Making Health Equity a Reality

Report
Making Health Equity a Reality:
Approaches to Transforming Public
Health Practice
Nicolas Freudenberg
ACHIEVE Action Institute
April 24, 2012
Advancing Health Equity
Nicholas Freudenberg
Distinguished Professor of Public Health
City University of New York School of Public Health
CDC ACHIEVE Meeting
24 April 2012
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Today’s Questions
1. What is health equity and why is it important?
2. What are the obstacles to health equity?
3. What strategies can public health staff, health
advocates and local policy makers use to advance
health equity?
4. What are the assets local health departments,
community organizations and local elected
officials can leverage to promote health equity?
5. How can we get started in making equity a
priority in our work?
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Health equity is
achieved when every
person has the
opportunity to
achieve their full
potential for health.
Amartya Sen
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In an equitable society,
everyone has opportunity to
Complete education needed
to support themselves and
families
Find food that sustains health
Live in safe housing
Breathe clean air and drink
clean water
Participate in making decisions
that affect well-being
What else?
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Some Examples of Health Inequalities
• Mortality rate for infants of mothers with less than 12 years of
education was 1.5 times higher than for those of mothers with 13
+ years of education.
• Native Hawaiians or other Pacific Islanders, American
Indians/Alaska Natives, African Americans, Hispanics/Latinos all
significantly more likely to have been diagnosed with diabetes
compared to White counterparts.
• More than twice as many children (2–5 years) from poor families
experienced a greater number of untreated dental caries than
children from non-poor families
• 25 year old with less than 9 years of school had average life
expectancy 8 years shorter than those who had finished high
school, and 12 years shorter than those who had finished at least
a year of college.
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Trends Driving Inequalities in Health
• Increasing poverty and unemployment rates
• Cuts in safety net programs for children, poor
people and others
• Decline of US manufacturing jobs that
provided road out of poverty
• Shift of health care costs from employer to
employee
• Reductions in state and local support for
education, health care, and child care
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Changes in Income Equality
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Racial/Ethnic Differences in School Completion
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Changes in Incarceration Rates by Race/Ethnicity
Source: http://filipspagnoli.wordpress.com/stats-on-human-rights/statistics-on-freedom/statistics-on-prisoner-population-rates/
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Strategies for Advancing Health Equity
1. Improve the living conditions that are
fundamental determinants of health
2. Protect populations against disease promoting
forces
3. Support policies that create health promoting
communities
4. Bring evidence to those who have the power to
change policy
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1. Improve the living conditions
that are fundamental determinants
of health.
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Deaths Attributable to Social Circumstances,
US, 2000
• 245,000 adult deaths attributable to low education,
defined as lack of a high school degree;
• 176,000 to racial segregation,
• 162,000 death to low social support, not being
connected to people can support health,
• 133,000 to individual-level poverty, defined as an
income of less than $10,000,
• 119,000 deaths to income inequality, and
• 39,000 to area-level poverty.
Source: Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati AAm J Public Health. 2011 ;101(8):1456-65.
•
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Better
lifetime
health
Improved
school
achievement
Improved
school
achievement
Better health
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How education improves health
More education contributes to:
• Higher incomes (and the
purchase of better food and
housing, more health care, etc.)
• More skills, knowledge and
resources to protect health
• More social support and stronger
social networks
• Lower rates of unhealthy
behavior
Having family members, peers or
neighbors with more education
also associated with better
health
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What are the health problems that
interfere with school achievement?
• Teen pregnancy
• Chronic illnesses such
as asthma and diabetes
• Vision and hearing
problems
• Learning disorders
• Psychological and
emotional problems
• Substance use
• Family health problems
• Violence and bullying
• Hunger and obesity
• Social isolation
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Components of a Comprehensive
School Health Program
• School based health center with primary care,
mental health and reproductive health services
• Comprehensive health and sexuality education
• Substance abuse prevention and treatment
• Healthy school environment
• Safety and violence prevention programs
• Family health services
• Food services and access to healthy food
• Physical activity program
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What are roles for health professionals
in improving school completion rates?
• Educate public and policy makers on education and
health virtuous circle
• Develop and advocate for health and other policies and
programs that reduce health-related school drop out
• Participate in multi-issue coalitions to improve public
schools
• Create an evidence base that can guide policy
What else?
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Other areas where evidence shows
improved living conditions can reduce
inequalities
• Support paid sick leave and
living wage campaigns
• End foreclosures and make
affordable housing a policy
priority
• Reduce institutional racism
and the residential
segregation that worsens
education, employment and
food inequalities
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2. Protect populations against
disease promoting forces
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US Deaths Related to Products of Key Industries
Industry
Health outcomes related to
products
Estimated Annual Deaths US
Alcohol
Accidents, homicides, liver
cancer, cirrhosis
100,000
Automobiles
Respiratory diseases
including lung cancer, heart
disease, injuries; obesity and
its associated conditions
Homicide, suicide, injuries
43,000
Obesity, diabetes, heart
disease, cancer
365,000
(includes deaths attributed to inactivity)
Pharmaceuticals
Over and under medication
100,000
Tobacco
Heart disease, lung and other
cancers, respiratory diseases
435,000
Firearms
Food and Beverages
35,000
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Communities fight Big Tobacco
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3. Support strategies that create
health promoting communities
Increase opportunities for safe
physical activity
Increase access to healthy foods
Decrease promotion of
unhealthy food
Use public space to promote
democratic participation
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4. Bring evidence to those who have
power to change policy
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Your homework assignment
• Who are the constituencies in your
community who can support your efforts to
change conditions that allow health inequality
to persist?
• What are the messages that will bring these
groups together ?
• What are the strategies that will mobilize
communities to act to reduce health
inequalities?
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What assets are available to
support campaigns to advance
health equity?
• Scientific and health evidence
• History of successful efforts
• Social Movements and community
organizations
• America’s Second Language
• Capacity for critical self-reflection
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Getting started
•
•
•
•
Look for deeper causes
Focus on equity
Find your partners
Just do it
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Stay in touch
Nicholas Freudenberg
[email protected]
CUNY School of Public Health
www.cuny.edu/sph
CUNY Doctor of Public Health Program
http://web.gc.cuny.edu/publichealth
Corporations and Health Watch
www.corporationsandhealth.org
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