1. Using “socially assigned race” to probe White advantages in health status

2. Camara Phyllis Jones, MD, MPH, PhD Benedict I. Truman, MD, MPH Laurie D. Elam-Evans, PhD, MPH Camille A. Jones, MD, MPH Clara Y. Jones, MD, MPH Ruth Jiles, PhD Susan F. Rumisha, MSc Geraldine S. Perry, DrPH

3. What is racism? Source: Jones CP, Phylon 2003

4. What is racism? A system Source: Jones CP, Phylon 2003

5. A system of structuring opportunity and assigning value What is racism? Source: Jones CP, Phylon 2003

6. A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”) What is racism? Source: Jones CP, Phylon 2003

7. A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”)  Unfairly disadvantages some individuals and communities What is racism? Source: Jones CP, Phylon 2003

8. A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”)  Unfairly disadvantages some individuals and communities  Unfairly advantages other individuals and communities What is racism? Source: Jones CP, Phylon 2003

9. A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”)  Unfairly disadvantages some individuals and communities  Unfairly advantages other individuals and communities  Saps the strength of the whole society through the waste of human resources What is racism? Source: Jones CP, Phylon 2003

10. “Reactions to Race” module Six-question optional module on the Behavioral Risk Factor Surveillance System Piloted by six states in 2002 Now available to all states Camara Phyllis Jones, MD, MPH, PhD

11. Arkansas2004 California2002 Colorado2004 Delaware200220042005 District of Columbia2004 Florida2002 Michigan2006 Mississippi2004 New Hampshire2002 New Mexico2002 North Carolina2002 Ohio20032005 Rhode Island20042007 South Carolina20032004 Washington2004 Wisconsin200420052006 States using “Reactions to Race” Camara Phyllis Jones, MD, MPH, PhD

12. Arkansas, Colorado, Delaware, District of Columbia, Mississippi, Rhode Island, South Carolina, Wisconsin States using “Reactions to Race” module on 2004 BRFSS Camara Phyllis Jones, MD, MPH, PhD

13. Socially-assigned “race” How do other people usually classify you in this country? Would you say:  White  Black or African-American  Hispanic or Latino  Asian  Native Hawaiian or Other Pacific Islander  American Indian or Alaska Native  Some other group Camara Phyllis Jones, MD, MPH, PhD

14. General health status Would you say that in general your health is:  Excellent  Very good  Good  Fair  Poor Camara Phyllis Jones, MD, MPH, PhD

18. General health status and “race” “White” social experience associated with better health Camara Phyllis Jones, MD, MPH, PhD

19. Self-identified ethnicity Are you Hispanic or Latino?  Yes  No Camara Phyllis Jones, MD, MPH, PhD

20. Self-identified “race” Which one or more of the following would you say is your race?  White  Black or African-American  Asian  Native Hawaiian or Other Pacific Islander  American Indian or Alaska Native  Other Which one of these groups would you say best represents your race? Camara Phyllis Jones, MD, MPH, PhD

21. Self-identified “race”/ethnicity Hispanic  “Yes” to Hispanic/Latino ethnicity question  Any response to race question White  “No” to Hispanic/Latino ethnicity question  Only one response to race question, “White” Black  “No” to Hispanic/Latino ethnicity question  Only one response to race question, “Black” American Indian/Alaska Native  “No” to Hispanic/Latino ethnicity question  Only one response to race question, “AI/AN” Camara Phyllis Jones, MD, MPH, PhD

22. WhiteBlackHispanicAIAN... White 26,373 98.4 0.1 0.3 0.1 1.1 Black 5,246 0.595.3 0.9 0.3 3.0 How self-identify Two measures of “race” How usually classified by others Camara Phyllis Jones, MD, MPH, PhD

23. WhiteBlackHispanicAIAN... White 26,373 98.4 0.1 0.3 0.1 1.1 Black 5,246 0.595.3 0.9 0.3 3.0 Hispanic 1,528 26.4 4.761.3 1.0 6.6 How self-identify Two measures of “race” How usually classified by others Camara Phyllis Jones, MD, MPH, PhD

24. WhiteBlackHispanicAIAN... White 26,373 98.4 0.1 0.3 0.1 1.1 Black 5,246 0.595.3 0.9 0.3 3.0 Hispanic 1,528 26.4 4.761.3 1.0 6.6 How self-identify Two measures of “race” How usually classified by others Camara Phyllis Jones, MD, MPH, PhD

25. 0 20 40 60 80 100 39.8 53.7 58.6 percent of respondents Report excellent or very good health Hispanic-HispanicHispanic-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004 Camara Phyllis Jones, MD, MPH, PhD

26. 0 20 40 60 80 100 39.8 58.6 percent of respondents Report excellent or very good health Hispanic-HispanicWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus White-White p < 0.0001 Camara Phyllis Jones, MD, MPH, PhD

27. 0 20 40 60 80 100 39.8 53.7 percent of respondents Report excellent or very good health Hispanic-HispanicHispanic-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health Hispanic-Hispanic versus Hispanic-White p = 0.0019 Camara Phyllis Jones, MD, MPH, PhD

28. 0 20 40 60 80 100 53.7 58.6 percent of respondents Report excellent or very good health Hispanic-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health Hispanic-White versus White-White p = 0.1895 Camara Phyllis Jones, MD, MPH, PhD

29. WhiteBlackHispanicAIAN... White 26,373 98.4 0.1 0.3 0.1 1.1 Black 5,246 0.595.3 0.9 0.3 3.0 Hispanic 1,528 26.4 4.761.3 1.0 6.6 AIAN 321 45.5 6.9 6.533.6 7.5 How self-identify Two measures of “race” How usually classified by others Camara Phyllis Jones, MD, MPH, PhD

30. WhiteBlackHispanicAIAN... White 26,373 98.4 0.1 0.3 0.1 1.1 Black 5,246 0.595.3 0.9 0.3 3.0 Hispanic 1,528 26.4 4.761.3 1.0 6.6 AIAN 321 45.5 6.9 6.533.6 7.5 How self-identify Two measures of “race” How usually classified by others Camara Phyllis Jones, MD, MPH, PhD

31. 0 20 40 60 80 100 32 52.6 58.6 percent of respondents Report excellent or very good health AIAN-AIANAIAN-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004 Camara Phyllis Jones, MD, MPH, PhD

32. 0 20 40 60 80 100 32 58.6 percent of respondents Report excellent or very good health AIAN-AIANWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health AIAN-AIAN versus White-White p < 0.0001 Camara Phyllis Jones, MD, MPH, PhD

33. 0 20 40 60 80 100 32 52.6 percent of respondents Report excellent or very good health AIAN-AIANAIAN-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health AIAN-AIAN versus AIAN-White p = 0.0122 Camara Phyllis Jones, MD, MPH, PhD

34. 0 20 40 60 80 100 52.6 58.6 percent of respondents Report excellent or very good health AIAN-WhiteWhite-White General health status, by self-identified and socially-assigned "race", 2004 Test of H 0 : No difference in proportions reporting excellent or very good health AIAN-White versus White-White p = 0.3070 Camara Phyllis Jones, MD, MPH, PhD

35. General health status and “race” “White” social experience associated with better health  Even within the same self-identified “race”/ethnic group Camara Phyllis Jones, MD, MPH, PhD

40. General health status and “race” “White” social experience associated with better health  Even within the same self-identified “race”/ethnic group  Even within the same educational level Camara Phyllis Jones, MD, MPH, PhD

45. General health status and “race” “White” social experience associated with better health  Even within the same self-identified “race”/ethnic group  Even within the same educational level “White” social experience associated with higher education Camara Phyllis Jones, MD, MPH, PhD

46. Key questions WHY is socially-assigned “race” associated with self-reported general health status?  Even within the same self-identified “race”/ethnic group  Even within the same educational level WHY is socially-assigned “race” associated with educational level? Camara Phyllis Jones, MD, MPH, PhD

47. A system of structuring opportunity and assigning value based on the social interpretation of how one looks (“race”)  Unfairly disadvantages some individuals and communities  Unfairly advantages other individuals and communities  Saps the strength of the whole society through the waste of human resources Racism Source: Jones CP, Phylon 2003

48. Our tasks Name racism Ask, “How is racism operating here?” Organize and strategize to act Camara Phyllis Jones, MD, MPH, PhD

49. 4770 Buford Highway NE Mailstop K-67 Atlanta, Georgia 30341 (770) 488-5268 phone (770) 488-5965 fax cdj9@cdc.gov

51. Social Determinants of Health Social Determinants of Equity and Camara Phyllis Jones, MD, MPH, PhD

52. Levels of health intervention Camara Phyllis Jones, MD, MPH, PhD

65. Medical care and tertiary prevention Safety net programs and secondary prevention Primary preventionAddressing the social determinants of health Camara Phyllis Jones, MD, MPH, PhD

66. But how do disparities arise? Differences in the quality of care received within the health care system Differences in access to health care, including preventive and curative services Differences in life opportunities, exposures, and stresses that result in differences in underlying health status Camara Phyllis Jones, MD, MPH, PhD

74. Differences in access to care Differences in exposures and opportunities Differences in quality of care (ambulance slow or goes the wrong way) Camara Phyllis Jones, MD, MPH, PhD

75. Addressing the social determinants of equity: Why are there differences in resources along the cliff face? Why are there differences in who is found at different parts of the cliff? Camara Phyllis Jones, MD, MPH, PhD

76. Health services Our goal: To move the conversation Camara Phyllis Jones, MD, MPH, PhD

77. Health services Social determinants of health Our goal: To move the conversation Camara Phyllis Jones, MD, MPH, PhD

78. Health services Social determinants of health Social determinants of equity Our goal: To move the conversation Jones CP. Expanding the “Fence or Ambulance” Debate: Addressing the Social Determinants of Health and Equity. Under review, 2008.

79. Camara Phyllis Jones, MD, MPH, PhD 4770 Buford Highway NE Mailstop K-67 Atlanta, Georgia 30341 (770) 488-5268 phone (770) 488-5965 fax cdj9@cdc.gov