04/27/2010
Health Equity and the Social Determinants of Health
Courtney Boen, Rebekah Gowler and Meghan Patterson
Center for Health Equity and Social Justice, Boston Public Health Commission.
1. Objectives:
· Define health disparities, health equities, and the social determinants of health.
· Understand a health equity framework
· Identify the social determinants of health
· Articulate the impact racism has on shaping the social determinants of health
· Identify how to use community assessments to shape practice.
2. What are health disparities? / What are health inequities?
· Health disparities: differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.
· Health inequities: differences in health status and mortality rates across population groups that are systemic, avoidable, unfair and unjust.
3. Disparities, Inequality and Inequity
DISPARITY= INEQUALITY and implies differences between individuals or population groups
INEQUITY refers to differences which are unnecessary and avoidable and, in addition, are also considered unfair and unjust.
4. Health Equity
The opportunity for everyone to attain their full health potential.
No one is disadvantaged from achieving this potential because of his or her social position or other socially determined circumstance
Distinct from health equality or health disparities
5. What explains these inequities in health? - A look at the social determinants of health
Segregation:
· Racial segregation concentrates poverty and excludes and isolates communities from mainstream resources.
· Segregation did not materialize naturally
· Today segregation is maintained by economic inequality.
Economic opportunity:
· ‘Poverty Tax”: residents in poor neighborhoods pay more for the exact same consumer products than those in higher income neighborhoods.
· Higher rates of asthma sleep disorders and lead toxicity are more likely in sub-standard housing.
· Food environment: Food desert are areas with no or distant grocery but with many choices of fast-food, convenience stores and liquor stores. Research show that residents in food desert suffer worse diet-related health outcomes, including diabetes, cancer, heart disease and premature health.
· Physical environment (fewer parks, recreational centers, swimming pools, and less walkable areas)
· Education: correlated with health outcomes and life expectancy.
· Social mobility, public safety,….
6. The stress of racism
· Creates structural barriers to health and well-being
· Stress associated with racism and discrimination takes a toll on the body: a study shows that Black women who reported they had been victims of racial discrimination were 31% more likely to develop breast cancer than those who did not. ( + reference to the movie “Unnatural causes: when the bough breaks”).
A health equity framework:
Social capital
Transportation
Education
Employment
Food access
RACISM <-------------- Socioeconomic Status --------------->HEALTH OUTCOMES -
Environmental exposure
Health behaviors
Access to health services
Housing
Public safety
Health and the built environment are inextricably linked: where you live impacts how you live.
- How do you work to eliminate health inequities?
We often say…. “I know my work is connected because….”
Degree of impact
Low High
We don’t We serve a We plan our work
Discriminate vulnerable in such a way to ensure it
Against anyone population addresses the factors
impacted by these leading to disparities
disparities
How can we all get here?
Low Degree of impact High
We don’t We serve a We plan our work
discriminate vulnerable in such way we ensure it
against anyone population addresses the factors
impacted by these leading to disparities
disparities
What can we do?
- Consider “upstream approaches”
- Aim for sustainable change in policy and practice: policy with long term consequences impacts the economic, social, physical and service environments.
- Engage staff and partners at all levels
- Ask questions differently:
Ex: How can we promote healthy behavior?
How can we target dangerous conditions and reorganize land use and transportation policies to ensure healthy spaces and places?
- Conduct a community assessment of the social determinants of health.
- Goal: Identify the key social determinants of health and racial disparities in the community, map assets and resources for addressing the identified needs, use results to shape and develop community-based strategies.
Proposed phases:
1. plan the assessment: review existing data, convene a team, develop tools, decide on methods.
2. conduct the assessment: utilize different methods as focus groups, listening sessions, interviews, paper survey, observations, windshield survey
3. document discussions and findings
4. develop an action plan,
5. organize the larger community
6. take action!
One of the many fun things we do at the RCHC during our lunch breaks, other than eating healthy ;), is hold a journal club. Awesome...I know! Every two weeks we select an article to read as a group and discuss it. Every other article is related to our work the other not-so much (for example we read two articles called "Colonial Legacies and Economic Growth" by RM Grier and "Colonialism and Development: A Comparative Analysis of Spanish and British Colonies" by M. Lange,et. al).
Our most recent journal club meeting focused on an article titled "Cultural Humility" by Melanie Tervalon and Jann Murray-Garcia. The authors argue that we can achieve cultural humility through education, although their focus was on physician education. They offer clear examples of how all of us can strive towards and practice cultural humility so long as we do not view it as something we can attain.
I cannot do this article any justice so I suggest you check it out:
http://info.kp.org/communitybenefit/assets/pdf/our_work/global/Cultural_Humility_article.pdf
