1. Leah Gregory Epidemiology of Chronic Disease Virginia Commonwealth University Health Equity of Chronic Disease

2. Outline Equality v. Equity Health Equity Understanding Understanding Social Theory Incidence/Prevalence of Health Equity/ Inequality in US Incidence/Prevalence of Health Equity/Inequality Globally Attributes of Health Equity Primary and Community Intervention to Improve Health Equity Research on Health Equity

3. Equality v. Equity v. Reality https://twitter.com/urbandata/status/695261718344290304

4. Health Equity Understanding What is Health Equity? https://www.youtube.com/watch?v=ZPVwgnp3dAc The Center for Health Equity and Social Justice: Shifting the Public Health Paradigm https://www.youtube.com/watch?v=mOxMiugtji U https://www.youtube.com/watch?v=mOxMiugtji U Health Inequality and the Glasgow Effect https://www.youtube.com/watch?v=r0cJ7CX1lCA

5. Social Constructionism Theory theory of knowledge in sociology and communication theory that examines the development of jointly constructed understandings of the world that form the basis for shared assumptions about reality.theory of knowledgesociologycommunication theory The theory centers on the notions that human beings rationalize their experience by creating models of the social world and share and reify these models through language.rationalizesocial world We are affected by how each of us see th eworld and how the world sees us

6. Social Determinants of Health economic and social conditions – and their distribution among the population – that influence individual and group differences in health status. They are health promoting factors found in one's living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual risk factors (such as behavioral risk factors or genetics) that influence the risk for a disease, or vulnerability to disease or injury Income and income distribution Education Unemployment and job security Employment and working conditions Early childhood development Food insecurity

7. Incidence of Health Inequality in the US

8. Incidence of Health Inequality Globally

9. Incidence of Health Equity in the West

10. Attributes of Health Equity

11. Education and Health Equity http://www.cdc.gov/dhdsp/maps/sd_high_school.htm

12. Unemployment and Health Equity http://www.cdc.gov/dhdsp/maps/sd_unemployment.htm

13. Poverty and Health Equity http://www.cdc.gov/dhdsp/maps/sd_poverty.htm

14. Health Access and Health Equity http://www.cdc.gov/dhdsp/maps/sd_insurance.htm

15. Health Access and Race- Figure 1. Percentage of adults aged 18–64 who were uninsured, by race and Hispanic origin: United States, 2013 and 2014 SOURCE: CDC/NCHS, National Health Interview Survey, 2013 and 2014.

16. Figure 2. Percentage of adults aged 18–64 with a usual place to go for medical care, by race and Hispanic origin: United States, 2013 and 2014 SOURCE: CDC/NCHS, National Health Interview Survey, 2013 and 2014.

17. Figure 3. Percentage of adults aged 18–64 that had seen or talked to a health care professional in the past 12 months, by race and Hispanic origin: United States, 2013 and 2014 SOURCE: CDC/NCHS, National Health Interview Survey, 2013 and 2014.

18. Figure 4. Percentage of adults aged 18–64 who did not obtain needed medical care due to cost at some time during the past 12 months, by race and Hispanic origin: United States, 2013 and 2014 SOURCE: CDC/NCHS, National Health Interview Survey, 2013 and 2014.

19. Interventions to Health Equity and Inequality

20. Primary Intervention-Medicaid Expansion

26. Community Intervention Mobile Good Foods Market (Toronto, ON) Metro Buses Converted Into Mobile Food Markets For Low Income Neighborhoods Former bus turned mobile food market in Toronto, Canada

27. Shalom Farms-Richmond, VA Our 6-acre sustainable farm at Westview on the James in Goochland, Virginia is an agricultural learning lab for visitors and volunteers of all backgrounds. Our partners use Shalom Farms produce in food pantries, pop-up markets, meal programs, and educational activities.

28. VCU Medical Center Health Safety Net Maintain an “open door” Provide a significant proportion of the preventive, acute and chronic health care services delivered to uninsured, Medicaid and other vulnerable populations in their region Virginia’s Indigent Care Program-Eligibility criteria: -Reside in the Commonwealth -U.S. Citizen -At or below 200% FPL -Meet asset test criteria

29. VCU Medical Center Health Safety Net Richmond Urban Primary Care Initiative- Integrated public health and primary care in one clinic site Women’s and Children’s Services Family Medicine Screening and Treatment for STD’s Arthur Ashe HIV/AIDS Early Intervention Program Case Management Services WIC Lab Pharmacy Financial Counseling https://www.google.com/search?q=Richmond+Urban+Primary+Care+Initiative- &espv=2&biw=1920&bih=911&source=lnms&tbm=isch&sa=X&ved=0ahUKEwinx7yb7afMAhWJ2D4KHZS0DW0Q_AUICCgD#tbm=isch&q=Richmond+health&i mgrc=ySA_xm7EoqE7gM%3A

30. VCU Medical Center Health Safety Net Hayes E. Willis Health Center In 1996, the Center was renamed for its Medical Director, Dr. Hayes Willis Major provider of primary care in South Richmond Annually serves over 4,000 patients https://www.google.com/search?q=Richmond+Urban+Primary+Care+Initiative- &espv=2&biw=1920&bih=911&source=lnms&tbm=isch&sa=X&ved=0ahUKEwinx7yb7afMAhWJ2D4KHZS0DW0Q_AUICCgD#tbm=isch&q=hayes+e+willis+clinic+ric hmond&imgrc=P-8MQH9mYS0s5M%3A

31. VCU Medical Center Health Safety Net Virginia Coordinated Care Program- Recognized as a model for managing care for uninsured patients Provides “medical homes” to patients who qualify for the VCU Health System’s Indigent Care program Partners with 50 community-based physicians to improve access to care https://www.google.com/search?q=Richmond+Urban+Primary+Care+Initiative- &espv=2&biw=1920&bih=911&source=lnms&tbm=isch&sa=X&ved=0ahUKEwinx7yb7afMAhWJ2D4KHZS0DW0Q_AUICCgD#tbm=isch&q=virginia+coordinated+care+pro gram&imgrc=jsjQhgvxXCcImM%3A

32. Research on Health Equity

33. http://www.commed.vcu.edu/Chronic_Disease/ Equity/2015/Denial.pdf Discussion, Thoughts, Questions Getting Past Denial: The High Cost of Health Care in the United States

34. http://www.richmond.com/entertainment- life/health/where-you-live-determines-how-long- you-live/article_2cc6b9b5-b2cb-5d45-838a- 6765c30bc20b.html Where you live determines how long you live…

35. The Future of Japan’s Health System — Sustaining Good Health with Equity at Low Cost https://www.google.com/search?q=health+equity+in+japan&espv=2&biw=1920&bih=911&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjyvIvI 66fMAhVproMKHbbvBTgQ_AUIBygC&dpr=1#tbm=isch&q=japan+health+system&imgrc=Dg4LdAfWK0co6M%3A

36. The Future of Japan’s Health System — Sustaining Good Health with Equity at Low Cost https://www.google.com/search?q=health+equity+in+japan&espv=2&biw=1920&bih=911&source=lnms&tbm=is ch&sa=X&ved=0ahUKEwjyvIvI66fMAhVproMKHbbvBTgQ_AUIBygC&dpr=1#tbm=isch&q=japan+health+system &imgrc=7KnSblVvW38x1M%3A

37. Questions?

38. http://www.tikkun.org/nextgen/health-care-versus-wealth-care-investors-with-a- conscience-should-divest-from-health-insurance-companies