Improving Health Outcomes for all People. Do you think health care is a right or a privilege? Why?

Improving Health Outcomes for all People

Do you think health care is a right or a privilege? Why?

Answers from Others A. A persons overall health should determine his cost for care. Everyone should pay their own way for health care benefits because some people are sicker than others or have diseases that cost so much to support.

Answers from Others B. A population that is sick cannot be productive and benefit the economy. We end up paying more if we dont provide health care to all. It is not a far leap to consider that improving health care access may be profitable to society as well as improve the health of individuals.

Answers from Others C. It is a privilege because people abuse rights when they take advantage of society. Unhealthy lifestyle choices and unwillingness to get health care is favored by the poor people and minorities. People visit the emergency room mainly for convenience. This privilege should be limited or cut. You get what you pay for!

Answers from Others D. Health care is a privilege because there are many factors that the individual controls themselves, such as practicing good nutrition and getting enough exercise. These are choices.

Answers from Others E. Resources and opportunities are not necessarily available to everyone in equal measure. In large part because of these inequities, I believe the right of individuals to health care carries a responsibility to contribute to the health of others, whether they be family members, friends, or strangers in the community

Answers from Others F. I wonder if we as a nation have done enough to prevent disease in the first place. Health care is a right of every citizen, and we need to do more to help the community be healthier.

Answers from Others G. I cannot understand how health care can be thought of as a privilege. The asymmetry of information in healthcare is greatly magnified. In a developed country, this is clearly unacceptable, unethical, and reflects a complete lack of morality with respect to the fundamental right to health.

Third Space

First space: one created by the majority and imposed on the minority Second space: one minority groups view as their actual culture Third space: a part of both the first and second spaces, that allows people to detach from existing parameters and examine the world with new eyes

What is the mission of the public health system?

Mission To fulfill societys interest in assuring conditions in which people can be healthy. - Institute of Medicine, 1988 What does this mean?

Culture and Beliefs Culture affects attitudes On what beliefs or attitudes was/is United States culture built in general? How does history affect our beliefs?

Individualism v Collectivism Individualism: cultures tend to include loose ties between individuals, and everyone is expected to look after him or herself and immediate family Collectivism: people are born into, raised by, and expected to demonstrate lifelong loyalty to strong, cohesive in-groups in which everyone is responsible for everyone (Hofstede, 2001)

Individualism v Collectivism IndividualismCollectivism IdentificationSelfGroup PrioritySelfGroup Goal of individualSelf-sufficiencyInterdependence Dx between individuals MuchLittle Associated withMen, UrbanWomen, Rural EmphasisInitiative, achievement Belonging MarriagesMay involve childrenMust involve children Purpose of education Learning how to learn Learning how to do

School & Work Has anyone ever done a group project at work or school? How did it go? How much do you enjoy work in which you must depend on other people to get the job done? What if this was the norm?

How is it different at home? Do you consider your kids and spouse when making decisions? What does that mean? What if you had to also consider your parents, siblings and their spouses and kids, grandparents, in-laws, aunts and uncles, cousins and their spouses? Would your decisions be different?

HEALTH

Factors of Health How do we achieve health? What is involved? What is health? Is it strictly the result of choices? What other factors may be at play?

How does poverty affect health?

What are the Outcomes? Do Americans who struggle financially have the same opportunities to be as healthy as others? Are they more vulnerable to poor health due to circumstances?

Factors of Health America leads the world in medical research and medical care, and for all we spend on health care, we should be the healthiest people on Earth Yet on some of the most important indicators, like how long we live, were not even in the top 25, behind countries like Bosnia and Jordan Scientists have found that the conditions in which we live and work have an enormous impact on our health, long before we ever see a doctor Where people live, learn, work and play has an enormous impact whether they stay well in the first place Copyright 2010 Robert Wood Johnson Foundation

Factors of Health Three key ingredients to health Ensure that everyone can afford to see a doctor when theyre sick Build preventive care like screening for cancer and heart disease into every health care plan and make it available to people who otherwise wont or cant go in for it, in malls and other public places, where its easy to stop for a test Stop thinking of health as something we get at the doctors office but instead as something that starts in our families, in our schools and workplaces, in our playgrounds and parks, and in the air we breathe and the water we drink Copyright 2010 Robert Wood Johnson Foundation

Factors of Health Availability of resources Access to opportunities Access to health care Quality of education and job training Opportunities for recreational and leisure- time activities Transportation options Public safety Social support Culture Social norms and attitudes Exposure to crime, violence, and social disorder Socioeconomic conditions Residential segregation Language/Literacy Access to mass media and emerging technologies (US DHHS, 2012) Social

Factors of Health In the entire city of Detroitan area of nearly 150 square milesthere are dozens of convenience stores but only five grocery stores. An apple a day may keep the doctor away, but you have to be able to buy an apple. Copyright 2010 Robert Wood Johnson Foundation

Factors of Health Physical Natural environment, such as green space or weather Built environment, such as buildings, sidewalks, bike lanes, and roads Worksites, schools, and recreational settings Housing and community design Exposure to toxic substances and other physical hazards Physical barriers, especially for people with disabilities Aesthetic elements (US DHHS, 2012)

Key Factors 1. Economic Stability Poverty Employment status Access to employment Housing stability 2. Education High school graduation rates School policies that support health promotion School environments that are safe and conducive to learning Enrollment in higher education (US DHHS, 2012)

Key Factors 3. Social and Community Context Family structure Social cohesion Perceptions of discrimination and equity Civic participation Incarceration/Institutionalization 4. Health and Health Care Access to health services Access to primary care Health technology (US DHHS, 2012)

Key Factors 5. Neighborhood and Built Environment Quality of housing Crime and violence Environmental conditions Access to healthy foods (US DHHS, 2012)

Equality v Equity What is equality? What is equity? Are they the same thing?

Equity v Equality Equality: fairness in proportion - ensuring everyone has similar access, an equal piece Equity: fairness in distribution, everyone has access that is appropriate and necessary to their needs everyone gets what they need regardless of the size of the pieces equity may also be likened to equality of outcomes

Socioeconomic Status Socioeconomic Status: the social standing or class of an individual or group; often measured as a combination of education, income, wealth, and occupation (American Anthropological Association, 2007)

Poverty Is all poverty the same? What does poverty mean? What does it mean to live in poverty?

Poverty Economic Social Cultural Political (UNESCO, n.d.)

Poverty Generational Poverty: families living in poverty for two or more generations Situational Poverty: people or families who fall into poverty due to lack of resources to address a specific event How are these different?

Poverty Poverty is a peculiar, insidious thing: a cause whose effects often cause the original cause, or an effect whose causes are caused by the effect (Shipler, 2004, p 53)

Mistakes & Achievements Personal mistakes have larger consequences Personal achievements yield smaller returns Middle class: every 3 months Poverty: every week What does this mean? (Shipler, 2004)

Poverty Were not just talking about the rich versus the poor. On Average, middle class Americans live shorter lives than those who are wealthy. We have to take responsibility for our lives and decisions. But all Americans should have an equal opportunity to make the decisions that allow them to live a long, healthy life, regardless of their level of income, education, or ethnicity. Copyright 2010 Robert Wood Johnson Foundation

Related Skills What skills do you need to work in a fast- food restaurant? What skills do you need to work in a C- suite? How are these skills obtained or built? Who teaches them? (Shipler, 2004)

Learning/Education If you do not have a roof over your head If you do not know with whom you are living If you do not know whether there will be food for dinner Are you going to worry about classwork? (Shipler, 2004)

Socioeconomic Class How many social classes are there in the US? Are there different mindsets that go with each class? What might be similar? What might be different?

We cant eradicate illness, but we can foster health. Health begins with healthy relationships, healthy communities, and healthy jobs, which protect us from the stress of everyday life. Copyright 2010 Robert Wood Johnson Foundation

We need a few good volunteers

Some Statistics People in the highest income group live an average of 6.5 years longer than those in the lowest People in the middle class will die an average of 2 years sooner than those at the top Low income people are 50% more likely to have heart disease than the wealthy Middle class people are 20% more likely to have heart disease than the wealthy (California Newsreel, 2008)

Some Statistics Children living in poverty are about 7 times more likely to be in poor or fair health as those in the top Middle class children are twice as likely to be in poor or fair health as the wealthy Rates of illness for poor people in their 30s and 40s are comparable to those of wealthy people in their 60s and 70s (California Newsreel, 2008)

Some Statistics If they get sick, 47% of US private sector workers must choose between staying home or losing a days pay The US is the only industrialized nation that does not require employers to provide paid sick leave The US is the only industrialized country in which paid vacations are not required by law 1 in 4 American workers receive NO paid holidays or vacations (California Newsreel, 2008)

Current Efforts: Federal National Partnership for Action to End Health Disparities Awarenessincrease awareness of the significance of health disparities, their impact on the nation, and the actions necessary to improve health outcomes LeadershipStrengthen and broaden leadership for addressing health disparities at all levels Health System and Life ExperienceImprove health and healthcare outcomes Cultural and Linguistic CompetencyImprove cultural competency and linguistic competency Research and Evaluation Improve coordination and utilization of research and evaluation outcomes

Current Efforts: Nebraska People are People are People: Increasing Your CQ Community Health Worker Coalition OHDHE Strategic Plan Promote chronic disease prevention, maternal child health promotion, reduction of obesity, and improve physical activity and nutrition Enhance awareness of health disparities and advance CQ Establish coordinated data collection, evaluation methods and outcomes, and provide relevant statistical data Expand and sustain statewide community partnerships and collaboration Encourage full racial and ethnic minority engagement Enhance collaboration/coordination and technical assistance efforts regarding tribal health

What are you/your organization doing? How do you fit in?

Final Comments? Questions? Thoughts?

References American Anthropological Association. (2007). Race: Are we so different? Retrieved from www.understandingrace.org California Newsreel. (2008). Unnatural causes: Is inequality making us sick? Retrieved from http://www.unnaturalcauses.org/ Hentoff, N. (1999, November). Expelling Huck Finn. The Washington Post. Retrieved from http://www.frontpagemag.com/archives/racerelations/ hentoff11-30- 99p.htmHofstede, G. (2001). Cultures consequences: Comparing values, behaviors, institutions, and organizations across nations. Thousand Oaks, CA: Sage Publications. Institute of Medicine. (1988, January 1). The future of public health. Washington, DC: National Academies Press. Shipler, D. K. (2004). The Working Poor: Invisible in America. New York NY: Knopf. United States Department of Health and Human Services. (2012). Healthy people 2020. Retrieved from http://www.healthypeople.gov/2020/default.aspx

More information Nebraska Office of Health Disparities & Health Equity 402-471-0152 http://dhhs.ne.gov/healthdisparities [email protected]

Improving Health Outcomes for all People. Do you think health care is a right or a privilege? Why?

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