Health Equity and Healthy Communities National Civic League All-America City Awards

1. Health Equity and Healthy CommunitiesNational Civic LeagueAll-America City Awards Ned Calonge, MD, MPH President and CEO The Colorado Trust

2. Key terms • Health disparities • Social determinants of health • Health equity

5. Health disparities • Health differences that are closely linked with social or economic disadvantage • Health disparities adversely affect groups who have systematically experienced greater social or economic obstacles to health based on characteristics of their group historically linked to discrimination or exclusion Dr. Paula Braveman

6. Social determinants of health • The complex, integrated, and overlapping social structures and economic systems that include the social environment, physical environment, and health services; structural and societal factors that are responsible for most health inequities • Inequities in and avoidable health inequalities arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces. World Health Organization Commission on the Social Determinants of Health (2008)

7. Social determinants of health • Think in terms of opportunities and barriers: • Early childhood development, schools, education, literacy • Economy, jobs, employment, occupation, working conditions, income, wealth • Housing, transportation, public safety, parks and recreation, healthy food access • Social status, culture, social network, political clout, justice • Environment, pollution, hazards

8. Poverty demographics (Denver)

9. Education demographics(Denver)

10. Health equity • Attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. Healthy People 2020

11. From: Bay Area Regional Health Inequities Initiative

12. “A rising tide will lift all boats” • You cannot address community health without addressing health equity • Success in achieving health equity will require intention focus on the social determinants of health, which affect different subgroups of a community differently

13. Washington D.C.: Short Distances to Large Disparities in Health

14. New Orleans Life Expectancy by Zip Code, 2009

15. Why now? --economic burden • Direct medical costs of health inequalities • Indirect costs of health inequalities • Costs of premature death Joint Center for Political and Economic Studies; www.jointcenter.org/hpi

16. Economic burden of health inequalities in the United States • Between 2003 and 2006, 30.6% of direct medical care expenditures for African Americans, Asians, and Hispanics were excess costs due to health inequalities • Eliminating health inequalities for minorities would have reduced direct medical care expenditures by $229.4 billion for the years 2003-2006. • Between 2003 and 2006 the combined costs of health inequalities and premature death were $1.24 trillion

17. Why now?--changing demographics

20. Colorado

21. The Colorado Trust • The Colorado Trust is a health foundation dedicated to achieving health equity • To create health equity, we believe all Coloradans should have fair and equal opportunities to lead healthy, productive lives regardless of race, ethnicity, income or where we live • Good health depends on more than medical care; it’s affected by where we live, the education we receive, the work we do, the wages we earn and by our opportunities to make decisions that improve our own and our family’s health • Partnering with communities, we can advance fair opportunities for all Coloradans to be healthy

23. Data and information • Data systems and routine monitoring of health inequities are put in place; more effective policy and programs are developed

24. Health equity information

25. Policy and advocacy • Policy options are researched, developed and implemented to support health equity

26. Policies to promote child and youth development and education, infancy through college Policies to promote economic development, reduce poverty, and reduce racial segregation Policy approaches to health equity Policies to promote healthier homes, neighborhoods, schools and workplaces Economic & Social Opportunities & Resources HEALTH Living & Working Conditions in Homes & Communities Medical Care Personal Behavior Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org

27. Community-based participatory grantmaking • Communities have the ability to organize all groups and act in a manner that promotes and realizes health equity

28. Evidence-based strategies (Joint Center for Political and Economic Studies) • Focus on prevention, particularly on the conditions in which people live, work, play, and study • Implement multiple strategies across sectors • Commit to sustained investment and a long-term policy agenda • Implement “place-based” strategies: investments in communities • Implement “people-based” strategies: such as investing in Early Childhood Education, increasing housing mobility options, etc.

29. Create healthier communities • Improve food and nutritional options through incentives for Farmer’s Markers and grocery stores, and regulation of fast food and liquor stores • Structure land use and zoning policy to reduce the concentration of health risks • Undertake “Health Impact Assessments” to determine the public health consequences of any new housing, transportation, labor, education policies

30. Improve the physical environment of communities: • Improve air quality (e.g., by relocating bus depots further from homes and schools) • Expand the availability of open space (e.g., encourage exercise- and pedestrian-friendly communities) • Address disproportionate environmental impacts (e.g., encourage Brownfields redevelopment)

31. Intersection of health, place and equity Health facilities Access to Healthy Food Schools/ Child care Health Housing Community Safety/ violence Environment Equity Parks/OpenSpace playgrounds TransportationTraffic patterns Work environments