What's Health Equity?

M.D. Candidate um AMSA - American Medical Student Association
3. Jan 2012

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What's Health Equity?

  1. 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
  2. Wake Up
  3. About Katherine
  4. 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
  5. The conscious recognize the need for change, awakening the unconscious is apart of that process.
  6. 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
  7. Inspiration
  8. 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
  9. What is Health Equity? A broad definition: The absence of socially unjust or unfair health disparities.
  10. 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)
  11. What is Health Equity? EQUITY An ethical concept based on fairness, distributive justice and, is normative.
  12. 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.”
  13. 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. .
  14. 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
  15. 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.
  16. 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.
  17. 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
  18. 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
  19. Social Determinants of Health Social gradient exists, glo bally. #sdoh
  20. 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
  21. What’s Health Equity? DISCUSSION #publichhealth #sdoh #countyhealthrankings #2011HELI
  22. 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 #2011HELI
  23. What’s Health Equity? DISCUSSION
  24. 1. novice 2. advanced-beginner 3. competent 4. proficient 5. expert What’s Health Equity? Another story
  27. 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
  28. 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
  29. 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
  30. 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
  31. What’s Health Equity? DIALOGUE
  32. 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
  33. What’s Health Equity? CONCLUSION
  34. When the end is the beginning…
  35. What’s Health Equity? Katherine D. Ellington @katellington on Twitter Katherine Ellington on Facebook Phone: 347.993.7877 Skype/IM: ellkatd

Hinweis der Redaktion

  1. With the sunrise you observe power that is positional, steady and consistent.
  2. New York City native from an African-American family of Southern roots and traditionsBorn and raised in Queens in a close-knit neighborhoods where the 2009 H1N1 outbreak had it genesis, one of the most racially and ethnically diverse communities in America.Prior to medical school, worked in business and community development in New York, southern Africa and the Caribbean.
  3. Dr. Troutman’s webinar – review it.
  5. Follow a few champions!
  6. Pushing forward and carrying on
  7. Inequity does carry moral tones and may considered inflammatory, judgmenta, accusatory.Avoid using the following termsAny variation of equal, equality or equalizingLeveling the playing fieldCreating balanceYou should also avoidUnjust/injusticeOutrage ImmoralUnconscionable
  8. The net effect is a health-wealth gradient, in which every descending rung of the socioeconomic ladder corresponds to worse health. And it’s not just the poorest among us who are suffering, but the middle classes too. Louisville Metro Public Health Department data maps reveal 5- and 10-year gaps in life expectancy between the city’s rich, middle and working-class neighborhoods. We also see how racial inequality imposes an additional burden on people of color.
  9. Pushing forward and carrying on
  10. Social advantage or disadvantage refers to wealth, power and/or prestige – how people are grouped in hierarchies
  11. Systemic, avoidable, unfair and unjust differences in health status and mortality rates and in the distribution of disease and illness across population groups. They are sustained over time and generations and beyond the control of individuals
  12. Social gradient exists, globally
  13. Historically, federal Indian policies have been destructive to Native American communities - ranging from removal to assimilation and termination. These policies have had a negative impact on health and health-related behaviors. More recent trends towards self-determination and tribal control provide reason to hope.
  14. Influenceson Health: Broadening the Focus Health is shaped by many influences, including age, sex, genetic make-up, medical care, individual behaviors and other factors not shown in this diagram. Behaviors, as well as receipt of medical care, are shaped by living and working conditions, which in turn are shaped by economic and social opportunities and resources.
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  18. Stephanie Summerville is an actress and a Broadway theater usher living in New York City.She has performed regionally in both the U.S. and abroad. Her New York credits include “Howling” (LaMaMa ETC.), “We Are Your Sisters” (Blue Heron Theatre) and “Medea” (National Black Theatre of Harlem). Currently she is in residence with the Instant Shakespeare Company, performing the Bard’s entire canon in branches of the New York Public Library, for nine months out of the year. She is a proud graduate of Sarah Lawrence College, and an alumna of the NY Shakespeare Festival Lab at the Joseph Papp Public Theater.
  19. Dr. Greenwald’s talk Cooper’s talk
  20. Dr. Greenwald’s talk Cooper’s talk
  21. Collaborative research effort between researchers at Harvard University, the University of Virginia, and University of Washington