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Health Equity
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  1. EPID 691 Spring 2012 Health Equity

  2. In a perfect world… • Health Equity • Attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. • U.S. DHHS, Office of Minority Health, 2010 (quoted in Healthy People 2020)

  3. Understanding Health Equity • Health Disparities • Health Inequity • Social Determinants • Research to Eliminate Inequities

  4. Health Disparities • Differences in the incidence and prevalence of health conditions and health status between groups • Braveman P, 2006 • Arise from socioeconomic status, race/ethnicity, sexual orientation, gender, disability status, geographic location, or some combination of these • Brennan Ramirez LK, et al., 2008

  5. Health Inequity • Health disparities are referred to as health inequities when they are the result of the systematic and unjust distribution of social determinants (healthy food, good housing, good education, safe neighborhoods, freedom from racism and other forms of discrimination) • Brennan Ramirez LK, et al., 2008

  6. Social Determinants • Life-enhancing resources whose distribution across populations effectively determines length and quality of life • Food supply • Housing • Economic and social relationships • Transportation • Education • Health care • James S, 2002

  7. Social Determinants • Social determinants of health include, but are not limited to: • Socioeconomic status • Discrimination • Housing • Physical environment • Food security • Child development • Culture • Social support • Healthcare services • Transportation • Working conditions • Democratic participation • VDH, 2012

  8. Factors Impacting Social Determinants – Poverty Source: U.S. Census Bureau, 2004 Small Area Income and Poverty Estimates Program Note: The number of people in poverty was estimated using direct and regression model estimates based on the Annual Social and Economic Supplement of the Current Population Survey and administrative records and census data, including tax returns and food stamp records.

  9. Race/Ethnicity: AI/AN Source: U.S. Census Bureau, Census 2000

  10. Race/Ethnicity: Asian/PI Source: U.S. Census Bureau, Census 2000

  11. Race/Ethnicity: Black Source: U.S. Census Bureau, Census 2000

  12. Race/Ethnicity: Hispanic/Latino Source: U.S. Census Bureau, Census 2000

  13. Race/Ethnicity: White Source: U.S. Census Bureau, Census 2000

  14. Health Disparities by Racial/Ethnic Group or by SES • Table adapted from Brennan Ramirez LK, et al., 2008

  15. Health Disparities by Racial/Ethnic Group or by SES • Table adapted from Brennan Ramirez LK, et al., 2008

  16. Factors Impacting Social Determinants – Education Source: 2005 CDC Area Resource File Note: "High school degree" includes either a high school diploma or the equivalent (G.E.D.)

  17. Health Disparities by Education • Table adapted from Brennan Ramirez LK, et al., 2008

  18. Factors Impacting Social Determinants – Urban vs. Rural Source: 2006 NCHS Urban-Rural Classification Scheme for Counties Based on the Office of Management and Budget's 2000 standards for defining metropolitan and micropolitan statistical areas, the December 2005 delineation of these areas, and Vintage 2004 postcensal estimates of the resident U.S. population.

  19. Health Disparities by Urban/Rural Areas • Table adapted from Brennan Ramirez LK, et al., 2008

  20. Current Research: Programs in U.S. Health Equity • Health Equity Institute (San Francisco State University) • BANPH: Bay Area Network for Positive Health • iN Touch: ODLs via Mobile Platforms for Youth with Obesity and Depression • MASAI: Reframing the Down Low: The Context of HIV Risk among African American Men

  21. Current Research: Programs in U.S. Health Equity • Robert Wood Johnson Foundation • Finding Answers/Aligning Forces for Quality • Dartmouth Atlas Project • Transforming Clinical Practice to Eliminate Racial-Ethnic Disparities in Healthcare • Research and Action Priorities for Linking Public Health, Food Systems, and Sustainable Agriculture • Accountability for Racial Equity in Healthcare

  22. Organizations/Programs • Kaiser Family Foundation • CDC Office of Minority Health and Health Equity • NPA (National Partnership for Action) to End Health Disparities • DHHS: Health Care for the Homeless Program

  23. References • U.S. Department of Health and Human Services, Office of Minority Health. National Partnership for Action to End Health Disparities. The National Plan for Action Draft as of February 17, 2010. Chapter 1: Introduction. Available at: http://www.minorityhealth.hhs.gov/npa/templates/browse.aspx?&lvl=2&lvlid=34 • Braveman P. Health disparities and health equity: concepts and measurement. Annual Review of Public Health 2006;27:167–194. • Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008. • James S. Social determinants of health: implications for intervening on racial and ethnic health disparities. Paper presented at: Minority Health Conference, 2002; University of North Carolina. • Virginia Department of Health, Office of Minority Health and Health Equity. Health Equity Definitions. 12 Jan 2012. Available at: http://www.vdh.state.va.us/healthpolicy/healthequity/definitions.htm • www.solvingdisparities.org