Public Health 101

Module IV: Social & Health Equity

Developed by: Alameda County Public Health Department -

Community Assessment Planning & Education Unit

Janet Brown, Dana Cruz Santana, Sandi Galvez, and Katherine Schaff

Learning Objectives

Increase awareness of:

Historical and Current Policies

Social inequities

Health inequities

Learn how ACPHD is planning to take action and find solutions

Barnga In five tricks, your goal is to win as many tricks

as possible.

You will have 5 minutes to study the rules on your handout.

The rules will then be taken away and NO VERBAL OR WRITTEN

COMMUNICATION IS ALLOWED.

You may gesture or draw pictures.

Goal: Get to the winning table

Barnga

How or what were you feeling?

How did you interpret others’ behavior?

What can you learn about yourself from

this activity?

Remain silent and write on your half sheet of paper:

Barnga—After the Activity What does this simulation

demonstrate or explain?

How do you think this relates to “inequity?”

What Is Social Inequity?

Social inequity excludes people from full and equal participation in society.

Social Inequities Root Causes of Health Inequities

Health Inequities

SegregationSegregation Income & EmploymentIncome & Employment EducationEducation

HousingHousing TransportationTransportation Air QualityAir Quality Food Access & Liquor StoresFood Access & Liquor Stores

Physical Activity & Neighborhood ConditionsPhysical Activity & Neighborhood ConditionsCriminal JusticeCriminal Justice

Access to HealthcareAccess to HealthcareSocial Relationships & Community CapacitySocial Relationships & Community Capacity

Social Inequities

ACPHD’s Approach to Achieving Health Equity

Community Capacity Building

Institutional Change

Policy Change

HEALTH EQUITY

Data and Research

Prog

ram

s Services

Segregation

“It is often easier to become outraged by injustice half a world away than by oppression and discrimination half a block from home.”

–Carl T. RowanAuthor and journalist

Racially Restrictive Covenant

Redlining practicesby banks and homeinsurance agents

Racial steeringand block-busting

practices by real estate agents

Displacement caused by federal highway construction and

other urban renewal projects

Middle class and white flight to the

suburbs

Discriminatory mortgage

underwriting by the FHA/VA

Disinvestment andconcentrated poverty

in urban centers

Historical Roots ofPresent-Day Inequities

Historical Forces Have Left a Legacy of Racism and Segregation

Segregation and Health

Health• Physical• Mental

Higher density of freeways and other highly traveled roadways

More sources of toxins

Lower municipal service levels lower quality of life

Reduced access to transportation, quality education, affordable housing, adequate parks, and grocery stores

Low-income, segregated areas typically have:

Finding Solutions

Sample policy recommendations: Ensure equitable government

infrastructure spending by neighborhood

Reduce low-density-only zoning to make more homes affordable

Video Clip—Invisible Wall

Invisible Wall

Video Clip—Invisible Wall

What stood out for you? How did you feel?

What are the implications for people living in the area today?

107th Avenue in Oakland(Last street before San Leandro city

limit)

Bristol Blvd.(Last San Leandro street before

Oakland city limit)

Invisible Wall Today

San Leandro Today Asians (29%) & Latinos (27%) each make

up a greater percentage of the population in San Leandro than non-Hispanic whites*

African American residents make up about 12% of the population

Discussion What is the story behind this demographic

shift? What are the implications for ACPHD?

Creekside? Health equity? *Census 2010 accessed at http://sanleandro.patch.com/articles/census-finds-san-leandro-bigger-and-more-diverse

What issues of equity are being raised in the cartoons and/or Occupy movement?

Finding Solutions

Occupy movement’s public health messagesSocial factors are related to health:

e.g., housing, income inequityForming policy solutions

e.g., “move your money”, “end corporate personhood”

Transportation

“My feet is weary, but my soul is rested.”

–Mother Pollard, Montgomery Bus

Boycott Participant

Unequal Public Transit Subsidies

Transportation and Health

Transportation

Highway and transit-related air pollution

Vehicle miles traveled and climate changeNoise pollution

Physical activity levels and pedestrian/bicyclist injuries

Health

Access to health-related goods and services (e.g., health care, healthy foods)

Access to employment

• Physical• Mental

Finding Solutions Airport Connector – Urban Habitat

vs. BART regarding civil right laws Measure VV parcel tax to preserve

low cost bus passes for youth, seniors and the disabled passed with the support of 16 local organizations

Effects of Social Inequities

Social Inequities

Body Mind Spirit

Effects of Social Inequities

“When the symbols, rituals, rites of one’s culture lose their legitimacy and power to compel thought and

action, then disruption occurs within cultural orientation and reflects itself as pathology in the psychology of the people belonging to that culture.” (Nobles, et al., 1987)

Not Quite Home: The Psychological Effects of Oppression Ken Hardy’s article “Home isn’t just a place to sleep and

hang your clothes; it is also a state of being, a sense of intrinsically fitting in to the community around you and being welcomed, invited, accepted and free to be complete…Home is the spirit we hope to find in others; an end to being pushed out in the cold because of some difference that is deemed unacceptable.”

Source: http://www.d.umn.edu/sw/cw/documents/NotQuiteHome_000.pdf

Impact of Social Inequities on Well-Being

Psychological homelessness: result of oppression and injustices by racism

Historical legacy of colonization Guilt, anger, self-hate & powerlessness Fear and depression Isolation, break up of families, loss of

identity and destruction of culture

When the External Becomes Internal How Health Inequities Get Inside the Body

Transportation

Housing

Segregation

Increased

commute times

Lack of access to stores, jobs,

services

Crime

Stress

Stress

Stress

Stress

Stress

Stress

Poor air quality

Stress Stres

s

Poor quality

Education

Physical and Mental Health Impacts

Impact on Native American Health

As you think about the video we just saw, what scenes stand out for you?

How do you think this impacts us in accomplishing our mission of “optimal health and well-being of all people?”

Group Discussion Do you recognize aspects of

psychological homelessness from your youth? As an adult?

Which observations have you made that you would consider manifestations of psychological homelessness?

How can we address this condition in ACPHD’s health equity work?

Example organization addressing psychological homelessness

Instituto Familiar de la Raza, Inc. in San Francisco’s Mission District

http://ifrsf.org/blog/about-us/philosophy/

What Is Health Inequity?

Health Disparities

“A difference in rates of illness, disease, or conditions among different populations.”

–UW, Robert Wood Johnson & NACCHO

Health Inequities

Health inequities are “differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.”

–Margaret Whitehead Department of Public Health

University of Liverpool

Place MattersHealth Inequities by Where People Live

Income Matters Health Inequities by Neighborhood Poverty

Source: Alameda County Vital Statistics files and American Community Survey, 2005-09

Race and Racism Matter Health Inequities by Race/Ethnicity

2.3 years5.9 years 7.9 years

Note: White and African American defined regardless of Latino origin. Source: Alameda County Vital Statistics files, 1960-2009

Racial Wealth Divide

Source: Pew Research Center tabulations of 2008 Survey of Income and Program Participation and various U.S. Census Bureau P70 Current Population reports, 2011.

Racial Wealth Divide

Source: Pew Research Center tabulations of 2008 Survey of Income and Program Participation and various U.S. Census Bureau P70 Current Population reports, 2011.

The Truth About the Economy

Moving Forward

Determinants of Health

Disease &

Injury

Risk Factors & Behaviors

Social Inequities

Institutional Power

MortalityDiscriminatory Beliefs (Isms)

Levels of Interventions

Emergency Rooms

ClinicsPatient Educatio

n

Comm. Capacity Building

Policy Advocacy

???

Socio-Ecological (society)

Medical Model (individuals)

ACPHD’s role in addressing a social and health inequitiesWhat is one useful thing that you learned or thought about today?What is one thing that you can collectively do to address social and health inequities?

ACPHD Work Moving Forward

1. Transform our organizational culture and align our daily work to achieve health equity

2. Enhance Public Health communications internally and externally

3. Ensure organizational accountability through measurable outcomes and community involvement

4. Support the development of a productive, creative, and accountable workforce.

5. Advocate for policies that address social conditions impacting health.

6. Cultivate and expand partnerships that are community driven and innovative.

ACPHD Strategic Plan

Resources Life and Death from Unnatural Causes: Health

and Social Inequity in Alameda County: http://www.acphd.org/data-reports/reports-by-topic/social-and-health-equity/life-and-death-from-unnatural-causes.aspx

ACPHD’s Social & Health Equity Web page http://www.acphd.org/social-and-health-equity.aspx

The National Association of County and City Health Officials’ Social Justice page http://www.naccho.org/topics/justice/index.cfm

Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the U.S. www.macses.ucsf.edu/downloads/Reaching_for_a_Healthier_Life.pdf

Resources (cont.) Spirit of 1848 listserv

http://www.spiritof1848.org/listserv.htm

Social Determinants of Health: The Solid Facts. WHO http://www.euro.who.int/document/e81384.pdf

Why Place Matters: Building the Movement for Healthy Communities. PolicyLink. http://www.policylink.org/documents/WhyPlaceMattersreport_web.pdf

Unnatural Causes http://www.unnaturalcauses.org

Occupy Public Health http://occupypublichealth.org

1. Health is more than health care.2. Health is tied to the distribution of resources.3. Racism imposes an added burden.4. The choices we make are shaped by the choices

we have.5. High demand + low control = chronic stress.6. Chronic stress can be deadly.7. Inequality – economic and political – is bad for our

health.8. Social policy is health policy. 9. Health inequities are not natural.10. We all pay the price for poor health.

–Unnatural Causes

10 Things to Know about Health