be given appropriate cardiac medications and minorities were more likely to receive lower limb amputation - approximately 59% of Americans were aware of racial and ethnic disparities is healthcare, specifically with regard to African Americans, and Hispanics or Latinos - low income people received worse care than high income persons for about 80% of core healthcare measures
resources that enhance quality of life include:
-Safe and affordable housing -Access to education -Public safety -Availability of healthy foods -Local emergency/health services -Environments free of life-threatening toxins
Social Justice Frame
- Focuses on societal systems, policies and practices that result in the inequitable distribution of health determinants. - Interventions tend to focus on sustainable, long-term change through a broader focus of all of the essential public health services
Service Environment
-Access to quality healthcare services -Public safety for education -Employment -Transportation -Grocery shopping -Recreation and other services directly or indirectly tied to health, and community support services are all necessary for a healthy community."
Current Frame
-Focuses on threats to the community -Most efforts are focused outside of the policy sphere. For example, nursing home visits, restaurant inspections, immunizations...
Which of the following accurately describes an impact of employment on health status? Employment...
-affects occupational risk of injury/illness -impacts access to health insurance -impacts quality of life
which of the following statements are true regarding educational achievement in the US? Education level...
-is largely affected by race and SES -Has a positive correlation with health status -impacts "health literacy"
Social networks are the social and cultural environments within a community. How can social networks positively impact a community?
-motivate individuals to act for common good -build trust among neighbors -improve community health and safety
There are numerous health disparities related to race and ethnicity. Which of the following is a true statement related to racial and ethnic health disparities? a. Infant mortality of African Americans, American Indian, and Alaskan Native babies is similar to that of white babies. b. The death rate from HIV/AIDS among African Americans is more than seven times the rate of their white counterparts. c. Vietnamese American women have a cervical cancer rate nearly five times the rate of white women. d. Both B and C
Both B and C
What are the strongest factors that shape our health? A. Economic & Social Opportunities & Resources B. Living & Working Conditions in Homes and Communities C. Medical Care and Personal Behavior D. Both A and B
D. Both A and B Where we live, learn work and play are the contexts that fundamentally shape choices for personal health behavior and impact one's ability to access good medical care. Health results from the choices that people are able to make in response to the options that they have. Conditions in the social and physical environments determine the range of options that are available, their attractiveness, and their relative ease or difficulty of use.
TRUE or FALSE Healthy People 2020 provides a renewed focus on identifying, measuring, tracking, and reducing health disparities through a determinants of health approach and emphasizes creating healthy sustainable community environments.
TRUE Healthy People 2020 highlights the importance of addressing the social determinants of health by including "Create social and physical environments that promote good health for all" as one of the four overarching goals for the decade.
How can we work within our communities to define and prioritize public health concerns? Current or Social Justice perspective?
Social Justice Frame
During the 20th century, U.S. life expectancy increased by 30 years. Which of the following was the most important factor behind the increase? A) Social reforms (such as wage and labor laws, housing codes, etc.) and increased prosperity B) New drugs (like penicillin) C) The development of the modern hospital system D) Migration from rural areas to cities E) More exercise and smoking cessation
Social reforms (such as wage and labor laws, housing codes, etc.) and increased prosperity RATIONAL: While researchers debate the relative importance of one factor versus another, most agree that better wages, housing, job security, working conditions, civil rights laws,sanitation and other protections that enlarged the middle class were central to expanding average American life expectancy. Death rates from tuberculosis, for example, fell by 70% even before treatment for TB was discovered in 1948 due to key social reforms.
What factor is often considered the most "fundamental cause" of health disparities?
Socioeconomic Status
What is THRIVE?
THRIVE is a tool to help you understand and prioritize the factors within your own community that can help improve health and safety can help answer questions such as: How can I identify key factors in my community and rate their importance? How are these factors related to health outcomes?
TRUE OR FALSE: Communities that shoulder a disproportionate amount of unequal health outcomes are often more economically challenged, racially segregated, and more likely to have fewer resources.
TRUE
TRUE OR FALSE: Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age. They impact a wide range of health, functioning and quality of life outcomes.
TRUE
It is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures.
TRUE In particular, there has been tremendous focus on the rise in rates of overweight and obesity and their contribution to chronic illnesses and health care spending.
TRUE or FALSEAs awareness has grown about the social, economic and environmental determinants of health, calls to promote "health in all policies" have come from the U.S. Department of Health and Human Services and the Institutes of Medicine
TRUE To reduce disparities and achieve true sustainable change in public health, we need to create a 'health in all policies' approach that reaches people where they live, work, play. The Health in All Policies Approach is view as an essential strategy by USDHHS as outlined in Healthy People 2020 to have sustainable healthy communities.
The United States spends more money per capita on health care expenses than any other developed nation.
TRUE - Despite this excessive spending, health outcomes in the United States are not proportionately successful.
TRUE OR FALSE: Health Inequity are differences in health which are not only unnecessary and avoidable, but in addition, are considered unfair and unjust. The term emerged to deepen the definition of disparities.
TRUE - The term health inequity emerged to deepen the definition of disparities. Inequity describes the systematic and repeating pattern of disparities.
United States, in comparison to other countries, has the greatest income inequality.
TRUE - While both infant mortality and life expectancy (key health indicators) have improved over the last quarter-century, U.S. rankings have fallen relative to other nations.
factors that determine individual and population health.
The range of personal, social, economic and environmental factors that influence health status are known as determinants of health. It is the interrelationships among these factors that determine individual and population health.
HIV
U.S. population, Blacks/African Americans accounted for half of the HIV diagnoses in adolescents and adults in 2010. The death rate from HIV/AIDS is more than 7 times the rate of their white counterparts.
Healthy People 2020 places new emphasis on... a. Addressing the social determinants of health b. Health education c. Individual lifestyle factors d. All of the above
a. Addressing the social determinants of health
Major advances in health status resulted from broad social reforms. These included actions such as:
abolishing child labor, shortening the working day, introducing social security, reducing the scale of poverty, improving the standard of living, and guaranteeing employment, or at least a minimum wage. Additional efforts include improving sanitation, ensuring food safety, and providing adequate housing.
Health in All Policies Approach
an approach that looks at all public- and private-sector policy making through a health lens, with the objective of promoting and protecting the health of the population by addressing the social and physical environment influences on health
Health Impact Assessments
analysis of how a particular policy or project will affect the health of a community and how those effects will be distributed throughout the population
Health disparities are very expensive. In terms of direct medical care expenditures, how much money would have been saved by eliminating health disparities for minorities during the three-year period from 2003 to 2006? a. $697 million b. $229.4 billion c. $335.2 billion d. $1.3 trillion
b. $229.4 billion
Which of the following statement(s) are true concerning stigma and health disparities? a. Social exclusion and discrimination do not affect someone's health directly. b. Stigma and discrimination do not play a role in socio-economic disparities. c. Discrimination and social exclusion affect people's health via complex mechanisms that often overlap. d. Both A and C
c. Discrimination and social exclusion affect people's health via complex mechanisms that often overlap.
. During the 20th century, U.S. life expectancy increased by 30 years. Which of the following is a true statement regarding the most important factor behind the increase? a. New drugs (like Penicillin) b. The development of the modern hospital system. c. Social reforms (such as wage and labor laws, housing codes, etc.) and increased prosperity. d. Americans active lifestyle makes them less likely to suffer from chronic illnesses, such as high blood pressure, heart disease, and diabetes.
c. Social reforms (such as wage and labor laws, housing codes, etc.) and increased prosperity.
Healthy People 2020 definition of "place"
conditions in the social, economic, physical and service environments Gaining an understanding as to how populations experience "place" and the impact of "place" on health is key to grasping the social determinants of health
Public Health plays an important role in addressing health equity. Which of the following are the public health roles? a. Monitoring and reporting of health determining social, economic and environmental conditions and trends and the reach of health services activities in terms of equity issues. b. Conducting community health assessments to form the basis of improving the health status of the community and educating policy makers of the links between various policy areas and health. c. Coalition building to harness existing resources in a community to implement interventions to close community health gaps and to reduce system fragmentation and increase program sustainability. d. All of the above
d. All of the above
Which of the following statements are true related to the social determinants of health? a. Individual lifestyle factors are the most significant. b. If you are poor, less educated or a minority in the U.S., your prospects for living a long healthy life are significantly worse than if you are more affluent, better educated or white. c. Race or ethnicity, gender, sexual identity, age, disability, socioeconomic status, education, employment, environment, housing, access to resources and geographic location all contribute. d. Both B and C
d. Both B and C
Community-Based Participatory Approaches
embrace the principles of making action research more democratic, fostering community participation (especially from underserved groups) and "capacity building," developing relationships between outside stakeholders and community members, and "incorporating local knowledge into the research process
The United States life expectancy at birth is greater than Japan, Iceland and Israel.
false The U.S. life expectancy is 77.9 years. Despite our high levels of spending on healthcare, our life expectancy rates are among the lowest
Eugenics
forced sterilizations - 60,000 Americans were sterilized against their will. victims were poor and members of minority communities. During the late 1960's and early 1970's surgical sterilization, often without consent, was performed on Native American women of child bearing age, by the Indian Health Service, a U.S. government-funded program
Community Health Assessments (CHA)
forms the basis of improving the health status of the community. It is also useful in educating policy makers, working to mobilize communities and organize existing resources. Is an evidenced-based practice in public health that is essential in addressing health disparities
what are the roots of health disparities?
health disparities are historically rooted in social and economic inequalities.
Jim Crow Laws
laws designed to prevent black citizens from improving their status or achieving equality. These statutes, known as Jim Crow laws, were in place and enforced until the 1950s and 60s. Prior to the Civil Rights Era, hospitals could legally refuse medical care to black patients even in emergency situations
Hurricane Katrina
most severely affected were the many African American communities - They went for days without food and potable water and without adequate transportation to move them to safe quarters. 1800 people dead and over 10,000 people homeless
What is Spectrum of Prevention?
used nationally in prevention initiatives targeting traffic safety, violence prevention, injury prevention, nutrition, and fitness.