Towards Health Equity A Prevention Framework for Reducing

Towards Health Equity: A Prevention Framework for Reducing Health and Safety Disparities Larry Cohen, MSW Rachel Davis, MSW Sharon Rodriguez, Rodriguez BA Chapter 9 www. preventioninstitute. org

Health Disparities Definition “ Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health ” conditions that exist among specific populations. National Institutes of Health

Leading Causes of Death Heart Disease Cancer Stroke Diabetes Injuries & Violence

HEALTH DISPARITIES: The same injuries and illnesses only more so

The Trajectory of Health Disparities A Key Opportunity for Prevention ENVIRONMENT EXPOSURES & BEHAVIORS MEDICAL CARE HEALTH DISPARITIES

The Prevention Continuum PRIMARY Approaches that take place BEFORE illness or injury SECONDARY TERTIARY Responses AFTER SYMPTOMS OR RISK of illness or injury Responses AFTER ONSET of illness or injury

MOVING UPSTREAM “We are still standing on the bank of the river, rescuing people who are drowning. We have not gone to the head of the river to keep them from falling in. That is the 21 st century task. ” Gloria Steinem Photo Source: http: //static. flickr. com/90/207590972_a 30260 c 293_b. jpg

a systematic process that promotes healthy behaviors and environments and reduces the likelihood or frequency of an incident, condition, or illness occurring. taking action to prevent problems from occurring before the onset of symptoms

u Child Restraint and Safety Belt Use u Smoking Prevention u Minimum Drinking Age Laws u Childhood Immunizations u Motorcycle and Bicycle Helmet Laws u Reduced Lead Levels in Children

Prevention is the Prescription u Changes norms: makes the healthy choice the easy choice u Comprehensive u Aimed at the community environment

Take 2 Steps Back Environment Exposures & Behaviors Medical Care

The Trajectory of Health Disparities ENVIRONMENT EXPOSURES & BEHAVIORS MEDICAL CARE u Unequal access u Unequal treatment HEALTH DISPARITIES

Medical Care Alone Cannot Reduce Disparities u Not the primary determinant of health u Treats one person at a time u Often comes late; can’t always restore health

Let’s take a step back. . . Exposures & Behaviors Medical Care

The Trajectory of Health Disparities ENVIRONMENT EXPOSURES & BEHAVIORS MEDICAL CARE u Absorption of toxins & stressors u Risky, unhealthy behaviors HEALTH DISPARITIES

Making Links to Exposures & Behaviors Diet & Activity Patterns Tobacco Alcohol Heart Disease Cancer Stroke Diabetes & Drugs Injuries & Violence SOURCE: Mc. Ginnis JM , Foege WH. Actual causes of death in the United States. Journal of the American Medical Association. 1993; 270: 2207 -2213.

“that people will change their It is unreasonable to expect behavior easily when so many forces in the social, cultural, and physical environment ” conspire against such change. Institute of Medicine

Let’s take another step back. . . Environment Exposures & Behaviors

The Trajectory of Health Disparities ENVIRONMENT u Root EXPOSURES & BEHAVIORS factors u Compromised social & physical environments MEDICAL CARE HEALTH DISPARITIES

Community Clusters for Health Equity Equitable Opportunity People Place

Community Factors for Health Equity EQUITABLE OPPORTUNITY u PLACE u u u u What’s sold & how it’s promoted Look, feel, safety Parks & open space Getting around Housing Air, water, soil Arts & culture u u Racial justice Jobs & local ownership Education PEOPLE u u u Social networks & trust Participation & willingness to act for the common good Norms/Costumes

Health Equity Trajectory ENVIRONMENT EXPOSURES & BEHAVIORS u Equitable u Toxin- u Social u Health- opportunities capital & positive norms u Healthy places & stressor-free promoting behaviors MEDICAL CARE u Accessible, high-quality, culturallycompetent medical care HEALTH EQUITY

For more information, see: THRIVE Tool for Health and Resilience In Vulnerable Environments http: //preventioninstitute. org/thrive/index. php

Health Equity Memo Date: January 2009

Recommendations to Promote Prevention and Health Equity 1. National strategy to promote health equity across racial, ethnic, and socioeconomic lines 2. High-level leadership at the White House and the department level 3. Build capacity of federal, state, and local health agencies to lead population-based prevention and health equity work.

Recommendations to Promote Prevention and Health Equity 4. Fund community-based initiatives. 5. Technical assistance and tools to support community-level efforts 6. National, state, and local data systems 7. Population-based prevention and health equity with an emphasis on translating research into targeted, community-specific strategies.

“ Given the broad roots of this problem, it is only with combined efforts of all sectors and disciplines of society -- the public and private sectors, business and labor, non-profit and community-based organizations, educational institutions, the faith community and others - that we can hope to eliminate racial and ethnic disparities. Call to the Nation to Eliminate Racial and Ethnic Disparities in Health ”

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