Envisioning Health Equity

Slides:



Advertisements
Similar presentations
Just how important are the 2000 Days before your child reaches Kindergarten? Early Literacy and Language Development.
Advertisements

Overcoming Indigenous Disadvantage in Australia Gary Banks Chairman, Productivity Commission OECD WORLD FORUM Statistics, Knowledge and Policy Measuring.
1 When DAP Meets GAP Promoting Peaceful Coexistence between Developmentally Appropriate Practice & the Need to Address the Achievement Gap International.
1 The SEP Gradient, Race, or the SEP Gradient and Race: Understanding Disparities in Child Health and Functioning Lisa Dubay, PhD, ScM The Urban Institute.
National Black Family Promotions Coalition: Methodological Approach Carolyn M. Springer, Ph.D. September 23, 2005.
State of Black Family Maternal and Child Health and Focus Group Results Carolyn M. Springer, Ph.D. Research funded by the MCH Bureau, HRSA Grant #: G97MC04454.
One Science = Early Childhood Pathway for Healthy Child Development Sentinel Outcomes ALL CHILDREN ARE BORN HEALTHY measured by: rate of infant mortality.
WHAT IS HEALTH PROMOTION?
Measuring and Eliminating Racism and Racial Disparities in MCH: The Need for New Paradigms James W. Collins, Jr. 12/10/08.
Life Course Theory Patricia J. Settle, MS RD
Life Course Model as an Organizational Framework
Healthy North Carolina 2020 Objective: Maternal and Infant Health
Social Change in Western Australia
PERINATAL HEALTH RESEARCH Michael C. Lu, MD, MPH UCLA Schools of Medicine & Public Health Panel on “The Future Research Agenda for MCH” 2004 APHA Annual.
5 by 5: Growing Healthy Learners An early childhood system of care designed to prepare vulnerable children for success in school and in life. Sylvia Echols.
Diverse Children: Race, Ethnicity, and Immigration in America’s New Non-Majority Generation by Donald J. Hernandez, Ph.D. Hunter College, City University.
Improving Health and Wellness Across the Life Span: Life Course Theory 101 Bright Futures Family Network Meeting 2012.
Children, Families and Poverty Ross A. Thompson, Ph.D. Department of Psychology.
Zeneyda Alfaro, Project Director x 107 Funded by the NJ Department of Health (NJ DOH)
The Life Course Approach
Child Health Disparities Denice Cora-Bramble, MD, MBA Professor of Pediatrics, George Washington University Executive Director Goldberg Center for Community.
The Link Between Childhood Adversity and Adult Health Risk Trajectories Andrea Willson Kim Shuey The University of Western Ontario.
Why Are We Unhealthy? Adrian Dominguez Bob Lutz.
Succeeding in the first 1000 days EARLY IS GOOD, EARLIER IS BETTER.
Health Equity 101 An Introduction to Health Equity June 26, 2013.
Reducing Child Welfare Involvement: The Promise and Limitations of Early Intervention Deborah Daro.
Chapter Objectives Define maternal, infant, and child health.
The Early Childhood Roots of Adult Health: Closing the Gap Between What We Know and What We Do JACK P. SHONKOFF, M.D. JULIUS B. RICHMOND FAMRI PROFESSOR.
FROM THEORY TO COMMUNITY PRACTICE The Life Course Approach Carol Brady, MA Executive Director Northeast Florida Healthy Start Coalition, Inc. Every Woman.
Dina C. Castro, M.P.H., Ph.D. Scientist, FPG Child Development Institute, University of North Carolina at Chapel Hill 15 th Annual Summer Public Health.
Social Determinants of Health Amy Burdette Associate Professor Department of Sociology and Public Health Program Florida State University.
Alameda County Food to Families BBC Meeting May 25,
The Health of Homeless Children David S. Buck, MD, MPH President & Founder, Healthcare for the Homeless-Houston Associate Professor, Baylor College of.
Stress, Resiliency, and Health Equity.  Present materials on the development and translation of a racial and gendered stress measure as the foundation.
Welcome to the 1 st Annual Summer Early Childhood Public Policy Institute!
Improving outcomes for children and young people: a Public Health perspective Sally Hogg Assistant Director of Public Health Suffolk County Council.
Jeffrey R. Backstrand, Ph.D. Chair, Department of Urban Public Administration Rutgers School of Public Health Associate Research Professor Rutgers School.
The Social Determinants of Health and Social Justice Elizabeth McGibbon, PhD, RN, Associate Professor St. Francis Xavier University Presentation for StFX.
Righting the Wrong of Social Injustice in Health The Health-Wealth Connection Symposium June 23, 2010 Maxine Hayes, MD, MPH Washington State Department.
Reducing disparities in perinatal outcomes: looking upstream May 8, 2006 Paula Braveman, MD, MPH Professor of Family & Community Medicine Director, Center.
National Head Start Association Leadership Institute January 29, 2009 Presentation by Joan Lombardi, Ph.D. Early Childhood Development: At the dawn of.
Early Childhood Adversity
1 Community Health What is it? Why should I care?.
Coming Together for Young Children and Families.  What we know  Where we have been  Where we are today  Where we need to go.
A NEW APPROACH TO MCH The Life Course Framework for the Early Childhood Systems Initiative.
DCFS School Readiness Planning Initiative Insure that all young children in the system start school ready to learn –Physically –Socially –Emotionally.
The Link Between Thriving Children and Economic Security: Creating Equity in Early Childhood for Our Common Good.
The Life Course Perspective: CuttingEdge Science for Urban MCH Michael C. Lu, MD, MPH Assistant Professor Department of Obstetrics & Gynecology David Geffen.
1 CHILD HEALTH RESEARCH Bernard Guyer Ling Shi Johns Hopkins Bloomberg School of Public Health Panel on “The Future Research Agenda for MCH” 2004 APHA.
Community Strategies to Improve Health March 16, 2006 Rebecca Flournoy, MPH.
Purpose of Health Inequity Report
Health Disparities in Contra Costa County July 2009.
MICHIGAN'S INFANT MORTALITY REDUCTION PLAN Family Impact Seminar December 10, 2013 Melanie Brim Senior Deputy Director Public Health Administration Michigan.
Padmini Parthasarathy, MPH Cheri Pies, MSW, DrPH Family, Maternal and Child Health Programs, Contra Costa Health Services Applying the Life Course Perspective.
Amy Fine Center for the Study of Social Policy
Healthy Start Coalition of Jefferson, Madison & Taylor Counties, Inc. State of the Infant Madison County 2014.
Family, Friend and Neighbor Care: An Opportunity Ruth W. Mayden The Annie E. Casey Foundation December 2,
State of the Child: Madison County Developed and Presented by Cecilia Freer, MPA Freer Consulting April 25, Freer Consulting.
Promoting Health Equity in the National Strategy on Infant Mortality.
Copyright © 2008 Delmar. All rights reserved. Chapter 25 Minority and Ethnic Populations.
Race and Child Welfare: Exits from the Child Welfare System Brenda Jones Harden, Ph.D. University of Maryland College Park Research Synthesis on Child.
Early Childhood Advisory Council and Early Brain & Child Development Meeting Name Presenter Name Date 1.
Social determinants. Determinants of health The range of social, economic and environmental factors which determine the health status of individuals or.
Defining and measuring disparities, inequities, and inequalities in the Healthy People initiative Richard Klein MPH, David Huang, Ph.D. National Center.
Rationale for building resilience Health inequalities are caused by ‘differences in poverty, power and resources needed for health’ (Due North, 2014).
II Inter-American Symposium: Policies and Strategies for the Child’s Successful Transition to Socialization and School Valparaiso, Chile May 27-29, 2009.
Rethinking MCH: Life Course “Cliff Notes”
Winona State University; Winona, MN, USA
Target Population & PICO Question Target Population: Newborns with a birth weight lower than 5.5lbs PICO Question: What interventions can be implemented.
Presentation on behalf of SACSoWACH
Presentation transcript:

Envisioning Health Equity Peter A. Gorski, M.D., M.P.A. Children’s Board of Hillsborough County and University of South Florida

Social Determinants of Health and Wealth Your neighborhood Physical, social, economic, educational qualities Your skin color Race, ethnicity Who’s your daddy Parents’ education, income, health, social capital

Poverty Sickens Strong connections between child health and adult health Between child wealth and adult wealth Between child wealth and adult health Regardless of child’s health condition Regardless if social class changes from childhood to adulthood Childhood poverty gets biologically embedded

Epigenetics Life Course Perspective Balance of stresses and supports across life course exert cumulative influence on health Especially during sensitive periods of development, powerful experience gets embedded into our biology Reforming DNA structure, gene expression and brain chemistry Consequences to BMI, blood pressure, immune function, memory, learning, attention and mental health

Racial and Ethnic Disparities in Birth Outcomes: A Life Course Perspective This may be particularly important for MCH, where one developmental stage often gets disconnected from another. In perinatal health, we focus so much on events occurring in the 9 months of pregnancy we forget that there are a great deal of life course influences on perinatal outcomes, and a great deal of perinatal influences on life course outcomes. For example, in explaining the Black-White gap in infant mortality, for decades we searched for maternal risk factors during pregnancy rather than looking at the mothers’ cumulative life course experiences. The danger of focusing solely on risk factors during pregnancy is not only that it doesn’t adequately explain the disparities, but more importantly it can misguide public health interventions and policies. For two decades we thought if we could get women universal access to good quality prenatal care, then we can do something about reducing infant mortality and racial disparities in this country. Many of us recognize now that to expect prenatal care, in less than nine months, to reverse all the cumulative disadvantages and inequities over the life course of the woman, may be expecting too much of prenatal care. If we as are serious as a nation about improving birth outcomes and reducing disparities, we have to start taking care of women not only during pregnancy, but before pregnancy and between pregnancies and indeed, across the entire life course of women and families. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal Child Health J. 2003;7:13-30.

School Readiness Trajectories Strategies to Improve School Readiness Trajectories Poverty Lack of health services Toxic Stress Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Ready to learn Pre-school “Healthy” Trajectory Health Services Appropriate Discipline Reading to child “At Risk” Trajectory Parent education Emotional Health Literacy “Delayed/Disordered ” Trajectory Birth Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool

Race is Not a Proxy for Poverty or Wealth

Beyond (or Underneath) SES African American infant mortality higher in more segregated cities even when controlling for SES

SES? – Ask the Professionals 10.2 6.8 And that African American women with more than 16 years of schooling still have higher infant mortality than White women with less than nine years of schooling. Think about this. These are African American women who have graduated from college, and gone on to graduate schools, medical schools, law schools, business schools to get their MD’s and JD’s, and MBA’s. We are talking about African American doctors and lawyers and business executives. And they still have higher infant mortality than White women who never went to high school in the first place. NCHS 2002

SES? – Ask the Africans Birth weight distribution of African-born blacks is more closely related to US-born whites than to US-born blacks David RJ, Collins JW. Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. N Engl J Med. 1997 Oct 23;337(17):1209-14.

Pathogenesis (and Salutogenesis): Complex Interaction between Biology and Environment This explains why many, if not all, of the chief public health killers have common root causes. Degradation of personal dignity, social justice and community I can only be as healthy as my neighbors

Enhancing Public Health – A Provocative Perspective Single disease prevention approach rarely works Treating symptoms rather than root causes Since inequities are at root of health disparities, we must work for the equitable distribution of conditions that promote health and healthy development – Social, educational, economic and environmental capital healthcare

Even More Provocative Compensatory or Disparities Model (Affirmative Health Action) flawed See next slide Equity Framework Health is a human right Every human being has intrinsic worth. Policies should be directed to what every person needs and deserves to thrive and contribute

Why Target Whole Communities? Health and well-being of each person depends on condition of all (see next slide) Cannot predict individual course based on group risk factors Cost burden of case-finding and treatment too high Moral weakness of accepting unequal outcomes

Post-neonatal Infant Mortality (per 100,000 live births,1986) Wilkinson RG. Income distribution and life expectancy. BMJ. 1992;304:165-168.

My Vision-Dream for the Health Equity Coalition Expand public understanding of health equity framework Forge strategic partnerships across the county’s public and private sectors – every decision impacts health Document and demonstrate the correlation and causal association between social, economic, educational, environmental and healthcare equity and population health outcomes Advocate for policies and practices that promote and create advantage for all citizens