1. Reducing Health Disparities through Prevention Frameworks, Successes, and Strategies www.preventioninstitute.org Jeremy Cantor, MPH Program Manager March 7, 2007 The California Partnership for Access to Treatment Sacramento, CA

2. Carolyn Porco, of the Space Science Institute, discussing a moon of Saturn. New York Times, 3/10/2006 “We have found an environment that is potentially suitable for living organisms.”

3. Is this a suitable environment?

4. African Americans are four times more likely to die of asthma. American Indians and Alaska Natives are 2.6 times more likely to have diabetes. The percentage of Hispanic children living below the poverty line is three times that of white children. African American children are five times more likely to be poisoned by lead. High School Graduation rates: 53% Hispanic, 51% Native American, 50% African American A Sample of Disparities

5. ROOT FACTORS DISPARITIES IN HEALTH The Trajectory of Health Disparities

6. DISPARITIES IN HEALTH ROOT FACTORS ENVIRONMENTALFACTORS & BEHAVIORAL The Trajectory of Health Disparities

7. HEALTH BEHAVIOR BEHAVIOR ENVIRONMENT

8. DISPARITIES IN HEALTH DISPARITIES IN HEALTH ROOT FACTORS ENVIRONMENTALFACTORS & BEHAVIORAL MEDICALSERVICES The Trajectory of Health Disparities

10.  Not the primary determinant of health  Treats one person at a time  Often comes late; can’t always restore health Medical Care Alone Cannot Reduce Disparities

11. No epidemic has ever been resolved by paying attention to the treatment of the affected individual. George W. Albee “ ”

12. A Key Opportunity for Prevention DISPARITIES IN HEALTH DISPARITIES IN HEALTH ROOT FACTORS ENVIRONMENTALFACTORS & BEHAVIORAL MEDICALSERVICES The Trajectory of Health Disparities

13. HEALTH BEHAVIOR BEHAVIOR ENVIRONMENT

14. HEALTH BEHAVIOR BEHAVIOR

15. Is it just behavior?

16. 9

18. It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change. “ ” Institute of Medicine

19. What’s wrong with this picture?

24. Causes of Death Heart Disease Cancer Stroke Diabetes Injuries & Violence

25. The same injuries and illnesses only more so

26. Let’s take a step back... Causes of Death Actual Causes of Death

27. Heart Disease Cancer Stroke Diabetes Injuries & Violence & Violence Diet & Activity Patterns Tobacco Alcohol & Drugs Making Links to Actual Causes of Death

28. Community Factors Actual Causes Let’s take another step back...

29. Elements of Community Health People Place EquitableOpportunity

30. People PlaceEquitableOpportunity Community Health Factors EQUITABLEOPPORTUNITY  Racial justice  Jobs & local ownership  Education

32. People PlaceEquitableOpportunity Community Health Factors PEOPLE  Social Networks & trust  Participation & willingness to act for the common good  Acceptable behaviors & attitudes

34. People PlaceEquitableOpportunity Community Health Factors PLACE  Look, feel & safety  Parks & open space  Getting around  Housing  What’s sold and how it’s promoted  Air, water, soil  Arts & culture

35. What’s Sold and Promoted VS. IndustryLow-WealthHigh-Wealth Group Neighborhood Neighborhood Bars/Taverns 727 2624 3511 Supermarkets Carry-out eating places

36.  Social Networks & trust  Participation & willingness to act for the common good  Acceptable behaviors & attitudes  Racial justice  Jobs & local ownership  Education  What’s sold & how it’s promoted  Look, feel & safety  Parks & open space  Getting around  Housing  Air, water, soil  Arts & culture Elements of Community Health THE PEOPLE THE PLACE EQUITABLE OPPORTUNITY

37. Build on Our Success (what’s right with this picture)

40.  A local coalition established a rubberized jogging path around the cemetery  More than 1,000 people a day use the new path  Nearness to walking paths appears to have a significant impact on physical activity for adults. Improved Opportunities for Walking and Jogging Boyle Heights, California

41. “Small things like the jogging path make a huge difference in how community residents see themselves and the community.” Community Advocate Improved Opportunities for Walking and Jogging Boyle Heights, California

43.  Child Restraint and Safety Belt Use  Smoking Prevention  Minimum Drinking Age Laws  Childhood Vaccinations  Motorcycle and Bicycle Helmet Laws  Reduced Lead Levels in Children

44. NORMS sanction behavior attitudes, beliefs, ways of being based in culture & tradition taken for granted more than a habit behavior shapers communicate regularity in behavior

45. Source: www.sfgov.org Changing Norms Toward a Community Solution

46. Norms Do Change

47. Necessary Strategies Reducing Disparities through Prevention

48. Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education Strengthening Individual Knowledge & Skills The Spectrum of Prevention

49. Working Across the Spectrum  Shut down 200 liquor stores in 3 years  An average 27% reduction in crime within a four-block radius of each closed liquor outlet South L.A., California

50. A good solution solves multipleproblems. Prevention Institute

51. A Good Solution Fruit and vegetable consumption increases for each supermarket in a census tract (Morland, et al, 2002) Upper Falls Community: Rochester, New York

52. “If we do not change direction, we are likely to end up where we are headed.” Chinese Proverb

53. www.preventioninstitute.org