Righting the Wrong of Social Injustice in Health NAACP Annual Fall Conference Affirming America’s Promise October 22, 2011 Maxine 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, nd 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,

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. 3

Inequities result in disparities in health status that are “unfair, unjust, avoidable and unnecessary.” 4

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. 5

Health Olympics 6

Not everyone has equal opportunity for health 7

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,

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 factors Source: Defining equity in health. J Epidemiol Community Health 2003, 57:

The Health-Wealth Relationship is Real! Higher income = longer life Low income = worse health Less education = worse health Lower income = more chronic disease 10

We Know What Determines Health National Institutes of Health 2000 Institute of Medicine 2001 National Research Council 2001 Institute of Medicine

12 EnvironmentalRisk Stress due To Social Factors Institutionalized Biases (racism, sexism, etc.) Language and Other Cultural Factors EconomicOpportunity and Equity EducationBackgroundandOpportunity Mental Health and Social Support Access to Health Services Health Behaviors and Personal Risk Factors Trust in Health System and Research SOCIAL DETERMINANTS OF HEALTH

Determinants of Health LIFESPANLIFESPAN Multiple levels of influence HEALTH Access to Health Care – 10% Environment – 20% Genetics – 20% Healthy Behaviors – 50% 13

14 HealthBehaviors Environment GeneticMakeup HealthCare 51% 22% 17% 10% 0%20%40%60%80%100% Source: McGinnis, et. al, 2002 What Influences Our Health?

How We Spend Our Money 15

TM 16

Tertiary Medical Care Secondary Medical 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 Care 90% Attributed to Population-Based Approaches Adapted from J. Michael McGinnis, MD 17

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

Inequalities Start Early Stress in early life affects physical growth, emotional, social and cognitive development as well as later health and health behaviors. 19

Birth/Adolescence/Work/Elderly ChildhoodYoung AdultCareer Parental Socioeconomic EducationalOccupationRetirement Resources Attainment& IncomeIncome HealthHealthHealthHealth 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. 21

Health Equity in ALL Policies! 22

Timing is Everything! 23

“We must all have the audacity to believe we can transform the current system” Maxine Hayes, MD, MPH 24