CHF Connections FALL 05conshfdn/images/uploads/files/... · 2010. 2. 1. · mentary titled “Unnatural Causes: Is Inequality Making Us Sick?” The four-hour film series will be

Vol. 9, No. 2 2007

Dedicated to making a differencein the health of the community

Honoring its commitment to makehealth justice a priority acrossmetropolitan Washington, D.C.,

the Consumer Health Foundation (CHF)made the topic the sole focus of itsannual meeting for the second year in a row. Titled Unnatural Causes: IsInequality Making Us Sick?, the 12thAnnual Meeting—held September 27 at The George Washington University in Washington, D.C.—grew out of theFoundation’s pledge to engage in healthequality dialogues “that address racialand ethnic disparities, particularly theimpact of structural racism on the healthand well-being of communities of colorin our region.”

The Foundation’s pledge to engage incommunity-wide discussions on healthjustice comes from its 2006 “SpeakoutReport” and is among its six recommenda-tions for improving health and health care inthe region. The report, Speaking Up andSpeaking Out for Health: A Community Callto Action to Improve Health and HealthCare in the Washington, D.C. MetropolitanRegion, was the result of five communityhealth “Speakout” events that CHF held inand around Washington, D.C. in 2004 and2005. A major theme of those events, inwhich more than 500 community membersparticipated, was the negative impact ofsocioeconomic inequities on health careaccess and health outcomes for minorities.

In her opening comments at the meeting,CHF President Margaret O’Bryon said:“It’s a fact that some of us get sicker anddie younger, and it’s a fact that factors likerace, ethnicity, income, education, andwhere you live dictate how long and howhealthy your life will be.”

She went on to illustrate her points,stating that African Americans now live,on average, almost six years less thanwhite Americans, and the difference inlife expectancy between residents of the healthiest and unhealthiest countiesin America is 20 years. Further, withinthe District of Columbia, 16 percent ofAfrican Americans and 23 percent ofLatinos reported being in fair or poorhealth compared to only four percent ofwhite residents, according to a recentstudy by the Kaiser Family Foundation.

According to O’Bryon, the solution lies notonly in ongoing work, both locally andnationally, to improve access to high-qualityhealth care, but also in identifying andaddressing the roots of health inequities,including the public policies, institutionalpractices, and societal norms that createand sustain these inequities based on skincolor, economic status, and stereotypes.“All of these things combine,” O’Bryonsaid, “in very deceptive ways to deny indi-viduals access to power and the ability tocontrol their own destiny. Deny opportunityand mobility and, thus, deny good healthand well being.”

The Foundation’s Annual Meeting wasintended as an opportunity for communi-ties to come together and keep thedrumbeat going across the region, tokeep up the discussion, and to beginidentifying ways to create conditions thatempower community members to livemore healthy, dignified lives.

Consumer HealthFoundation

CHF Continues the Drumbeat on Health Justiceat 12th Annual Meeting

Connections

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CHF Continues the Drumbeat on HealthJustice at 12th Annual MeetingPage 1

Annual Meeting Photo GalleryPage 3

10 Things Everyone ShouldKnow about HealthPage 4

CHF Thanks Our Summer FellowPage 4

In This Issue:

Keynote speaker Dr. Adewale Troutman

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Speakers Seek to Educate, Inspire The meeting began with a presentationby Rachel Poulain, director of outreachat California Newsreel and associateproducer of a forthcoming PBS docu-mentary titled “Unnatural Causes: IsInequality Making Us Sick?” The four-hour film series will be released inMarch 2008, and will air on PBSstations in the spring. A brief clip of an earlier version of the same documentary was screened at CHF’s annual meeting last year.

Ms. Poulain introduced the one-hourvideo preview, explaining that the filmwill be released with a communityoutreach toolkit designed to bringpeople together to view the film anddiscuss ways to take action in theircommunities. “We believe the realpower of the film comes when folkslike you use it to foster dialogues aboutwhat we can and should do to addressthe glaring socioeconomic and racialdisparities in health,” she said.

Before screening the film, Ms. Poulainexplained that it tells stories that illustrate the different ways socialdeterminants—such as race, ethnicity,income, education, and where welive—impact our health. For example,one of the stories, titled “When theBough Breaks,” focuses on the impactof racism on health over the course of alifetime, and explores the phenomenaof high rates of low-birth weight andinfant mortality among AfricanAmerican women, even those with high levels of education, income, andhealth insurance. Another, titled “PlaceMatters,” looks at neighborhoods, theenvironment, and how where we liveimpacts our health.

Following a brief audience discussionabout the film, Dr. Adewale Troutman,director of the Louisville (KY) MetroPublic Health & Wellness Departmentand associate professor at theUniversity of Louisville School of PublicHealth, delivered the keynote address:Creating Health Equity Through SocialJustice: The Next Social Revolution.

Dr. Troutman illustrated what healthinequity looks like in terms of excessdeaths—the number of deaths aboveand beyond what can be expectedbased on average death rates—within

the African American population eachyear. Through research conducted with former U.S. Surgeon General, Dr.David Satcher, Dr. Troutman found thatbetween 1960 and 2000, there wereapproximately 83,000 excess deathsevery year among African Americans—or three million excess deaths over 40 years.

Based on that startling figure alone, Dr.Troutman said, the U.S. cannot afford to focus its health improvement effortsonly on “downstream interventions,”like increasing access to healthier foodsor screening programs for specific conditions like hypertension, cancer, and diabetes. He labeled those types of efforts “symptomatic interventions”and said that they maintain the statusquo and don’t address the disease ofhealth inequity, which is caused bythings like racism, gender discrimination,and classism.

Power of StorytellingDr. Troutman spoke about the power ofstorytelling to explain the impact ofsocial determinants of health care. As anexample, he told of a 56-year-old grand-mother he cared for as a young medicalstudent in Newark. The woman came tothe emergency room with advancedstage cervical cancer that had spreadthroughout her body; she died six monthslater. Cervical cancer is highly curable ifdiagnosed and treated early, but thiswoman was first seen in a public clinicthat was three bus rides from her home,by a male physician who didn’t speak thesame language and didn’t understand herculture, and in a clinic where all the staffare overworked and underpaid. When hersuspicious Pap test result came in, theclinic mailed it to her home, but it maynot have reached her, and no one everfollowed up. Given the difficult circum-stances, who’s to say why the womandied? Was it cancer? Or was it becausethe health care system failed her?

According to Dr. Troutman, it is storieslike these that best illustrate the needfor physicians and other health careproviders to understand more than justhow to diagnose and treat illness andinjury. It is important that they under-stand social determinants as well. Dr.Troutman believes that health is“harmony in mind, body, and spirit.” Healso believes that, like people, commu-nities have a mind, body, and spirit and

that we need to understand the contextof peoples’ lives, not just the medicalconditions of their bodies, in order toimprove the health of individuals andtheir communities.

Dr. Troutman went on to explain hispreference for the term health“inequities” over health “disparities.”The word “disparity” strikes him as anunempowered, victim-based descriptionof an intolerable condition. On the otherhand, “inequity” implies empowermentand the ability to right a wrong. Eventhough the U.S. hasn’t declared healthcare a fundamental right, he believes itis one. He said the World HealthOrganization has declared it so in itsConstitution, which states that theenjoyment of the highest standard ofhealth is a fundamental right of everyhuman being without distinction ofrace, religion, political belief, economicor social conditions.

Unfortunately, in the United States, thenumber of deaths caused by healthinequities every year is comparable to the loss of life from lung cancer,diabetes, motor vehicle crashes, HIVinfection, and homicide combined—according to a 1995 study conducted by the Harvard School of Public Healthand referenced by Dr. Troutman.

Dr. Troutman concluded his remarks bydiscussing the creation of the first-of-its-kind Center for Health Equity, which hefounded within the Louisville HealthDepartment. Currently in its second year,the Center is busy retraining its publichealth workforce to think about socialdeterminants and health inequities, anddetermine the best ways to intervene.Among other solutions, the Center haslaunched a public awareness and educa-tion campaign around issues of healthequity, and started working withcommunity leaders to help determinethe biggest needs and best approachesto address them. Dr. Troutman has alsocreated a course on social determinantsfor the University of Louisville School ofPublic Health.

After lively audience discussion, themeeting was adjourned.

Note: The CHF Speakout Report and a completetranscript of the 12th Annual Meeting are availableon our website: www.consumerhealthfdn.org.More information about the PBS documentary is available online at www.unnaturalcauses.org.

Vol. 9, No. 2 2007Connections

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Vol. 9, No. 2 2007Connections

Annual Meeting Photo Gallery

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Vol. 9, No. 2 2007Connections

Ten Things Everyone ShouldKnow About Health 1. Health is more than health care.

Doctors treat us when we’re ill, but whatmakes us healthy or sick in the first place?Research shows that social conditions—thejobs we do, the money we’re paid, the schoolswe attend, the neighborhoods we live in—areas important to our health as our genes, ourbehaviors, and even our medical care.

2. Health is tied to the distribution ofresources. The single strongest predictor of our health isour position on the class ladder. Whethermeasured by income, schooling, or occupation,those at the top have the most power andresources and, on average, live longer andhealthier lives. Those at the bottom are mostdisempowered and get sicker and die younger.The rest of us fall somewhere in between. Onaverage, people in the middle are twice as likelyto die an early death compared to those at thetop; those on the bottom, four times as likely.Even among people who smoke, poor smokershave a greater risk of dying than rich smokers.

3. Racism imposes an added health burden. Past and present discrimination in housing,jobs, and education means that today people ofcolor are likely to be lower on the class ladder.But even at the same rung, African Americanstypically have worse health and die sooner thantheir white counterparts. In many cases, so doother populations of color. Segregation, socialexclusion, encounters with prejudice, thedegree of hope and optimism people have,differential access and treatment by the healthcare system—all of these can impact health.

4. The choices we make are shaped by the choices we have. Individual behaviors—smoking, diet, drinking,and exercise—matter for health. But makinghealthy choices isn’t just about self-discipline.Some neighborhoods have easy access tofresh, affordable produce; others have only fastfood joints, liquor and convenience stores.Some are happy places, with nice homes, cleanparks, safe places to walk, jog, bike or play, andwell-financed schools offering gym, art, musicand after-school programs. What governmentand corporate practices can better ensurehealthy spaces and places for everyone?

5. Chronic stress can be deadly. Exposure to fear and uncertainty trigger astress response. Our bodies go on alert: theheart beats faster, blood pressure rises, glucosefloods the bloodstream—all so we can hitharder or run faster until the threat passes. But when threats are constant, our physiolog-ical systems don’t return to normal. Likegunning a car, this constant state of arousal,even if low-level, wears down our engines over time, increasing our risk for disease.

6. High demand + low control = toxic stress. It’s not CEOs who are dying of heart attacks, it’stheir subordinates. People at the top certainlyface pressure but they are more likely to havethe power and resources to manage those pres-sures. The lower in the pecking order we are,the greater our exposure to forces that canupset our lives—insecure and low-paying jobs,uncontrolled debt, capricious supervisors, unreli-able transportation, poor childcare, no health-care, noisy and violent living conditions—andthe less access we have to the money, power,knowledge and social connections that can helpus cope and gain control over those forces.

7. Inequality—economic and political—is bad for our health. The United States has by far the mostinequality in the industrialized world—and theworst health. The top 1% now owns as muchwealth as the bottom 90%. Tax breaks for therich, deregulation, the decline of unions, racismand segregation, outsourcing and globalization,as well as cuts in social programs destabilizecommunities and channel wealth and power—and health— to the few at the expense of themany. Economic inequality in the U.S. is nowgreater than at any time since the 1920s.

8. Social policy is health policy. Average life expectancy in the U.S. improved by30 years during the 20th century. Researchersattribute much of that increase not to drugs ormedical technologies but to social reforms—forexample, improved wage and work standards,universal schooling, and civil rights laws. Socialmeasures like living wage jobs, paid sick andfamily leave, guaranteed vacations, universalpreschool and access to college, and guaran-teed health care can further extend our lives byimproving our lives. These are as much healthissues as diet, smoking, and exercise.

9. Health inequalities are not natural. Health disparities that arise from our racial andclass inequities result from decisions we as asociety have made—and can make differently.Other industrialized nations already have, withtwo important differences: they make sureabsolute inequality is less (e.g., Sweden’s childpoverty rate is 4%, compared to our 17%), andthey guarantee that everyone has a chance forprosperity and good health regardless of afamily’s personal resources (e.g., good schoolsand health care are available to everyone, notjust the affluent). As a result, they livehealthier, longer lives than we do.

10. We all pay the price for poor health. It’s not only the poor but also the middleclasses whose health is suffering. We alreadyspend $2 trillion a year to patch up our bodies,more than twice per person than what otherindustrialized countries spend, and our healthcare system is strained to the breaking point.Yet our life expectancy is 30th in the world,infant mortality 28th, and lost productivity due to illness costs businesses more than $1 trillion a year.

Reprinted with permission from the Unnatural Causeswebsite: www.unnaturalcauses.org

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Connections is the award-winning bi-annual newsletter of the ConsumerHealth Foundation. Established in 1994, the Foundation is dedicated toimproving the health status ofWashington, D.C. area communities,particularly the most vulnerable membersof those communities, and supportingactivities that enable people to be moreactively involved in their own health.

Consumer Health Foundation1400 16th Street, NW, Suite 710Washington, D.C. 20036-2224Phone: 202.939.3390Fax: [email protected]

Board of TrusteesEleanor A. Walker, ChairDiane C. Lewis, Vice Chair/Assistant SecretaryThomas W. Chapman, Secretary/TreasurerMargaret K. O’Bryon, President and CEOJonca C. Bull-HumphriesDeborah I. ChangStephen P. GormanKaryne JonesRobin KelleyEd LazereNaomi MezeyJeannette NolteniusRuth RuttenbergMary B. TierneyMatthew S. Watson

StaffJacquelyn A. Brown, Program Officer

for Communications and OutreachJulie Farkas, Senior Program OfficerJoyce McCannon, Director of Finance

and Human ResourcesBerlette McMillan, Executive Assistant Margaret O’Bryon, President and CEONivo Razafindratsitohaina, Administrative

AssistantRachel Wick, Program Officer for Policy

and Evaluation

Editing: Burness CommunicationsLayout: Salas Design

CHF Thanks OurSummer FellowIn August, CHF said farewell andthank you to Tiffany MichelleSturdivant, a second-year graduatestudent at the University of Michigan,who participated in our 2007 MPHSummer Fellowship program. Tiffany,who will graduate in 2008, is pursuinga Master of Public Health degree inHealth Management and Policy. Sheis interested in policy researchconcerning faith-based healthservices and racial and ethnicdisparities in health.