Health equity coalition vision

Peter A. Gorski, M.D., M.P.A.
Children’s Board of Hillsborough County and
University of South Florida
Envisioning Health Equity

Social Determinants of Health and Wealth
Your neighborhood
Physical, social, economic, educational qualities
Your skin color
Race, ethnicity
Who’s your daddy
Parents’ education, income, health, social capital

Poverty Sickens
3
Strong connections between child health and adult health
Between child wealth and adult wealth
Between child wealth and adult health
Regardless of child’s health condition
Regardless if social class changes from childhood to adulthood
Childhood poverty gets biologically embedded

Epigenetics
Life Course Perspective
Balance of stresses and supports across life course exert cumulative influence on health
Especially during sensitive periods of development, powerful experience gets embedded into our biology
Reforming DNA structure, gene expression and brain chemistry
Consequences to BMI, blood pressure, immune function, memory, learning, attention and mental health

Racial and Ethnic Disparities in Birth Outcomes: A Life Course Perspective
5
Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.Maternal Child Health J. 2003;7:13-30.

Pre-school
Ready to learn
Health Services
Appropriate Discipline
Reading to child
Parent education
Emotional Health
Literacy
Late Preschool
Late Infancy
Late Toddler
Birth
Age
6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs
Early Infancy
Early Toddler
Early Preschool
Strategies to Improve
School Readiness Trajectories
Toxic Stress
Lack of health services
“Healthy” Trajectory
Poverty
“At Risk” Trajectory
“Delayed/Disordered ” Trajectory

Race is Not a Proxy for Poverty or Wealth

Beyond (or Underneath) SES
African American infant mortality higher in more segregated cities even when controlling for SES

SES? – Ask the Professionals
9
10.2
6.8
NCHS 2002

SES? – Ask the Africans
10
Birth weight distribution of African-born blacks is more closely related to US-born whites than to US-born blacks
David RJ, Collins JW. Differing birth weight among infants of U.S.-born blacks, African-born
blacks, and U.S.-born whites. N Engl J Med. 1997 Oct 23;337(17):1209-14.

Pathogenesis (and Salutogenesis):Complex Interaction between Biology and Environment
This explains why many, if not all, of the chief public health killers have common root causes.
Degradation of personal dignity, social justice and community
I can only be as healthy as my neighbors

Enhancing Public Health – A Provocative Perspective
Single disease prevention approach rarely works
Treating symptoms rather than root causes
Since inequities are at root of health disparities, we must work for the equitable distribution of conditions that promote health and healthy development –
Social, educational, economic and environmental capital
healthcare

Even More Provocative
Compensatory or Disparities Model (Affirmative Health Action) flawed
See next slide
Equity Framework
Health is a human right
Every human being has intrinsic worth.
Policies should be directed to what every person needs and deserves to thrive and contribute

Why Target Whole Communities?
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Health and well-being of each person depends on condition of all (see next slide)
Cannot predict individual course based on group risk factors
Cost burden of case-finding and treatment too high
Moral weakness of accepting unequal outcomes

Post-neonatal Infant Mortality(per 100,000 live births,1986)
15
Wilkinson RG. Income distribution and life expectancy. BMJ. 1992;304:165-168.

My Vision-Dream for the Health Equity Coalition
Expand public understanding of health equity framework
Forge strategic partnerships across the county’s public and private sectors – every decision impacts health
Document and demonstrate the correlation and causal association between social, economic, educational, environmental and healthcare equity and population health outcomes
Advocate for policies and practices that promote and create advantage for all citizens

Health equity coalition vision

by HealthEquityCoalition

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