Reducing Health Disparities through Prevention Frameworks, Successes, and Strategies Jeremy Cantor, MPH Program Manager March.

Reducing Reducing Health Health

Disparities Disparities through through

PreventionPreventionFrameworks, Frameworks,

Successes, and Successes, and Strategies Strategies

www.preventioninstitute.orgwww.preventioninstitute.org

Jeremy CantorJeremy Cantor, , MPH MPH

Program ManagerProgram Manager

March 7, 2007 March 7, 2007 The California Partnership for The California Partnership for Access to TreatmentAccess to TreatmentSacramento, CASacramento, CA

Carolyn Porco, of the Space Science Carolyn Porco, of the Space Science Institute, discussing a moon of Institute, discussing a moon of

Saturn. New York Times, 3/10/2006Saturn. New York Times, 3/10/2006

““We have found We have found an environment that an environment that

is potentially suitable is potentially suitable for living organisms.”for living organisms.”

Is this a suitable environment?Is this a suitable environment?

African Americans are four times

more likely to die of asthma.American Indians and Alaska Natives are 2.6 times more

likely to have diabetes.

The percentage of Hispanic children living below the poverty line is

three times that of white children.

African American children are five times more likely to be poisoned by lead.

High School Graduation rates: 53% Hispanic, 51% Native American, 50% African American

A Sample of DisparitiesA Sample of Disparities

ROOT ROOT FACTORSFACTORS

DISPARITIDISPARITIES ES IN IN

HEALTHHEALTH

The Trajectory of Health DisparitiesThe Trajectory of Health Disparities

DISPARITIDISPARITIES ES IN IN

HEALTHHEALTH

DISPARITIDISPARITIES ES ININ

HEALTHHEALTH


ENVIRONMENTENVIRONMENTAL AL

FACTORSFACTORS

& BEHAVIORAL& BEHAVIORAL


HEALTHHEALTH

BEHAVIORBEHAVIORBEHAVIORBEHAVIOR

ENVIRONMENTENVIRONMENT


HEALTHHEALTH


HEALTHHEALTH



FACTORSFACTORS

& BEHAVIORAL& BEHAVIORAL MEDICALMEDICALSERVICESSERVICES


Not the primary determinant of healthNot the primary determinant of health

Treats one person at a timeTreats one person at a time

Often comes late; can’t always restore Often comes late; can’t always restore healthhealth

Medical Care Alone Medical Care Alone Cannot Reduce DisparitiesCannot Reduce Disparities

No epidemic has ever been resolved by

paying attention to the treatment of the

affected individual.

George W. Albee

““

””

A Key A Key Opportunity Opportunity

for for PreventionPrevention


HEALTHHEALTH


HEALTHHEALTH



FACTORSFACTORS

& BEHAVIORAL& BEHAVIORAL MEDICALMEDICALSERVICESSERVICES


HEALTHHEALTH


ENVIRONMENTENVIRONMENT

HEALTHHEALTH


Is it just Is it just behavior?behavior?

9

It is unreasonable to expect It is unreasonable to expect

that people will change their that people will change their

behavior behavior easilyeasily when so many when so many

forces in the social, cultural, forces in the social, cultural,

and physical environment and physical environment

conspire against such change.conspire against such change.

““

””Institute of MedicineInstitute of Medicine

What’s wrong with this picture?

Causes of DeathCauses of Death

Heart Heart DiseaseDisease

CancerCancer

StrokeStroke

DiabetesDiabetes

Injuries & ViolenceInjuries & Violence

The same The same injuries and injuries and

illnesses only illnesses only more somore so

Let’s take a step back...

Causes of DeathActual

Causes of Death

Heart DiseaseHeart Disease

CancerCancer

StrokeStroke

DiabetesDiabetes

InjuriesInjuries

& Violence& Violence

Diet & Diet &

Activity Activity

PatternsPatterns

TobaccoTobacco

Alcohol Alcohol

& Drugs& Drugs

Making Links to Actual Causes of DeathMaking Links to Actual Causes of Death

CommunitCommunity Factorsy Factors

Actual Actual CausesCauses

Let’s take anotherstep back...

Elements of Community HealthElements of Community Health

PeoplPeoplee

PlacPlacee

EquitableEquitableOpportunityOpportunity

PeoplePeople

PlacPlacee


Community Health FactorsCommunity Health Factors

EQUITABLEEQUITABLEOPPORTUNITYOPPORTUNITY

Racial justiceRacial justice

Jobs & local ownershipJobs & local ownership

EducationEducation

PeoplePeople

PlacPlacee



PEOPLEPEOPLE Social Networks & trustSocial Networks & trust

Participation & Participation & willingness to act for the willingness to act for the common goodcommon good

Acceptable behaviors & Acceptable behaviors & attitudesattitudes

PeoplePeople

PlacPlacee



PLACEPLACE Look, feel & safety Look, feel & safety

Parks & open spaceParks & open space

Getting aroundGetting around

HousingHousing

What’s sold and how it’s What’s sold and how it’s promotedpromoted

Air, water, soil Air, water, soil

Arts & cultureArts & culture

What’s Sold and PromotedWhat’s Sold and Promoted

VS.VS.

Industry Low-Wealth High-Wealth Group Neighborhood Neighborhood

Bars/Taverns

727

26 24

35 11

SupermarketsCarry-out eating places

Social Networks & trustSocial Networks & trust

Participation & willingness to act Participation & willingness to act for the common goodfor the common good

Acceptable behaviors & Acceptable behaviors & attitudesattitudes

Racial justiceRacial justice

Jobs & local ownershipJobs & local ownership

EducationEducation

What’s sold & how What’s sold & how it’s promotedit’s promoted

Look, feel & safety Look, feel & safety

Parks & open spaceParks & open space

Getting aroundGetting around

Housing Housing

Air, water, soil Air, water, soil

Arts & cultureArts & culture

Elements of Community HealthElements of Community Health

THE PEOPLETHE PEOPLE

THE PLACETHE PLACEEQUITABLE EQUITABLE OPPORTUNITOPPORTUNITYY

Build Build on Our Success on Our Success

(what’s right with (what’s right with this picture)this picture)

A local coalition established A local coalition established a rubberized jogging path a rubberized jogging path around the cemeteryaround the cemetery

More than 1,000 people a More than 1,000 people a day use the new pathday use the new path

Nearness to walking paths Nearness to walking paths appears to have a significant appears to have a significant impact on physical activity impact on physical activity for adults. for adults.

Improved Opportunities Improved Opportunities for Walking and Joggingfor Walking and Jogging

Boyle Heights, CaliforniaBoyle Heights, California

““Small things like the jogging Small things like the jogging path make a huge difference path make a huge difference in how community residents in how community residents

see themselves and the see themselves and the community.”community.”

Community AdvocateCommunity Advocate

Improved Opportunities Improved Opportunities for Walking and Joggingfor Walking and Jogging

Boyle Heights, CaliforniaBoyle Heights, California

Child Restraint and Safety Belt UseChild Restraint and Safety Belt Use

Smoking PreventionSmoking Prevention

Minimum Drinking Age LawsMinimum Drinking Age Laws

Childhood VaccinationsChildhood Vaccinations

Motorcycle and Bicycle Helmet LawsMotorcycle and Bicycle Helmet Laws

Reduced Lead Levels in ChildrenReduced Lead Levels in Children

NORMSNORMSsanction behaviorsanction behavior

attitudes, beliefs,

attitudes, beliefs, ways of beingways of being

based in based in culture & traditionculture & tradition

taken for grantedtaken for granted

more than a habitmore than a habit

behavior shapersbehavior shapers

communicate regularity communicate regularity

in behaviorin behavior

Source: www.sfgov.orgSource: www.sfgov.org

Changing NormsChanging NormsToward a Community SolutionToward a Community Solution

Norms Do ChangeNorms Do Change

Necessary StrategiesNecessary Strategies

Reducing Disparities Reducing Disparities through Preventionthrough Prevention

Influencing Policy & LegislationInfluencing Policy & Legislation

Changing Organizational PracticesChanging Organizational Practices

Fostering Coalitions & NetworksFostering Coalitions & Networks

Educating ProvidersEducating Providers

Promoting Community EducationPromoting Community EducationStrengthening Individual Knowledge & SkillsStrengthening Individual Knowledge & Skills

The Spectrum of PreventionThe Spectrum of Prevention

Working Across the SpectrumWorking Across the Spectrum

Shut down 200 liquor stores Shut down 200 liquor stores in 3 yearsin 3 years

An average 27% reduction in An average 27% reduction in crime within a four-block radius crime within a four-block radius of each closed liquor outletof each closed liquor outlet

South L.A., CaliforniaSouth L.A., California

A good solution A good solution solvessolvesmultiplemultipleproblems.problems.

Prevention InstitutePrevention Institute

A Good SolutionA Good Solution

Fruit and vegetable Fruit and vegetable consumption increases consumption increases

for each supermarket for each supermarket in a census tract in a census tract (Morland, et al, 2002)(Morland, et al, 2002)

Upper Falls Community: Rochester, New YorkUpper Falls Community: Rochester, New York

““If we do not change direction,If we do not change direction,

we are likely to end upwe are likely to end up

where we are headed.”where we are headed.”

Chinese ProverbChinese Proverb

www.preventioninstitute.orgwww.preventioninstitute.org

Reducing Health Disparities through Prevention Frameworks, Successes, and Strategies Jeremy Cantor, MPH Program Manager March.

Documents

equitableopportunity

health behavior behavior

ca slide

albee slide

root factors disparities

prevention disparities

health medical care

sample of disparities