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

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

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

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  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

  33. Cotter Lane

  34. Park DuValle

  35. Park DuValle

  36. Making the case for policy makers; GIS Mapping

  37. The Power of Poverty

  38. 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”

  39. Racism

  40. Local Public Health Response; The Public Health System

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