Social Determinants of Health Disparities by xQ826l5g

VIEWS: 26 PAGES: 47

									     Social Determinants
     of Health Disparities
        Moving the nation to care
          about social justice
            Camara Phyllis Jones, MD, MPH, PhD
             Social Determinants of Health and Equity

           18th National Health Equity Research Webcast
University of North Carolina Gillings School of Global Public Health
                           June 5, 2012

          Office of Surveillance, Epidemiology, and Laboratory Services
          Epidemiology and Analysis Program Office
   Social Determinants
   of Health Disparities
     Moving the nation to care
       about social justice
     The findings and conclusions in this presentation
                  are those of the author,

and do not necessarily represent the official position of the
     U.S. Centers for Disease Control and Prevention.


       Office of Surveillance, Epidemiology, and Laboratory Services
       Epidemiology and Analysis Program Office
                                Overview
   Social determinants of health disparities differ from social
    determinants of health
   Health disparities don’t “just to happen”
     Definition of racism
     Generalized definition of structured inequity
   Three-part definition of health equity
   International Convention on the Elimination of all forms of
    Racial Discrimination
   Barriers in moving the nation to care about social justice
     Ahistorical culture
     Myth of meritocracy
     Focus on the individual
Levels of health intervention
Addressing the                  Primary prevention
social determinants of health




                                Safety net programs and
                                secondary prevention




                                Medical care and
                                tertiary prevention
              But how do disparities arise?
   Differences in the quality of care received within the
    health care system

   Differences in access to health care, including
    preventive and curative services

   Differences in life opportunities, exposures, and
    stresses that result in differences in underlying health
    status
                        Differences in




                                         Differences in access to care
                        exposures and
                        opportunities




Differences in quality of care
(ambulance slow or goes the wrong way)
Addressing the
social determinants of health disparities:

Why are there differences
in resources
along the cliff face?

Why are there differences
in who is found
at different parts of the cliff?
3 dimensions of health intervention
3 dimensions of health intervention

Health services
3 dimensions of health intervention

Health services

Addressing social determinants of health
3 dimensions of health intervention

Health services

Addressing social determinants of health

Addressing social determinants of health
disparities



Source: Jones CP et al. J Health Care Poor Underserved 2009.
           What is racism?
A system
                 What is racism?
A system of structuring opportunity and assigning
value
                 What is racism?
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(“race”)
                   What is racism?
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(“race”)

 Unfairly disadvantages some individuals and communities
                   What is racism?
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(“race”)

 Unfairly disadvantages some individuals and communities
 Unfairly advantages other individuals and communities
                                            What is racism?
     A system of structuring opportunity and assigning
     value based on the social interpretation of how we look
     (“race”)

        Unfairly disadvantages some individuals and communities
        Unfairly advantages other individuals and communities
        Saps the strength of the whole society through the waste of
         human resources




Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
              What is [inequity] ?
A system of structuring opportunity and assigning
value based on [fill in the blank]
                  What is [inequity] ?
A system of structuring opportunity and assigning
value based on [fill in the blank], which

 Unfairly disadvantages some individuals and communities
 Unfairly advantages other individuals and communities
 Saps the strength of the whole society through the waste of
  human resources
                  Many axes of inequity
   “Race”
   Gender
   Ethnicity
   Labor roles and social class markers
   Nationality, language, and legal status
   Sexual orientation
   Disability status
   Geography
   Religion

These are risk markers, not risk factors
                                  Achieving health equity
    “Health equity” is assurance of the conditions for
     optimal health for all people

    Achieving health equity requires
        Valuing all individuals and populations equally
        Recognizing and rectifying historical injustices
        Providing resources according to need


    Health disparities will be eliminated when health
     equity is achieved

Source: Jones CP 2010, adapted from the National Partnership for Action to End Health Disparities.
        ICERD: International Convention on the
    Elimination of all forms of Racial Discrimination
   International anti-racism treaty adopted by the UN
    General Assembly in 1965
    http://www2.ohchr.org/english/law/cerd.htm


   US signed in 1966
   US ratified in 1994

   2nd US report submitted to the UN Committee on the
    Elimination of Racial Discrimination (CERD) in 2007
    http://www2.ohchr.org/english/bodies/cerd/docs/AdvanceVersion
    /cerd_c_usa6.doc
               CERD Concluding Observations
   14-page document (8 May 2008) available online
    http://www.state.gov/documents/organization/107361.pdf

   Concerns and recommendations
       Racial profiling (para 14)
       Residential segregation (para 16)
       Disproportionate incarceration (para 20)
       Differential access to health care (para 32)
       Achievement gap in education (para 34)
           Changing opportunity structures
               Challenges and strategies
   Understand the importance of history
   Challenge the narrow focus on the individual
   View systems and structures as modifiable
   Transform consumers to citizens
   Expose the myth of meritocracy
   Break down barriers to opportunity
   Build bridges to opportunity
              Valuing all people equally
               Challenges and strategies
   Break out of bubbles to experience our common
    humanity
   Embrace all children as OUR children
   Open up decision-making processes to achieve
    transparency, inclusion, and parity
                                 Reprise
   Social determinants of health disparities differ from social
    determinants of health
   Health disparities don’t “just to happen”
     Definition of racism
     Generalized definition of structured inequity
   Three-part definition of health equity
   International Convention on the Elimination of all forms of
    Racial Discrimination
   Barriers in moving the nation to care about social justice
     Ahistorical culture
     Myth of meritocracy
     Focus on the individual
Camara Phyllis Jones, MD, MPH, PhD

1600 Clifton Road NE
Mailstop E-33
Atlanta, Georgia 30333

(404) 498-1128 phone
(404) 498-1111 fax
cdj9@cdc.gov
For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov     Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.




                   Office of Surveillance, Epidemiology, and Laboratory Services
                   Epidemiology and Analysis Program Office

								
To top