Collabora'veforHealthEquityCookCounty&CookCountyDepartmentofPublicHealth:Confron'ngstructuralracismasarootcauseofhealth

inequi'esJimBloyd,MPH

RegionalHealthOfficerCookCountyDepartmentofPublicHealth

9thAnnualHealthDispari'es&SocialJus'ceConference

CenterforCommunityHealthEquity-DePaulUniversity-RushUniversityAugust12,2016DePaulCenter,Chicago,Illinois

WhatIwillcover…

•  UsefulFrameworks&Approaches:Crucialforpublichealthprac''oners

•  CookCountyDepartmentofPublicHealth(CCDPH)WePLAN2020

•  Collabora'veforHealthEquityCookCounty(CHE)

CCDPHservessuburbanCookCounty,Illinois

•  125municipali'es

•  2.5millionresidents

•  Oneof6cer'fiedhealthdepartmentsintheCounty

•  Jurisdic'on:notCityofChicagonorothercer'fiedLHD’s

•  Governance:17-memberCookCountyBoardOfCommissioners

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Map:CookCounty,ILwithloca'onsof4ForcesofChangeAssessmentFocusGroups

CookCountyDepartmentofPublicHealth 3

Krieger(2011)1.  “…theoriesofdisease

distribu'onarevitaltotheconductofepidemiology;

2.  thesetheoriesalltooodeninformepidemiologicresearchimplicitly,ratherthanexplicitly;

3.  analysisofepidemiologictheoriesofdiseasedistribu'oncanimprovetheintellectualrigorofthefield.Inotherwords,theoryisaprac'calnecessity,notanobscureluxury.”P.34

EcosocialTheory:Levels,Pathways&Power(Krieger2011)

Framingsocialdetermina'onvs.socialdeterminantorienta'on(Spiegel,Breilh,Yassi2015)

CommissionontheSocialDeterminantsofHealthConceptualFramework(WHOSolar&Irwin2010)

StructuralDeterminantsofHealth

•  “…structuralmechanismsarethosethatgeneratestra'fica'onandsocialclassdivisionsinthesocietyandthatdefineindividualsocioeconomicposi'onwithinhierarchiesofpower,pres'geandaccesstoresources.”

Solar,O.,&Irwin,A.(2007).Aconceptualframeworkforac'ononthesocialdeterminantsofhealth.

8

SocialDeterminantsofHealth•  Theeconomicandsocialcondi'onsthatinfluencethehealthofindividuals,communi'es,andjurisdic'onsasawhole.–  Availabilityoffood–  Affordablehousing–  Qualityeduca'on–  Jobsecurity–  Socialconnec'onandsafety–  Livingwage–  Accesstotransporta'on

Raphael,D.(2009).Socialdeterminantsofhealth:Canadianperspec4ves.CanadianScholars’Press.

9

ModifiedWHOFramework-PresentedtoCCHHSBdMay27,2016

Socioeconomic/Poli'calContext

SocioeconomicPosi'on

SocialDeterminants HealthEquity

•  Governance•  Economic

policy•  Socialpolicy•  Publicpolicy•  Culturaland

socialvalues

•  Socialclass•  Gender•  Race

•  Accesstohealthcare

•  Housing•  Neighborhood•  Work

environment•  Income

StructuralDeterminants

ModifiedfromSolar,O.,&Irwin,A.(2007).Aconceptualframeworkforac'ononthesocialdeterminantsofhealth.

10

StructuralRacism:Examples•  84%increaseinUSaveragewealthconcentra'onamongWhitefamilies-1.2Xand3XhigherthanLa'no&Blackincrease(www.ips-dc.org2016)

•  ILeduca'onfinancingsystem(Mar're2/11/14hqps://www.youtube.com/watch?v=Xk6ogZzzvk8)

•  Chicago-areapoorchildrenofcolorexposedtoneighborhoodpovertywhilewhitepoorchildrenarenot(diversitydata.org2007“ChildrenLedBehind”)

•  HealthyChilddevelopmentopportunityinequi'es(Acevedo-Garcia2014;diversitydatakids.org2014)

•  Federalhomemortgagepolicyanddiscriminatorylending1930’s-present(CountyofCookv.WellsFargo11/28/14case#14-cv-9548;

Racialsegrega'onexposesmorepoorLa'nothanWhitechildrentohighpovertyneighborhoods

Divesitydata.org“ChildrenLedBehind:HowMetropolitanAreasAreFailingAmerica’sChildrenChartbook”

Racialsegrega'onexposesmorepoorBlackthanWhitechildrentohighpovertyneighborhoods

Divesitydata.org“ChildrenLedBehind:HowMetropolitanAreasAreFailingAmerica’sChildrenChartbook”

Commonali'es:Theseframeworks&approachesconsider…

•  Powerdynamics&poli'cs•  History•  Evidence•  Values-socialjus'ce•  Alliances,socialmovementsContrastwithothers:HealthImpactPyramid;HP2020SDOH;CDC3BucketsofPreven'on,PublicHealth3.0,biomedicalmodel,lifestyle…

Ques%onstoiden%fyforcesofchange:

• Occurrences,threatsandopportuni%es• Pa8erns—WhoisaffectedandHow?• Ins%tu%ons,powerandinterests

ForcesofChange

Socialdeterminantsofhealth

HealthandHealthequity

CCDPHUsed:AForcesofChangeAssessmentFrameworkEmphasizingtheSocialDeterminantsofHealth-informedbyNACCHO(2014),andSolar&Irwin(2010)

CookCountyDepartmentofPublicHealth 15

CookCountyDepartmentofPublicHealth 16

Par'cipants-Sr.Staff&Leadership:•  IllinoisCoali'onforImmigrant&

RefugeeRights•  IllinoisSelfAdvocacyAlliance•  LoyolaUniversity•  MetropolitanTenants

Organiza'on•  NorthwestCompass•  Preven'onPartnership•  RespondNow•  RestaurantOpportuni'esCenter-

Chicago•  SaferFounda'on•  SchaumbergTownship

CommunityCoali'on•  SchoolDistrict147•  SEIUHealthCareIllinois•  SouthSuburbanCollege•  UICSchoolofPublicHealth•  USEnvironmentalProtec'on

Agency

•  Advocate•  AfricanAmericanFamily

Commission•  AgencyforToxicSubstances&

DiseaseRegistryUSDHHS•  AIDSFounda'onofChicago•  Backbones•  BlackYouthProject100•  ChicagoSouthlandChamberof

Commerce(2)•  FoodChainWorkersAlliance•  GrandPrairieServices•  GreaterChicagoFoodDepository•  GreaterILChapter-Na'onal

Mul'pleSclerosisSociety•  Health&MedicinePolicyResearch

Group•  IllinoisCaucusforAdolescent

HealthCookCountyDepartmentofPublicHealth 17

FindingsForcesofChangeAssessmentWePLAN2020

Source:hqp://cookcountypublichealth.org/files/weplan-2020/community-health-assessments/ccdph-foca-summaryandreport.pdf

FindingsCCDPHForcesofChangeAssessmentWePLAN2020

Source:hqp://cookcountypublichealth.org/files/weplan-2020/community-health-assessments/ccdph-foca-summaryandreport.pdf

Focusgrouppar'cipant:

“…theindividualsjustcan’tpayenoughintothesysteminordertomakesurethattheseservicesareprovidedforandsothat,fromourperspec4vewe’retalkingaboutthemajorcorpora4ons,theonepercent,thebillionaire,millionaireclasswhoarebenefi4ngfromthesepolicies,anditisworkingpeoplewhoaresuffering…”

Focusgrouppar'cipant:

“…wehavepeoplethatdohavelivingwageposi4onsbutthey’rehighlysegregated,oDenonlyoccupiedbywhitemen,andsoit’sthiskindofissuelikeracialandgenderdynamicsandwhogetstheopportuni4esandwhodoesn’t,butevenifweaddressitthere’ss4llnotenoughofthoselivingwageposi4onstobalanceouttomakeitequitable…”

Electedofficialstooodendisconnected:

•  “…socialworkersshouldbepoli4ciansandpoli4ciansshouldspendsome4meassocialworkersandthenthey’dunderstand.”

•  “…theywerejustlike‘Wow,I’venevermetanybodyonfoodstamps’andherethey’redeba4ng,peoplearedeba4ngmillionsoflives.It’salsoalackofknowledge.Yeah,andgeKngthatdata,theanecdotesinfrontoftheminperson.”

Focusgrouppar'cipant:

“theindividualswhoarebenefi4ngarethewealthy,theverywealthy,Ithinkthemiddle-classandespeciallytheunderservedminoritypopula4onsaretheoneswhoarebeingharmedthemostbywhat’shappening.”

CCDPHDradImplementa'onStrategies

•  Raiseawarenessoftheexistenceofhealthinequi'es&createanewnarra've.

•  Analyze,assess,andreportonsocialcondi'onsandhealthinequi'esusingpar'cipatoryprocesses

•  Organiza'onalDevelopmenttotransformpublichealthprac'ce

•  Recommendandadvocatepoliciesthatadvancehealthequityandtacklerootcauses.

•  BuildPowerofcommuni'estosecureresourcesnecessaryforhealthintheirneighborhoodandlivingcondi'ons.

•  www.checookcounty.org•  Twiqer:@CHECookCounty•  SpearheadingCCDPHstructuralracism-healthinequi'espriorityinWePLAN2020

•  17-MembergoverningSteeringCommiqee•  1of19teamsintheUSNa'onalCollabora'vesforHealthEquity;communityofprac'ce;BrianSmedley

Mission:changethepoliciesandprac4cesfuelingtheinequitabledistribu4onofpowerand

resourcesinCookCountythatresultfromstructuralracism.Ouraimistoincreasehealthequitybyaddressingeduca4on,unemployment,violenceandothersocialdeterminantsofhealth.www.CHECookCounty.org

CHELeadershipDevelopment:Videoapplica'ontoRobertWoodJohnsonFounda'onCultureofHealthavailableathqps://

youtu.be/ZzfvuktE0jo

CHEWork•  Rela'onshipswithorganizers•  #FightFor15•  #OneFairWageROCChicago•  RaisingofAmericaCommunitydiscussions-Aus'n,Cicero,SouthSuburbs

•  InvitedspeakersIns'tuteofMedicine,WashingtonDC

•  IndexofConcentra'onattheExtremes(ICE)measuresneighborhoodprivilege&depriva'on

AverageLifeExpectancy(2003-2007)byMedianIncomeofCensusTract/Municipality(2009),

CookCounty

73.2

78.8 79.9 79.9

87.0

65

70

75

80

85

90

Less than 25k 25k - 35k 35k - 44k 44k - 53k Greater than 53k

Life

exp

ecta

ncy

at b

irth

in y

ears

MedianIncome Source: Life expectancy calculated by the VCU Center on Human Needs from 2003-2007 data provided by Cook County Health Department: Median Income from 2009 Geolytics Premium Estimates.

13.8Years

8.2 7.17.1

31

ThankYou!

www.checookcounty.orgwww.cookcountypublichealth.org@CHECookCounty @CookCoHealthYoutube.com/ccplacemaqersJimBloyd,MPH,RegionalHealthOfficerCookCountyDepartmentofPubicHealth15900S.CiceroAvenueOakForest,Illinois60452jbloyd@cookcountyhhs.org708-633-8314