A presentation for the Oklahoma Health Equity Campaign on racial health inequity in Oklahoma, including history, causes, and policy recommendations.

2. looking up the river Looking Up the River: The Impact of Race & Ethnicity on Health

3. objectives Introduce a framework for understanding racial health inequity in a historical and political context Understand the role of health providers in creating and eliminating racial health inequity Present policy recommendations to eliminate inequity and improve patient outcomes Looking Up the River: The Impact of Race & Ethnicity on Health

4. The numbers Looking Up the River: The Impact of Race & Ethnicity on Health

5. national racial inequity In 2004, 67% of white Medicare beneficiaries over 65 received flu vaccines, compared with 55% and 45%, respectively, of their Latino and Black counterparts. For pneumonia, only 39% of blacks and 34% of Latinos were vaccinated, compared with 61% of whites. Although one in three Americans is a person of color, blacks, Latinos and Native Americans represent less than 9% of nurses and 6% of physicians and are only 5% of dentists. Physicians of color are more likely to work in disadvantaged communities or communities of color. Looking Up the River: The Impact of Race & Ethnicity on Health

6. national racial inequity Native American / Native Alaskan adolescents have the highest rates of attempted suicides and suicide death. Asian Americans account for the highest rates of depression and the second-highest suicide rate among women ages 15–24. Together, Black women and Latinas account for 82% of reported AIDS cases among women even though they only constitute 24% of the U.S. female population. Black women are nearly four times more likely to die in childbirth than white women because of insufficient prenatal care. Looking Up the River: The Impact of Race & Ethnicity on Health

7. national racial inequity Black infants are two to three times more likely than white infants to have low birth weight, which results in higher mortality rates. More than 11 million immigrants were uninsured in 2003, contributing to a quarter of the U.S. uninsured. Between 1998 and 2003, immigrants accounted for 86% of the growth in the uninsured population. Only 1 in 4 pharmacies located in predominantly non-white neighborhoods carry adequate supplies, compared with 72% of pharmacies in predominantly white neighborhoods. Looking Up the River: The Impact of Race & Ethnicity on Health

8. oklahoma racial inequity Looking Up the River: The Impact of Race & Ethnicity on Health

9. oklahoma racial inequity Looking Up the River: The Impact of Race & Ethnicity on Health

10. oklahoma racial inequity Looking Up the River: The Impact of Race & Ethnicity on Health

11. history Looking Up the River: The Impact of Race & Ethnicity on Health

12. slave health deficit Of the total time that persons of African descent have had a presence in the U.S.: 64.2% of that time was as chattel slavery 26.1% of that time was spent in de jure or Jim Crow segregation. Only during 9.6% of the total time in the U.S. have African-Americans had full legal status as citizens Thus, from a health perspective, 64.2% of the time was spent in establishing a health deficit, 26.1% in maintaining it, and at no point has it been eliminated. Looking Up the River: The Impact of Race & Ethnicity on Health

13. enduring health deficit Evidence in Oklahoma: Life expectancy of white people during slavery was 20% longerthan that of people of African descent In Tulsa today, life expectancy in the 74114 ZIP code (90.2% white) is 14 years — or 18% — longer than in 74126 (81.8% people of color) just five miles away Graphic: Tulsa World Looking Up the River: The Impact of Race & Ethnicity on Health

14. race as pseudo-science Race, though a social construct, has been misappropriated by science to justify discrimination Racial classifications — including who qualifies as White — have shifted and transformed over time Different groups were granted White status as it became economically beneficial to the majority Looking Up the River: The Impact of Race & Ethnicity on Health

15. exploitation Fictional slave diseases Involuntary experimentation Surgical experiments on enslaved people (1932-1972) Tuskegee syphilis experiment (1953-1954) Radioactive iodide testing Plutonium testing (1963) Live cancer cell injections (1970s) Blood sample testing for “genetic criminality” Looking Up the River: The Impact of Race & Ethnicity on Health

16. exploitation (1997) Blood substitution experiments Inmate testing Sickle cell debacle Segregation Forced sterilization Unfulfilled social programs Forced institutionalization or internment Patient dumping Looking Up the River: The Impact of Race & Ethnicity on Health

17. Where we stand Looking Up the River: The Impact of Race & Ethnicity on Health

18. race still matters “Racial/ethnic background affects health status, health insurance coverage, and health care access and quality. The aggregate data used to produce national averages often mask disparities for people of color — especially those who are poor or near poor.” — Kaiser Family Foundation Looking Up the River: The Impact of Race & Ethnicity on Health

19. racial wealth divide Looking Up the River: The Impact of Race & Ethnicity on Health Lifting as We Climb: Women of Color, Wealth, and American’s Future, Insight Center for Community Economic Development

20. institutionalized racism Looking Up the River: The Impact of Race & Ethnicity on Health

21. continuum of health care Before seeking care Accessing care Treatment Institutionalized racism impacts people of color at each stage of health Looking Up the River: The Impact of Race & Ethnicity on Health

22. before seeking care Exposure to environmental toxins Predatory marketing (tobacco, alcohol, drugs) Food scarcity Military recruitment Underrepresentation in research (especially at the intersections) Violence (including domestic violence) Looking Up the River: The Impact of Race & Ethnicity on Health

23. access to care Health coverage Existence of providers Historic and de facto segregation Barriers to access transportation time off work childcare Absence of trust Looking Up the River: The Impact of Race & Ethnicity on Health

24. treatment Lack of true cultural competency Medicaid & Medicare reimbursement gaps Less time with physicians, lower quality and quantity of visits, fewer diagnostic workups Lack of translators / multilingual care Unacknowledged impact Unintentionally discriminatory policies and practices Looking Up the River: The Impact of Race & Ethnicity on Health

25. the script Oklahoma Task Force to Eliminate Health Disparities Looking Up the River: The Impact of Race & Ethnicity on Health

26. data committee findings Disparities do exist in Oklahoma Health disparities occur in the context of broader historic and contemporary social and economic inequality, and possible discrimination in many sectors of Oklahoma life due to lack of understanding of cultural differences. There is currently insufficient data, data collection systems, and resources to identify all of the factors that may contribute both directly and indirectly to health disparities in Oklahoma. Looking Up the River: The Impact of Race & Ethnicity on Health

27. challenges of ensuring health care access Developing minority health professionals, including African American and Hispanic medical school graduates and physicians Reducing the high percentage of uninsured persons in the state, most notably Hispanics at 40% Ensuring collaboration and communication between state policymakers and local community stakeholders with diverse cultural backgrounds Developing cultural competence and cultural sensitivity among health professionals Integrating mental health and primary care services Looking Up the River: The Impact of Race & Ethnicity on Health

28. challenges of ensuring health care access Developing accessible and accurate data to determine the extent of health access and disparities issues both nationally and locally Improving the socio-economic factors (i.e., education, income, economic development, etc.) contributing to the inability of persons and businesses to afford rising health care costs Reducing the utilization of emergency rooms and trauma centers as a primary source of care Ensuring the availability of adequate services and resources (i.e., physicians, transportation, community health centers, etc.) in communities with the greatest health needs. Looking Up the River: The Impact of Race & Ethnicity on Health

29. neutrality of whiteness Looking Up the River: The Impact of Race & Ethnicity on Health

30. recommendations A New Way of Thinking Looking Up the River: The Impact of Race & Ethnicity on Health

31. broaching Broaching refers to the practitioner’s consideration of race, ethnicity and culture within the clinical setting and for developing treatment plans. The broaching technique is a consistent, well thought out, researched and ongoing attitude of openness with clients with a genuine commitment to continually inviting the client to explore issues of diversity. Looking Up the River: The Impact of Race & Ethnicity on Health

32. examining privilege Health care practitioners are disproportionately White and health care pedagogy has a European bias Public health care clients are disproportionately people of color This disparity introduces white (male, middle class) privilege into the system, and left unexamined, results in practice, policies, and procedures that discriminate against people of color — this is where we can intervene! Looking Up the River: The Impact of Race & Ethnicity on Health

33. examining privilege Health care providers and support staff need to reflect on their internalized biases and begin to dismantle the structures of racism we have all absorbed This can be done in racially caucused spaces that are accountable to people of color This is a long-term process that involves investment of time and resources Looking Up the River: The Impact of Race & Ethnicity on Health

34. examining privilege Medical schools, health care institutions, and policy makers must evaluate their policies and procedures to determine which ones result in discriminatory impact This must be done in a way that is accountable to people of color Task forces, committees, or ad hoc groups assigned with this task must be completely empowered to effect institutional change Looking Up the River: The Impact of Race & Ethnicity on Health

35. the “r” word The origin of “reparations” is “repair” “Reparations should be viewed as an obligation to make the repairs necessary to correct current harms done by past wrongs. This is a much more expansive view than merely calculating the economic harm and writing a check. Under this view, reparations becomes a process that restores hope and dignity and rebuilds the community. Reparations, conceived as repair, can help mend the tear in the social fabric for the benefit of both people of color and mainstream America. This view allows for responsibility and action by all parties. It allows for healing to begin by allowing the souls of people of color and Whites to be cleansed.” Looking Up the River: The Impact of Race & Ethnicity on Health

36. the “r” word Eliminate the inequities in disease, illness and death A focus on education and prevention through targeted services The provision of a liveable wage for all persons and families The eradication of environmental hazards in communities of color The elimination of targeting by tobacco and alcohol industries Looking Up the River: The Impact of Race & Ethnicity on Health

37. the “r” word Assure Access to Health Care Assuring universal health care Locating adequate health care facilities within communities of color Assuring competent health care workforce in communities of color Assure health and health care research on issues affecting communities of color Looking Up the River: The Impact of Race & Ethnicity on Health

38. the “r” word Assuring the cultural competence of the health care workforce by requiring health professional schools to train providers from a diverse background all physicians to have a rotation during their internship and externship the focus on providing culturally competent care providers to take continuing educational units in cultural competency health care facilities and managed care organizations to complete and submit on regular basis a cultural competency assessment to a regulatory agency health care be provided in accordance with realities of the needs of the various "classes" of the Black community. Looking Up the River: The Impact of Race & Ethnicity on Health

39. the “r” word Eliminate Racial Discrimination in Health Care and Research through laws that Recognize multiple forms of discrimination Authorize and fund medical testers Recognize disparate impact Assure fines and regulatory enforcement Require a health scorecard for agency, provider or facility Looking Up the River: The Impact of Race & Ethnicity on Health

40. the “r” word Provide individual and organizational right of action Require data collection and reporting Establish an Equality Health Care Council Assure adequate fines and regulatory enforcement Pay prevailing plaintiff’s attorney fees Allow punitive damage to fund monitoring and assessment programs Looking Up the River: The Impact of Race & Ethnicity on Health

41. resources Looking Up the River: The Impact of Race & Ethnicity on Health

42. resources websites VernelliaR. Randall, J.D., homepages.udayton.edu/~randalvr Kaiser Family Foundation, www.kff.org/minorityhealth/disparities.cfm Empowering Marginalized Communities and Serving Vulnerable Populations through Prevention, Best Practices, and Scientific Research, conference, www.tulsa-health.org/community-health/annual-prevention-health-summit/3rd-annual-conference books Dying While Black by Vernellia R. Randall, J.D. The Race Myth by Joseph L. Graves, Jr. An American Health Dilemma: Race, Medicine, and Health Care in the United States by W. Michael Byrd and Linda A. Clayton Gender, Race, Class and Health: Intersectional Approaches edited by Amy J. Schulz and LeithMullings Tackling Health Inequities Through Public Health Practice: Theory To Action by Richard Hofrichter and Rajiv Bhatia Looking Up the River: The Impact of Race & Ethnicity on Health

43. resources articles “Broaching the subjects of race, ethnicity and culture during the counseling process” byDay-Vines et. al. Journal of Counseling and Development, 9/22/2007 “Levels of Racism: A Theoretic Framework and a Gardener’s Tale” by CamaraPhyllis Jones, MD, MPH, PhD, www.citymatch.org/UR_tale.php “Is There a Black, Latino Doctor in the House?” by Gail Zoppo, DiversityInc, 6/15/2010, www.diversityinc.com/article/7779/Is-There-a-Black-Latino-Doctor-in-the-House presentations and additional training Dr. Andrew Jolivette, “HIV/AIDS Health Disparities in Communities of Color: A Personal Narrative,” 11/6/2009, lecture Ethics: A Fresh Look at Discrimination and the Impact of Racism on Therapist and Client, YWCA professional workshop Witnessing Whiteness and Mosaic, YWCAbook discussion groups Looking Up the River: The Impact of Race & Ethnicity on Health

44. Questions? Looking Up the River: The Impact of Race & Ethnicity on Health

45. Contact information Mana Tahaie Director of Racial Justice YWCA Tulsa (918) 858-2348 mtahaie@ywcatulsa.org Looking Up the River: The Impact of Race & Ethnicity on Health