Reducing Health Disparities through Prevention

1. Reducing Health Disparities through Prevention Jeremy Cantor, MPH Program Manager March 7, 2007 The California Partnership for Access to Treatment Sacramento, CA Frameworks, Successes, and Strategies www.preventioninstitute.org

2. “We have found an environment that is potentially suitable for living organisms.” Carolyn Porco, of the Space Science Institute, discussing a moon of Saturn. New York Times, 3/10/2006

3. Is this a suitable environment?

4. A Sample of Disparities The percentage of Hispanic children living below the poverty line is three times that of white children. High School Graduation rates: 53% Hispanic, 51% Native American, 50% African American African American children are five times more likely to be poisoned by lead. American Indians and Alaska Natives are 2.6 times more likely to have diabetes. African Americans are four times more likely to die of asthma.

5. ROOT FACTORS The Trajectory of Health Disparities DISPARITIES IN HEALTH

6. ROOT FACTORS The Trajectory of Health Disparities DISPARITIES INHEALTH DISPARITIES IN HEALTH ENVIRONMENTAL FACTORS & BEHAVIORAL

7. BEHAVIOR BEHAVIOR ENVIRONMENT TOXINS HEALTH

8. ROOT FACTORS MEDICAL SERVICES The Trajectory of Health Disparities DISPARITIES IN HEALTH DISPARITIES INHEALTH ENVIRONMENTAL FACTORS & BEHAVIORAL

10. Medical Care Alone Cannot Reduce Disparities • Not the primary determinant of health • Treats one person at a time • Often comes late; can’t always restore health

11. “ No epidemic has ever been resolved by paying attention to the treatment of the affected individual. ” George W. Albee

12. A Key Opportunity for Prevention ROOT FACTORS MEDICAL SERVICES DISPARITIES IN HEALTH DISPARITIES INHEALTH ENVIRONMENTAL FACTORS & BEHAVIORAL The Trajectory of Health Disparities

13. BEHAVIOR BEHAVIOR ENVIRONMENT TOXINS HEALTH

14. HEALTH BEHAVIOR BEHAVIOR

15. Is it just behavior?

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18. “ It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change. ” Institute of Medicine

19. What’s wrong with this picture?

24. Heart Disease Cancer Stroke Diabetes Injuries & Violence Causes of Death

25. The same injuries and illnesses only more so

26. Let’s take a step back... Causes of Death Actual Causes of Death

27. Making Links to Actual Causes of Death Diet & Activity Patterns Heart Disease Cancer Tobacco Stroke Diabetes Alcohol & Drugs Injuries & Violence

28. Let’s take another step back... Actual Causes Community Factors

29. Elements of Community Health Equitable Opportunity Place People

30. Equitable Opportunity Place People Community Health Factors EQUITABLE OPPORTUNITY • Racial justice • Jobs & local ownership • Education

32. Equitable Opportunity Place People Community Health Factors PEOPLE • Social Networks & trust • Participation & willingness to act for the common good • Acceptable behaviors & attitudes

34. Equitable Opportunity Place People Community Health Factors PLACE • Look, feel & safety • Parks & open space • Getting around • Housing • What’s sold and how it’s promoted • Air, water, soil • Arts & culture

35. What’s Sold and Promoted VS. Industry Low-Wealth High-Wealth Group Neighborhood Neighborhood Supermarkets 7 27 26 24 35 11 Carry-out eating places Bars/Taverns

36. Elements of Community Health EQUITABLE OPPORTUNITY THE PLACE • What’s sold & how it’s promoted • Look, feel & safety • Parks & open space • Getting around • Housing • Air, water, soil • Arts & culture • Racial justice • Jobs & local ownership • Education THE PEOPLE • Social Networks & trust • Participation & willingness to act for the common good • Acceptable behaviors & attitudes

37. Build on Our Success (what’s right with this picture)

40. Improved Opportunities for Walking and Jogging Boyle Heights, California • A local coalition established a rubberized jogging path around the cemetery • More than 1,000 people a day use the new path • Nearness to walking paths appears to have a significant impact on physical activity for adults.

41. Improved Opportunities for Walking and Jogging Boyle Heights, California “Small things like the jogging path make a huge difference in how community residents see themselves and the community.” Community Advocate

43. Prevention Works Prevention Works • Child Restraint and Safety Belt Use • Smoking Prevention • Minimum Drinking Age Laws • Childhood Vaccinations • Motorcycle and Bicycle Helmet Laws • Reduced Lead Levels in Children

44. NORMS more than a habit sanction behavior based in culture & tradition attitudes, beliefs, ways of being taken for granted behavior shapers communicate regularity in behavior

45. Toward a Community Solution Changing Norms Source: www.sfgov.org

46. Norms Do Change

47. Reducing Disparities through Prevention Necessary Strategies

48. The Spectrum of Prevention Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education Strengthening Individual Knowledge & Skills

49. Working Across the Spectrum South L.A., California • Shut down 200 liquor stores in 3 years • An average 27% reduction in crime within a four-block radius of each closed liquor outlet

50. A good solution solves multiple problems. Prevention Institute