Collabora'veforHealthEquityCookCounty&CookCountyDepartmentofPublicHealth:Confron'ngstructuralracismasarootcauseofhealth
inequi'esJimBloyd,MPH
RegionalHealthOfficerCookCountyDepartmentofPublicHealth
9thAnnualHealthDispari'es&SocialJus'ceConference
CenterforCommunityHealthEquity-DePaulUniversity-RushUniversityAugust12,2016DePaulCenter,Chicago,Illinois
WhatIwillcover…
• UsefulFrameworks&Approaches:Crucialforpublichealthprac''oners
• CookCountyDepartmentofPublicHealth(CCDPH)WePLAN2020
• Collabora'veforHealthEquityCookCounty(CHE)
CCDPHservessuburbanCookCounty,Illinois
• 125municipali'es
• 2.5millionresidents
• Oneof6cer'fiedhealthdepartmentsintheCounty
• Jurisdic'on:notCityofChicagonorothercer'fiedLHD’s
• Governance:17-memberCookCountyBoardOfCommissioners
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Map:CookCounty,ILwithloca'onsof4ForcesofChangeAssessmentFocusGroups
CookCountyDepartmentofPublicHealth 3
Krieger(2011)1. “…theoriesofdisease
distribu'onarevitaltotheconductofepidemiology;
2. thesetheoriesalltooodeninformepidemiologicresearchimplicitly,ratherthanexplicitly;
3. analysisofepidemiologictheoriesofdiseasedistribu'oncanimprovetheintellectualrigorofthefield.Inotherwords,theoryisaprac'calnecessity,notanobscureluxury.”P.34
EcosocialTheory:Levels,Pathways&Power(Krieger2011)
Framingsocialdetermina'onvs.socialdeterminantorienta'on(Spiegel,Breilh,Yassi2015)
CommissionontheSocialDeterminantsofHealthConceptualFramework(WHOSolar&Irwin2010)
StructuralDeterminantsofHealth
• “…structuralmechanismsarethosethatgeneratestra'fica'onandsocialclassdivisionsinthesocietyandthatdefineindividualsocioeconomicposi'onwithinhierarchiesofpower,pres'geandaccesstoresources.”
Solar,O.,&Irwin,A.(2007).Aconceptualframeworkforac'ononthesocialdeterminantsofhealth.
8
SocialDeterminantsofHealth• Theeconomicandsocialcondi'onsthatinfluencethehealthofindividuals,communi'es,andjurisdic'onsasawhole.– Availabilityoffood– Affordablehousing– Qualityeduca'on– Jobsecurity– Socialconnec'onandsafety– Livingwage– Accesstotransporta'on
Raphael,D.(2009).Socialdeterminantsofhealth:Canadianperspec4ves.CanadianScholars’Press.
9
ModifiedWHOFramework-PresentedtoCCHHSBdMay27,2016
Socioeconomic/Poli'calContext
SocioeconomicPosi'on
SocialDeterminants HealthEquity
• Governance• Economic
policy• Socialpolicy• Publicpolicy• Culturaland
socialvalues
• Socialclass• Gender• Race
• Accesstohealthcare
• Housing• Neighborhood• Work
environment• Income
StructuralDeterminants
ModifiedfromSolar,O.,&Irwin,A.(2007).Aconceptualframeworkforac'ononthesocialdeterminantsofhealth.
10
StructuralRacism:Examples• 84%increaseinUSaveragewealthconcentra'onamongWhitefamilies-1.2Xand3XhigherthanLa'no&Blackincrease(www.ips-dc.org2016)
• ILeduca'onfinancingsystem(Mar're2/11/14hqps://www.youtube.com/watch?v=Xk6ogZzzvk8)
• Chicago-areapoorchildrenofcolorexposedtoneighborhoodpovertywhilewhitepoorchildrenarenot(diversitydata.org2007“ChildrenLedBehind”)
• HealthyChilddevelopmentopportunityinequi'es(Acevedo-Garcia2014;diversitydatakids.org2014)
• Federalhomemortgagepolicyanddiscriminatorylending1930’s-present(CountyofCookv.WellsFargo11/28/14case#14-cv-9548;
Racialsegrega'onexposesmorepoorLa'nothanWhitechildrentohighpovertyneighborhoods
Divesitydata.org“ChildrenLedBehind:HowMetropolitanAreasAreFailingAmerica’sChildrenChartbook”
Racialsegrega'onexposesmorepoorBlackthanWhitechildrentohighpovertyneighborhoods
Divesitydata.org“ChildrenLedBehind:HowMetropolitanAreasAreFailingAmerica’sChildrenChartbook”
Commonali'es:Theseframeworks&approachesconsider…
• Powerdynamics&poli'cs• History• Evidence• Values-socialjus'ce• Alliances,socialmovementsContrastwithothers:HealthImpactPyramid;HP2020SDOH;CDC3BucketsofPreven'on,PublicHealth3.0,biomedicalmodel,lifestyle…
Ques%onstoiden%fyforcesofchange:
• Occurrences,threatsandopportuni%es• Pa8erns—WhoisaffectedandHow?• Ins%tu%ons,powerandinterests
ForcesofChange
Socialdeterminantsofhealth
HealthandHealthequity
CCDPHUsed:AForcesofChangeAssessmentFrameworkEmphasizingtheSocialDeterminantsofHealth-informedbyNACCHO(2014),andSolar&Irwin(2010)
CookCountyDepartmentofPublicHealth 15
CookCountyDepartmentofPublicHealth 16
Par'cipants-Sr.Staff&Leadership:• IllinoisCoali'onforImmigrant&
RefugeeRights• IllinoisSelfAdvocacyAlliance• LoyolaUniversity• MetropolitanTenants
Organiza'on• NorthwestCompass• Preven'onPartnership• RespondNow• RestaurantOpportuni'esCenter-
Chicago• SaferFounda'on• SchaumbergTownship
CommunityCoali'on• SchoolDistrict147• SEIUHealthCareIllinois• SouthSuburbanCollege• UICSchoolofPublicHealth• USEnvironmentalProtec'on
Agency
• Advocate• AfricanAmericanFamily
Commission• AgencyforToxicSubstances&
DiseaseRegistryUSDHHS• AIDSFounda'onofChicago• Backbones• BlackYouthProject100• ChicagoSouthlandChamberof
Commerce(2)• FoodChainWorkersAlliance• GrandPrairieServices• GreaterChicagoFoodDepository• GreaterILChapter-Na'onal
Mul'pleSclerosisSociety• Health&MedicinePolicyResearch
Group• IllinoisCaucusforAdolescent
HealthCookCountyDepartmentofPublicHealth 17
FindingsForcesofChangeAssessmentWePLAN2020
Source:hqp://cookcountypublichealth.org/files/weplan-2020/community-health-assessments/ccdph-foca-summaryandreport.pdf
FindingsCCDPHForcesofChangeAssessmentWePLAN2020
Source:hqp://cookcountypublichealth.org/files/weplan-2020/community-health-assessments/ccdph-foca-summaryandreport.pdf
Focusgrouppar'cipant:
“…theindividualsjustcan’tpayenoughintothesysteminordertomakesurethattheseservicesareprovidedforandsothat,fromourperspec4vewe’retalkingaboutthemajorcorpora4ons,theonepercent,thebillionaire,millionaireclasswhoarebenefi4ngfromthesepolicies,anditisworkingpeoplewhoaresuffering…”
Focusgrouppar'cipant:
“…wehavepeoplethatdohavelivingwageposi4onsbutthey’rehighlysegregated,oDenonlyoccupiedbywhitemen,andsoit’sthiskindofissuelikeracialandgenderdynamicsandwhogetstheopportuni4esandwhodoesn’t,butevenifweaddressitthere’ss4llnotenoughofthoselivingwageposi4onstobalanceouttomakeitequitable…”
Electedofficialstooodendisconnected:
• “…socialworkersshouldbepoli4ciansandpoli4ciansshouldspendsome4meassocialworkersandthenthey’dunderstand.”
• “…theywerejustlike‘Wow,I’venevermetanybodyonfoodstamps’andherethey’redeba4ng,peoplearedeba4ngmillionsoflives.It’salsoalackofknowledge.Yeah,andgeKngthatdata,theanecdotesinfrontoftheminperson.”
Focusgrouppar'cipant:
“theindividualswhoarebenefi4ngarethewealthy,theverywealthy,Ithinkthemiddle-classandespeciallytheunderservedminoritypopula4onsaretheoneswhoarebeingharmedthemostbywhat’shappening.”
CCDPHDradImplementa'onStrategies
• Raiseawarenessoftheexistenceofhealthinequi'es&createanewnarra've.
• Analyze,assess,andreportonsocialcondi'onsandhealthinequi'esusingpar'cipatoryprocesses
• Organiza'onalDevelopmenttotransformpublichealthprac'ce
• Recommendandadvocatepoliciesthatadvancehealthequityandtacklerootcauses.
• BuildPowerofcommuni'estosecureresourcesnecessaryforhealthintheirneighborhoodandlivingcondi'ons.
• www.checookcounty.org• Twiqer:@CHECookCounty• SpearheadingCCDPHstructuralracism-healthinequi'espriorityinWePLAN2020
• 17-MembergoverningSteeringCommiqee• 1of19teamsintheUSNa'onalCollabora'vesforHealthEquity;communityofprac'ce;BrianSmedley
Mission:changethepoliciesandprac4cesfuelingtheinequitabledistribu4onofpowerand
resourcesinCookCountythatresultfromstructuralracism.Ouraimistoincreasehealthequitybyaddressingeduca4on,unemployment,violenceandothersocialdeterminantsofhealth.www.CHECookCounty.org
CHELeadershipDevelopment:Videoapplica'ontoRobertWoodJohnsonFounda'onCultureofHealthavailableathqps://
youtu.be/ZzfvuktE0jo
CHEWork• Rela'onshipswithorganizers• #FightFor15• #OneFairWageROCChicago• RaisingofAmericaCommunitydiscussions-Aus'n,Cicero,SouthSuburbs
• InvitedspeakersIns'tuteofMedicine,WashingtonDC
• IndexofConcentra'onattheExtremes(ICE)measuresneighborhoodprivilege&depriva'on
AverageLifeExpectancy(2003-2007)byMedianIncomeofCensusTract/Municipality(2009),
CookCounty
73.2
78.8 79.9 79.9
87.0
65
70
75
80
85
90
Less than 25k 25k - 35k 35k - 44k 44k - 53k Greater than 53k
Life
exp
ecta
ncy
at b
irth
in y
ears
MedianIncome Source: Life expectancy calculated by the VCU Center on Human Needs from 2003-2007 data provided by Cook County Health Department: Median Income from 2009 Geolytics Premium Estimates.
13.8Years
8.2 7.17.1
31
ThankYou!
www.checookcounty.orgwww.cookcountypublichealth.org@CHECookCounty @CookCoHealthYoutube.com/ccplacemaqersJimBloyd,MPH,RegionalHealthOfficerCookCountyDepartmentofPubicHealth15900S.CiceroAvenueOakForest,[email protected]