Presentation by Camara Jones, MD, MPH, PhD at the 2009 Virginia Health Equity Conference.
Dr. Jones presents the “Cliff Analogy” for understanding four levels of health intervention: medical care, secondary prevention, primary prevention, and addressing the social determinants of health. She described how health disparities arise on three levels (differences in quality of care, differences in access to care, and differences in underlying exposures and opportunities) and expand the “Cliff Analogy” to illustrate the relationship between addressing the social determinants of health and addressing the social determinants of equity, which is a fifth level of health intervention.
She identifies racism as one of the social determinants of equity and a fundamental cause of “racial”/ethnic health disparities in the United States, with racism defined as a system of structuring opportunity and assigning value based on the social interpretation of how one looks, which is what we call “race.” She described how racism impacts health on three levels (institutionalized, personally-mediated, and internalized) and animate understanding of these levels of racism with her “Gardener’s Tale” allegory.
Finally, using data from the “Reactions to Race” module on the 2004 Behavioral Risk Factor Surveillance System, she examined the relationship between responses to “How do other people usually classify you in this country?” and self-rated general health status to provide evidence of the impacts of racism on health. Dr. Jones challenges us to broaden the scope of our public health interventions by asking the question “How is racism operating here?” and then working to create a system in which ALL people are highly valued and ALL people are able to develop to their full potential.