When we fight we win Physician leaders, health inequities and
the movement for healt
Physicians, health reform, and health equity: When we fight, we
win!Jim Bloyd, MPHCollaborative for Health Equity Cook
CountyCHECookCounty.org @CHECookCounty
February 15, 2016 3:00-4:15 p.m.Health Advocacy and Policy
ForumUniversity of Illinois, College of Medicine Collaborative For
Health Equity Cook CountyWHERE PEOPLE, PLACE, AND POWER MATTER
1
My topics today:When we fight we win!Collaborative for Health
Equity Cook CountyPhysician-leaders who inspire meExamples of
health inequities in the USEvidence, power & policy changeWhat
produces health inequities? (Theres nothing as practical as a good
theory)Health care reform-community benefits (a bit)
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER2
The time is ripe for a radical expansion of public health
leadership. Begun & Malcolm 2014
http://www.springerpub.com/leading-public-health.html2
When we fight, We win!Jobin-Leeds & AgitArte 2016 The New
Press. New YorkMovements are sources of lessonsTrying is the path
to victoryWinning requires a weTransformative change, in the face
of powerful forces, requires a fightWe win our own personal
transformationClaiming our humanity and right to fight is a winWhen
we fight we win: voices of cutting edge leaders addressing root
causes of inequities2/15/16Collaborative For Health Equity Cook
County WHERE PEOPLE PLACE AND POWER MATTER3
WHENWE FIGHT, WE WIN!: Twenty-First-Century Social Movements and
the Activists That Are Transforming Our WorldLongtime social
activist Greg Jobin-Leeds joins forces with AgitArte, a collective
of artists and organizers, to capture the stories, philosophy,
tactics, and art of todays leading social change movements. When We
Fight, We Win! weaves together interviews with todays most
successful activists and artists from across the country and
beyond. Whenwefightwewin.com
3
2015 STRATEGIC PLAN FINAL REPORT April 2011To optimize health
and achieve health equity for all people and communities of Cook
County through our leadership and collaborations.we need to make
significant changes in how we workBecause health depends causally
on its environmental, economic, technological, informational,
cultural and political contexts, social justice is prerequisite to
achieving optimal and equitable public health.
4
19 interdisciplinary pLACE MATTERS teams work in the United
States through an initiative of the National Collaborative for
Health Equity. The mission of the National Collaborative is to
promote health equity by catalyzing collaboration among racial
equity advocates, grassroots and community-based organizations,
researchers, public health professionals, and other key
stakeholders. PLACE MATTERS is designed to build the capacity of
leaders and communities around the country to identify and address
social, economic, and environmental factors that shape health
inequities; Two other teams frm the midwest are Wayne and Cuyahoga
counties. IN the East are teams from Boston, Baltimore, and
Washington DC, Prince Georges and Marlboro Counties. South Delta
Counties, Orlenas Parish, and Mid-Mississippi Delta Teams are from
the Delta areas. Teams in New Mexico are from the of San Juan,
Mcknley, Bernalillo and Dona Ana Counties. And in the West teams
are located in the Martin Luther King, Jr., Alameda and San Joaquin
Counties. I want to thank my fellow Team mates and the National
Collaborative for their their generosity in sharing their tools and
lessons learned and for their steadfast commitment to health
equity.
The project will connect research, policy analysis,
communications, and activism to ultimately support policy, systems,
and environmental change that addresses the legacy of racism,
particularly its less visible-but more insidious-structural
manifestations, and their health consequences. The National
Collaborative will convene leaders to share innovative ideas,
provide technical assistance to support multi-sector racial equity
initiatives, and conduct research and policy analysis that supports
on-the-ground activism.
5
Collaborative For Health Equity Cook County19 National
Collaboratives For Health EquityLearning
Communitywww.checookcounty.org @checookcounty
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER6
Rudolph Virchow
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER7Father of social medicine and
virologyInfectious diseases due to social conditionsFor the
prevention and eradication of epidemics, political and economic
change was as important as medical intervention if not more so
(Howard Waitzkin Nov 8 2010 Illness-generating conditions of
capitalism and empire: The contributions of Engels, Virchow, and
Allende)
May the rich remember during the winter, when they sit in front
of their hot stoves and give Christmas apples to their little ones,
that the shiphands who brought the coal and the apples died from
cholera. It is so sad that thousands always must die in misery, so
that a few hundred may live well.
Virchows visions of the social origins of illness pointed out
the wide scope of the medical task:Study of social conditions as
part of clinical research and health workers engagement in
political actionVirchow frequently drew connections among medicine,
social science, and politics: "Medicine is a social science, and
politics is nothing more than medicine in larger scale."
7
Paul Bertau Cornely (1906-2002)
1970 critiqued public health as outside the power structure,
acting as a mere bystander.(Fairchild etal 2010)1st Black President
American Public Health Association1st Black DrPH, and Doctorate in
anatomy (via Murray, L. n.d.)2/15/16Collaborative For Health Equity
Cook County WHERE PEOPLE PLACE AND POWER MATTER8
In the view of critics, public health professionals have, over
the course of a century, defined their mandate ever more narrowly
and shrunk from political engagement with powerful interests such
as corporations and business that created unhealthful environments.
They failed to con-front medical specialists interested in defining
preventive interventions as clinical and hence as reimbursable.
This critique was made perhaps most memorably by Paul Cornely in a
1970 address to the American Public Health Association. Newly
elected as the groups first African American president, Cornely
leveled a blistering attack on what he saw as the complacency of
his profession. It had been a mere bystander to the profound
changes in the health care system pressed to join the coalitions
mak- professionals committed both to that had taken place in the
1960s; its members wasted their time on piddling resolutions and
their wordings. Public health, he charged, remained outside the
power structure.52 Cornelys ad-dress was a clarion call for more
aggressive action against a host of health problems integral to
modern industrial society.5 Fairchild et al 2010 page 608
Salvador Allende (1908-1973)
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER9Salvador Allende, La Realidad Medico-Social
Chilena, 1939 (Waitzkin 2010) Pathologist, student of Engels and
Virchow (and Max Westenhofer) Later senator, president of Chile
Health and mental health in wide-ranging epidemiological study
Salvador Allende, late president of Chile and a pathologist,
helped establish the field of Latin American social medicine with
his path-breaking epidemiological work, accomplished during the
1930s. Although social medicine has become a widely respected field
of research, teaching, and clinical practice in Latin America, the
accomplishments of this field remain little known in the
English-speaking world p. 739 (Waitzkin, H. (2005). Commentary:
Salvador allende and the birth of latin american social medicine.
International Journal of Epidemiology, 34(4), 739-41.
doi:10.1093/ije/dyh17)9
Ernesto Che Guevara (1928-1967)
The life of a single human being is worth a million times more
than all the property of the richest man on
earth.2/15/16Collaborative For Health Equity Cook County WHERE
PEOPLE PLACE AND POWER MATTER10
https://www.marxists.org/archive/guevara/1960/08/19.htm
was an Argentine Marxist revolutionary, politician, author,
physician, military theorist, and guerrilla leader during the Cuban
revolution. Following his execution in Bolivia, he became both a
stylised countercultural icon and symbol of rebellion for leftist
movements worldwide.
After graduation, due to special circumstances and perhaps also
to my character, I began to travel throughout America, and I became
acquainted with all of it. Except for Haiti and Santo Domingo, I
have visited, to some extent, all the other Latin American
countries. Because of the circumstances in which I traveled, first
as a student and later as a doctor, I came into close contact with
poverty, hunger and disease; with the inability to treat a child
because of lack of money; with the stupefaction provoked by the
continual hunger and punishment, to the point that a father can
accept the loss of a son as an unimportant accident, as occurs
often in the downtrodden classes of our American homeland.10
H. Jack Geiger (L),John W. Hatch (b1928)(R) construction of
Delta Health Center, Bayou Mound, Mississippi 1968
John Hatch: Head of community organizing Delta CHC; first
African-American endowed chair UNC School of Public Health.Jack
Geiger: used health care as an instrument of social justice and
empowerment for those oppressed by racism and poverty.The Flint
Disaster: Why Doesnt Black Health Matter? (Geiger. Feb 3 2016
physicansforhumanrights.org/blog)Photo: Dan
Bernstein2/15/16Collaborative For Health Equity Cook County WHERE
PEOPLE PLACE AND POWER MATTER11
when Delta Health Center physicians literally wroteand arranged
to fillemergency prescriptions for food for impoverished families
with seriously malnourished and infected children, and charged the
costs to the centers pharmacy budget, the voernor of Mississippi
accused them of communism.
a shocking public health failure. It is an assault on human
rights a recognition that has been largely absent from most
discussions of how and why this could have happened in the advanced
industrial democracy of the United States. It is arguably the
largest discrete violation of its type since the infamous and
grossly unethical Tuskegee syphilis medical study of the last
century. The water poisoning in Flint was finally forced into
official recognition by a brave and stubborn pediatrician, Dr. Mona
Hanna-Attisha, who documented what was really happening to Flints
vulnerable children and other residents. - See more at:
http://physiciansforhumanrights.org/blog/the-flint-disaster-why-doesnt-black-health-matter.html#sthash.z2ALH6HQ.0TpcT6qP.dpuf
11
Linda Rae Murray (b1948)
Past-President American Public Health AssociationFaculty UIC
School of Public HealthU Med Alum 1977Internal medicine,
Occupational therapy, Cook County HospitalChief Med Officer Amb
& Comm Health Network Cook County 2005policy is not made by
p-valueRacism is critical to how capitalism functions
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER12
Social Movements and Collective Action (House Staff Strike 1975)
County Ansel (2011)
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER13
#SavetheNHS
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER14
Camara Phyllis Jones
President, American Public Health AssociationLevels of Racism: A
theoretical framework and a gardeners tale AmJPH
2000;90(8):1212-1215it is difficult for any of us to recognize a
system of inequity that privileges usI hope that your understanding
will move you to action. Email me. [email protected]
(thenationshealth.org Feb2016)
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER15
MD, MPH, PhD15
Mona Hannah-Attisha
Dir of Pediatrics Hurley Childrens Hospital, Flint
MichiganProfessor, Michigan State UniversitySo I was called an
"unfortunate researcher," that I was causing near hysteria, that I
was splicing and dicing numbers, and that the state data was not
consistent with my data. ..we regrouped and told them "No, you were
wrong.Photo: Junfu Han The Ann Arbor News2/15/16Collaborative For
Health Equity Cook County WHERE PEOPLE PLACE AND POWER
MATTER16Jan15-2016
http://www.democracynow.org/2016/1/15/flint_doctor_mona_hanna_attisha_on
http://www.mlive.com/news/ann-arbor/index.ssf/2016/02/flint_pediatrician_at_u-m_you.html
Jan15-2016
http://www.democracynow.org/2016/1/15/flint_doctor_mona_hanna_attisha_on
"There's a lot we know that we can do," she said. "A lot of that
lives in the policy world, a lot lives in the world of the primary
caregivers, and a lot lives in the public health world.
Well, that evening, we were attacked. So I was called an
"unfortunate researcher," that I was causing near hysteria, that I
was splicing and dicing numbers, and that the state data was not
consistent with my data. And as a scientist, as a researcher, as a
professional, you double-check and you triple-check, and the
numbers didnt lie. And we knew that. But when the state, with a
team of like 50 epidemiologists, tells you youre wrong, you
second-guess yourself. But that lasted just a short period, and we
regrouped and told them why, "No, you were wrong." And after about
a week and a half or two weeks, after some good conversations, they
relooked at their numbers and finally said that the states findings
were consistent with my findings.
Gov. Snyder (Why Austerity Kills: Book)Violation of ph ethics:
Public health malpracticeJack Geiger Why Doesnt Black Health
MatterWhat is Illinois or Chicagos parallel crisis: Education,
housing, police killings, young adult
unemployment-not-in-school,
16
Quentin Young (b 1923), ChicagoMany
othersYou!2/15/16Collaborative For Health Equity Cook County WHERE
PEOPLE PLACE AND POWER MATTER17
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER1
Bd. President Preckwinkle continued saying People living in
areas with a median income greater than $53,000 per year have a
life expectancy that is almost 14 years longer than people living
in areas with a median income below $25,000 per year. July 26, 2012
Press Conf/ PM Action Lab, Chicago
Our Teams Report made 6 recommendations, including that
sufficient funds be allocated to increase healthy food retail in
neighborhoods with low food access, and that the voices and
aspirations of neighborhood residents be reflected in solutions to
hunger and poor nutrition; to Ensure workplace justice for workers
throughout the food chain and specifically included the restaurant
industry; that persistent poverty be addressed by engaging multiple
sectors, and the the 2008 WHO Final Report of the Commission on the
SDH be implemented.
The report found evidence of a relationship between life
expectancy and neighborhood income. Among Chicago census tracts and
suburban Cook County municipalities grouped 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. 18
Map of Child Opportunity in Cook County (Source:
Diversitydatakids.org)
Children in Cook County grow up in neighborhoods with stark,
unfair differences in opportunity for healthy development.
Nationally, 40% of Black and 32% of Hispanic children live in very
low-opportunity neighborhoods compared to 9% of White
children.(Acevedo-Garcia, etal 2015)2/15/16Collaborative For Health
Equity Cook County WHERE PEOPLE PLACE AND POWER MATTER19
Metro Chicago: Poverty Composition of Neighborhoods Where Poor
Children Live By RaceSource: Diversitydata.org, (2011, from 2000
Census Data)
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER20Poor Children by Race%
This slide shows the dramatic affect of segregation on Metro
Chicago which exposes only poor children of color to high levels of
concentrated poverty, while locating poor white children in
neighborhoods of low poverty.
While 90% of poor white children live in low poverty
neighborhoods about 75% of Black children and 45% of Latino
Children are exposed to the health and life threatening
environments of higher poverty neighborhoods. This is also
described by the 2008 Institute Of Medicine report by J A
Cohen.
Cohen, J. A., Ed. (2008). CHALLENGES AND SUCCESSES IN REDUCING
HEALTH DISPARITIES. Washington, D.C., INSTITUTE OF MEDICINE OF THE
NATIONAL ACADEMIES.
20
Reform Can move us toward health equity if we understand the
origins of health inequities and take power and systems of
advantage-disadvantage into account
Solar & Irwin, WHO (2010) For example p5
We have repeatedly referred to Hilary Grahams warning about the
tendency to conflate the social determinants of health and the
social processes that shape these determinants unequal
distribution, by lumping the two phenomena together under a single
label. Maintaining the distinction is more than a matter of
precision in language. As Graham argues, blurring these concepts
may lead to seriously misguided policy choices. There are drawbacks
to applying health-determinant models to health inequalities. To do
so may blur the distinction between the social factors that
influence health and the social processes that determine their
unequal distribution. The blurring of this distinction can feed the
policy assumption that health inequalities can be diminished by
policies that focus only on the social determinants of health.
(Solar and Irwin, 2010 p47)21
World Health Organization Commission on the Social Determinants
of Health Conceptual FrameworkSolar & Irwin (2010)
http://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER22
Structural Determinants: The social determinants of health
inequitiesSource: World Health Organization, 2010, Solar and Irwin
p. 35.
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER23
Gradient & Fundamental CausesAge standardized mortality rate
for avoidable (left axis) and non-avoidable (right axis) causes of
mortality by Carstairs deciles for women 1981-2001. (Scott et al
2013 NHS Scotland)
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER24
Thatavoidablemortalityshoulddisplayasocioeconomicgradient
whilstnonavoidablemortalitydoesnot,suggeststhatsocioeconomicgradientsinmortalityresultfrom
eitheradifferenceinknowledgeonhowtoavoidharmoradifferenceintheabilitytoactonthat
knowledge.Recentworkexploringtherelationshipbetweenknowledge,motivationandoutcomesina
Scottishpopulationsampleindicatesthelatterismorelikely(24).Thisisfurthersupportedbyrecentwork
whichhasshownthattrendsinhealthinequalitiesmirrortrendsinsocioeconomicinequalities(2,3).Taken
togethertheseobservationssignalthat:socioeconomicinequalityisafundamentalcauseofhealth
inequalities;focusingoncontrollingproximalmediatorssuchastobaccowillultimatelyfailtoeradicate
socioeconomicinequalitiesinhealth;andthateliminationofhealthinequalitieswillrequirethatunderlying
resourceinequalitiesbeaddressed.page 33
24
Evidence, power and policy
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER25
Wall Street Journal page 1 January 19, 2016 online story at
http://www.wsj.com/articles/unitedhealth-reports-profit-decline-amid-exchange-weakness-14532044042/15/16Collaborative
For Health Equity Cook County WHERE PEOPLE PLACE AND POWER
MATTER26
The Coverage GapSupreme Courts decision in 2012 allowed States
to opt out of Medicaid ExpansionIndividuals below the FPL living in
states that have not expanded Medicaid experience difficulty
accessing affordable health coverage4 million people fall into the
coverage gap created by states not expanding Medicaid85 percent of
these individuals reside in the South, half are African American or
Hispanic
Opportunity to align hospitals community benefits with community
needs
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER28
sample does some-what underrepresent hospitals affiliated with
systemssample was limited to tax-exempt hospitals that reported
their community benefit expenditures to the IRS at the individual
hospital level and were not exempt from Form 990 Schedule H
reporting under a group exemption .sample was limited to 1 year of
data (2009), the first year for which hospitals were required to
report their community ben-efit expenditures to the IRS.some
measurement error may existconsistent with previous studies, we
defined a hospitals community as the county in which the hospital
is located.5,11 Clearly, the communities for most hospitals are not
fully equivalent to the county in which they are located.For
community benefit reporting, the IRS allows hospitals to define
their community.
hospitals are free to define the community they serve in terms
of, for instance, specific geographical areas or target populations
served.
Conclusiongs: important opportunities exist for hospitals to
improve the alignment between their charitable activities and
community needs.the lack of a relationship between community health
needs and hospitals provision of community benefits aimed at
broadly improving the health of their communities,
28
Working Definition of Population Health IOM Roundtable on
Population Health Improvement (2014)
defining population health solely in terms of clinical
populations can draw attention away from the critical role that
non-clinical factors such as education and income play in producing
health. Geopolitical areas rather than simply geographic areas are
recommended when measuring total population health since funding
decisions and regulations are inherently political in nature
(Jacobson and Teutsch, 2012) [emphasis added]The Roundtable uses
population health in the spirit of the Jacobson-Teutsch
critique.2/15/16Collaborative For Health Equity Cook County WHERE
PEOPLE PLACE AND POWER MATTER29
many embrace a population health or population medicine
perspective (Harvard Pilgram Health Care Institute, 2013), a few
are striving towards a geographic regional emphasis in their
definition of population health (Kindig and Whittington, 2011).
there is variation in how Triple Aim practices define population
health.Enrollees in a health planpopulation of patients in a
hospital
This shift from volume-based payment to value-based payment may
result in more hospital prioritization of community health
initiatives, partic-ularly among hospitals in communities with a
relatively high incidence of chronic illness, because hospitals
will have financial incentives to reduce service utilization for
individuals for whom they are responsible. (Singh et al p 919)
29
Community Benefits: An opportunity to tackle health inequities
in metro-ChicagoACA requires non-profit hospitals to conduct
community health needs assessments (CHNA)Community BenefitsTax
exempt statusNationally in 2009, 7.5% avg of operating budgets; 85%
for clinical services (Young)Value of tax exemption $24.6 billion
2011 Rules affect more than 80% of hospitalsthe health needs of a
community include not only the need to address financial and other
barriers to care but also the need to prevent illness, to ensure
adequate nutrition, or the need to address social, behavioral, and
environmental factors that influence health in the community (IRS,
2014 in Rosenbaum 2015). requires non-profit hospitals to conduct
and implement a community health needs assessment at least every
three years with participation from public health professionals and
community members (Folkemer et al., 2011 in Woodcock & Nelson
2015).
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER30
do hospitals respond to greater community health needs by
spending more on health? Is there a general correspondence between
types of community needs and types of community benefit
expenditures?We investigated the pattern of hospital community
benefit expenditures in relation to community health needs on the
basis of a broad set of indicators of health needs from the County
Health Rankings.12
We sought to assess the relationship between hospital community
benefit expenditures and com-munity health needs before the ACA.
This information can help gauge the success of the community health
needs assessment mandate in the future.
Hospitals did not, however, dedicate more financial resources to
programs and activities that would benefit the community more
broadly in the form of direct spending on community health
initiatives or financial and in-kind contributions to community
groups. In fact, the group of hospitals that spent the most on
community health improvement initiatives were hospitals in quartile
1 (i.e., hospitals serving the healthiest communities).
Our multivariate model did not reveal any relationship between
our global community health needs indicator and hospital spending
on community health improvement initiatives.
Hospitals in communities with greater needs do not appear to
spend more on community improvement initiatives than do hospitals
in communities with fewer needs. Page 917
30
IRS Form 990for purposes of Form 990 Schedule H reporting
hospitals have a good deal of latitude in what they call a
community health improvement initiative. Hospitals may report
expenditures on activities that have more to do with their
organizational priorities than with the health needs of their
communities. (p918 Singh et al 2015)2/15/16Collaborative For Health
Equity Cook County WHERE PEOPLE PLACE AND POWER MATTER31
for purposes of Form 990 Schedule H report-ing hospitals have a
good deal of latitude in what they call a community health
improvement initiative. Hospitals may report expenditures on
activities that have more to do with their organizational
priorities than with the health needs of their communities. P
918
he IRS and other fed-eral agencies should closely monitor the
implementation of the ACA community health needs assessment
requirement and evaluate its impact on aligning hospital community
benefit activities with community health needs.
with the advent of Form 990 Schedule H, there may eventually be
more transparency and scrutiny of the community benefits hospitals
provide, a development that may lead to shifting hospital spending
priorities for community benefits that are better aligned with
community needs.8,23 Community advocacy groups are beginning to
take steps to improve the publics access to Form 990 Schedule H
data through Web-based re-sources. Better access to this
information will likely result in further discussion of the
adequacy of hospitals community benefit activities because of the
specific needs of the population served.
The IRS has amended Schedule H, which accompanies Form 990, to
include extensive facility-specific information regarding 501(r)
compliance. (Schedule H also requires a hospital organizations to
provide organization-specific information about its community
benefit expenditures as a charitable organization under 501(c)(3)).
(Rausenbaum, Health Affairs Blog, 2015)31
Defining community benefitsFor example, hospitals may report
expenditures for community-based services that function, at least
in part, as referral programs for specific clinical programs the
hospital offers. Hospitals may also report expenditures for
activities that are located in geographical areas where the
hospital is attempting to expand its reputation or market share
rather than areas with the greatest health needs (p918 Singh etal
2015) 2/15/16Collaborative For Health Equity Cook County WHERE
PEOPLE PLACE AND POWER MATTER32
least in part, as referral programs for specific clinical
programs the hospital offers. Hospitals may also report
expenditures for activities that are located in geographical areas
where the hospital is attempting to expand its reputation or market
share rather than areas with the greatest health needs32
Disagreements about USA Fed Govt Spending Levels expand, cut
back, or keep the sameCut backExpand
(Page, Bartels & Seawright 2013)2/15/16Collaborative For
Health Equity Cook County WHERE PEOPLE PLACE AND POWER MATTER33
If wealthy Americans wield an extra measure of influence over
policy making, and if they strongly favor deficit reductions
through spending cutsincluding cuts in Social Security and
Medicarethis may help explain why a number of public officials have
advocated deep cuts in the very social welfare programs that are
most popular among ordinary Americans. Page 5633
Page et al 20132/15/16Collaborative For Health Equity Cook
County WHERE PEOPLE PLACE AND POWER MATTER34
Page et al 20132/15/16Collaborative For Health Equity Cook
County WHERE PEOPLE PLACE AND POWER MATTER35
35
Affluence and Influence: The preference/policy link (Gilens
2012)under most circumstances, the preferences of the vast majority
of Americans appear to have essentially no impact on which policies
the government does or doesnt adopt. [loc196]When less-well-off
Americans hold preferences that diverge from those of the affluent,
policy responsiveness to the well-off remains strong but
responsiveness to lower-income groups all but disappears.
[Loc278]
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER36
Justice Brandeis: We can have democracy in this country, or we
can have great wealth concentrated in the hands of a few, but we
cannot have both.Main data set: 1,923 survey questions asked of
national samples of the US population between 1981-2002.
Supplemented with additional survey questions asked during 196469
and 2005-2006.
how the level of support or opposition to a policy among poor,
middle-class, or affluent Americans affects the probability of that
policy being adopted
36
When we fight, We win!Movements are sources of lessonsTrying is
the path to victoryWinning requires a weTransformative change, in
the face of powerful forces, requires a fightWe win our own
personal transformationClaiming our humanity and right to fight is
a winWhen we fight we win: voices of cutting edge leaders
addressing root causes of inequities2/15/16Collaborative For Health
Equity Cook County WHERE PEOPLE PLACE AND POWER MATTER37
Reading Suggestions
The Health Gap (Marmot)Epidemiology and the Peoples Health
(Krieger)The New Jim Crow (Alexander)Racing To Justice (powell)The
History of White People (Painter)Globalization and Health (Kawachi
& Wamala)The Assassination of Fred Hampton (Haas)
Ella Baker and the Black Freedom Movement (Ransby)Talking the
Walk (Cutting & Themba-Nixon)Leading Public Health (Begun &
Malcolm)Medicine and Public Health at the End of Empire
(Waitzkin)Forked (Saru Jayaraman, ROC United)Beyond Evidence-based
Policy in Public Health (Smith)2/15/16Collaborative For Health
Equity Cook County WHERE PEOPLE PLACE AND POWER MATTER38
ResourcesDemocracy Now! Flint Doctor Mona Hanna-Attisha on How
She Fought Gov't Denials to Expose Poisoning of City's Kids January
15, 2016
http://www.democracynow.org/2016/1/15/flint_doctor_mona_hanna_attisha_onBrown,
T. M., & Fee, E. (2011). Paul B. Cornely (1906-2002): Civil
rights leader and public health pioneer. American Journal of Public
Health, 101(Supplement 1), S164. doi:10.2015/AJPH.2010.30005Fafard,
P. (2008). Evidence and healthy public policy insights from health
and political sciences. Ottawa, Ont.: Canadian Policy Research
Networks. Retrieved from National Collaborating Centre for Healthy
Public Policy:
http://www.ncchpp.ca/docs/FafardEvidence08June.pdfGilens, M.
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2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER39
Thank youJim Bloyd, [email protected]
County Department of Public Health15900 S. CiceroOak Forest, IL
60452
@j_bloyd
2/15/16Collaborative For Health Equity Cook County WHERE PEOPLE
PLACE AND POWER MATTER40