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What's Health Equity?
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What's Health Equity?



Presentation for the 2011 Health Equity Leadership Institute New York City

Presentation for the 2011 Health Equity Leadership Institute New York City



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  • With the sunrise you observe power that is positional, steady and consistent.
  • New York City native from an African-American family of Southern roots and traditionsBorn and raised in Queens in a close-knit neighborhoods where the 2009 H1N1 outbreak had it genesis, one of the most racially and ethnically diverse communities in America.Prior to medical school, worked in business and community development in New York, southern Africa and the Caribbean.
  • Dr. Troutman’s webinar – review it.
  • http://www.pbs.org/newshour/bb/politics/jan-june11/shieldsbrooks_01-14.htmlMo
  • Follow a few champions!
  • Pushing forward and carrying on
  • Inequity does carry moral tones and may considered inflammatory, judgmenta, accusatory.Avoid using the following termsAny variation of equal, equality or equalizingLeveling the playing fieldCreating balanceYou should also avoidUnjust/injusticeOutrage ImmoralUnconscionable
  • The net effect is a health-wealth gradient, in which every descending rung of the socioeconomic ladder corresponds to worse health. And it’s not just the poorest among us who are suffering, but the middle classes too. Louisville Metro Public Health Department data maps reveal 5- and 10-year gaps in life expectancy between the city’s rich, middle and working-class neighborhoods. We also see how racial inequality imposes an additional burden on people of color.
  • Pushing forward and carrying on
  • Social advantage or disadvantage refers to wealth, power and/or prestige – how people are grouped in hierarchies
  • Systemic, avoidable, unfair and unjust differences in health status and mortality rates and in the distribution of disease and illness across population groups. They are sustained over time and generations and beyond the control of individuals
  • Social gradient exists, globally
  • Historically, federal Indian policies have been destructive to Native American communities - ranging from removal to assimilation and termination. These policies have had a negative impact on health and health-related behaviors. More recent trends towards self-determination and tribal control provide reason to hope.
  • Influenceson Health: Broadening the Focus Health is shaped by many influences, including age, sex, genetic make-up, medical care, individual behaviors and other factors not shown in this diagram. Behaviors, as well as receipt of medical care, are shaped by living and working conditions, which in turn are shaped by economic and social opportunities and resources.
  • .
  • http://www.countyhealthrankings.org/take-action/health-care-professionals-and-advocates
  • .
  • Stephanie Summerville is an actress and a Broadway theater usher living in New York City.She has performed regionally in both the U.S. and abroad. Her New York credits include “Howling” (LaMaMa ETC.), “We Are Your Sisters” (Blue Heron Theatre) and “Medea” (National Black Theatre of Harlem). Currently she is in residence with the Instant Shakespeare Company, performing the Bard’s entire canon in branches of the New York Public Library, for nine months out of the year. She is a proud graduate of Sarah Lawrence College, and an alumna of the NY Shakespeare Festival Lab at the Joseph Papp Public Theater.
  • Dr. Greenwald’s talk http://www.youtube.com/watch?v=xRUs9Ni3Bv8&feature=relmfuDr. Cooper’s talk http://www.youtube.com/watch?v=Vx3h332Sd90&feature=relmfu
  • Dr. Greenwald’s talk http://www.youtube.com/watch?v=xRUs9Ni3Bv8&feature=relmfuDr. Cooper’s talk http://www.youtube.com/watch?v=Vx3h332Sd90&feature=relmfu
  • Collaborative research effort between researchers at Harvard University, the University of Virginia, and University of Washington
  • https://implicit.harvard.edu/implicit/demo/takeatest.html

What's Health Equity? What's Health Equity? Presentation Transcript

  • What’s Health Equity? 2011 Health Equities Leadership Institute Friday, April 1, 2011 Katherine D. Ellington Vice President, Program Development#2011HELI American Medical Student Association
  • Wake Up
  • About Katherine
  • About Katherine @katellington • New York City native from an African- American family with Southern roots, traditions and sensibilities • Born and raised in Queens, one of the most racially and ethnically diverse communities in America • Untraditional path to medical school • Moving toward family medicine and community health
  • The conscious recognize the need forchange, awakening the unconscious is apart of that process.
  • Moments in Timefrom moments to movements We saw a white, Catholic, Republican federal judge murdered on his way to greet a Democratic woman, member of Congress, who was... Jewish. Her life was saved initially by a Mexican-American college student... and eventually by a Korean-American combat surgeon… And then it was all eulogized and explained by our African-American president. And... thats a remarkable statement about the country. ~Mark Shields PBS Newshour January 14, 2011
  • Inspiration
  • What’s Health Equity?Overview  Definitionsand framework  “Unnatural Causes” clips and quiz  County Health Rankings  Another story  Implicit Association Test 1. novice 2. advanced-beginner  Dialgoue 3. competent 4. proficient 5. expert
  • What is Health Equity? A broad definition: The absence of socially unjust or unfair health disparities.
  • What is Health Equity? HEALTH “The presence of physical, psychological, social, economic and spiritual well being not merely the absence of disease or infirmity” (based on the WHO definition of health)
  • What is Health Equity? EQUITY An ethical concept based on fairness, distributive justice and, is normative.
  • What is Health Equity? “Health equity is the realization by ALL people of the highest attainable level of health. Achieving health equity requires valuing all individuals and populations equally, and entails focused and ongoing societal efforts to address avoidable inequalities by assuring the conditions for optimal health for all groups, particularly for those who have experienced historical or contemporary injustices or socioeconomic disadvantage.”
  • What is Health Equity? Health equity is the absence of systematic disparities in the health (or its social determinants) between more and less advantaged groups. .
  • Racial and ethnic healthcaredisparities  Pervasive  Associated with systemic social advantage/disadvantage  Complex and interrelated factors  Root causes are found upstream  Requires fundamental changes in underlying social and/or economic structures
  • Health Disparities Healthcare sysems, polices and infrastructure Individual at the patient-provider level. Differences, disparities and discrimination. Populations with equal access to healthcare. SOURCE: Gomes and McGuire, 2001. Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Smedley BD, Stith AY, Nelson AR, eds. 2003 National Academies Press. Washington, DC.
  • Health Disparities Finding 1-1: Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable. Recommendations 2-1: Increase awareness of racial and ethnic disparities in healthcare among the general public and key stakeholders. Recommendations 2-2: Increase healthcare providers’ awareness of disparities. Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Smedley BD, Stith AY, Nelson AR, eds. 2003 National Academies Press. Washington, DC.
  • Health inequities have beendefined as differences inhealth that are unnecessary,avoidable, unfair and unjust.Whitehead,M. The concept and principles of equity in health.Int J Health Serv1992;22:429-445. first published in Europe
  • Social Determinants of Health The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. #sdoh
  • Social Determinants of Health Social gradient exists, glo bally. #sdoh
  • Social Determinants of Health There’s more to health than health care. What about where your live, go to work, attend school and play? #sdoh
  • What’s Health Equity? DISCUSSION #publichhealth #sdoh #countyhealthrankings#2011HELI
  • What’s Health Equity? #PublicHealth“The new public healthoperates out front, in the fulllight of day, connecting thedots, buildingpartnerships, and creatingcollaborative relationshipsthat reach far into everycorner of the community.”President CEO RisaLavizzo-Mourey, MD, MBA, RobertWood Johnson Foundation www.countyhealthrankings.org #2011HELI
  • What’s Health Equity? DISCUSSION
  • 1. novice2. advanced-beginner3. competent4. proficient5. expert What’s Health Equity? Another story
  • http://www.charactersunite.com/
  • http://www.charactersunite.com/
  • Implicit Association Research The Psychology of Blink: Level 2  Mental operations  First level: higher, deliberate, rational, thoughtful  Second level: lower, automatic, impulsive, unthinkingUnconscious cognition Implicit Association Research is a glimpse into “Level 2” We work to overcome Level 2 and IAT is a start
  • Implicit Association ResearchThe Psychology of Blink: Level 2 The Blink part comes from a reference to Greenwalds work in chapter three of Gladwells book Leading researchers o Anthony Greenwald, Ph.D., University of Washington o MahzarinBanaji, Ph.D., Harvard University o Brian Nosek, Ph.D., University of Virigina o Lisa Cooper, MD, MPH, Johns Hopkins
  • Project Implicit Interactive studies that examine thoughts and feelings that exist either outside of conscious awareness or outside of conscious control Educational and engaging experience
  • Project Implicit A safe, secure, and well-designed virtual environment to investigate psychological issues and, at the same time, provide visitors and participants Collaborative research effort between researchers at Harvard University, the University of Virginia, and University of Washington
  • What’s Health Equity? DIALOGUE
  • What’s Health Equity?Review  Heal Equity, defined  Racial and ethnic healthcare disparities  Social determinants of health  County Health Rankings 1. novice 2. advanced-beginner  IAT 3. competent 4. proficient 5. expert
  • What’s Health Equity? CONCLUSION
  • When the end is the beginning…
  • What’s Health Equity? Katherine D. Ellington vpp@amsa.org @katellington on Twitter Katherine Ellington on Facebook Phone: 347.993.7877 Skype/IM: ellkatd