Connecting Race, Place and Health to Equity

Mildred Thompson, DirectorPolicyLink Center for Health Equity and Place

September 8, 2012

Maryland Women’s Coalition for Health Care Reform Conference

PolicyLink is a national research and action institute

advancing economic and social equity by

Lifting Up What Works. ®

The Center for Health Equity and Place

Where you live affects how you live.

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PolicyLinkCenter for Health Equity and Place

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• Research

• Capacity Building/ TA

• Convening

• Communications

• Advocacy/Action

• Thought Leadership

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Defining Health:Overall state of physical,

economic, social and spiritual well-being

THE FACE OF AMERICA IS CHANGING

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Obesity Data/Statistics – United States*

• In 2010, African American women were 40% more likely to be obese than Non-Hispanic White women.

• Native Hawaiian/Pacific Islanders are 2.7 times more likely to be obese than the overall Asian American population.

• In 2007- 2008 Mexican American children, between the ages 6 and 17, were 40% more likely to be overweight as Non- Hispanic White Children.

• American Indian/Alaskan Natives are 40 percent more likely to be obese than Non-Hispanic whites.

*US Department of Health and Human Services, Office of Minority Health

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Obesity Data/Statistics – Maryland

Maryland obesity statistics*

• 2011, Maryland was ranked the 26th most obese state in the US but 15 years ago was ranked the 23rd most obese state.

• The overall adult obesity rate in Maryland is now at 27.1%

Racial and ethnic categories show• 36.3% obese rates among Blacks,• 27.4% among Latinos, and• 24.3% among Whites

Overweight and Obesity Rates for Adults by Gender, 2010**

• 59.1% of women in Maryland were overweight or obese in comparison to 57% of women in the United States

*reported in F as in Fat from the Trust for America’s Health and Robert Wood Johnson Foundation**Kaiser Family Foundation State Health Facts

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Health of Women in Maryland*

• Heart disease and cancer accounted for nearly half (48%) of all female deaths.

• The leading causes of death are the same for both White and Black women (heart disease, cancer, and stroke).

• Black women have higher death rates from heart disease than white women.

• HIV is the third leading cause of death among black women ages 25-44 years old.

*”The Health of Maryland Women 2011", produced by The Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene (DHMH)

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Health of Women in Maryland*

• More women died from lung cancer than any other cancer.

• Cancer mortality rates for women have declined from 2001 to 2009 by nearly 4%.

• Death rates from breast cancer were highest for black women than all other race/ethnicities.

• Hypertension and diabetes was most prevalent among blacks and women over 65 years of age.

*”The Health of Maryland Women 2011", produced by The Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene (DHMH)

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Race, Class, Ethnicity and Health

African Americans, Hispanics, Native Americans

and some Asian Americans suffer poorer health

outcomes than whites, regardless of S.E.S.

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Social Determinants of Health

• Poverty, Unemployment

• Neighborhood Conditions

• Housing

• Food Access

• Parks, Physical Activity

• Safety Concerns

• Toxic Environment

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Making the case for Equity

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What is Equity?

• Equity means just and fair inclusion.

• An equitable society is one in which all can participate and prosper. The goals of equity must be to create conditions that allow all to reach their full potential. In short, equity creates a path from hope to change.

• Achieving equity requires intentionality, focus, and a commitment to community engagement and participation.

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Complexity of Health DisparitiesInstitutionalized biases (racism, sexis

m, etc.)

Mental Health Social Support/Networks

Econo

mic Opportunityand Equity

Education Background and Opportunity

Health Behaviors and Personal Risk Factors

Access to Health Services

Language and other

Cultural Factors

Environmental/

Toxic Risk Factors

Safety and Perception of Safety

Belief

and Trustin Health System

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Health Inequities

Systematic and unjust distribution of social, economic, and environmental conditions needed for health:

• Income

• Employment

• Education

• Housing

• Access to healthcare

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EquityEnvironment

Health

Intersection of Health, Place & Equity

Access toHealthy

Food

Schools/Child care

Health facilities

CommunitySafety/ violence

TransportationTraffic patterns

Work environments

Housing

Parks/OpenSpace playgrounds

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• Parks• Grocery Stores• Financial

Institutions• Better

Performing Schools

• Good Public Transportation

• Vibrant healthy homes

• Fast Food Restaurants

• Liquor Stores• Unsafe/Limited

Parks• Poor Performing

Schools• Increased Pollution

and Toxic Waste Sites

• Limited Public Transportation

• Increased crime

Communities of Opportunity

Low- Income Communities

Good Health Status

Poor Health Status

Contributes to health disparities:

• Obesity

• Diabetes

• Asthma

• Increased injury

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Equitable Policies

• Equity as a criteria for inclusion and/or prioritization of policies

• Identify policies that are important to low-income communities, communities of color and other vulnerable populations specifically

• Target benefits to vulnerable populations

• Prioritize the provision of resources to areas that need it most 27

Equity Considerations in Strategy Development

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1. Is the strategy conceptualized to promote equity/reduce inequities? If so, how? If not, how can you modify it to specifically address inequities?

2. How will you deliberately focus on implementing this strategy in a way that promotes equity?

3. How will your strategy promote meaningful and authentic community engagement?

4. What inequities will be reduced as a result of this strategy?

5. How have low-income communities and communities of color benefited from implementing this strategy?

6. Identify barriers and unintended consequences

1. Ask Key Questions : who benefits, who pays, who decides?

2. Increase Political Power of Vulnerable Populations, including Immigrants

3. Enforce Laws that Prohibit discrimination

4. Shift Public Perceptions

5. Substantive Community Engagement

6. Target Policies that Disproportionately Harm Vulnerable Populations

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How to Take Action

• Health in all policies • Health Impact Assessments (HIAS)• Healthy Food Access• Transportation Reauthorization• Joint use Agreements• Safe water and safe parks• Healthy Housing Policies• Leveraging federal resources

1. HFFI (fresh food financing initiatives)2. Sustainable Communities3. Promise Neighborhoods

Examples of Equity Promoting Policies

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The California FreshWorks Fund (CAFWF) is a public-private partnership loan fund modeled after the Pennsylvania Fresh Food Financing Initiative and aligned with President Obama’s National Healthy Food Financing Initiative (HFFI). It was created to:

1. Increase access to healthy food in underserved communities

2. Spur economic development that supports healthy communities

3. Inspire innovation in healthy food retailing

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California FreshWorks Fund (CAFWF)

Benefits:1. Access to Healthier Food

2. New Jobs

3. Improved Property Values

4. Increased Tax Revenue

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California FreshWorks Fund (CAFWF)

Principles for Community Engagement

• Empower residents through meaningful inclusion and partnerships

• Build capacity for high level engagement• Prioritize community knowledge and

concerns• Target resources to support ongoing

engagement• Facilitate mechanisms that encourage

mutual learning and feedback mechanisms

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Towards More Equitable Public Engagement Processes

Inclusive: What communities and interests need to be represented and in what capacity?

Accessible: Will people and organizations from a diversity of backgrounds feel comfortable and engaged?

Transparent: How does public engagement interact and influence decision-making?

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Engagement and Leadership

• Efforts to achieve revitalized communities of opportunity will not be successful without substantial community engagement

• Meaningful community engagement requires participation in governance and decision making

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Community Engagement Context

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Equity & Improved

Health Outcomes

Engaged

Community

IssueIdentify issue

Agree on priority

ResearchAnalysis & Data

Mapping TrendsRates

BarriersChallenges

ContributionPerceptions

Explore SolutionsAdvocacy

PolicySystem Change

Affirm Solutions that

workStrengths/Capacity

PartnersAgencies

PolicymakersBusinesses

Schools Churches

CommunicationMessage

developmentSpokespersonsMedia tools &

products

ActionsLegislative

School boardLegal

AdministrativeInstitutional

ImpactCBPR

Create IndicatorsMonitor & Track

Progress

FeedbackShare successes

& challengesDocument Progress

Host Convening

SustainabilityInvestment

CommitmentAccountability

Persistence

Institutional Structures for Community Engagement

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Governance Level

• Appointment to decision making boards and commissions

Consortia• Membership based group with

options for decision making

Advisory Groups• Provide guidance and advice to

decision makers

Task forces

• Short term participation with opportunity to offer recommendations

Focus Groups• One-time opportunity to

provide input

Town Hall Meetings

• Information provided one time, sometimes an ability to offer group comments

Ascending Impact

DescendingImpact

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Getting Equity Advocacy Results (GEARS)

Measuring Health Equity

1) Measurement of community conditions relevant to health

2) Measurement of the implementation of strategies, campaigns, policies and plans

3) Measurement of health behaviors and health outcomes

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'Of all the forms of inequality, injustice in health care is the most

shocking and most inhumane' - Martin

Luther King, Jr. (March 25, 1966)

Mildred Thompson, DirectorPolicyLink Center for Health Equity and Place

www.PolicyLink.org

Thank you!