Prepared by Cheza Garvin, PhD, MPH, MSWAssistant Professor and Academic Director,

Consortium for Infant and Child Health (CINCH)

Presented by Keisha Cutler, MPH, Assistant Director, CINCH

Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical School

African American children and youth have higher* rates of….:Poverty Overweight/obesity (girls) Injuries from violence (boys)High school dropoutsAsthma (uncontrolled) Infant mortality and low birth weight

*Rates are usually in comparison to caucasian peers, sometimes to general population, income groups or other communities of color.

And higher risks of Type II diabetesEnvironmental toxin exposuresAdverse effects of exposure to tobacco

smoke And lower rates of

Academic achievementEmployment and incomeTwo-parent families

Etc.

Definitions from Virginia Department of Health:“Health equity is achieving the highest level of

health for all people” If health inequity derives from disparities that are

systemic, avoidable, and unjust, then it is encumbent upon us to create and maintain a system that will prevent these inequities from occurring.

Why is this important? “A chain is only as strong as its weakest

link”Common sentiment expressed to encourage

team building, what about building a healthy community?

• Health equity cannot be achieved if any group is left out, marginalized, disenfranchised, if health status gaps are not closed….

Social Determinants underlie most health inequitiesWe tend to focus on health conditions:

overweight/obesity, asthma, injuries, infant mortality, etc. Lots of “bootstrap theory” for success, focusing

only on individual behavior. This is important, butWe also need to focus on the world into which

we are bringing our children – the social, economic and physical environment they face

Support community strengths, mitigate deficits

Health care access and quality Economics/Income Education and school/workforce preparedness Employment/working conditions Transportation: public, private, walking,

biking, etc. Exposure to toxins Healthy food access: proximity, cost, quality

Healthy, walkable, built environment Pollution-free (limited) environment Freedom from discrimination/racism/unfair

bias Housing: construction, air quality, location,

etc. Safety (from crime and hazards) Social integration and expression (belonging) Civic engagement: having a say, community

investment

Cohen & Swift, 1998

Asthma treatment for 12 year-old delayed due to high co-pay, inadequate health insurance (MD)

14 year old girl assumed to be sexually active by clinic doctor, even though she had never been sexually active and resented the stereotype (DC)

Mother of toddler describes triage nurse as condescending and disrespectful, likely class and race-biased, refuses to return to that source of medical care (Hampton Roads, VA)

All African Americans, All with health impacts

Demographics Population: 100,565; households: over 38,000; African American:

53% 25,854 children, of whom 51% are below 200% of Federal Poverty

Guidelines and 36% live in high poverty 74% of school children are African American in public housing or

neighborhoods with barriers to safe places to play and healthy eating

Food Only 10 grocery stores, lots of corner stores with few fresh food

options One farmer’s market, downtown, once a month, summer only

Play and Fitness One main public park with a children’s playground and athletic

areas, 32 total parks, 15 with some play equipment 8 recreation centers, most in disrepair and in high crime areas

Built Environment Suburban design of “drivability”, not walkability

Health High overweight (>65%), obesity (>29%) rates, not known for

children yet

What does it mean for a low-income mother of three, without a car, to shop for healthy food when the grocery store is several miles away and takes three buses to get there? Meanwhile, the corner store is a two minute walk away and easy to get to after working all day.

If you see two children, ages 6 and 11, playing in the street in a neighborhood where the local gang members are known to harass and/or try to enlist kids, what do you feel?

Is that a mirage, or is it a light at the end of the tunnel?

Long, lonely road ahead or are there many sources of expertise and support for these efforts?

CDC Initiatives REACH (Racial and Ethnic Approaches to Community

Health) Steps to Health ACHIEVE (Action Communities for Health, Innovation, and

EnVironmental changE) Robert Wood Johnson Foundation Initiatives

Active Living by Design (ALD) Communities Creating Healthy Environments (CCHE)

W. K. Kellogg Foundation Initiatives Place Matters Food and Fitness

Other Federal Initiatives Champion Program Communities Putting Prevention to Work

Action Communities for Health, Innovation, and EnVironmental changE (ACHIEVE) Bringing community leadership together to

develop and implement policies that favorably impact health

Portsmouth ACHIEVEs Recently awarded ACHIEVE community grant

via CINCH from National Association of Chronic Disease Directors (NACDD)

Accomack County ACHIEVE Recently awarded ACHIEVE community grant

via the YMCA of Hampton Roads from YMCA-USA Alexandria ACHIEVE

ACHIEVE award from previous year via health department from National Association of City and County Health Officials (NACCHO)

Unnatural CausesFour hours of film from California NewsreelExploring policy, systems and environmental

causes of health inequitiesCommunity dialogues to raise awareness and

prompt change Place Matters

W. K. Kellogg Foundation funded national initiative coordinated by the Joint Center for Political and Economic Studies Health Policy Institute

Goal to eliminate health disparities by addressing social determinants of health

ChampionBodyWorks in Hampton RoadsBreastfeeding at Work

BMI AssessmentsBMI 4KidzObesity prevention in Portsmouth

ACHIEVEAlexandria, Accomack and Portsmouth

Communities Putting Prevention to Work (CPPW)Application pending for Accomack and Alexandria

Instill health and safety considerations into land use and planning decisions.

Improve safety and accessibility of public transportation, walking, and bicycling.

Enhance opportunities for physical activity. Enhance availability of healthy products and reduce

exposure to unhealthy products in underserved communities.

Increase housing quality, affordability, stability, and proximity to resources.

Improve air, water, and soil quality. Prevent violence using a public health framework.

Provide high-quality, affordable health coverage for all.

Institute culturally and linguistically appropriate screening, counseling, and health care treatment.

Monitor health care models/procedures that are effective in reducing inequities in health and data documenting racial and ethnic differences in care outcomes.

Provide health care resources in the heart of the community and promote a Medical Home model.

Strengthen the diversity of the health care workforce to ensure that it is reflective and inclusive of the communities it is serving.

Establish sustainable funding mechanisms to support community health and prevention.

Collaborate with multiple fields to ensure that health, safety, and health equity are considered in every relevant decision, action, and policy.

Provide technical assistance and tools to support community-level efforts to address determinants of health and reduce inequities.

Tackle the inequitable distribution of power, money, and resources—the structural drivers of the conditions of daily life that contribute to inequitable health and safety outcomes—and especially address race, racism, and discrimination in institutions and polices; racial and socioeconomic segregation; and socioeconomic conditions.

Improve access to quality education and improve educational outcomes.

Invest in early childhood.

ACHIEVE Opportunity to change city codes and enhance school and

recreation regulations to promote healthy environments and prevent childhood smoking and exposure to tobacco smoke

BMI 4Kidz Portsmouth Health Department purchased equipment to

easily and non-intrusively collect body mass index (BMI) measures to help assess needs and guide overweight and obesity prevention interventions

Very few comprehensive approaches to tracking BMI in VA

Champion Body Works Program Training the trainers to teach parents methods of

promoting healthy food and physical activity for their children

Portsmouth YMCA Swim Gym All second graders learn to swim – equipment and

supplies provided

Call to Action for communities, organizations, government and electorate

Furthering Partnerships Implementation of best practices Working “upstream” to change policy

(prevention) to avoid “downstream” patching of problems after they occur. This is systems change.

Would a round table be more

inclusive, more inviting, more

effective for communication?Who gets a vote? Civic

engagement is more than

the voting booth.

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Safe Routes

to School in

Walkable Built

Environments

Easy access to Healthy Food Options

Equal access and support for high Educational Achievement

Greater Economic Opportunity

Physical Fitness for Life, Safe Play Places

Elimination of Racism & Discrimination

Full access to High Quality Health Care

Ease of

Transportation

Housing (e)quality