What’s Health Equity?
2011 Health Equities Leadership Institute
Friday, April 1, 2011
Katherine D. Ellington
Vice President, Program Development
#2011HELI American Medical Student Association

Wake Up

About Katherine

About Katherine @katellington
• New York City native from an African-
American family with Southern
roots, traditions and sensibilities
• Born and raised in Queens, one of the
most racially and ethnically diverse
communities in America
• Untraditional path to medical school
• Moving toward family medicine and
community health

The conscious recognize the need for
change, awakening the unconscious
is apart of that process.

Moments in Time
from moments to movements
We saw a white, Catholic, Republican federal judge murdered
on his way to greet a Democratic woman, member of
Congress, who was... Jewish. Her life was saved initially by a
Mexican-American college student... and eventually by a
Korean-American combat surgeon… And then it was all
eulogized and explained by our African-American president.
And... that's a remarkable statement about the country.
~Mark Shields PBS Newshour
January 14, 2011

Inspiration

What’s Health Equity?
Overview
 Definitionsand framework
 “Unnatural Causes” clips and quiz
 County Health Rankings
 Another story
 Implicit Association Test 1. novice
2. advanced-beginner
 Dialgoue 3. competent
4. proficient
5. expert

What is Health Equity?
A broad definition:
The absence of socially unjust or
unfair health disparities.

What is Health Equity?
HEALTH
“The presence of physical, psychological, social, economic
and spiritual well being not merely the absence of disease
or infirmity” (based on the WHO definition of health)

What is Health Equity?
EQUITY
An ethical concept based on fairness, distributive justice
and, is normative.

What is Health Equity?
“Health equity is the realization by ALL people of the
highest attainable level of health. Achieving health
equity requires valuing all individuals and populations
equally, and entails focused and ongoing societal
efforts to address avoidable inequalities by assuring
the conditions for optimal health for all groups,
particularly for those who have experienced historical
or contemporary injustices or socioeconomic
disadvantage.”

What is Health Equity?
Health equity is the absence of systematic
disparities in the health (or its social determinants)
between more and less advantaged groups.
.

Racial and ethnic healthcare
disparities
 Pervasive
 Associated with systemic social advantage/disadvantage
 Complex and interrelated factors
 Root causes are found upstream
 Requires fundamental changes in underlying social and/or
economic structures

Health Disparities
Healthcare
sysems, polices
and
infrastructure
Individual at the
patient-provider
level.
Differences, disparities and discrimination. Populations with equal access to
healthcare. SOURCE: Gomes and McGuire, 2001.
Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health
care. Smedley BD, Stith AY, Nelson AR, eds. 2003 National Academies Press. Washington, DC.

Health Disparities
 Finding 1-1: Racial and ethnic disparities in
healthcare exist and, because they are
associated with worse outcomes in many
cases, are unacceptable.
 Recommendations 2-1: Increase awareness of
racial and ethnic disparities in healthcare among
the general public and key stakeholders.
 Recommendations 2-2: Increase healthcare
providers’ awareness of disparities.
Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care.
Smedley BD, Stith AY, Nelson AR, eds. 2003 National Academies Press. Washington, DC.

Health inequities have been
defined as differences in
health that are unnecessary,
avoidable, unfair and unjust.
Whitehead,M. The concept and principles of equity in health.
Int J Health Serv1992;22:429-445. first published in Europe

Social Determinants of Health
The social determinants of health
are the circumstances in which
people are born, grow
up, live, work and age, and the
systems put in place to deal with
illness. These circumstances are in
turn shaped by a wider set of
forces: economics, social
policies, and politics.
#sdoh

Social Determinants of Health
Social
gradient
exists, glo
bally.
#sdoh

Social Determinants of Health
There’s more to
health than
health care.
What about where your live, go to
work, attend school and play?
#sdoh

What’s Health Equity?
DISCUSSION
#publichhealth
#sdoh
#countyhealthrankings
#2011HELI

What’s Health Equity? #PublicHealth
“The new public health
operates out front, in the full
light of day, connecting the
dots, building
partnerships, and creating
collaborative relationships
that reach far into every
corner of the community.”
President CEO RisaLavizzo-
Mourey, MD, MBA, Robert
Wood Johnson Foundation
www.countyhealthrankings.org #2011HELI

What’s Health Equity?
DISCUSSION

1. novice
2. advanced-beginner
3. competent
4. proficient
5. expert
What’s Health Equity?
Another story

http://www.charactersunite.com/

http://www.charactersunite.com/

Implicit Association Research
The Psychology of Blink: Level 2
 Mental operations
 First level: higher, deliberate, rational, thoughtful
 Second level: lower, automatic, impulsive, unthinking
Unconscious cognition
Implicit Association
Research is a glimpse
into “Level 2”
We work to overcome Level 2 and IAT is a start

Implicit Association Research
The Psychology of Blink: Level 2
 The Blink part comes from a reference to Greenwald's work
in chapter three of Gladwell's book
 Leading researchers
o Anthony Greenwald, Ph.D., University of Washington
o MahzarinBanaji, Ph.D., Harvard University
o Brian Nosek, Ph.D., University of Virigina
o Lisa Cooper, MD, MPH, Johns Hopkins

Project Implicit
 Interactive studies that examine thoughts and
feelings that exist either outside of conscious
awareness or outside of conscious control
 Educational and engaging experience

Project Implicit
 A safe, secure, and well-designed virtual environment to
investigate psychological issues and, at the same time,
provide visitors and participants
 Collaborative research effort between researchers at
Harvard University, the University of Virginia, and
University of Washington

What’s Health Equity?
DIALOGUE

What’s Health Equity?
Review
 Heal Equity, defined
 Racial and ethnic healthcare
disparities
 Social determinants of health
 County Health Rankings 1. novice
2. advanced-beginner
 IAT 3. competent
4. proficient
5. expert

What’s Health Equity?
CONCLUSION

When the end is the beginning…

What’s Health Equity?
Katherine D. Ellington
vpp@amsa.org
@katellington on Twitter
Katherine Ellington on Facebook
Phone: 347.993.7877
Skype/IM: ellkatd