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What’s Race Got To Do With It?The Impact of Racism on Health
1st Annual Northeast Regional Community Health Network Area (CHNA) Networking
Forum
May 15, 2012
BPHC Mission
The mission of the Boston Public Health Commission is to protect, preserve and promote the health and well-being of all Boston residents, particularly those most vulnerable.
What are disparities in health?
The NIH defines health disparities as “differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”
Health InequitiesDifferences in health
that are not only unnecessary and avoidable but, in
addition, are considered unfair and
unjust.
References: Braveman P. Health disparities and health equity: concepts and measurement. Annual Review of Public Health 2006;27:167-194:Whitehead M, Dahlgren G. Levelling Up (Part 1): A Discussion Paper on Concepts and Principles for Tackling Social Inequities in Health. World Health Organization. Available at http://www.euro.who.int/ document/e89383.pdf.
Health Disparities
Differences in the presence of disease, health outcomes, or access to health care between population
groups.
Racial & Ethnic InequitiesInfant Mortality & Education
African Americans
16+ years of schooling
White Americans <9
years of schooling
Per 1,000 Live Births
NCHS 2002
10.2
6.8
Racial & Ethnic InequitiesInfant Mortality & Household Income
African Americans
with Household
Income $35,000+
White Americans with
Household Income
<$10,000
Per 1,000 Live Births
16.6
11.2
Racial & Ethnic InequitiesInfant Mortality & Cigarette Smoking
African American Non-
Smokers
White American
Smokers
Per 1,000 Live Births
NCHS 2002
13.2
9.2
Racial & Ethnic InequitiesInfant Mortality & Prenatal Care
African Americans
First Trimester
Prenatal Care
White Americans
Prenatal Care After
1st Trimester or
None
Per 1,000 Live BirthsNCHS 2002
12.7
7.1
• Race has no clear biologic or genetic basis…”there are no characteristics, no traits, not even one gene that turns up in all members of one so-called race, yet is absent from others” (L. Adelman. Race and Gene Studies)
• The meanings of racial designations- White, Black, Asian- are subject to historical, cultural and political forces; “race justified social inequalities as natural”.
RACE
Racial & Ethnic InequitiesInfant Mortality & Nativity
0
2
4
6
8
10
12
14
16
Foreign Born United States Born
Black Women
9.2
14.2
Per 1,000 Live Births
NCHS 2002
Low Birth Weight by Maternal Birthplace - Boston, 2004
8.1% 7.3%
4.9%
12.5%
10.0%
12.3%
6.8%
15.1%
10.5%
13.8%
7.2%8.1%
0.0%
4.0%
8.0%
12.0%
16.0%
20.0%
Pe
rce
nta
ge
of B
irth
s W
ithin
Birt
hp
lace
SOURCE: Boston resident live births, Massachusetts Department of Public HealthANALYSIS: Boston Public Health Commission Research Office
The Experience of Racism & Discrimination
2.9%
18.1%20.8%
0.0%
10.0%
20.0%
30.0%
40.0%
Black Latino White
Per
cent
age
of r
espo
nden
ts
1.9%4.0%8.3%
0.0%
10.0%
20.0%
30.0%
40.0%
Black Latino WhiteP
erce
nta
ge
of
resp
on
den
ts
Boston Adults Who Report Having Been Treated Worse Than People of Other Races At Work During the Previous Year, By Race/Ethnicity
Boston Adults Who Report Having Been Treated Worse Than People of Other Races When Seeking Health Care During the Previous Year, By Race/Ethnicity
Note: Data about Asian residents not shown due to inadequate sample sizeSOURCE: Behavioral Risk Factor Surveillance System, Massachusetts Department of Public Health and Boston Public Health Commission
Community Voices
“My doctor ignored my complaints that I was in pain as he removed my post-op tubes in the Emergency Room”
“My physician never looks me in the eyes or treats me like a person”
“When I was seeing the doctor for the flu, he wanted to talk about AIDS and drugs. It was like he thought all Latinos were addicts”
BPHC definition - adapted from a number of sources
RacismRacial and cultural prejudice and discrimination, supported intentionally or unintentionally by institutional power and authority, used to the advantage of one race (Whites) and the disadvantage of other races.
The critical element which differentiates racism from prejudice and discrimination is the use of institutional power and authority to support prejudices and enforce discriminatory behaviors in systemic ways with far-reaching outcomes and effects.
In other words…Racial Prejudice + Power = Racism
Levels of Racism
Racism operates on four levels:
• Internalized Racism• Interpersonal Racism• Institutional Racism• Structural Racism
A Health Equity Framework
Racism
Transportation
Food Access
SocioeconomicStatus
Environmental Exposure
Health Behaviors
Access to Health Services
Housing
Public Safety
Health Outcomes
Employment
Social Capital
Education
BPHC Overarching Goals
• Reduce the low birth-weight rate among Boston infants and reduce the gap between the White and Black LBW rate by 25%
• Reduce obesity rates among Boston residents and reduce the gap between White and Black/Latino overweight/obesity rates by 30% for children and 20% for adults
• Reduce Chlamydia rates among Boston teens and young adults and reduce the gap between Black/Latino and White Chlamydia rates by 25%
Racial Justice & Health Equity Initiative
Goals
• Align all BPHC programs, policies, practices, and operations within a racial justice and health equity framework
• Build capacity of BPHC to effectively reduce inequities across the city
Anti-Racism Advisory Committee (ARAC)
ARAC’s Charge:“to review, assess and develop recommendations on policies, practices, structures and systems at the Commission in an inclusive process that engages all Commission staff”
Professional Development Series
RACIAL JUSTICE AND HEALTH EQUITY INITIATIVE Professional Development Series
Goal:To ensure that all BPHC staff apply the principles and practices of health equity and racial justice to all of the Commission’s work.
Objectives:• Increase staff understanding
• Equip staff with strategies, resources, and tools
• Create a culture of ongoing learning