Structural Racism and Public Health: How to Talk to Policymakers and Communit...
TNPAC VDAY
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Addressing Health Disparities at the Community Level
February 2017 TNPAC Meeting
Carol Nixon, Ph.D., Hasina Mohyuddin, MBA, MS,
Kelly Smith, MA., Shea Davis, Sahar Fakhruddin
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Agenda
n Definitions
n Why is this important?
n Methods
n Health disparities findings
n Questions for discussion
n Resources
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What are Health Disparities?
Health disparities are gaps in health outcomes based on a
variety of demographic factors such as: race or ethnicity,
gender, age, sexual identity, veteran status, disability,
socioeconomic status, geographic location, etc. (Healthy
People, 2014).
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Why is it important?
Tools from the CAPT: Increasing Cultural Competence to Reduce Behavioral Health
Disparities, October 2016
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Assessment
Approaches
to
reducing
behavioral
health
disparities
Evaluation
Sustainability
and
Cultural
Competence
Capacity
Implementation
Planning
SPF and Health Disparities
Tools from the CAPT: Increasing Cultural Competence to Reduce Behavioral Health
Disparities, October 2016
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Why are health disparities
important recap
n Health Equity
n Grant Requirements, specifically for PFS
n Make sure our strategies are benefiting all populations.
n Make sure strategies are relevant to your unique
communities.
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Methods
n 21 coalition interviews have been completed
n Interviews range from 50min to 2hrs.
n Region: 8 East, 9 Middle, 3 West, 1 statewide
n Population: Mean = 247 K; Range from 7.5 K – 1M
n Funding: 6 have PFS grant & 15 do not
n Longevity: Mean = 9.45; Range 1-30 years
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Main Themes from the Interviews
n Defining Health Disparities
n Community Knowledge
n Coalition Strategies to Address Disparities
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Defining Health Disparities
n About half of coalitions were unsure of the definition of
“health disparities”
n Opportunity for discussion and training
n Coalition definitions focused on:
n Intermediary Determinants
n Structural Determinants
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Intermediary Determinants
Material Circumstances, Behavior & Biological Factors,
Psychosocial factors, Health System
n “I would say health disparity is where an individual is at a
lesser chance of success for health based on the lack of
accessibility to resources”
n “A lot of it's access to service.We have limited treatment in
terms of alcohol and drugs.We have no actual smoking
cessation classes.You can call the quit line or you can go
online but some of our families; they're lucky to have
running water.Transportation is huge. They may not
even have access to some of those services.”
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Structural Determinants
Socioeconomic & Political Context Impact on the
Inequality of Groups of People
n “There's the system but then there's also just the
environment.When I say system, I mean health systems,
school systems, whatever but then I also mean just their
environment and the community that they're in and if
they're living in a bad neighborhood that's not going to
change. Unless you either find ways to make that community
and neighborhood better, it's going to be a struggle.”
n “One example is we know that almost 26% of our kids here in
X county they are on welfare…we know that those kids may
be at higher risk”
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Neighborhood Characteristics
n Neighborhood Disorganization
n “It's a not a positive impact but the biggest impact on our
community is the high murder rate, the high crime rate, and
that sets the stage for everything else for successes, for failures.”
n Family Structure
n “I don't have any numbers at all, but a lot of the kids here they get
their prescription drugs.They just kind of take them from the
grandparents or their own parents because in X County there's a
high amount of youth who live with their grandparents, and so
it's fairly easy for them to get those substances if they want to do
so.”
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Data Access
n Challenges
n “Right now, I don't have any of that data.There is no data that breaks
it down in ethnicity in X County as to the usage, the risky behaviors
that are going on.They don't do that. Now, the new survey for the state,
that will determine what, that will show me that type of data. Right
now, I have none of that.”
n “I'm definitely aware of issues that exist. I'm aware of where
underage drinking is more prevalent, in what population. I'm more
aware of marijuana is more prevalent in the population here in X
county. Those are not things that I have specifically in data that I
can point to.”
n Successes
n “Some of that is, a more affluent city, they always think it's the county's
problem.The reality is it's not and trying to educate that it's
everyone's problem and that these are the data points and they
actually come from your students. Definite eye opener, I think, for a
lot of our community members.”
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Group Differences
n Class
n “Income really plays a huge role in any health issue […] That's the
way they're taking care of their family.We have to keep that in mind
too.They may have, in some cases, higher use rates. In other cases,
they may not be using it at all but they're distributing drugs in our
community and that's the way they're making a living.”
n Race/ Ethnicity
n “We have approximately 0.3 ... well, let's say 3% of our population, 3%
to 4% that are Mexican. 30% maybe a little more than 30%, maybe
closer to 35% that are African American in X county. And the others
are Caucasians, whites”
n “Our population is important to know that being predominately
African American there's a disproportionately higher number of
African American men in their late teens and 20's locked up for
marijuana violations”
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Coalition Strategies
n No Response—lack of resources
n Targeted Interventions
n Cultural Competency
n Building Partnerships
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Strategies: No Response
n Many coalitions mentioned that they are not currently
addressing health disparities.
n Funds were also a problem
n “It is an interesting conundrum to be funded by the state for
underage alcohol and tobacco use but then not be funded
specifically to be in our schools and be addressing particular
groups of students... I think maybe as more funding comes
available we can certainly write to that to help us track those kids
that are health disparity” (Participant 21).
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Targeted Interventions
n “So, we reach out to different communities.We
understand, we make an effort, and we make a purposeful
effort to go to Hispanic events or Latino events so that we can
make sure we get information out to them about the dangers
of drug use. Especially during that like whole opiate
epidemic.”
n “That can vary based on the substance that we're talking
about.When you're looking at marijuana use, for example,
our data tells us that there are higher rates among our
African American population.When we go into the schools
that have higher rates of African American students, we're
going to hit marijuana a little bit harder in those particular
areas than we would in a more predominantly.”
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Strategies: Cultural Competency
n Ensure community involvement in all areas
n Stress the importance of relevant, culturally appropriate
prevention approaches
n “We are very attuned to diversity that is on our coalition.When we
engage them in activities, diversity is a key factor. If we were doing
a ... Let's say we were doing a media campaign […] We are very aware of
who listens to what stations and where to place billboards so that
they are going to be viewed by all of our service recipients here in X
County.”
n Promote cultural competence among program staff that
reflects the communities they serve.
n Include the target population in all aspects of prevention
planning
n “What we're missing in our community is we don't necessarily have
leadership avenues in those particular areas that would allow us to
be able to approach somebody in that community to say we really want
your voice to be heard at the table.”
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Strategies: Cultural Competency
Challenges
Strategies not discussed by coalitions:
n Use population-based definition of community (i.e., let
the community define itself)
n Employ culturally competent evaluators
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Strategies: Building Partnerships
“Our community is trying to get us food co-op and there's not
very many food co-ops in Tennessee… ‘What does that have to
do with prevention?’ Anything that makes the community
stronger that brings people together to improve the
community and they get healthier and they get stronger in
some way is going to help in the overall prevention of
whatever.”
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Discussion/Q & A
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Were there any quotes about health
disparities that resonated with you when
thinking about your community?
