Creating Health Equity Through Social Justice; More Than an Apple a Day and A Walk in the Park

1. Creating Health Equity Through Social Justice; More Than an Apple a Day and A Walk in the Park Center for Health Policy Washington University June 11. 2008 Adewale Troutman, M.D., M.A., M.P.H.

2. Healthy People 2010 Two Goals Increase Quality and Years of Health Life Eliminate Health Disparities

3. How you frame an issue determines your focus and direction in its resolution

4. A systems approach; But Why?

5. Continuing to do the same things in the same way but expecting a different outcome is insanity

6. It all begins from a belief in the right to health and a belief in the existence of universal principles. This gives it a spiritual not just a pragmatic base.

7. The Problem

8. Vital Statistics:

9. What If We Were Equal? Progress in closing gap in Civil Rights, housing, education Health Inequities continue to exist Overall widening of mortality gap Some improvement for African American women but trending up again Infants and Men account for majority

10. Let�s agree with the terms

11. Health �The presence of physical, psychological, social, economic and spiritual well being not merely the absence of disease or infirmity� �The maintenance of a harmonious balance of mind, body and spirit� Community and individual

12. Equity Justice according to natural law or right Freedom from bias or favoritism

13. Health Equity �The absence of unfair and avoidable or remediable differences in health among social groups� ( The Commission ) A value position supported by an evidence base There is and will be political opposition to the core value of health equity

14. Health inequities are systemic, avoidable, unfair and unjust differences in health status and mortality rates and in the distribution of disease and illness across population groups. They are sustained over time and generations and beyond the control of individuals

15. Justice The quality of fairness The principle of moral rightness; equity Conformity to moral rightness in action or attitude

16. Social Justice The application of principles of justice to the broadest definition of society Implies Equity Equal access to societal power, goods and services Universal respect for human and civil rights

17. Rights: Claims or entitlements that are recognized by legal or moral principles

18. Rights are enforced by legislation and rules, the force of law

19. Human Rights: A higher order right MORALLY based and UNIVERSAL. It belongs to all persons equally because they are human beings(Declaration of Independence)

20. Health is a Basic Human Right Not a Privilege

21. The Right to Health Preamble to the constitution of the WHO states � The enjoyment of the highest standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief,economic or social condition

22. �The time has come to herald human rights as both the foundation of public health and the compass of public policy�JAPHA 2000

23. Looking Upstream

24. Personal Choice vs. Systemic Change

25. Determinants of Health; A Holistic Approach Social and Economic Environment Physical Environment Health Behaviors Health Care Access Policies & The Political Environment The Balance of Power Genetics/Biology

26. Why Social Determinants?

27. Socioeconomic Status Occupation Education Income Income gaps Racism & discrimination Housing Political power

28. Social Determinants ( WHO ) The Social Gradient Stress Early Life Social Exclusion Work Unemployment Social Support Addiction Food Transport

29. The Evidence and Knowledge Network (MEKN) Develop an expert consensus on the sources of evidence for the social determinants of health and health inequities To collect, assess and synthesize global knowledge on existing methodologies to evaluate the effectiveness of policies, interventions and actions on social determinants of health which are aimed at improving health outcomes and health equity

30. Housing

31. Public Health and the Built Environment

32. Housing and Health Lead Indoor air quality Unsafe environments Obesity Asthma Stress

34. These are pictures from a recent NYT article. I�ll talk a little later about how we use our GIS to look at housing, these photos show you the zone in ways that maps cannot. These are examples of environmental interventions in progress and/or environmental problems in the zone. These are pictures from a recent NYT article. I�ll talk a little later about how we use our GIS to look at housing, these photos show you the zone in ways that maps cannot. These are examples of environmental interventions in progress and/or environmental problems in the zone.

35. Cotter Lane

36. Park DuValle

37. Park DuValle

38. Making the case for policy makers; GIS Mapping

46. The Power of Poverty

47. Income Inequities 1995 study Kennedy, Kawachi and Prothrow-Stith 282 cities in the U.S. Death from income inequities � is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, HIV infection and homicide�

49. Racism

50. Local Public Health Response; The Public Health System

52. Center Activities

53. Center Activities Staff Training on Community Organizing Staff and Community Training on Capacity Building Community Policy Mini-grants Speakers series On line learning in Health Equity for consumers and state employees in health Training in policy development

54. Activities Food Security Task Force Community Visioning Process Dialogue Process- Yale University Framing Research followed by Social Marketing Strategy Emergency Preparedness and Health Equity/Social Justice

55. Activities School of Public Health and Information Sciences course development �White Paper� on Health Equity and Social Justice Implementation of focus on HIA�s Office of Faith and Health ( Social Justice ) Tommie Smith Youth Athletic Initiative Undoing Racism workshops

57. Adewale Troutman, M.D.,M.P.H.The Troutman Group5109 Forrest Grove PlaceLouisville, Ky 40059denzibell@aol.com adedrum@aol.comwww.adewaletroutman.comwww.thetroutmangroup.org502 544 8570

58. Local Public Health; Agents for Health Equity Adewale Troutman,M.D., M.A., M.P.H. University of Louisville Louisville Department of Public Health and Wellness

59. Core Public Health Functions

60. The Essential Public Health Services Monitor health status Diagnose and investigate health problems Inform and educate Mobilize communities to address health problems Develop policies and plans Enforce laws and regulations Link people to needed health services Assure a competent health services workforce Evaluate health services Conduct research for new innovations The ten essential services are shown here on the screen and include: Monitor health status to identify and solve community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems The ten essential services are shown here on the screen and include: Monitor health status to identify and solve community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems