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When Good Intentions Fail: Why Health Disparities Persist and what you can do about them. David R. Williams, PhD, MPH Florence & Laura Norman Professor of Public Health Professor of African & African American Studies and of Sociology Harvard University.

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When good intentions fail why health disparities persist and what you can do about them

When Good Intentions Fail: Why Health Disparities Persist and what you can do about them

David R. Williams, PhD, MPH

Florence & Laura Norman Professor of Public Health

Professor of African & African American Studies and of Sociology

Harvard University


There is a racial gap in health in early life minority white mortality ratios 2000
There Is a Racial Gap in Health in Early Life:Minority/White Mortality Ratios, 2000


There is a racial gap in health in mid life minority white mortality ratios 2000
There Is a Racial Gap in Health in Mid Life:Minority/White Mortality Ratios, 2000


There is a racial gap in health in late life minority white mortality ratios 2000
There Is a Racial Gap in Health in Late Life:Minority/White Mortality Ratios, 2000


Diabetes death rates 1955 1995
Diabetes Death Rates 1955-1995

Source: Indian Health Service; Trends in Indian Health 1998-99


Life expectancy at birth 1900 2000
Life Expectancy at Birth, 1900-2000

76.1

77.6

71.7

71.9

69.1

69.1

64.1

60.8

47.6

Age

33.0

Year


The persistence of racial disparities
The Persistence of Racial Disparities

  • We have FAILED!

  • In spite of:

  • -- a War on Poverty

  • -- a Civil Rights revolution

  • -- Medicare & Medicaid

  • -- the Hill-Burton Act

  • -- Major advances in medical research & technology

  • We have made little progress in reducing the elevated death rates of blacks and American Indians relative to whites.


Understanding elevated health risks
Understanding Elevated Health Risks

“Has anyone seen the SPIDER that is spinning this complex web of causation?”

Krieger, 1994


Sat scores by income
SAT Scores by Income

Source: (ETS) Mantsios; N=898,596


Ses a key determinant of heath
SES: A Key Determinant of Heath

  • Socioeconomic Status (SES) usually measured by income, education, or occupation influences health in virtually every society.

  • SES is one of the most powerful predictors of health, more powerful than genetics, exposure to carcinogens, and even smoking.

  • The gap in all-cause mortality between high and low SES persons is larger than the gap between smokers and non-smokers.

  • Americans who have not graduated from high school have a death rate two to three times higher than those who have graduated from college.

  • Low SES adults have levels of illness in their 30s and 40s that are not seen in the highest SES group until after the ages of 65-75.




Relative risk of premature death by family income u s
Relative Risk of Premature Death by Family Income (U.S.)

Relative Risk

Family Income in 1980 (adjusted to 1999 dollars)

9-year mortality data from the National Longitudinal Mortality Survey


Added burden of race
Added Burden of Race

  • Race and SES reflect two related but not interchangeable systems of inequality

  • SES accounts for a large part of the racial differences in health

  • BUT, there is an added burden of race, over and above SES that is linked to poor health.


Percent of persons with fair or poor health by race 1995
Percent of persons with Fair or Poor Health by Race, 1995

Poor=Below poverty; Near poor+<2x poverty; Middle Income = >2x poverty but <$50,000+

Source: Parmuk et al. 1998


Percent of Women with Fair or Poor Health by Race and Income, 1995




Why race still matters
Why Race Still Matters

1. All indicators of SES are non-equivalent across race. Compared to whites, blacks receive less income at the same levels of education, have less wealth at the equivalent income levels, and have less purchasing power (at a given level of income) because of higher costs of goods and services.

2. Health is affected not only by current SES but by exposure to social and economic adversity over the life course.

3. Personal experiences of discrimination and institutional racism are added pathogenic factors that can affect the health of minority group members in multiple ways.


Race ethnicity and wealth 2000 median net worth
Race/Ethnicity and Wealth, 2000Median Net Worth

Orzechowski & Sepielli 2003, U.S. Census


Wealth of whites and of minorities per 1 of whites 2000
Wealth of Whites and of Minorities per $1 of Whites, 2000

Source: Orzechowski & Sepielli 2003, U.S. Census


Race and economic hardship 1995
Race and Economic Hardship 1995

African Americans were more likely than whites to experience the following hardships 1:

1. Unable to meet essential expenses

2. Unable to pay full rent on mortgage

3. Unable to pay full utility bill

4. Had utilities shut off

5. Had telephone shut off

6. Evicted from apartment

1 After adjustment for income, education, employment status, transfer payments, home ownership, gender, marital status, children, disability, health insurance and residential mobility.

Bauman 1998; SIPP


Racism potential mechanisms
Racism: Potential Mechanisms

  • Institutional discrimination can restrict economic attainment and thus differences in SES and health.

  • Segregation creates pathogenic residential conditions.

  • Discrimination can lead to reduced access to desirable goods and services.

  • Internalized racism (acceptance of society’s negative beliefs) can adversely affect health.

  • Racism can lead to increased exposure to traditional stressors (e.g. unemployment).

  • Experiences of discrimination may be a neglected psychosocial stressor.


Perceived Discrimination:Experiences of discrimination may be a neglected psychosocial stressor


MLK Quote

“..Discrimination is a hellhound that gnaws at Negroes in every waking moment of their lives declaring that the lie of their inferiority is accepted as the truth in the society dominating them.”

Martin Luther King, Jr. [1967]


Discrimination persists
DiscriminationPersists

  • Pairs of young, well-groomed, well-spoken college men with identical resumes apply for 350 advertised entry-level jobs in Milwaukee, Wisconsin. Two teams were black and two were white. In each team, one said that he had served an 18-month prison sentence for cocaine possession.

  • The study found that it was easier for a white male with a felony conviction to get a job than a black male whose record was clean.

Source: Devan Pager; NYT March 20, 2004


Percent of job applicants receiving a callback
Percent of Job Applicants Receiving a Callback

Source: Devan Pager; NYT March 20, 2004


Every Day Discrimination

  • In your day-to-day life how often do the following things happen to you?

  • You are treated with less courtesy than other people.

  • You are treated with less respect than other people.

  • You receive poorer service than other people at restaurants or stores.

  • People act as if they think you are not smart.

  • People act as if they are afraid of you.

  • People act as if they think you are dishonest.

  • People act as if they’re better than you are.

  • You are called names or insulted.

  • You are threatened or harassed.


Everyday discrimination and subclinical disease
Everyday Discrimination and Subclinical Disease

In the study of Women’s Health Across the Nation (SWAN):

-- Everyday Discrimination was positively related to subclinical carotid artery disease (IMT; intima-media thickness) for black but not white women

-- chronic exposure to discrimination over 5 years was positively related to coronary artery calcification (CAC)

Troxel et al. 2003; Lewis et al. 2006


Arab american birth outcomes
Arab American Birth Outcomes

  • Well-documented increase in discrimination and harassment of Arab Americans after 9/11/2001

  • Arab American women in California had an increased risk of low birthweight and preterm birth in the 6 months after Sept. 11 compared to pre-Sept. 11

  • Other women in California had no change in birth outcome risk pre-and post-September 11

Lauderdale, 2006


Determinants of health in the u s
Determinants of Health in the U.S.

U.S. Surgeon General, 1979


Needed behavioral changes
Needed Behavioral Changes

  • Reducing Smoking

  • Improving Nutrition and Reducing Obesity

  • Increasing Exercise

  • Reducing Alcohol Misuse

  • Improving Sexual Health

  • Improving Mental Health


Reducing Inequalities I

Reducing Negative Health Behaviors?

*Changing health behaviors requires more than just more health information. “Just say No” is not enough.

*Interventions narrowly focused on health behaviors are unlikely to be effective.

*The experience of the last 100 years suggests that interventions on intermediary risk factors will have limited success in reducing social inequalities in health as long as the more fundamental social inequalities themselves remain intact.

House & Williams 2000; Lantz et al. 1998; Lantz et al. 2000


Changes in Smoking Over Time -I

  • Successful interventions require a coordinated and comprehensive approach:

    • The active involvement of professionals and volunteers from many organizations (government, health professional organizations, community agencies and businesses)

    • The use of multiple intervention channels (media, workplaces, schools, churches, medical and health societies)

Warner 2000


Changes in Smoking Over Time -2

  • The use of multiple interventions –

    • Efforts to inform the public about the dangers of cigarette smoking (smoking cessation programs, warning labels on cigarette packs)

    • Economic inducements to avoid tobacco use (excise taxes, differential life insurance rates)

    • Laws and regulations restricting tobacco use (clean indoor air laws, restricting smoking in public places and restricting sales to minors)

  • Even with all of these initiatives, success has been only partial

  • Warner 2000


    Moving upstream

    Moving Upstream

    Effective Policies to reduce inequalities in health must address fundamental non-medical determinants.


    WHY?

    WHY?


    Centrality of the Social Environment

    An individual’s chances of getting sick are largely unrelated to the receipt of medical care

    Where we live, learn, work, play and worship determine our opportunities and chances for being healthy

    Social Policies can make it easier or harder to make healthy choices


    SES and Health Risks

    SES is linked to:

    *Exposures to health enhancing resources

    *Exposures to health damaging factors

    *Exposure to particular stressors

    *Availability of resources to cope with stress

    Health practices (smoking, poor nutrition, drinking, exercise, etc.) are all socially patterned


    Making healthy choices easier
    Making Healthy Choices Easier

    Factors that facilitate opportunities for health:

    • Facilities and Resources in Local Neighborhoods

    • Socioeconomic Resources

    • A Sense of Security and Hope

    • Exposure to Physical, Chemical, & Psychosocial Stressors

    • Psychological, Social & Material Resources to Cope with Stress


    Redefining health policy
    Redefining Health Policy

    Health Policies include policies in all sectors of society that affect opportunities to choose health, including, for example,

    • Housing Policy

    • Employment Policies

    • Community Development Policies

    • Income Support Policies

    • Transportation Policies

    • Environmental Policies


    Policy implications

    Policy Implications

    Since the socio-political environment and SES is a key determinant of health, improving social and economic conditions is critical to improving health and reducing health disparities


    Policy area
    Policy Area

    Place Matters!

    Geographic location determines exposure to risk factors and resources that affect health.


    Racial segregation is
    Racial Segregation Is

    1. …"basic" to understanding racial inequality in America (Myrdal 1944) .

    2. …key to understanding racial inequality (Kenneth Clark, 1965) .

    3. …the "linchpin" of U.S. race relations and the source of the large and growing racial inequality in SES (Kerner Commission, 1968) .

    4. …"one of the most successful political ideologies" of the last century and "the dominant system of racial regulation and control" in the U.S (John Cell, 1982).

    5. …"the key structural factor for the perpetuation of Black poverty in the U.S." and the"missing link" in efforts to understand urban poverty (Massey and Denton, 1993).


    How segregation can affect health
    How Segregation Can Affect Health

    • Segregation determines quality of education and employment opportunities.

    • Segregation can create pathogenic neighborhood and housing conditions.

    • Conditions linked to segregation can constrain the practice of health behaviors and encourage unhealthy ones.

    • Segregation can adversely affect access to high-quality medical care.

    Source: Williams & Collins , 2001


    Segregation: Distinctive for Blacks

    • Blacks are more segregated than any other racial/ethnic group.

    • Segregation is inversely related to income for Latinos and Asians, but is high at all levels of income for blacks.

    • The most affluent blacks (income over $50,000) are more highly segregated than the poorest Latinos and Asians (incomes under $15,000).

    • Thus, middle class blacks live in poorer areas than whites of similar SES and poor whites live in much better neighborhoods than poor blacks.

    • African Americans manifest a higher preference for residing in integrated areas than any other group.

    Source: Massey 2004


    Residential segregation and ses
    Residential Segregation and SES

    A study of the effects of segregation on young African American adults found that the elimination of segregation would erase black-white differences in

    • Earnings

    • High School Graduation Rate

    • Unemployment

      And reduce racial differences in single motherhood by two-thirds

      Cutler, Glaeser & Vigdor, 1997


    Racial differences in residential environment
    Racial Differences in Residential Environment

    • In the 171 largest cities in the U.S., there is not even one city where whites live in ecological equality to blacks in terms of poverty rates or rates of single-parent households.

    • “The worst urban context in which whites reside is considerably better than the average context of black communities.” p.41

    Source: Sampson & Wilson 1995


    Proportion of black latino children in poorer neighborhoods than worst off white children
    Proportion of Black & Latino Children in Poorer Neighborhoods Than Worst Off White Children


    American Apartheid: Neighborhoods Than Worst Off White ChildrenSouth Africa (de jure) in 1991 & U.S. (de facto) in 2000

    Source: Massey 2004; Iceland et al. 2002; Glaeser & Vigitor 2001


    Reducing inequalities ii address underlying determinants of health
    Reducing Inequalities II Neighborhoods Than Worst Off White ChildrenAddress Underlying Determinants of Health

    • Improve conditions of work, re-design workplaces to reduce injuries and job stress

    • Enrich the quality of neighborhood environments and increase economic development in poor areas

    • Improve housing quality and the safety of neighborhood environments


    Neighborhood renewal and health i
    Neighborhood Renewal and Health - I Neighborhoods Than Worst Off White Children

    • A 10-year follow-up study of residents in 5 neighborhood types in Norway found that changes in neighborhood quality were associated with improved health.

    • The neighborhood improvements: a new public school, playground extensions, a new shopping center with restaurants and a cinema, a subway line extension into the neighborhood, a new sports arena & park, and organized sports activities for adolescents.

    • Residents of the area that had experienced these dramatic improvements in its social environment reported improved mental health 10 years later

    • This effect was not explained by selective migration

    Dalgard and Tambs 1997


    Neighborhood renewal and health ii
    Neighborhood Renewal and Health - II Neighborhoods Than Worst Off White Children

    • Neighborhood improvement in a poorly functioning area in England was linked to improved health and social interaction.

    • Improvements: housing was refurbished (made safe & sheltered from strangers), traffic regulations improved, improved lighting & strengthening of windows, enclosed gardens for apartments, closed alleyways, and landscaping. Residents involved in planning process.

    • One year later:

      • Levels of optimism, belief in the future, identification with their neighborhood, trust in other neighbors, and contact between the neighbors had all increased.

      • Symptoms of anxiety and depression had declined.

    Halpern, 1995


    Neighborhood change and health
    Neighborhood Change and Health Neighborhoods Than Worst Off White Children

    • The Moving to Opportunity Program randomized families with children in high poverty neighborhoods to move to less poor neighborhoods.

    • It found, three years later, that there were improvements in the mental health of both parents and sons who moved to the low-poverty neighborhoods.

    Leventhal and Brooks-Gunn, 2003


    Reducing inequalities iii address underlying determinants of health
    Reducing Inequalities III Neighborhoods Than Worst Off White ChildrenAddress Underlying Determinants of Health

    • Improve living standards for poor persons and households

    • Increase access to employment opportunities

    • Increase education and training that provide basic skills for the unskilled and better job ladders for the least skilled

    • Invest in improved educational quality in the early years and reduce educational failure


    Increased income and health
    Increased Income and Health Neighborhoods Than Worst Off White Children

    • A study conducted in the early 1970s found that mothers in the experimental income group who received expanded income support had infants with higher birth weight than that of mothers in the control group.

    • Neither group experienced any experimental manipulation of health services.

    • Improved nutrition, probably a result of the income manipulation, appeared to have been the key intervening factor.

    Kehrer and Wolin, 1979


    Income change and health
    Income Change and Health Neighborhoods Than Worst Off White Children

    • A natural experiment assessed the impact of an income supplement on the mental health of American Indian children.

    • It found that increased family income (because of the opening of a casino) was associated with declining rates of deviant and aggressive behavior.

    Costello et al. 2003


    Economic policy is health policy
    Economic Policy is Health Policy Neighborhoods Than Worst Off White Children

    In the last 50 years, black-white differences in health have narrowed and widened with black-white differences in income


    Changes in mortality rates per 100 000 population age 35 74 between 1968 and 1978 men
    Changes in Mortality Rates per 100,000 Population, Age 35-74, Between 1968 and 1978 (Men)

    Cooper et al., 1981b



    Median family income of blacks per 1 of whites
    Median Family Income of Blacks per $1 of Whites (Women)

    Source: Economic Report of the President, 1998


    Health Status Changes, 1980-1991 (Women)

    Indicator 1980 1991

    • Excess Deaths (Blacks) 59,000 66,000

    • Infant Mortality

      Black/White Ratio, Males 1.9 2.1

      Black/White Ratio, Females 2.0 2.3

    • Life Expectancy

      Black/White Gap, Males 6.9 8.3

      Black/White Gap, Females 5.6 5.8

    Source: NCHS, 1994.



    Policy area1
    Policy Area (Women)

    Reducing Childhood Poverty

    Challenges and Opportunities


    Childhood poverty u s 1996 percent of children under age 18
    Childhood Poverty, U.S., 1996 (Women)Percent of Children Under Age 18

    Source: U.S. Census Bureau (Pamuk et al. 1998)


    Family structure and ses
    Family Structure and SES (Women)

    Compared to children raised by 2 parents those raised by a single parent are more likely to:

    • grow up poor

    • drop out of high school

    • be unemployed in young adulthood

    • not enroll in college

    • have an elevated risk of juvenile delinquency and participation in violent crime.

    McLanahan & Sandefur 1994; Sampson 1987


    Determinants of family structure
    Determinants of Family Structure (Women)

    • Economic marginalization of males (high unemployment & low wage rates) is the central determinant of high rates of female-headed households.

    • Marriage rates are positively related to average male earnings.

    • Marriage rates are inversely related to male unemployment.

    Bishop 1980; Testa et al. 1993; Wilson & Neckerman 1986




    Policy matters

    Policy Matters (Women)

    Investments in early childhood programs in the U.S. have been shown to have decisive beneficial effects


    The high scope perry preschool study to age 40

    The High/Scope Perry Preschool Study to Age 40 (Women)

    Larry Schweinhart

    High/Scope Educational Research Foundation

    www.highscope.org


    High scope perry preschool
    High/Scope Perry Preschool (Women)

    • 123 young African-American children, living in poverty and at risk of school failure.

    • Randomly assigned to initially similar program and no-program groups.

    • 4 teachers with bachelors’ degrees held a daily class of 20-25 three- and four-year-olds and made weekly home visits.

    • Children participated in their own education by planning, doing, and reviewing their own activities.


    Results at age 40
    Results at Age 40 (Women)

    • Those who received the program had better academicperformance (more likely to graduate from high school)

    • Program recipients did better economically (higher employment, annual income, savings & home ownership)

    • The group who received high-quality early education had fewer arrests for violent, property and drug crimes

    • The program was cost effective: A return to society of $17 for every dollar invested in early education

      _____________________________________________________________________

      Schweinhart & Montie, 2005


    Building on resources
    Building on Resources (Women)

    We Need to Better Understand How Resilience Factors and Processes Can Affect Health and how to Build on the Strengths and Capacities of Communities


    Religion & Health: Potential Mechanisms (Women)

    • Religious institutions can provide support, intimacy, a sense of connectedness and belonging

    • Religious beliefs and values can provide systems of meaning to interpret and re-interpret stress

    • Religious beliefs can provide feelings of strength to cope with adversity

    • By encouraging moderation in all things and reducing risk taking behavior, religious involvement can reduce exposure to stress.

    • Religious participation can discourage negative health behaviors (tobacco, alcohol, drugs, risky sexual practices)

    • Religious institutions can generate stress: time demands, role conflicts, social conflicts, criticism


    Religion and adolescent risk behavior
    Religion and Adolescent Risk Behavior (Women)

    • Religious high school seniors are less likely than their non-religious peers to

      • Carry a weapon (gun, knife, club) to school

      • Get into fights or hurt someone

      • Drive after drinking

      • Ride with driver who had been drinking

      • Smoke cigarettes

      • Engage in binge drinking (5 or more drinks in a row)

      • Use marijuana

    • Religious seniors were more likely to

      • Wear seat belts

      • Eat breakfast, green vegetables and fruit

      • Get regular exercise

      • Sleep at least 7 hours per night

    Wallace and Forman 1998; Monitoring the Future Study


    U s life expectancy at age 20 by religious attendance
    U.S. Life Expectancy at Age 20 (Women)by Religious Attendance

    63.5

    63.4

    60.1

    57.9

    60.1

    56.1

    52.4

    46.4

    Age

    Hummer et al. 1999


    Religious services as therapy
    Religious Services as Therapy? (Women)

    • Several aspects of some religious services are distinctive in the provision of opportunities to articulate and manage personal and collective suffering.  

    • The expression of emotion and active congregational participation can promote “collective catharsis” in ways that facilitate the reduction of tension and the release of emotional distress. 

    • There are parallels between all the key elements of formal psychotherapy and the rituals of some religious services.  

    Griffith et al. (1980); Gilkes (1980): Pargament et al. (1983)



    Overall goal
    Overall Goal (Women)

    The RWJF Commission to Build a Healthier America is a national, comprehensive effort to raise awareness about the large socio-economic status (SES) differences in health among Americans and then seek practical, common-ground solutions to improve the health of all.


    Key objectives
    Key Objectives (Women)

    • Increase awareness about the relationships between social factors and health, and how these relationships have produced large inequalities in health among Americans

    • Generate concern and motivate efforts to address the problem of health inequalities based on socioeconomic status and race/ethnicity

    • Foster and inform constructive public discourse about ways to reduce these health inequalities

    • Identify and prioritize the adoption of public and private policies and interventions to reduce social inequalities and thereby improve the health of Americans overall


    Commission infrastructure
    Commission Infrastructure (Women)

    • RWJF Foundation Board and Staff

    • Central Office: George Washington University, Dept. of Health Policy

    • Research Arm: Center on Social Disparities in Health, UCSF

    • Communications Partners:

      • Burness Communications

      • Health 360 Strategies -- a service of Chandler Chicco Agency and Mehlman Vogel Castagnetti, Inc


    Approach
    Approach (Women)

    Raise awareness and identify areas for action by

    • Targeting decision-makers in public and private sector

    • Reaching beyond health care to non-traditional allies and advocates

    • Making academic research on social inequalities more accessible to policy makers

    • Conducting work in a resolutely nonpartisan fashion

    • Designing a plan that is sustainable, flexible and relevant


    Commission activities
    Commission Activities (Women)

    • Commission meetings & Special Events

    • Field Hearings

    • Reports

    • Storybank Development

    • Outreach

    • Website


    Commission meetings field hearings
    Commission Meetings & Field Hearings (Women)

    • Raising awareness across the country

    • Taking the message beyond Capitol Hill to real communities

    • Listening to and learning from real people and communities who face the problem of social inequalities every day

    • Highlighting promising potential solutions


    Commission timeline
    Commission Timeline (Women)

    • Two Year life

    • February/March 2008 launch

    • Ongoing activities in 2008 and 2009

    • Culminating in actionable recommendations that policy makers can embrace


    Report from rwjf to the commission
    Report from RWJF to the Commission (Women)

    • Presents new evidence of health inequalities across income, education, and racial/ethnic groups

    • Estimates economic costs of health inequalities

    • Reviews literature documenting lasting impact of physical and social environments on a child’s health and chances of becoming a healthy adult

    • Examines roles of personal and societal responsibilities for health

    • Offers a framework for seeking solutions



    Summary
    Summary (Women)

    A serious commitment on the part of the RWJ Foundation to:

    • Explore the factors that influence health

    • Raise public awareness of social inequalities in health

    • Provide meaningful recommendations to spur action so that millions of people will have a chance to lead healthier lives



    A 7-part documentary series & public impact campaign (Women)

    www.unnaturalcauses.org

    Produced by California Newsreel with Vital Pictures

    Presented on PBS by the National Minority Consortia of Public Television

    Impact Campaign in association with the Joint Center Health Policy Institute


    Unnatural causes
    Unnatural Causes (Women)

    • Seven-part documentary series on PBS

    • DVD release

    • Companion Web site and other support tools

    • Ambitious Outreach and Public Impact Campaign

      …to help reframe the nation’s debate over health and what we as a society can—and should—do to tackle our health inequities.


    Schedule
    SCHEDULE (Women)

    • PBS broadcast: Begins March 27, 2008

      (check local listings)

    • DVD release (March, 2008)

    • Web site launch: March 15, 2008

      (temporary site now up: www.unnaturalcauses.org)


    Reframing the debate society matters
    REFRAMING THE DEBATE (Women)Society Matters

    • Health depends on more than our meds, our genes or behaviors…

    • Improving the conditions in which weare born, live and work can have aprofound affect on our health and well-being


    The public impact campaign a broad based multi tiered effort
    THE PUBLIC IMPACT CAMPAIGN (Women)A Broad-Based, Multi-Tiered Effort

    • Press Relations

    • Interactive Companion Web Site

    • Educational Dissemination

    • Outreach Screenings, Forums, Briefings & Public Dialogues

      • Public Health

      • Non-health sectors

      • Govt. officials

      • Community-based organizations


    Impact campaign goals reframing the debate
    IMPACT CAMPAIGN GOALS (Women)Reframing the Debate

    • Sound the alarm

    • Help introduce the importance of social policies into discussions of health

    • Inject health consequences into debates over social and economic policies

    • Health inequities are a societal problem (“we”), not a special interest (“they”)

    • Communicate hopeful solutions

    • Build a “new story” connecting individual aspirations for better health to a new language of “social connectedness.”


    Three arenas for use a tool to
    THREE ARENAS FOR USE (Women)A Tool to…

    • Educate

      • Raise awareness of the extent and root causes of health inequities and demonstrate that we as a society can make different policy choices

  • Organize

    • Reach out to and build alliances with other stakeholder groups and connect people to health equity initiatives

  • Advocate

    • Bring mobilized constituencies together to educate public officials and advocate for health equity


  • Screening possibilities
    Screening Possibilities (Women)

    • Staff training / Leadership development

    • Cross-sectoral dialogues and alliances

    • Civic / labor / business organizations

    • Campus-Community Partnerships

    • Community Dialogs / Town-Hall Meetings

    • Conferences and conventions

    • Policy forums, briefings for govt. officials

    • Contact your PBS station outreach director


    Outreach campaign examples
    Outreach Campaign Examples (Women)

    • NACCHO:100 Town-Hall Meetings nationwide

      organized by LPHDs

    • Black Women’s Agenda—18 national organizations mobilizing members around a racial justice framework for infant health

    • ISAIAH / Gamaliel central Minnesota interfaith health justice coalition-80 congregations-Lent kick-off

    • Sonoma County (CA) Board of Supervisors-Health Equity Advisory Committee

    • HPI “Place Matters” teams—winning buy-in for new initiatives in 26 counties


    Campaign support tools
    Campaign Support Tools (Women)

    • Community Action “Tool-Kit”

    • Discussion Guides

    • Handouts, Fact Sheets and Backgrounders

    • Viral Marketing: “Myth-buster” video clips

    • Engagement Tools (e.g. “Health Literacy Quiz,” “Community Stress Test”)

    • “Connect-Up!” Data Base

    • Press Kits

    • Companion Web site: www.unnaturalcauses.org


    Conditions for health
    Conditions for HEALTH (Women)

    H - Housing

    E – Education & Environment

    A - Access

    L - Labor

    T – Transportation

    H – Hope and Happiness


    California newsreel
    CALIFORNIA NEWSREEL (Women)

    500 Third Street, #505

    San Francisco, CA 94103

    415-284-7800

    www.newsreel.org

    www.unnaturalcauses.org

    Rachel Poulain

    Director of Outreach

    [email protected]


    Conclusions i
    Conclusions -I (Women)

    • Health officials and organizations cannot improve health by themselves

    • Improving health and reducing inequalities in health is not just about more health programs, it is about a new path to health

    • All policy that affects health is health policy

    • Health officials need to work collaboratively with other sectors of society to initiate and support social policies that promote health and reduce inequalities and health


    Conclusions ii
    Conclusions -II (Women)

    • Inequalities in health are created by larger inequalities in society.

    • SES and racial/ethnic disparities in health reflect the successful implementation of social policies.

    • Eliminating them requires political will for and a commitment to new strategies to improve living and working conditions.

    • Our great need is to begin in a systematic and comprehensive manner, to use all of the current knowledge that we have.

    • Now is the time


    A call to action
    A Call to Action (Women)

    “The only thing necessary for the triumph [of evil] is for good men to do nothing.”

    Edmund Burke, British Philosopher



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