Health Equity and the Elimination of Cardiovascular Disease Disparities

1. Health Equity and the Elimination of Cardiovascular Disease Disparities Leandris C. Liburd, PhD, MPH Associate Director for Minority Health and Health Equity Centers for Disease Control and Prevention October 18, 2012 Office of Minority Health & Health Equity Office of the Director

2. CDC’s Office of Minority Health (OMH) CDC's Office of Minority Health (OMH) was established by the CDC Director on August 8, 1988 as a small coordination office, set up in response to Secretary Heckler‘s 1985 landmark report on minority health.

3. Patient Protection and Affordable Care Act, PL 111-148 (2010) Select Provisions Related to Minority Health and Health Disparities “The heads of the Centers for Disease Control and Prevention, Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Agency for Healthcare Research and Quality, Food and Drug Administration, and the Centers for Medicare and Medicaid Services shall establish an office to be known as the Office of Minority Health. “

4. Office of Minority Health and Health Equity Mission To accelerate the work of CDC and its partners in improving health by eliminating health disparities, promoting conditions conducive to health, and achieving health equity.

5. Presentation Objectives • Provide an overview of the Office of Minority Health and Health Equity’s Strategic Priorities (2012 – 2015) • Define health disparities, health equity, health inequities, and the social determinants of health • Explore how achieving health equity will reduce disparities in heart disease and stroke particularly among African Americans • Pose questions that will inform the continued development, implementation, and refinement of population-based strategies to reduce CVD and stroke

6. OMHHE’s Strategic Priorities • Reframe eliminating health disparities as achievable • Facilitate the implementation of policies across CDC that promote the elimination of health disparities • Assure implementation of proven strategies across CDC programs that reduce health disparities in communities at highest risk • Advance the science and practice of health equity • Collaborate with national and global partners to promote the reduction of health inequalities

7. 2011 CDC Health Disparities and Inequalities Report (CHDIR)

8. Program Response to the 2011 CDC Health Disparities and Inequalities Report (CHDIR) 2013 2013 Program Response to the

9. Health Equity MattersE-Newsletter http://www.cdc.gov/minorityhealth/newsletter/current.html

10. Conversations in EquityBlog http://blogs.cdc.gov/healthequity/

11. Health disparities Minority Health Social determinants of health Health equity Health inequities What’s the difference?

12. Defining Health Disparities Health disparities are differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes.

13. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their • racial or ethnic group; • religion; • socioeconomic status; • gender; • age; • mental health; • cognitive, sensory, or physical disability; • sexual orientation or gender identity; • geographic location; • or other characteristics historically linked to discrimination or exclusion.

14. Defining Health Equity Health Equity is attainment of the highest level of health for all people.

15. Defining Health Equity Health Equity is 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 healthcare disparities.

16. Defining Health Inequities Health inequities are those health disparities that are avoidable and unfair.

17. Conditions in the social, physical, and economic environment in which people are born, live, work and age that influence health outcomes. Social Determinants of Health Environment Neighborhood Transportation Health Care Food Security Education Social Context Jobs

18. Cardiovascular Disease Disparities • In the 45–74 age group, black women and men have much higher coronary heart disease (CHD) and stroke mortality than women and men of the three other races: Findings from the CDC Health Disparities and Inequalities Report – United States, 2011

19. The “big five” CVD risk factors + 3 • Diet [high fat, high sodium] • Physical [in]activity • Cigarette smoking • [uncontrolled] high blood pressure • [high] cholesterol • Diabetes • Depression • Psychosocial stress

20. Social determinants of heart disease & stroke • Saturation of fast food restaurants, vendors of alcoholic beverages, and vendors of tobacco products • Limited opportunities for recreational physical activity • Limited access to major grocery chains, farmers’ markets, and whole-food markets • Aggressive marketing of unhealthy products • Chronic stress

21. Reducing health disparities in cardiovascular disease • Surveys and surveillance systems: large-scale community-based designed to monitor the health status of minority populations • Strategies : community-specific, culturally tailored that include system, environmental, and individual level interventions • Current CDC activities: Heart Disease and Stroke Atlases, WISEWOMEN, and Racial and Ethnic Approaches to Community Health (REACH), Million Hearts http://www.cdc.gov/Features/dsREACHUS/

22. Reducing health disparities in cardiovascular disease Individual level interventions: • healthy diet • regular physical activity • not smoking • healthy weight; • adherence to medication CDC Division of Heart Disease and Stroke Prevention

23. Reducing health disparities in cardiovascular disease System and community interventions: • Continuing education health care providers • Health promotion programs that use community health workers • Health communications campaigns • Focus is on tobacco-free living • Focus on sodium and trans fats in the food supply TRANS FAT http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_aian.htm

24. Moving toward Health Equity… • In addition to monitoring the health status of minority populations, how might we monitor and report on the social determinants of heart disease and stroke? • In contemporary, culturally diverse communities, how can we engage community members in identifying, implementing and evaluating strategies to reduce heart disease and stroke? • How can our communications campaigns represent heart healthy living in more inviting ways? • How can we accelerate our understanding of how cultures change and use this knowledge to promote heart health?

25. “It is in justice that the ordering of society is centered.”Aristotle

26. Thank You For Your Time Office of the Director Office of Minority Health & Health Equity