Peter A. Gorski, M.D., M.P.A. Childrens Board of Hillsborough County and University of South Florida Envisioning Health Equity.

Peter A. Gorski, M.D., M.P.A.Children’s Board of Hillsborough

County and University of South Florida

Envisioning Health Equity

Social Determinants of Health and Wealth

Your neighborhood Physical, social, economic, educational

qualities

Your skin colorRace, ethnicity

Who’s your daddyParents’ education, income, health,

social capital

Poverty Sickens

3

• Strong connections between child health and adult health

• Between child wealth and adult wealth• Between child wealth and adult health

– Regardless of child’s health condition – Regardless if social class changes from

childhood to adulthood• Childhood poverty gets biologically

embedded

Epigenetics

Life Course PerspectiveBalance of stresses and supports across life

course exert cumulative influence on healthEspecially during sensitive periods of

development, powerful experience gets embedded into our biologyReforming DNA structure, gene expression

and brain chemistryConsequences to BMI, blood pressure,

immune function, memory, learning, attention and mental health

Racial and Ethnic Disparities in Birth Outcomes: A Life Course Perspective

5Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course

perspective.Maternal Child Health J. 2003;7:13-30.

Birth

Early Infancy

Late Infancy

Early Toddler

Late Toddler

Early Preschool

Late Preschool

Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs

Read

y to

lear

nStrategies to Improve

School Readiness Trajectories

“At Risk” Trajectory

“Delayed/Disordered ” Trajectory

“Healthy” Trajectory

Parent educationEmotional HealthLiteracy

Reading to child

Pre-school

Appropriate Discipline

Poverty

Lack of health services

Toxic Stress

Health Services

Race is Not a Proxy for Poverty or Wealth

Beyond (or Underneath) SES

African American infant mortality higher in more segregated cities even when controlling for SES

SES? – Ask the Professionals

9NCHS 2002

6.8

10.2

SES? – Ask the Africans

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David RJ, Collins JW. Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. N Engl J Med. 1997 Oct 23;337(17):1209-14.

Birth weight distribution of African-born blacks is

more closely related to US-born whites than to

US-born blacks

Pathogenesis (and Salutogenesis):

Complex Interaction between Biology and

Environment

This explains why many, if not all, of the chief public health killers have common root causes.

Degradation of personal dignity, social justice and community

I can only be as healthy as my neighbors

Enhancing Public Health – A Provocative Perspective

Single disease prevention approach rarely worksTreating symptoms rather than root causes

Since inequities are at root of health disparities, we must work for the equitable distribution of conditions that promote health and healthy development – Social, educational, economic and environmental capital healthcare

Even More Provocative

Compensatory or Disparities Model (Affirmative Health Action) flawedSee next slide

Equity Framework Health is a human right Every human being has intrinsic worth. Policies should be directed to what every person

needs and deserves to thrive and contribute

Why Target Whole Communities?

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• Health and well-being of each person depends on condition of all (see next slide)

• Cannot predict individual course based on group risk factors

• Cost burden of case-finding and treatment too high

• Moral weakness of accepting unequal outcomes

Post-neonatal Infant Mortality(per 100,000 live births,1986)

15Wilkinson RG. Income distribution and life expectancy. BMJ.

1992;304:165-168.

My Vision-Dream for the Health Equity Coalition

Expand public understanding of health equity framework

Forge strategic partnerships across the county’s public and private sectors – every decision impacts health

Document and demonstrate the correlation and causal association between social, economic, educational, environmental and healthcare equity and population health outcomes

Advocate for policies and practices that promote and create advantage for all citizens