Breakout Session A – Health Equity: Understanding ...
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Spring 2020 Tobacco Control Institute ‐Breakout A
4/16/2020
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Breakout Session A –Health Equity: Understanding
Structural Racism, Social Determinants, Bias, and Cultural Humility
April 16, 20201:00pm – 2:30pm
Welcome to the Virtual Spring Tobacco Control Institute
Health Equity: Understanding Structural Racism, Social
Determinants, Bias, and Cultural Humility
April 16, 20201:00pm – 2:30pm
Welcome to Breakout Session A
Roshal RossmanSouth Dakota Tobacco Control
Program
Spring 2020 Tobacco Control Institute ‐Breakout A
4/16/2020
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We acknowledge the spiritual and ceremonial value of tobacco in
our American Indian culture.
All references to tobacco at the Institute refer to commercially produced tobacco products and not
traditional tobacco.
Traditional Tobacco
About Adobe Connect
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Draw Function
HEALTH EQUITYUNDERSTANDING STRUCTURAL RACISM, SOCIAL DETERMINANTS, BIAS, AND CULTURAL HUMILITY
Rachel MarquezEmory Centers for Training
and Technical Assistance
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PRESENTATION PHILOSOPHY
It is normal to feel discomfort as you reflect on and deepen your understanding of issues of inequality, poverty and race
Listen with an open mind/heart-assume good intentions
Seek understanding
LIFE EXPECTANCY – THE BEST MEASURE OF HEALTH
Average US Life Expectancy: 78.6 years
Average South Dakota Life Expectancy: 79.57 years
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LIFE EXPECTANCY – HEALTH DISPARITIES
SOUTH DAKOTA – LIFE EXPECTANCY BY COUNTY
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GROUP ACTIVITY
Regions 3 & 4 Regions 1, 2, 5 & 6
HOW DOES THAT MAKE YOU FEEL?
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WHAT DO YOU THINK IS HAPPENING?
ZIP CODE A BETTER PREDICTOR OF HEALTH
52% live below the Federal Poverty Level
Fewer than 3 out 10 are employed
9% have Bachelor’s degree
Life Expectancy = 66.81
14.6% live below the Federal Poverty Level
(better than National Avg)
3% Unemployment Rate
28% have Bachelor’s degree
Life Expectancy = 79.57
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HEALTH EQUITY
The absence of avoidable, unfair, or remediable differences among groups of people
"Health equity” or “equity in health” implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.
WHAT CONTRIBUTES TO INEQUITIES?
Structural/Institutional Racism
Social Determinants of Health
Unconscious (Implicit) Bias
Lack of Cultural Humility
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STRUCTURAL/INSTITUTIONAL RACISM
Refers to social processes that intentionally protect the advantages of a dominant group while maintaining an unequal position over a subordinate group
Views inequality as part of a society’s structure
Allows individuals and groups to operate within a social structure ensuring racial dominance through laws, customs, religious beliefs, etc., operating within a society
NATIVE AMERICANS AND STRUCTURAL/INSTITUTIONAL RACISM
Indian Removal Act Federal Governments forcible relocation of
Native Americans in the southeast to make room for white settlement
“Trail of Tears” – forced march west of the Mississippi River resulting in the death of thousands from hunger, disease, and exhaustion
Dawes Act Conversion of communally held tribal lands
into small, individually owned lots.
2/3 of reservation lands were seized and redistributed to white Americans.
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STRUCTURAL/INSTITUTIONAL RACISM
Housing Discrimination in 1930s
“Redlining”
Segregation
STRUCTURAL/INSTITUTIONAL RACISM – RESULTS TODAY
“Native Americans experienced deep wounds in the age of colonization and expansion, wounds that largely remain
unhealed and strongly impact the generations to this day.” – U.S. bishops,
Open Wide Our Hearts
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TIME FOR REFLECTION
KEY TAKEAWAY: STRUCTURAL RACISM
Racialization distorts all parts of our Systems
Created inherited groups of disadvantage or advantage
Allowed for the differential valuation in human life by race
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WHAT CONTRIBUTES TO INEQUITIES?
Structural/Institutional Racism
Social Determinants of Health
Unconscious (Implicit) Bias
Lack of Cultural Humility
SOCIAL DETERMINANTS OF HEALTH
The conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.
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SOCIAL DETERMINANTS OF HEALTH
Health disparities result from multiple factors, including:
• Poverty
• Environmental threats
• Inadequate access to health care
• Inadequate access to healthy foods
• Individual and behavioral factors
• Educational inequalities
SOCIAL DETERMINANTS AND TOBACCO-RELATED DISPARITIES
Higher prevalence of smoking for:
American Indian, Alaska Natives
Individuals who have high school diploma or less
Individuals who live below the federal poverty guideline
Individuals who live in the Midwest
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PUTTING IT ALL TOGETHER
WHAT ARE STRUCTURAL DRIVERS?
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DIMINISHING DISPARITIES WITH HEALTH EQUITY APPROACH
CDC’s Health Equity in Tobacco Prevention and Control lists helpful resources to address specific social determinants in tobacco control
KEY TAKEAWAY: SOCIAL DETERMINANTS OF HEALTH
Taking a social determinants of health approach helps to:
Achieve equity and eliminate disparities
Have equal distribution of resources and services
Understand that people with low SES will need more efforts and resources focused directly to their communities to overcome disparities
Allows us to move beyond simply controlling diseases to addressing the factors of their root causes
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WHAT CONTRIBUTES TO INEQUITIES?
Structural/Institutional Racism
Social Determinants of Health
Unconscious (Implicit) Bias
Lack of Cultural Humility
Stroop TaskOn the next couple of slides you will see color names (red, green, blue, yellow) in different “print” colors. You need to respond to the print color. For example, if you see: GREEN You need to respond to the print color (red).
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BASEBALL BAT AND A BALL COST $1.10 TOGETHER THE BAT COSTS $1.00 MORE THAN THE BALLHOW MUCH DOES THE BALL COST?
ALTHOUGH $1.00 + $0.10 DOES EQUAL $1.10,
IF YOU TAKE $1.00 – $0.10 YOU GET $0.90, BUT THE PROBLEM REQUIRES THAT THE BAT COSTS $1 MORE THAN THE BALL.
SO, THE BALL MUST COST $0.05, AND THE BAT MUST COST $1.05 SINCE $1.05 + $0.05 = $1.10
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HOW MANY TRIANGLES DO YOU SEE?
UNCONSCIOUS MIND
System 1 thinking is quick, intuitive, spontaneous, and effortless. It’s the type of processing that instantly helps us to recognize faces, to act when confronted with dangers and solve simple questions.
System 2 thinking, on the other hand, is slow, rational, reflective, and effortful. It gets into the driver’s seat when you focus and concentrate on a complicated problem.
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BIAS
Evaluation or belief of one group and its members relative to another
EXPLICIT BIAS
When a person is aware of his/her evaluation of a group, believes that evaluation to be correct, and has time/motivation to act on it in a give situation
IMPLICIT BIAS
Attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner
Activated by
Situational cues (person’s skin color or accent)
Environment
Past Experiences
Culture
UNCONSCIOUS BIAS
Unconscious Mind Drives Unconscious Biases
Deletes information (don’t pay attention to these, pay attention to this)
Distort (emphasize or de-emphasize)
Generalize (gather bits of information with other bits into groups)
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EVERYONE HAS IMPLICIT BIASES
Preference for a certain group
Dislike for a certain group
Based on stereotypes and attitudes
Usually developed early in life
Tend to strengthen over time
KNOW YOUR BIASES
Project Implicit
https://implicit.harvard.edu/implicit/takeatest.html
Implicit Association Tests to assess attitudes and beliefs:
Gender-Career
Gender-Science
Race
Age
Disability
Weight
Weapons
Skin-tone
Sexuality
Arab-Muslin
Religion
Native American
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GROUP REFLECTION:
THINK ABOUT A TIME, IN HINDSIGHT, WHERE A BIAS YOU POSSES INFLUENCED A DECISION YOU MADE
KEY TAKEAWAY: BIAS
• Most of our decisions, actions, emotions and behaviors are driven by our unconscious brain or auto pilot
• Awareness of one’s own bias is critical
• Acknowledgement that bias occurs without our awareness is key
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GROUP ACTIVITY:
IF I ASKED YOU TO DESCRIBE SOUTH DAKOTA’S CULTURE WHAT WOULD YOU SAY?
WHAT ABOUT BEING A SOUTH DAKOTAN WOULD HELP/HINDER YOU IN LIVING A HEALTHY LIFESTYLE?
WHAT CONTRIBUTES TO INEQUITIES?
Structural/Institutional Racism
Social Determinants of Health
Unconscious (Implicit) Bias
Lack of Cultural Humility
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CULTURAL HUMILITY
Ability to maintain a interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the (person)
3 Important Features:
A lifelong commitment to self-evaluation and self-critique, there is no point where you are done learning
Fix power imbalances
Develop partnerships with people and groups who advocate for others
CULTURALLY COMPETENT SMOKING CESSATION INTERVENTIONS
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KEY TAKEAWAY: CULTURAL HUMILITY
Culturally Targeted Interventions
Understanding of the target audience: focusing on the people, rather than the health problem
Accounting for aspects of culture that would hinder success and addressing proactively
“It is more important to know what kind of patient has the disease than
what kind of disease the patient has.”
Sir William Osler
CONCLUSION
We’ve explored the four major components of health equity and how those comprise the inequities we see play out for people:1. Structural Racism: The powerful way that injustices in federal policy has shaped
neighborhoods in the United States.
2. Social Determinants of Health: The conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.
3. Implicit Bias: Powerful, unconscious drivers: attitudes, stereotypes or preferences for certain groups that affect our understanding, actions.
4. Cultural Humility: The ability to understand, communicate with and effectively interact with people across cultures.
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QUESTIONS?
NEXT STEPS:
TYPE IN THE CHAT BOX: WHAT IS ONE THING THAT YOU LEARNED TODAY, YOU MIGHT NOT HAVE KNOWN BEFORE WE STARTED?
ON YOUR OWN: WHAT IS ONE THING YOU CAN COMMIT TO DOING IN ORDER TO HAVE A MORE EQUITABLE APPROACH IN YOUR WORK?
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We hope you’ll join us…
Addressing Health Equity
April 16
Tobacco Cessation and
Recovery
April 23
Engaging Youth in Policy
Advocacy
April 30
Thank you for joining us!
Spring Tobacco Control Institute
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