Achieving Health Equity Addressing racism as a threat to the health and well-being of our nation

1. Achieving Health EquityAddressing racism as a threatto the health and well-beingof our nation Camara Phyllis Jones, MD, MPH, PhD Social Determinants of Health and Equity Genesee County Health Department 2012 Public Health Week Conference April 3, 2012 Office of Surveillance, Epidemiology, and Laboratory Services Epidemiology and Analysis Program Office

2. Achieving Health EquityAddressing racism as a threatto the health and well-beingof our nation The findings and conclusions in this presentation are those of the author, and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention. Office of Surveillance, Epidemiology, and Laboratory Services Epidemiology and Analysis Program Office

3. Levels of health intervention

16. Addressing the social determinants of health Primary prevention Safety net programs and secondary prevention Medical care and tertiary prevention

17. 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

25. Differences in exposures and opportunities Differences in access to care Differences in quality of care (ambulance slow or goes the wrong way)

26. 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?

27. 3 dimensions of health intervention

28. 3 dimensions of health intervention Health services

29. 3 dimensions of health intervention Health services Addressing social determinants of health

30. 3 dimensions of health intervention Health services Addressing social determinants of health Addressing social determinants of equity Source: Jones CP et al.J Health Care Poor Underserved 2009.

31. Individual behaviors Determinants of health

32. Social determinants of health (contexts) Individual behaviors Determinants of health

33. Social determinants of health (contexts) Individual behaviors Determinants of health Determinants of health and illness that are outside of the individual Beyond genetic predispositions Beyond individual behaviors

34. Social determinants of health (contexts) Individual behaviors Determinants of health Determinants of health and illness that are outside of the individual Beyond genetic predispositions Beyond individual behaviors The contexts in which individual behaviors arise

35. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth

36. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth Neighborhood resources Housing, food choices, public safety, transportation, parks and recreation, political clout

37. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth Neighborhood resources Housing, food choices, public safety, transportation, parks and recreation, political clout Hazards and toxic exposures Pesticides, lead, reservoirs of infection

38. Social determinants of health (contexts) Individual behaviors Determinants of health Individual resources Education, occupation, income, wealth Neighborhood resources Housing, food choices, public safety, transportation, parks and recreation, political clout Hazards and toxic exposures Pesticides, lead, reservoirs of infection Opportunity structures Schools, jobs, justice

39. Individual behaviors Determinants of health Societal determinants of context Social determinants of health (contexts)

40. Individual behaviors Determinants of health Determine the range of observed contexts Societal determinants of context Social determinants of health (contexts)

41. Individual behaviors Determinants of health Determine the range of observed contexts Societal determinants of context Social determinants of health (contexts) Determine the distribution of different populations into those contexts

42. Individual behaviors Determinants of health Determine the range of observed contexts Include capitalism, racism, and other systems of power Societal determinants of context Social determinants of health (contexts) Determine the distribution of different populations into those contexts

43. Individual behaviors Determinants of health Determine the range of observed contexts Include capitalism, racism, and other systems of power Societal determinants of context Social determinants of health (contexts) Determine the distribution of different populations into those contexts The social determinants of equity Source: Jones CP, Jones CY, Perry GS, Barclay G, Jones CA. Addressing the Social Determinants of Children’s Health: A Cliff Analogy. J Health Care Poor Underserved2009.

44. Beyond individual behaviors • Address the social determinants of health, including poverty, in order to achieve large and sustained improvements in health outcomes • Address the social determinants of equity, including racism, in order to achieve social justice and eliminate health disparities

45. Why racism? • To eliminate racial disparities in health, need examine fundamental causes • “Race” is only a rough proxy for social class, culture, or genes • “Race” precisely measures the social classification of people in our “race”-conscious society • Hypothesize racism as a fundamental cause of racial disparities in health

46. What is racism? A system

47. What is racism? A system of structuring opportunity and assigning value

48. What is racism? A system of structuring opportunity and assigning value based on the social interpretation of how we look (“race”)

49. 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

50. 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