The Opportunity The Challenge The Framework Danger and Opportunity Where Do We Go From Here?

1. FROM HEALTH DISPARITIES TO HEALTH EQUITYAnnual MeetingDirectors of Health Promotion and EducationNew Orleans, LAAugust 10-11, 2010

2. Stephen B. Thomas, PhD.Professor, Department of Health Services AdministrationDirector, Maryland Center for Health Equity School of Public Health The University of Marylandsbt@umd.eduwww.healthequity.umd.edu

3. Craig S. Fryer, DrPH, Mary A. Garza, Ph.D., Stephen B. Thomas, Ph.D., Sandra C. Quinn, Ph.D. and James Butler, III, DrPHwww.healthequity.umd.edu

4. The Opportunity • The Challenge • The Framework • Danger and Opportunity • Where Do We Go From Here?

5. THE OPPORTUNITY

6. “America’s health needs to be improved now, not five or ten years from now” (2010, p. 1486). David R. Williams, Mark B. McClellan, and Alice M. RivlinBeyond The Affordable Care Act: Achieving Real Improvements In Americans’ Health Health Affairs 29, NO. 8 (2010): 1481–1488

7. VISION To be a vibrant contributor to the University of Maryland’s re-invigorated land grant mission, which includes a commitment to eliminate racial and ethnic disparities and achieve health equity.

8. According to Health People 2020: • “A health disparity is a particular type of health difference that is closely linked to…people who have experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, mental health, cognitive, sensory, or physical disability, sexual orientation, geography, or other characteristics historically linked to discrimination or exclusion.“ • http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx Attending public launch of HP2020 at George Washington University, December 2, 2010: Drs. James Butler III, Robert S. Gold, Sandra Quinn, Adewale Troutman, Stephen B. Thomas, Mary A. Garza and Craig S. Fryer

9. Institute of Medicine Definition of Health DisparitiesDifferences, Disparities, and Discrimination: Populations with Equal Access to Healthcare SOURCE: Gomes and McGuire, 2001

10. In 2004, the CDC published “Actual Causes of Death in the United States. 2000,” which identified tobacco (435,000 deaths; 18.1% of total U.S. deaths) and poor diet and physical inactivity (400,000 deaths; 16.6% of total U.S. deaths) as the leading contributors to loss of life (Mokdad,et al, 2004. Actual causes of death in the United States. 2000. J. Am. Med. Assoc)

12. THE CHALLENGE

15. Race the Power of an Illusion, PBS http://www.pbs.org/race/000_General/000_00-Home.htm

16. Shariff-Marco, S., Klassen, A. C., & Bowie, J. V. (2010). Racial/Ethnic Differences in Self-Reported Racism and Its Association With Cancer-Related Health Behaviors. Am J Public Health, 100(2), 364-374. • “… general racism was associated with smoking, binge drinking, and being overweight or obese; health care racism was associated with not being up to date with screening for prostate cancer…. Associations between general racism and lifestyle behaviors suggest that racism is a potential stressor that may shape cancer-related health behaviors... “ (p. 364)

17. Ford, C. and Airhihenbuwa C. (2010). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. American Journal of Public Health, 100: S30-S35. • Ford, C. and Airhihenbuwa C. (2010). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. American Journal of Public Health, 100: S30-S35.

18. THE FRAMEWORK

19. Thomas, S. B., S. C. Quinn, et al. (2011). "Toward a Fourth Generation of Disparities Research to Achieve Health Equity." Annual Review of Public Health 32(1): 399-416.

20. Third Generation Research: A Color Blind Evidence Base “Because limited race and ethnicity data were available, it is unknown if the intervention had differential effects for different racial or ethnic groups” Task Force on Community Preventive Services recommended interventions for prevention of obesity and tobacco use. Source: Adapted from The Guide to Community Preventive Services

22. Fourth Generation Health Disparity Research Health Equity Action Research Trajectory HEART From the Public Health Critical Race praxis perspective, four key principles should inform intervention research: • The primacy of racialization, • Structural determinism, • Critical approaches, and • Intersectionality Thomas, S. B., S. C. Quinn, Butler, J., Fryer, C..S., Garza, M.A. (2011). "Toward a Fourth Generation of Disparities Research to Achieve Health Equity." Annual Review of Public Health 32(1): 399-416

23. INNOVATION

24. Health Advocates In-Research and Research (H.A.I.R.) Network of Black Barbershops & Beauty Salons

25. THE FAMILY HEALTH HISTORY

26. THE PEDIGREE: A GENETIC FAMILY HEALTH TREE The goal of the session is to elicit a three-generation pedigree for accurate risk assessment.

27. LESSONS FROM EVIDENCE BASED RESEARCH Focus on common risk factors for chronic disease Pre-hypertension and Pre-Diabetes Smoking Obesity Stress Family health history

28. PROGRAM ACTIVITIES Physical Activity Nutrition Education & Guidance Stress Management Smoking Cessation Family Health History Self-Management of Chronic Disease Referral to Medical Home

29. LIFESTYLE: African American women participate in a community based Water Aerobics class. The Healthy Black Family Project, a Program of the Maryland Center for Health Equity (NIH-NIMHD, P60) Disease Prevention: "We have made some progress towards eliminating health disparities. Yet there is much unfinished business. We have to reexamine our strategy and accelerate the pace through innovative, sustainable and results-orientedapproaches... " (Dr. John Ruffin, Director, NIH-NIMHD, 2010)

31. DANGER AND OPPORTUNITY

32. The danger is to assume that: • racism is notrelevant in the scientific pursuit of solutions for the elimination of health disparities; • that some populations will always suffer premature illness and death by virtue of their culture bound lifestyle choices; and thus, • that the elimination of disparities is impossible and health equity unachievable in a free market society. Thomas, S. B., S. C. Quinn, Butler, J., Fryer, C..S., Garza, M.A. (2011). "Toward a Fourth Generation of Disparities Research to Achieve Health Equity." Annual Review of Public Health 32(1): 399-416

33. The opportunity is to recognize health disparities as an issue of justice because specific groups were subjected to systematic racial discrimination and denied the basic benefits of society, a violation of the social contract.Boucher, David and Paul Kelly, eds. 1994.The Social Contract from Hobbes to Rawls, New York: Routledge

34. WHERE DO WE GO FROM HERE ?

35. ACHIEVING HEALTH EQUITY “…we can no longer be victims of inaction. Our role as scientists is to provide the knowledge and perspectives for effective practice and policies… We have a moral obligation in our society to do what is necessary to improve health, and the health disparities research community should be in the vanguard of that movement” (Ruffin, 2010, p. S9). Ruffin J. 2010. The Science of Eliminating Health Disparities: Embracing a New Paradigm. American Journal of Public Health. 100:S8-S9

36. Acknowledgement & Disclaimer • The project described was supported by Award Number 7RC2MD004766 from the National Institute on Minority Health And Health Disparities (NIMHD). • The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMHD or the National Institutes of Health.

37. THANK YOU VERY MUCH !