1. Building Healthier Communities: where People Live, Learn, Work, Play and Worship David R. Williams, PhD, MPH Florence & Laura Norman Professor of Public Health Professor of African & African American Studies and of Sociology Harvard University
8. Diabetes Death Rates 1955-1998 Source: Indian Health Service; Trends in Indian Health 2000-2001
9. Life Expectancy Lags, 1950-2006 Murphy, NVSS 2000; Braveman et al. in Press, NLMS 1988-1998 63.6 70.6 60.8 69.1 74.4 76.1 69.1 68.2 71.7 64.1 71.4 73.2 78.2 77.6
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12. SAT Scores by Income Source: (ETS) Mantsios; N=898,596 873 Less than $10,000 920 $10,000 to $20,000 964 $20,000 to $30,000 992 $30,000 to $40,000 1016 $40,000 to $50,000 1034 $50,000 to $60,000 1049 $60,000 to $70,000 1064 $70,000 to $80,000 1085 $80,000 to $100,000 1129 More than $100,000 Median Score Family Income
18. Relative Risk of Premature Death by Family Income (U.S.) Relative Risk Family Income in 1980 (adjusted to 1999 dollars) 9-year mortality data from the National Longitudinal Mortality Survey
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21. Life Expectancy At Age 25, 1998 Murphy, NVSS 2000; Braveman et al. in Press, NLMS 1988-1998 5.0 48.4 53.4 All Difference Black White Group
22. Life Expectancy At Age 25, 1998 Murphy, NVSS 2000; Braveman et al. in Press, NLMS 1988-1998 6.4 Difference 56.5 d. College Grad 55.2 c. Some College 54.1 b. 12 Years 50.1 a. 0-12 Years 5.0 48.4 53.4 All Education Difference Black White Group
23. Life Expectancy At Age 25, 1998 Murphy, NVSS 2000; Braveman et al. in press, NLMS 1988-1998 5.3 6.4 Difference 52.3 56.5 d. College Grad 50.9 55.2 c. Some College 49.9 54.1 b. 12 Years 47.0 50.1 a. 0-12 Years 5.0 48.4 53.4 All Education Difference Black White Group
24. Life Expectancy At Age 25, 1998 Murphy, NVSS 2000; Braveman et al. in Press, NLMS 1988-1998 5.3 6.4 Difference 4.2 52.3 56.5 d. College Grad 4.3 50.9 55.2 c. Some College 4.2 49.9 54.1 b. 12 Years 3.1 47.0 50.1 a. 0-12 Years 5.0 48.4 53.4 All Education Difference Black White Group
29. Wealth of Whites and of Minorities per $1 of Whites, 2000 Source: Orzechowski & Sepielli 2003, U.S. Census 35 ¢ 31 ¢ $ 208,023 Richest 20% 39 ¢ 35 ¢ $ 92,842 4 th Quintile 19 ¢ 19 ¢ $ 59,500 3 rd Quintile 12 ¢ 11 ¢ $ 48,500 2 nd Quintile 2 ¢ 1 ¢ $ 24,000 Poorest 20% 12 ¢ 9 ¢ $ 79,400 Total Hisp/W Ratio B/W Ratio White Household Income
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32. Reducing Inequalities Reducing Negative Health Behaviors? *Changing health behaviors requires more than just more health information. “Just say No” is not enough. *Interventions narrowly focused on health behaviors are unlikely to be effective. *The experience of the last 100 years suggests that interventions on intermediary risk factors will have limited success in reducing social inequalities in health as long as the more fundamental social inequalities themselves remain intact. House & Williams 2000; Lantz et al. 1998; Lantz et al. 2000
33. Moving Upstream Effective Policies to reduce inequalities in health must address fundamental non-medical determinants.
35. Centrality of the Social Environment An individual’s chances of getting sick are largely unrelated to the receipt of medical care Where we live, learn, work, play and worship determine our opportunities and chances for being healthy Social Policies can make it easier or harder to make healthy choices
36. Our Neighborhood Affects Our Health Unhealthy Community Healthy Community vs Exposure to toxic air, hazardous waste Clean air and environment Unsafe even in daylight Safe neighborhoods, safe schools, safe walking routes No parks/areas for physical activity Well-equipped parks and open/spaces/organized community recreation Limited affordable housing is run-down; linked to crime ridden neighborhoods High-quality mixed income housing, both owned and rental Convenience/liquor stores, cigarettes and liquor billboards, no grocery store Well-stocked grocery stores offering nutritious foods
37. Our Neighborhood Affects Our Health Burned-out homes, littered streets Well-kept homes and tree-lined streets Streets and sidewalks in disrepair Clean streets that are easy to navigate No culturally sensitive community centers, social services or opportunities to engage with neighbors in community life Organized multicultural community programs, social services, neighborhood councils or other opportunities for participation in community life No local health care services Primary care through physicians’ offices or health center; school-based health programs Lack of public transportation, walking or biking paths Accessible, safe public transportation, walking and bike paths Unhealthy Community Healthy Community vs
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47. Policy Matters Investments in early childhood programs in the U.S. have been shown to have decisive beneficial effects
48. The High/Scope Perry Preschool Study to Age 40 Larry Schweinhart High/Scope Educational Research Foundation www.highscope.org
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53. Median Family Income of Blacks per $1 of Whites Source: Economic Report of the President, 1998
62. A 7-part documentary series & public impact campaign www.unnaturalcauses.org Produced by California Newsreel with Vital Pictures Presented on PBS by the National Minority Consortia of Public Television Impact Campaign in association with the Joint Center Health Policy Institute
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Editor's Notes
Source: NCHS Data, Table 29, 2007
Source: NCHS Data, Table 29, 2007
Source: NCHS data, Table 29, 2007
Source: NCHS data, Table 29, 2007
Source: Indian Health Services; Trends in Indian Health 2000-2001 Table 4.11; Age-adjusted death rates; other outcomes include heart dz, unintentional , cancer, chronic liver and cirrhosis, flu, pulmonary, tb, suicide, HIV, alzheimer’s SEE TABLE 30 and TABLE 4.11.
--These are the percentages listed in Table 8 of U.S. Census 2006. --“Some Other Race alone” not included (“Number and Percentage of People in Poverty in the Past 12 Months by Race and Hispanic Origin: 2006)
--These are the data from Table 8 of U.S. Census 2006, with number converted to percentages --“Some Other Race alone” not included (“Number and Percentage of People in Poverty in the Past 12 Months by Race and Hispanic Origin: 2006)
David Weikart was director of special education for the Ypsilanti Public Schools in the 1960s. He shared the district’s concern about widespread school failure and grade repetition as an inadequate answer. Principals showed little interest in school reform. Some children, moving from the South, had not attended kindergarten or first grade and were hopelessly behind. The idea of improving young children’s intellectual ability was in the air.
So David Weikart and his colleagues decided to run a preschool program. Some early childhood educators, however, feared this would not help and might even harm the children. So Weikart and colleagues decided to conduct a study of the program’s effects. From 1962 to 1965, they identified 123 young African-American children living in poverty and at risk of school failure. They defined poverty as parents having little schooling (9 th grade average) and low occupational status (unemployed or unskilled jobs), along with high household density (1.4 persons per room). The key to the scientific strength of this study is that children were randomly assigned to program or no-program group – essentially by a flip of the coin. The two resultant groups were almost exactly alike in background characteristics, except that one group got the preschool program and the other did not. The program employed 4 certified teachers serving 20-25 children with daily class and weekly home visits. This was a program of participatory education, in which children could plan, do, and re view their own activities.
So David Weikart and his colleagues decided to run a preschool program. Some early childhood educators, however, feared this would not help and might even harm the children. So Weikart and colleagues decided to conduct a study of the program’s effects. From 1962 to 1965, they identified 123 young African-American children living in poverty and at risk of school failure. They defined poverty as parents having little schooling (9 th grade average) and low occupational status (unemployed or unskilled jobs), along with high household density (1.4 persons per room). The key to the scientific strength of this study is that children were randomly assigned to program or no-program group – essentially by a flip of the coin. The two resultant groups were almost exactly alike in background characteristics, except that one group got the preschool program and the other did not. The program employed 4 certified teachers serving 20-25 children with daily class and weekly home visits. This was a program of participatory education, in which children could plan, do, and re view their own activities.
The recommendations are rooted in a twin philosophy: good health requires individuals to make responsible personal choices and requires a societal commitment to remove the obstacles preventing too many Americans from making healthy decisions. The recommendations focus on people and the places where we spend the bulk of our time: homes and communities, schools and workplaces.
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