Righting the Wrong of Social Injustice in Health

NAACP Annual Fall ConferenceAffirming America’s Promise

October 22, 2011Maxine Hayes, MD, MPH

Washington State Department of Health 1

“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, 19982

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.

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Inequities result in disparities in health status that are

“unfair, unjust, avoidable and unnecessary.”

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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.

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Health OlympicsHealth Olympics 2002

UN Human Development Report 20

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Not everyone has equal opportunity for health

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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

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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

factorsSource: Defining equity in health. J Epidemiol Community Health 2003, 57: 254-258

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The Health-Wealth Relationship is Real!

•Higher income = longer life•Low income = worse health•Less education = worse health•Lower income = more chronic disease

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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

ResearchResearch SOCIALDETERMINANTS

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%13

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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

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TM

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Tertiary

Medical Care

SecondaryMedical Care

Primary Medical Care

Population-Based Services

Health Care Pyramid

95% + Health Care $$Spent on Acute Care

10% of Improvement in Health Status Attributed to Medical Care90% Attributed to Population-Based Approaches

Adapted from J. Michael McGinnis, MD

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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

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Inequalities Start Early

Stress in early life affects physical growth,

emotional, social and cognitive development as well as later health and health behaviors.

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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 20

Community Action:Speak Truth to Power!

Work with others to attack the “root causes” of disease, illness to assure health.

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Health Equity in ALL Policies!

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Timing is Everything!

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“We must all have the audacity to believe we can transform the

current system”

Maxine Hayes, MD, MPH

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