Pathways to Health Equity:

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Pathways to Health Equity

• Providing a Framework

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Framework

• Levels of health intervention
• Implications for defining health equity
• Axes of inequity
• Musings

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Levels of health intervention
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Primary prevention
Addressing the social determinants of health
Safety net programs and secondary prevention
Medical care and tertiary prevention
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But how do disparities arise?

• Differences in the quality of care received
  within the health care system
• Differences in access to health care, including
  preventive and curative services
• Differences in life opportunities, exposures, and
  stresses that result in differences in underlying
  health status

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Differences in exposures and opportunities
Differences in access to care
Differences in quality of care (ambulance slow or
goes the wrong way)
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Addressing the social determinants of
equity Why are there differences in
resources along the cliff face? Why are there
differences in who is found at different parts of
the cliff?
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Three dimensions

• Health services
• Addressing the social determinants of health
• Addressing the social determinants of equity

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Implications for definition

• Must acknowledge historical injustices
• Role of structure
• Differences in distributions of resources
• Differences in distributions of populations
• Motivated by fairness
• All persons and populations valued equally
• Requires intervention
• Active process
• Role of assurance

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Defining health equity

• Health equity is a process which requires
• Valuing all individuals and populations equally
• Recognizing and rectifying historical injustices
• Focusing societal efforts to achieve optimal
  conditions for health for all
• Elimination of health disparities is an outcome

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Many axes of inequity

• Race
• Social class
• Geography
• Nationality, language, and legal status
• Gender
• Sexual orientation
• These are risk markers, not risk factors

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What is racism?

• A system

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What is racism?

• A system of structuring opportunity and
  assigning value

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What is racism?

• A system of structuring opportunity and
  assigning value based on the social
  interpretation of how we look (race)

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What is racism?

• A system of structuring opportunity and
  assigning value based on the social
  interpretation of how we look (race)
• Unfairly disadvantages some individuals and
  communities

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What is racism?

• A system of structuring opportunity and
  assigning value based on the social
  interpretation of how we look (race)
• Unfairly disadvantages some individuals and
  communities
• Unfairly advantages other individuals and
  communities

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What is racism?

• A system of structuring opportunity and
  assigning value based on the social
  interpretation of how we look (race)
• Unfairly disadvantages some individuals and
  communities
• Unfairly advantages other individuals and
  communities
• Saps the strength of the whole society through
  the waste of human resources

Source Jones CP, Phylon 2003
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What is inequity?

• A system of structuring opportunity and
  assigning value based on fill in the blank,
  which
• Unfairly disadvantages some individuals and
  communities
• Unfairly advantages other individuals and
  communities
• Saps the strength of the whole society through
  the waste of human resources

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Musings

• Necessary for those at the top to understand that
  they are adversely impacted by a lack of equity
• Feeling interconnected with others going from
  talking about your children and my children
  to talking about our children
• Equally valuing all people recognizing that
  everyone has important gifts to share

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Musings

• Can address social determinants of health without
  acknowledging the three-dimensionality of the
  cliff
• This can result in increasing the magnitude of
  inequities in exposures and disparities in
  outcomes
• Addressing social determinants of equity is ALL
  ABOUT the three-dimensionality of the cliff

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Musings

• On measurement
• Measuring equity in exposures and opportunities,
  resources and risks involves comparing
  distributions rather than individuals
• Confirming the elimination of health disparities
  involves observing random variations in the
  magnitude and direction of between-group
  differences around the value 0

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Framework

• Levels of health intervention
• Health services, social determinants of health,
  social determinants of equity
• Implications for defining health equity
• Structure and process, role of history, equal
  valuation, relation to outcomes
• Axes of inequity
• Systems of structuring opportunity and assigning
  value
• Musings

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Our goal To move the conversation
Health services
Social determinants of health
Social determinants of equity
Jones CP. Expanding the Fence or Ambulance
Debate Addressing the Social Determinants of
Health and Equity. Under review, 2007.
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Resources

• California Newsreel Unnatural Causes Is
  Inequality Making Us Sick?
• http//www.unnaturalcauses.org/
• World Health Organization Commission on Social
  Determinants of Health
• http//www.who.int/social_determinants/en/

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Resources

• UNESCO International Coalition of Cities
  Against Racism
• http//www.unesco.org/shs/citiesagainstracism
• United Nations World Conference Against Racism,
  Racial Discrimination, Xenophobia, and Related
  Intolerance
• http//www.un.org/WCAR/

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Camara Phyllis Jones, MD, MPH, PhD 4770
Buford Highway NE Mailstop K-67 Atlanta,
Georgia 30341 [phone] phone (770)
488-5965 fax cdj9_at_cdc.gov