Post on 26-Dec-2015
transcript
Righting the Wrong of Social Injustice in Health
The Health-Wealth Connection SymposiumJune 23, 2010
Maxine Hayes, MD, MPHWashington State Department of Health
Mission of Public Health
Assure health, safety and quality of life for everyone!
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“Public Health ≠ Publicly Funded or Charity Medicine”
Philosophy behind Science:to discover truth
Philosophy behind Medicine: use that truth for a patient
Philosophy behind Public Health:use that truth for everyone
19941994Life expectancyLife expectancy
= = 7575 years years
25 of these years 25 of these years are due to are due to advances in public advances in public healthhealth
19001900Life expectancyLife expectancy
== 4545 yearsyears
Our Life Span Has Increased By 30 Our Life Span Has Increased By 30 Years Since 1900*Years Since 1900*
Our Life Span Has Increased By 30 Our Life Span Has Increased By 30 Years Since 1900*Years Since 1900*
*United States
Health OlympicsHealth Olympics 2002
UN Human Development Report 20
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WHY?
Not everyone has equal opportunity for health
Health Disparities vs. Inequities
• Disparity only defines differences between groups.
• Inequity describes the “causes” of disparities in the context of environmental conditions that are required to generate parity and equality.
Inequities result in disparities in health status that are “unfair, unjust, avoidable and unnecessary.”
“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”
Martin Luther King Jr. – March 25, 19662nd National Convention of the Medical Committee for Human Rights
“Nowhere are the divisions of race and ethnicity more sharply drawn than in the health of our people…no matter what the reason, racial and ethnic disparities in health are unacceptable in a country that values equality and equal opportunity for all.”
Bill Clinton – February 21, 1998
Healthy People 2010 addressed the need to eliminate disparities, but these disparities are
rooted in societal inequities manifested through institutional racism, income gaps, entrenched poverty and social injustice!
A new vision for Healthy People 2020 is needed.
Public health must not lose sight of the importance of attending to the social context of disease prevention and health promotion.
Equalizing opportunities to be healthy requires addressing the most important
social and economic determinants of health including not only health care,
but also living conditions in households and communities, working conditions, racism, and policies that affect any of
these factors
Source: Defining equity in health. J Epidemiol Community Health 2003, 57: 254-258
Social Justice
“When access to certain basic rights, such as good health, education, and fair and equal treatment has been distributed unevenly or denied to certain groups, the problem becomes an issue of social justice”
Healton & Nelson, 2004
The Health-Wealth Relationship is Real!
• Higher income = longer life•Low income = worse health•Less education = worse health•Lower income = more chronic disease
We Know What Determines Health
National Institutes of Health 2000
Institute of Medicine 2001
National Research Council 2001
Institute of Medicine 2000
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EnvironmentalEnvironmentalRiskRisk
Stress dueStress due
To SocialTo Social
FactorsFactors
InstitutionalizedInstitutionalized
Biases Biases (racism, sexism, (racism, sexism,
etc.)etc.)
Language andLanguage andOther CulturalOther Cultural
FactorsFactors
EconomicEconomicOpportunityOpportunityand Equityand Equity
EducationEducationBackgroundBackground
andandOpportunityOpportunity
Mental HealthMental Health
and Socialand Social
SupportSupport
Access to Access to
Health ServicesHealth Services
HealthHealthBehaviors andBehaviors and
PersonalPersonalRisk FactorsRisk Factors
Trust in HealthTrust in Health
System andSystem and
ResearchResearchSOCIAL
DETERMINANTS OF HEALTH
Determinants of Health
LIFE
SPAN
Multiple levels of influence HEALTHHEALTH
Access to Health Care – Access to Health Care – 10%10%
Environment – 20%Environment – 20%
Genetics – 20%Genetics – 20%
Healthy Behaviors – 50%Healthy Behaviors – 50%
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HealthHealthBehaviorsBehaviors
EnvironmentEnvironment
GeneticGeneticMakeupMakeup
HealthHealthCareCare
51%51%
22%22%
17%17%
10%10%
0%0% 20%20% 40%40% 60%60% 80%80% 100%100%
Source: McGinnis, et. al, 2002
What Influences Our Health?What Influences Our Health?
How We Spend Money
0.3%
2.5%
2.5%
97.4%
0% 20% 40% 60% 80% 100%
Health Care
Identify & Mitigate Health RiskFactors
Mitigate Environmental Hazards
Increase Healthy Behaviors
Source: Priorities of Government II, Summer 2004
How We Spend Our MoneyHow We Spend Our Money
TM
Social Environments and Health
Individuals and families are embedded within social, political, and economic systems that shape behaviors and constrain access to resources necessary to maintain health.
Greater emphasis is needed on public health interventions that involve communities, with the goal of collectively identifying resources, needs and solutions…
-- Institute of Medicine, Health and Behavior 2001
Inequalities Start Early
Stress in early life affects physical growth, emotional, social and cognitive development as well as later health and
health behaviors.
Birth/ Adolescence/ Work/ ElderlyChildhood Young Adult Career ParentalSocioeconomic Educational Occupation
RetirementResources Attainment & Income Income Health Health Health Health
Reaching for a Healthier Life , Facts on SES and Health in the U.S. MacArthur Foundation
Public Health Action:Speak Truth to Power!
Work with others to attack the “root causes” of disease, illness to assure
health.
Health Equity in ALL Policies!
Timing is Everything!
“We must all have the audacity to believe we can transform the current system”
Maxine Hayes, MD, MPH
References• Overcoming Obstacles to Health
– RWJ Foundation 2/2008• The Spirit Level – Richard
Wilkinson and Kate Pickett (Why Greater Equality Makes Societies Stronger)
• The Stakes for Women of Childbearing Age in Health Reform – CDC 8/10/2009 - MMWR
• Health Equity and Children’s Rights – Pediatrics, Volume 125, #4, 4/2010, 125; 838-849
• Building on a Life Course Perspective in Maternal Child Health – editorial, Maternal and Child Health Journal, Volume 7, no. 1, 3/2003
• Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective – Maternal and Child Health Journal, Volume 7, no. 1 3/2003
• Reaching for a Healthier Life, Facts on SES and Health in the U.S. – MacArthur Foundation