PLACE MATTERS and Health Promotion
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PLACE MATTERS and Health Promotion

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Invited guest presentation at University of Illinois at Chicago, Health Inequities class on Friday, February 1, 2013. Professors Linda Rae Murray MD, MPH, and Angela Odoms-Young, PhD. Selected ...

Invited guest presentation at University of Illinois at Chicago, Health Inequities class on Friday, February 1, 2013. Professors Linda Rae Murray MD, MPH, and Angela Odoms-Young, PhD. Selected quotations, selected results from the Cook County PLACE MATTERS Health Equity Report released July 2012.

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  • Where do addictions come from? What are social causes of addictions?
  • “ My efforts were expended in working on the symptoms of closed societies; the basic conditions giving rise to the symptoms were untouched.” Brown E, Margo, G (1978) Int J Health Services, Vol. 8, Number 1 “Health Education: Can the Reformers Be Reformed?”
  • “ In the Chicago metropolitan area, fewer than 25 percent of all black children live in neighborhoods with low poverty rates between 0-10 percent; the remainder lives in neighborhoods with poverty rates between 10.1 and 40 percent. (top figure). In contrast, over 85 percent of white children living in the Chicago metropolitan area live in neighborhoods with poverty rates below 10.1 percent. Opportunity neighborhoods exist for white children but, on the whole, black children live in totally different neighborhoods.” Cohen, J. A. (Ed.). (2008). CHALLENGES AND SUCCESSES IN REDUCING HEALTH DISPARITIES . Washington, D.C.: INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES.
  • Figure C “shows that less than 5 percent of poor black children live in low-poverty neighborhoods, and more than 95 percent live in high poverty neighborhoods. Nearly 75 percent of poor white children live in neighborhoods in which the poverty level is 10 percent or less. This means that white children do not live in areas in which they have to contend with familial and environmental pressures associated with living in high-poverty neighborhoods.” Figure D shows that the distribution of poor white children remains more favorable than the distribution for nonpoor black children. The socioeconomic profile for Hispanic children at the family, neighborhood and school levels is similar to the profile of black children. If Hispanic children continue to live in these high poverty environments, outcomes for Hispanic children will eventually resemble the outcomes seen for black children in similar neighborhoods.
  • On April 13, 1933, President Roosevelt urged the House and the Senate to pass a law that would (1) protect small homeowners from foreclosure, (2) relieve them of part of the burden of excessive interest and principal payments incurred during a period of higher values and higher earning power,# and (3) declare that it was national policy to protect home ownership. (Jackson, 1980) The HOLC is important to housing history because it introduced, perfected, and proved in practice the feasibility of the long-term, self-amortizing mortgage with uniform payments spread over the whole life of the debt.
  • The fiery rhetoric and confrontational tactics of Gale Cincotta, co-founder of National People ’s Action, helped lead to the passage of the Community Reinvestment Act in 1977. (Courtesy National People’s
  • Action)WHO reference: http://www.who.int/social_determinants/thecommission/finalreport/closethegap_how/en/index2.html
  • Healthy Weight- it ’s not a diet, it’s a lifestyle!
  • Structural racism includes the aspects of our history and culture that have allowed the privilege associated with 'whiteness' and the disadvantage of 'color' to endure and adapt over time. A discussion of structural racism points out the ways in which public policies and institutional practices contribute to inequitable racial outcomes. It lays out assumptions and stereotypes that are embedded in our culture that, in effect, legitimize racial disparities, and it illuminates the ways in which progress toward racial equity is undermined.
  • In 2009, life expectancy in Cook County was significantly correlated with a number of key social, economic and demographic indicators:   Areas (census tracts and suburban municipalities) where a higher percentage of the population was non-Hispanic white had significantly longer life expectancies. Areas with a higher percentage of non-Hispanic blacks had significantly shorter life expectancies. Owner-occupied housing was associated with longer life expectancies, while a high vacancy rate was associated with shorter life expectancies. People living in areas with high concentrations of poverty and unemployment had significantly shorter life expectancies than people living in areas with higher median incomes. People living in areas with lower educational attainment (less than high school) had shorter life expectancies than those living in areas where a high percentage of the population had at least a Bachelor ’s degree.
  • Figure 4 illustrates the relationship between life expectancy and income. We grouped Chicago census tracts and suburban Cook County municipalities into quintiles (5 equal groups) based on median income and calculated the average life expectancy of each quintile. People living in areas with a median income greater than $53,000 per year had a life expectancy that was almost 14 years longer than that of people living in areas with a median income below $25,000 per year.
  • Figure 4 illustrates the relationship between life expectancy and income. We grouped Chicago census tracts and suburban Cook County municipalities into quintiles (5 equal groups) based on median income and calculated the average life expectancy of each quintile. People living in areas with a median income greater than $53,000 per year had a life expectancy that was almost 14 years longer than that of people living in areas with a median income below $25,000 per year.

PLACE MATTERS and Health Promotion PLACE MATTERS and Health Promotion Presentation Transcript

  • Place Matters and Health Promotion University of Illinois at Chicago,School of Public Health, Health Inequities Class Jim Bloyd, MPH Cook County Department of Public Health February 1, 2013
  • Outline• Video Community Voice: Bonnie Rateree• Selected quotes on Health Promotion• Residential Segregation• Health Equity Report Cook County Place Matters
  • “Six Voices” videos onYouTube.com/ccplacematters &Facebook.com/ccplacematter s
  • Health Promotion Ethics “We consider the normative ideal of health promotion to be that aspect of public health practice that is particularly concerned with the equity of social arrangements”Carter et.al. (2012) Public Health Reviews
  • “We are dealing with serious food addictions.People in America are addicted to sugar theyreaddicted to fat theyre addicted to salt andpeople dont feel satisfied with their food iftheyre not getting heavy doses of that…”“The food addictions are what is holding us backprimarily And ignorance Part of that ignorance isdeliberate. People dont want to know.”John Mackey, CEO Whole Fodes, National Public Radio InterviewJanuary 17, 2013http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=169580493&m=169580893
  • Dorothy Nyswander• “Have I not actually helped to maintain the status quo in these situations? Have I not taught people to accept those gifts approved by the establishment which would make life more bearable but which would not threaten the power of the establishment itself?”Nyswander (1967) H Ed Monographs cited in Brown & Margo (1978)
  • LaVeist et.al. 2011 Health Affairs• “We further concluded that when social factors are equalized, racial disparities are minimized. Policies aimed soley at health behavior change, bilogical differences among racial groups, or increased access to health care are limited in their ability to close racial disparities in health. Such policies must address the differing resources of neighborhoods and must aim to improve the underlying conditions of health for all.”
  • Metro Chicago: Poverty Composition of Neighborhoods of All Children Source: Diversitydata.org, 2011
  • Metro Chicago: Poverty Composition of Neighborhoods of Poor Children Source: Diversitydata.org, 2011
  • 1930’s Home Owners Loan Corporation:“HOLC initiatedthe practice of redlining” (Jackson, 1980)
  • South Side Chicago HOLC Map: State sponsored segregation through finance
  • Gale Cincotta: The fight against redlining- a victory in 1977• “Activists will need to do their homework. Theyll need to figure out who owns what in order to target those who really have the power.”Gail Cincotta Feb 1996 Illinois Issues photo National People’s Action
  • World Health Organization• How to close the health equity gap? “Tackle the inequitable distribution of power, money and resources” World Health Organization
  • Slow Death (Sovereignty, Obesity, Lateral Agency)• “I am focusing here on the way the attrition of the subject of capital articulates survival as slow death.” “In this scene some activity toward reproducing life is not identical to making it or oneself better, or to a response to the structural conditions of a collecive failure to thrive, but to making a less bad experience. It’s a relief.” Lauren Berlant (2007) Critical Inquiry
  • The individual, personal behavior approach is deceptiveCDC WebPage:“HealthyWeight- it’snot a diet, it’sa lifestyle!”Source: CDChttp://www.cdc.gov/healthyweight/healthy_eating/drinks.html
  • Cook County Place Matters is part of a National Initiative– W.K. Kellogg Foundation / Joint Center for Political and Economic Studies Health Policy Institute / CommonHealth Action National Meeting in Chicago: July 25-27, 2012 18April 26, 2012 Cook County Place Matters
  • Cook County Place Matters Steering CommitteeDaniel Block, PhD Chicago State UniversityJim Bloyd, MPH Cook County Department of Public HealthSheila Castillo, MUPP, Midwest Latino Health Research, Training, and Policy CenterKathryn Bocanegra, LCSW ENLACE ChicagoSheelah Muhammad, DN, MBA ‘Fresh Moves’John Owens Centers for New HorizonsApril 26, 2012 Cook County Place Matters 1
  • Vision• To build a health equity movement that works to eliminate structural racism and creates the opportunity for all people of Cook County to live healthy lives.April 26, 2012 Cook County Place Matters 1
  • Goals• raise awareness that inequitable social conditions are the root causes of unfair health inequities• build the power of residents and leaders from affected communities who support a fair distribution of society’s resources• Policy advocacy that leads to neighborhood conditions that support and produce healthApril 26, 2012 Cook County Place Matters 1
  • Health Equity• ‘health differences which are socially produced, systematic in their distribution across the population and unfair’ (World Health Organization)• Health inequities are a result of ‘systematically unequal distribution of power, prestige and resources among groups in society’ (WHO)
  • PLACE MATTERS emphasizes the social determinants of disease…• Obesity is the toxic consequence of economic insecurity and a failing economic environment."...social justice has less to do with larger portions of broccoli and more to do with eroding minimum wage, lack of healthcare, and wholesale looting of the American economy. It is a shame that many of the current strategies for obesity management are based not around alleviating poverty but around recommending high-cost foods to low-income people. That approach will not work in the US or elsewhere." Drewnowski spotlight 2008
  • Structural Racism• the ways in which public policies and institutional practices contribute to inequitable racial outcomes• privilege associated with whiteness and the disadvantage of color• assumptions and stereotypes that are embedded in our culture that, in effect, legitimize racial disparities• Undermines progress toward racial equitySource: Aspen Institute, http://www.racialequitytools.org/ci-issues-sr.htm
  • Structural Racism• “To address structural racialization, we must understand the work that our institutions and policies are in fact doing, not what we want or hope for them to do.” (john powell)
  • er ul u C & yi m F l a t Health HealthInequities Disparities
  • er ul u C & yi m F l a tInequities Disparities
  • er ul u C & yi m F l a tConditions Consequences
  • er ul u C& yi m F l a t School Grade Drop-Out Absence/ Failure Truancy
  • er ul u C & yi m F l a tNarrative Policy Place power
  • Life Expectancy by Census Tract and Municipality, Cook County and Chicago, (2003 – 2007)April 26, 2012 Cook County Place Matters 1
  • April 26, 2012 Cook County Place Matters 1
  • April 26, 2012 Cook County Place Matters 1
  • EducationApril 26, 2012 Cook County Place Matters 1
  • Persistent poverty April 26, 2012 Cook County Place Matters 1
  • Findings• Gap in life expectancy of 14 years between wealthy and poor areas of metro-Chicago• Residents with least access to chain supermarkets and larger independent grocers live on average 11 years less then people with highest access• Conditions of concentrated poverty make it more difficult for African Americans and Latinos to live healthy lives• “Your zip code is more important than your genetic code”
  • PLACE MATTERS Recommendations1. Improve daily living conditions/ tackle inequitable distribution of power, resources2. Track health inequities3. Strengthen data collection on food access4. Implement public ‘seed money’ for food retail in areas with low food access5. Ensure workplace justice for workers in the food chain6. Address persistent poverty
  • Thank you!Jim Bloyd, MPHjbloyd@cookcountyhhs.orgw) 708-633-831415901 S. Cicero Av Bldg B 3d FloorOak Forest IL 60452