Charting the Course from Health Disparities to Health Equity

Valerie Rochester, Director of Programs Black Women’s Health Imperative

Promoting Health Justice

Addressing Health Inequities in the African American Community

October 22, 2013

Disclosure

• Disclosed no conflict of interest

Health Disparities: Our National Shame

• America’s women of color have poorer health outcomes than white women and often receive a lesser standard of health care and treatment. ▫ Causes are complex, persistent, costly and

deadly ▫ Driven by social and economic determinants

It’s time to move beyond differences!

Diabetes: Gendered Racism and Classism • Black women represent about 13% of diagnosed

diabetes cases • In the past 30 years, diabetes prevalence has

doubled among Black men and increased by almost 70% among Black females.

• Surveillance data suggest that based on the relative increase in diabetes among Blacks, 2 out of every 5 Blacks born in 2000 or later will develop diabetes at some point in their lifetime.

Diabetes: Gendered Racism and Classism • Health disparities exist such that Blacks are not

only more likely to be diagnosed with diabetes, but also develop diabetes-related complications because of poor diabetes management

• Although diabetes is a serious burden for all Americans, both physically, psychologically and financially, Black women bear a disproportionate share of the burden and have a higher incidence of complications, resulting from uncontrolled diabetes.

• In fact, one in four Black women in the US over 55 years of age has diabetes.

Health Disparities Sources

Environment

Behaviors Stress

Quality of Clinical Care

Health Disparities

Health Equity Concepts and Understanding • Reaching the highest attainable standard; implies

equal treatment. • “Fair access to critical opportunity structures, such

as education, employment, healthcare, healthy communities and housing, across racial, class and ethnic populations.

• Focus on health equity helps broaden disease prevention efforts beyond individual risk factors to root causes that influence health behaviors and outcomes.

Health Equity Ethical Principles & Values

Health Equity

Justice

Standards and Protocols for

Quality Clinical Care

Opportunities and Choice

Empowered

Consumers

Health Equity Three Steps Back Framework The three steps back framework offers an understanding of what happens prior to the onset of illness and injury. This approach identifies the underlying factors that shape health and affect health equity to ensure that we are not only treating medical conditions but also reducing the likelihood they will occur.

Three Steps Back The three steps back framework is from disease or injury (e.g. type II diabetes, asthma) to neighborhoods and environmental exposures to behaviors that increase the risk for poor health outcomes (e.g., inadequate diet, limited physical activity, exposure to poor quality air) to the health care system.

Environment Stress & Behaviors

Lower Quality

Clinical Care Health

Inequities

The First Step Back

The first step back is to the environment, i.e., root factors and community conditions such fewer grocery stores and recreational facilities or polluting smokestacks, lack of sidewalks, street lights that shape behaviors and lead to unhealthy exposures to lead and allergens. Place Matters!

Environment/ Neighborhood

The Second Step Back

Diet & Activity Pattern

Chronic Stress related to

poverty, violence

Heart Disease

Cancer

Obesity

Diabetes

The Third Step Back

The third step back is to the health care system, hospitals, and providers that offer lower quality care at higher cost than other institutions, without appropriate standards and protocols of care that are patient-centered.

Environment/d Environment/Neighborhood

Lower Quality Clinical Care

Recommendations for equity in care and treatment • Must link any interventions with enhancements in self-concept • Support and provide opportunities for individuals to have bodily autonomy; support self-determination • Address daily realities and “lived lives” •Offer supportive structures that allow for exploration and expanded thinking on personal issues/experiences •Promote linkages between the individual and larger social forces that impact our lives – social, political and economic

Recommendations for equity in care and treatment • Advocate for policies that increase access to and opportunities for improving health outcomes • Amplify the voices of those we serve to shift public perception and policies for social change • Promote evidence and practice based wellness and lifestyle balance models that provide strategies for individuals, families and communities to address health inequities • Synthesize, translate and disseminate information and research findings to strengthen our understanding and knowledge base

Health Equity

The health of our African American communities is at a crossroad! The fierce urgency of NOW is to establish health equity as a priority to ensure justice, opportunity and fairness for all!

Contact Valerie Rochester Director of Programs Black Women’s Health Imperative vrochester@blackwomenshealth.org www.blackwomenshealth.org Follow us: @blkwomenshealth Black Women’s Health Imperative