Breakout Session A – Health Equity: Understanding

Spring 2020 Tobacco Control Institute ‐Breakout A

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Breakout Session A –Health Equity: Understanding

Structural Racism, Social Determinants, Bias, and Cultural Humility

April 16, 20201:00pm – 2:30pm

Welcome to the Virtual Spring Tobacco Control Institute

Health Equity: Understanding Structural Racism, Social

Determinants, Bias, and Cultural Humility

April 16, 20201:00pm – 2:30pm

Welcome to Breakout Session A

Roshal RossmanSouth Dakota Tobacco Control

Program


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We acknowledge the spiritual and ceremonial value of tobacco in

our American Indian culture.

All references to tobacco at the Institute refer to commercially produced tobacco products and not

traditional tobacco.

Traditional Tobacco

About Adobe Connect


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Draw Function

HEALTH EQUITYUNDERSTANDING STRUCTURAL RACISM, SOCIAL DETERMINANTS, BIAS, AND CULTURAL HUMILITY

Rachel MarquezEmory Centers for Training

and Technical Assistance


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PRESENTATION PHILOSOPHY

It is normal to feel discomfort as you reflect on and deepen your understanding of issues of inequality, poverty and race

Listen with an open mind/heart-assume good intentions

Seek understanding

LIFE EXPECTANCY – THE BEST MEASURE OF HEALTH

Average US Life Expectancy: 78.6 years

Average South Dakota Life Expectancy: 79.57 years


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LIFE EXPECTANCY – HEALTH DISPARITIES

SOUTH DAKOTA – LIFE EXPECTANCY BY COUNTY


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GROUP ACTIVITY

Regions 3 & 4 Regions 1, 2, 5 & 6

HOW DOES THAT MAKE YOU FEEL?


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WHAT DO YOU THINK IS HAPPENING?

ZIP CODE A BETTER PREDICTOR OF HEALTH

52% live below the Federal Poverty Level

Fewer than 3 out 10 are employed

9% have Bachelor’s degree

Life Expectancy = 66.81

14.6% live below the Federal Poverty Level

(better than National Avg)

3% Unemployment Rate

28% have Bachelor’s degree

Life Expectancy = 79.57


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HEALTH EQUITY

The absence of avoidable, unfair, or remediable differences among groups of people

"Health equity” or “equity in health” implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.

WHAT CONTRIBUTES TO INEQUITIES?

Structural/Institutional Racism

Social Determinants of Health

Unconscious (Implicit) Bias

Lack of Cultural Humility


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STRUCTURAL/INSTITUTIONAL RACISM

Refers to social processes that intentionally protect the advantages of a dominant group while maintaining an unequal position over a subordinate group

Views inequality as part of a society’s structure

Allows individuals and groups to operate within a social structure ensuring racial dominance through laws, customs, religious beliefs, etc., operating within a society

NATIVE AMERICANS AND STRUCTURAL/INSTITUTIONAL RACISM

Indian Removal Act Federal Governments forcible relocation of

Native Americans in the southeast to make room for white settlement

“Trail of Tears” – forced march west of the Mississippi River resulting in the death of thousands from hunger, disease, and exhaustion

Dawes Act Conversion of communally held tribal lands

into small, individually owned lots.

2/3 of reservation lands were seized and redistributed to white Americans.


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STRUCTURAL/INSTITUTIONAL RACISM

Housing Discrimination in 1930s

“Redlining”

Segregation

STRUCTURAL/INSTITUTIONAL RACISM – RESULTS TODAY

“Native Americans experienced deep wounds in the age of colonization and expansion, wounds that largely remain

unhealed and strongly impact the generations to this day.” – U.S. bishops,

Open Wide Our Hearts


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TIME FOR REFLECTION

KEY TAKEAWAY: STRUCTURAL RACISM

Racialization distorts all parts of our Systems

Created inherited groups of disadvantage or advantage

Allowed for the differential valuation in human life by race


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SOCIAL DETERMINANTS OF HEALTH

The conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.


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SOCIAL DETERMINANTS OF HEALTH

Health disparities result from multiple factors, including:

• Poverty

• Environmental threats

• Inadequate access to health care

• Inadequate access to healthy foods

• Individual and behavioral factors

• Educational inequalities

SOCIAL DETERMINANTS AND TOBACCO-RELATED DISPARITIES

Higher prevalence of smoking for:

American Indian, Alaska Natives

Individuals who have high school diploma or less

Individuals who live below the federal poverty guideline

Individuals who live in the Midwest


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PUTTING IT ALL TOGETHER

WHAT ARE STRUCTURAL DRIVERS?


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DIMINISHING DISPARITIES WITH HEALTH EQUITY APPROACH

CDC’s Health Equity in Tobacco Prevention and Control lists helpful resources to address specific social determinants in tobacco control

KEY TAKEAWAY: SOCIAL DETERMINANTS OF HEALTH

Taking a social determinants of health approach helps to:

Achieve equity and eliminate disparities

Have equal distribution of resources and services

Understand that people with low SES will need more efforts and resources focused directly to their communities to overcome disparities

Allows us to move beyond simply controlling diseases to addressing the factors of their root causes


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Stroop TaskOn the next couple of slides you will see color names (red, green, blue, yellow) in different “print” colors. You need to respond to the print color. For example, if you see: GREEN You need to respond to the print color (red).


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BASEBALL BAT AND A BALL COST $1.10 TOGETHER THE BAT COSTS $1.00 MORE THAN THE BALLHOW MUCH DOES THE BALL COST?

ALTHOUGH $1.00 + $0.10 DOES EQUAL $1.10,

IF YOU TAKE $1.00 – $0.10 YOU GET $0.90, BUT THE PROBLEM REQUIRES THAT THE BAT COSTS $1 MORE THAN THE BALL.

SO, THE BALL MUST COST $0.05, AND THE BAT MUST COST $1.05 SINCE $1.05 + $0.05 = $1.10


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HOW MANY TRIANGLES DO YOU SEE?

UNCONSCIOUS MIND

System 1 thinking is quick, intuitive, spontaneous, and effortless. It’s the type of processing that instantly helps us to recognize faces, to act when confronted with dangers and solve simple questions.

System 2 thinking, on the other hand, is slow, rational, reflective, and effortful. It gets into the driver’s seat when you focus and concentrate on a complicated problem.


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BIAS

Evaluation or belief of one group and its members relative to another

EXPLICIT BIAS

When a person is aware of his/her evaluation of a group, believes that evaluation to be correct, and has time/motivation to act on it in a give situation

IMPLICIT BIAS

Attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner

Activated by

Situational cues (person’s skin color or accent)

Environment

Past Experiences

Culture

UNCONSCIOUS BIAS

Unconscious Mind Drives Unconscious Biases

Deletes information (don’t pay attention to these, pay attention to this)

Distort (emphasize or de-emphasize)

Generalize (gather bits of information with other bits into groups)


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EVERYONE HAS IMPLICIT BIASES

Preference for a certain group

Dislike for a certain group

Based on stereotypes and attitudes

Usually developed early in life

Tend to strengthen over time

KNOW YOUR BIASES

Project Implicit

https://implicit.harvard.edu/implicit/takeatest.html

Implicit Association Tests to assess attitudes and beliefs:

Gender-Career

Gender-Science

Race

Age

Disability

Weight

Weapons

Skin-tone

Sexuality

Arab-Muslin

Religion

Native American


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GROUP REFLECTION:

THINK ABOUT A TIME, IN HINDSIGHT, WHERE A BIAS YOU POSSES INFLUENCED A DECISION YOU MADE

KEY TAKEAWAY: BIAS

• Most of our decisions, actions, emotions and behaviors are driven by our unconscious brain or auto pilot

• Awareness of one’s own bias is critical

• Acknowledgement that bias occurs without our awareness is key


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GROUP ACTIVITY:

IF I ASKED YOU TO DESCRIBE SOUTH DAKOTA’S CULTURE WHAT WOULD YOU SAY?

WHAT ABOUT BEING A SOUTH DAKOTAN WOULD HELP/HINDER YOU IN LIVING A HEALTHY LIFESTYLE?







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CULTURAL HUMILITY

Ability to maintain a interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the (person)

3 Important Features:

A lifelong commitment to self-evaluation and self-critique, there is no point where you are done learning

Fix power imbalances

Develop partnerships with people and groups who advocate for others

CULTURALLY COMPETENT SMOKING CESSATION INTERVENTIONS


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KEY TAKEAWAY: CULTURAL HUMILITY

Culturally Targeted Interventions

Understanding of the target audience: focusing on the people, rather than the health problem

Accounting for aspects of culture that would hinder success and addressing proactively

“It is more important to know what kind of patient has the disease than

what kind of disease the patient has.”

Sir William Osler

CONCLUSION

We’ve explored the four major components of health equity and how those comprise the inequities we see play out for people:1. Structural Racism: The powerful way that injustices in federal policy has shaped

neighborhoods in the United States.

2. Social Determinants of Health: The conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.

3. Implicit Bias: Powerful, unconscious drivers: attitudes, stereotypes or preferences for certain groups that affect our understanding, actions.

4. Cultural Humility: The ability to understand, communicate with and effectively interact with people across cultures.


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QUESTIONS?

NEXT STEPS:

TYPE IN THE CHAT BOX: WHAT IS ONE THING THAT YOU LEARNED TODAY, YOU MIGHT NOT HAVE KNOWN BEFORE WE STARTED?

ON YOUR OWN: WHAT IS ONE THING YOU CAN COMMIT TO DOING IN ORDER TO HAVE A MORE EQUITABLE APPROACH IN YOUR WORK?


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We hope you’ll join us…

Addressing Health Equity

April 16

Tobacco Cessation and

Recovery

April 23

Engaging Youth in Policy

Advocacy

April 30

Thank you for joining us!

Spring Tobacco Control Institute

Documents

Breakout Session A – Health Equity: Understanding