This document summarizes a presentation about how place matters for health. It discusses how residential segregation and unequal access to resources like supermarkets negatively impact health outcomes. Health inequities are rooted in structural racism and unequal distribution of power and money. The Place Matters initiative aims to build awareness of these issues and advocate for policies that create fair conditions to support health, like improving daily living conditions, strengthening food access data, and addressing poverty. Recommendations include investing in underserved areas and ensuring workplace justice in the food system.
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Place Matters and Health Promotion
1. Place Matters and Health
Promotion
University of Illinois at Chicago,
School of Public Health, Health Inequities Class
Jim Bloyd, MPH
Cook County Department of Public Health
February 1, 2013
2. Outline
• Video Community Voice: Bonnie Rateree
• Selected quotes on Health Promotion
• Residential Segregation
• Health Equity Report Cook County Place
Matters
3. “Six Voices”
videos on
YouTube.com/
ccplacematters
&
Facebook.com
/ccplacematter
s
4. Health Promotion Ethics
“We consider the normative ideal of health
promotion to be that aspect of public health
practice that is particularly concerned with
the equity of social arrangements”
Carter et.al. (2012) Public Health Reviews
5. “We are dealing with serious food addictions.
People in America are addicted to sugar they're
addicted to fat they're addicted to salt and
people don't feel satisfied with their food if
they're not getting heavy doses of that…”
“The food addictions are what is holding us back
primarily And ignorance Part of that ignorance is
deliberate. People don't want to know.”
John Mackey, CEO Whole Fodes, National Public Radio Interview
January 17, 2013
http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=169580493&m=169580893
6. Dorothy Nyswander
• “Have I not actually helped to maintain the
status quo in these situations? Have I not
taught people to accept those gifts approved
by the establishment which would make life
more bearable but which would not threaten
the power of the establishment itself?”
Nyswander (1967) H Ed Monographs cited in Brown & Margo
(1978)
7. LaVeist et.al. 2011 Health Affairs
• “We further concluded that when social
factors are equalized, racial disparities are
minimized. Policies aimed soley at health
behavior change, bilogical differences among
racial groups, or increased access to health
care are limited in their ability to close racial
disparities in health. Such policies must
address the differing resources of
neighborhoods and must aim to improve the
underlying conditions of health for all.”
8.
9.
10. Metro Chicago: Poverty Composition of
Neighborhoods of All Children
Source: Diversitydata.org, 2011
11. Metro Chicago: Poverty Composition of Neighborhoods
of Poor Children
Source: Diversitydata.org, 2011
12. 1930’s Home
Owners Loan
Corporation:
“HOLC initiated
the practice of
redlining”
(Jackson, 1980)
13. South Side Chicago HOLC Map: State sponsored
segregation through finance
14. Gale Cincotta: The fight against
redlining- a victory in 1977
• “Activists will
need to do their
homework.
They'll need to
figure out who
owns what in
order to target
those who really
have the
power.”
Gail Cincotta Feb 1996 Illinois Issues
photo National People’s
Action
15. World Health Organization
• How to close the health equity gap? “Tackle
the inequitable distribution of power, money
and resources” World Health Organization
16. Slow Death (Sovereignty, Obesity,
Lateral Agency)
• “I am focusing here on the way the attrition of
the subject of capital articulates survival as
slow death.” “In this scene some activity
toward reproducing life is not identical to
making it or oneself better, or to a response to
the structural conditions of a collecive failure
to thrive, but to making a less bad experience.
It’s a relief.” Lauren Berlant (2007) Critical
Inquiry
17. The individual, personal behavior
approach is deceptive
CDC Web
Page:
“Healthy
Weight- it’s
not a diet, it’s
a lifestyle!”
Source: CDC
http://www.cdc.gov/h
ealthyweight/healthy
_eating/drinks.html
18. Cook County Place Matters is part of a National Initiative– W.K.
Kellogg Foundation / Joint Center for Political and Economic
Studies Health Policy Institute / CommonHealth Action
National Meeting in Chicago: July 25-27, 2012
18
April 26, 2012 Cook County Place Matters
19. Cook County Place Matters
Steering Committee
Daniel Block, PhD Chicago State University
Jim Bloyd, MPH Cook County Department of Public Health
Sheila Castillo, MUPP, Midwest Latino Health Research,
Training, and Policy Center
Kathryn Bocanegra, LCSW ENLACE Chicago
Sheelah Muhammad, DN, MBA ‘Fresh Moves’
John Owens Centers for New Horizons
April 26, 2012 Cook County Place Matters 1
20. Vision
• To build a health equity movement that works
to eliminate structural racism and creates the
opportunity for all people of Cook County to
live healthy lives.
April 26, 2012 Cook County Place Matters 1
21. Goals
• raise awareness that inequitable
social conditions are the root
causes of unfair health inequities
• build the power of residents and
leaders from affected
communities who support a fair
distribution of society’s resources
• Policy advocacy that leads to
neighborhood conditions that
support and produce health
April 26, 2012 Cook County Place Matters 1
22. Health Equity
• ‘health differences which are socially
produced, systematic in their distribution
across the population and unfair’ (World
Health Organization)
• Health inequities are a result of
‘systematically unequal distribution of power,
prestige and resources among groups in
society’ (WHO)
23. PLACE MATTERS emphasizes the social
determinants of disease…
• Obesity is the toxic consequence of economic
insecurity and a failing economic environment.
"...social justice has less to do with larger portions of
broccoli and more to do with eroding minimum wage,
lack of healthcare, and wholesale looting of the
American economy. It is a shame that many of the
current strategies for obesity management are based
not around alleviating poverty but around
recommending high-cost foods to low-income people.
That approach will not work in the US or elsewhere."
Drewnowski 'spotlight' 2008
24. Structural Racism
• the ways in which public policies and institutional
practices contribute to inequitable racial
outcomes
• privilege associated with 'whiteness' and the
disadvantage of 'color'
• assumptions and stereotypes that are embedded
in our culture that, in effect, legitimize racial
disparities
• Undermines progress toward racial equity
Source: Aspen Institute, http://www.racialequitytools.org/ci-issues-sr.htm
25. Structural Racism
• “To address structural
racialization, we must
understand the work that
our institutions and policies
are in fact doing, not what
we want or
hope for them to do.” (john
powell)
26.
27. er ul u C
& yi m F
l a
t
Health Health
Inequities Disparities
28. er ul u C
& yi m F
l a
t
Inequities Disparities
29. er ul u C
& yi m F
l a
t
Conditions Consequences
30. er ul u C
& yi m F
l a
t
School Grade Drop-Out
Absence/ Failure
Truancy
31. er ul u C
& yi m F
l a
t
Narrative Policy Place
power
32. Life Expectancy by Census Tract and Municipality, Cook
County and Chicago, (2003 – 2007)
April 26, 2012 Cook County Place Matters 1
37. Findings
• Gap in life expectancy of 14 years between
wealthy and poor areas of metro-Chicago
• Residents with least access to chain
supermarkets and larger independent grocers
live on average 11 years less then people with
highest access
• Conditions of concentrated poverty make it more
difficult for African Americans and Latinos to live
healthy lives
• “Your zip code is more important than your
genetic code”
38. PLACE MATTERS Recommendations
1. Improve daily living conditions/ tackle
inequitable distribution of power, resources
2. Track health inequities
3. Strengthen data collection on food access
4. Implement public ‘seed money’ for food retail in
areas with low food access
5. Ensure workplace justice for workers in the food
chain
6. Address persistent poverty
39. Thank you!
Jim Bloyd, MPH
jbloyd@cookcountyhhs.org
w) 708-633-8314
15901 S. Cicero Av Bldg B 3d Floor
Oak Forest IL 60452
Hinweis der Redaktion
Where do addictions come from? What are social causes of addictions?
“ My efforts were expended in working on the symptoms of closed societies; the basic conditions giving rise to the symptoms were untouched.” Brown E, Margo, G (1978) Int J Health Services, Vol. 8, Number 1 “Health Education: Can the Reformers Be Reformed?”
“ In the Chicago metropolitan area, fewer than 25 percent of all black children live in neighborhoods with low poverty rates between 0-10 percent; the remainder lives in neighborhoods with poverty rates between 10.1 and 40 percent. (top figure). In contrast, over 85 percent of white children living in the Chicago metropolitan area live in neighborhoods with poverty rates below 10.1 percent. Opportunity neighborhoods exist for white children but, on the whole, black children live in totally different neighborhoods.” Cohen, J. A. (Ed.). (2008). CHALLENGES AND SUCCESSES IN REDUCING HEALTH DISPARITIES . Washington, D.C.: INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES.
Figure C “shows that less than 5 percent of poor black children live in low-poverty neighborhoods, and more than 95 percent live in high poverty neighborhoods. Nearly 75 percent of poor white children live in neighborhoods in which the poverty level is 10 percent or less. This means that white children do not live in areas in which they have to contend with familial and environmental pressures associated with living in high-poverty neighborhoods.” Figure D shows that the distribution of poor white children remains more favorable than the distribution for nonpoor black children. The socioeconomic profile for Hispanic children at the family, neighborhood and school levels is similar to the profile of black children. If Hispanic children continue to live in these high poverty environments, outcomes for Hispanic children will eventually resemble the outcomes seen for black children in similar neighborhoods.
On April 13, 1933, President Roosevelt urged the House and the Senate to pass a law that would (1) protect small homeowners from foreclosure, (2) relieve them of part of the burden of excessive interest and principal payments incurred during a period of higher values and higher earning power,# and (3) declare that it was national policy to protect home ownership. (Jackson, 1980) The HOLC is important to housing history because it introduced, perfected, and proved in practice the feasibility of the long-term, self-amortizing mortgage with uniform payments spread over the whole life of the debt.
The fiery rhetoric and confrontational tactics of Gale Cincotta, co-founder of National People ’s Action, helped lead to the passage of the Community Reinvestment Act in 1977. (Courtesy National People’s
Healthy Weight- it ’s not a diet, it’s a lifestyle!
Structural racism includes the aspects of our history and culture that have allowed the privilege associated with 'whiteness' and the disadvantage of 'color' to endure and adapt over time. A discussion of structural racism points out the ways in which public policies and institutional practices contribute to inequitable racial outcomes. It lays out assumptions and stereotypes that are embedded in our culture that, in effect, legitimize racial disparities, and it illuminates the ways in which progress toward racial equity is undermined.
In 2009, life expectancy in Cook County was significantly correlated with a number of key social, economic and demographic indicators: Areas (census tracts and suburban municipalities) where a higher percentage of the population was non-Hispanic white had significantly longer life expectancies. Areas with a higher percentage of non-Hispanic blacks had significantly shorter life expectancies. Owner-occupied housing was associated with longer life expectancies, while a high vacancy rate was associated with shorter life expectancies. People living in areas with high concentrations of poverty and unemployment had significantly shorter life expectancies than people living in areas with higher median incomes. People living in areas with lower educational attainment (less than high school) had shorter life expectancies than those living in areas where a high percentage of the population had at least a Bachelor ’s degree.
Figure 4 illustrates the relationship between life expectancy and income. We grouped Chicago census tracts and suburban Cook County municipalities into quintiles (5 equal groups) based on median income and calculated the average life expectancy of each quintile. People living in areas with a median income greater than $53,000 per year had a life expectancy that was almost 14 years longer than that of people living in areas with a median income below $25,000 per year.
Figure 4 illustrates the relationship between life expectancy and income. We grouped Chicago census tracts and suburban Cook County municipalities into quintiles (5 equal groups) based on median income and calculated the average life expectancy of each quintile. People living in areas with a median income greater than $53,000 per year had a life expectancy that was almost 14 years longer than that of people living in areas with a median income below $25,000 per year.