Creating Health Equity Through Social Justice More Than an Apple a Day and A Walk in the Park

1
Creating Health Equity Through Social Justice
More Than an Apple a Day and A Walk in the Park

• Center for Health Policy
• Washington University June 11. 2008
• Adewale Troutman, M.D., M.A., M.P.H.

2
Healthy People 2010

• Two Goals
• Increase Quality and Years of Health Life
• Eliminate Health Disparities

3
How you frame an issue determines your focus and
direction in its resolution
4
A systems approach But Why?
5
Continuing to do the same things in the same way
but expecting a different outcome is insanity
6
It all begins from a belief in the right to
health and a belief in the existence of universal
principles. This gives it a spiritual not just a
pragmatic base.
7
The Problem
8
Vital Statistics
9
What If We Were Equal?

• Progress in closing gap in Civil Rights, housing,
  education
• Health Inequities continue to exist
• Overall widening of mortality gap
• Some improvement for African American women but
  trending up again
• Infants and Men account for majority

10
Lets agree with the terms
11
Health

• The presence of physical, psychological, social,
  economic and spiritual well being not merely the
  absence of disease or infirmity
• The maintenance of a harmonious balance of mind,
  body and spirit
• Community and individual

12
Equity

• Justice according to natural law or right
• Freedom from bias or favoritism

13
Health Equity

• The absence of unfair and avoidable or
  remediable differences in health among social
  groups ( The Commission )
• A value position supported by an evidence base
• There is and will be political opposition to the
  core value of health equity

14
Health inequities are systemic, avoidable, unfair
and unjust differences in health status and
mortality rates and in the distribution of
disease and illness across population groups.
They are sustained over time and generations and
beyond the control of individuals
15
Justice

• The quality of fairness
• The principle of moral rightness equity
• Conformity to moral rightness in action or
  attitude

16
Social Justice

• The application of principles of justice to the
  broadest definition of society
• Implies
• Equity
• Equal access to societal power, goods and
  services
• Universal respect for human and civil rights

17
Rights Claims or entitlements that are
recognized by legal or moral principles
18
Rights are enforced by legislation and rules, the
force of law
19
Human Rights A higher order right MORALLY based
and UNIVERSAL. It belongs to all persons equally
because they are human beings(Declaration of
Independence)
20
Health is a Basic Human Right Not a Privilege
21
The Right to Health

• Preamble to the constitution of the WHO states
  The enjoyment of the highest standard of health
  is one of the fundamental rights of every human
  being without distinction of race, religion,
  political belief,economic or social condition

22
The time has come to herald human rights as both
the foundation of public health and the compass
of public policyJAPHA 2000
23
Looking Upstream
24
Personal Choice vs. Systemic Change
25
Determinants of Health A Holistic Approach

• Social and Economic Environment
• Physical Environment
• Health Behaviors
• Health Care Access
• Policies The Political Environment
• The Balance of Power
• Genetics/Biology

26
Why Social Determinants?
27
Socioeconomic Status

• Occupation
• Education
• Income
• Income gaps
• Racism discrimination
• Housing
• Political power

28
Social Determinants ( WHO )

• The Social Gradient
• Stress
• Early Life
• Social Exclusion
• Work
• Unemployment
• Social Support
• Addiction
• Food
• Transport

29
The Evidence and Knowledge Network (MEKN)

• Develop an expert consensus on the sources of
  evidence for the social determinants of health
  and health inequities
• To collect, assess and synthesize global
  knowledge on existing methodologies to evaluate
  the effectiveness of policies, interventions and
  actions on social determinants of health which
  are aimed at improving health outcomes and health
  equity

30
Housing
31
Public Health and the Built Environment
32
Housing and Health

• Lead
• Indoor air quality
• Unsafe environments
• Obesity
• Asthma
• Stress

33
(No Transcript)
34
(No Transcript)
35
Cotter Lane
36
Park DuValle
37
Park DuValle
38
Making the case for policy makers GIS Mapping
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
The Power of Poverty
47
Income Inequities

• 1995 study Kennedy, Kawachi and Prothrow-Stith
• 282 cities in the U.S.
• Death from income inequities is comparable to
  the combined loss of life from lung cancer,
  diabetes, motor vehicle crashes, HIV infection
  and homicide

48
(No Transcript)
49
Racism
50
Local Public Health Response The Public Health
System
51
(No Transcript)
52
Center Activities
53
Center Activities

• Staff Training on Community Organizing
• Staff and Community Training on Capacity Building
  
• Community Policy Mini-grants
• Speakers series
• On line learning in Health Equity for consumers
  and state employees in health
• Training in policy development

54
Activities

• Food Security Task Force
• Community Visioning Process
• Dialogue Process- Yale University
• Framing Research followed by Social Marketing
  Strategy
• Emergency Preparedness and Health Equity/Social
  Justice

55
Activities

• School of Public Health and Information Sciences
  course development
• White Paper on Health Equity and Social Justice
  
• Implementation of focus on HIAs
• Office of Faith and Health ( Social Justice )
• Tommie Smith Youth Athletic Initiative
• Undoing Racism workshops

56
(No Transcript)
57
Adewale Troutman, M.D.,M.P.H.The Troutman
Group5109 Forrest Grove PlaceLouisville, Ky
40059denzibell_at_aol.com adedrum_at_aol.comwww.adewa
letroutman.comwww.thetroutmangroup.org502 544
8570
58
Local Public Health Agents for Health Equity

• Adewale Troutman,M.D., M.A., M.P.H.
• University of Louisville
• Louisville Department of Public Health and
  Wellness

59
Core Public Health Functions

• Assessment
• Assess the health needs of the community
• Investigate the occurrence of health effects and
  health hazards in the community
• Analyze the determinants of identified health
  needs
• Policy development
• Advocate for public health, build constituencies,
  and identify resources in the community
• Set priorities among health needs
• Develop plans and policies to address priority
  health needs
• Assurance
• Manage resources and develop organizational
  structures
• Implement programs
• Evaluate programs and provide quality assurance
• Inform and educate the public

60
The Essential Public Health Services

• Monitor health status
• Diagnose and investigate health problems
• Inform and educate
• Mobilize communities to address health problems
• Develop policies and plans

• Enforce laws and regulations
• Link people to needed health services
• Assure a competent health services workforce
• Evaluate health services
• Conduct research for new innovations