Serving The Underserved Facing Failure & Choosing Change

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SERVING THE UNDERSERVED POPULATIONS OF IL:

FACING FAILUREAND

CHOOSING CHANGE

Deleshia “Dyi” Kinney, M.D., M.A.T.

Health Care Advocatewww.drkinney.webnode.com

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ACKNOWLEDGEMENTS

2008IL WOMEN'S HEALTH CONFERENCE

IL Dept. of Public HealthSpecial Thanks to:

Brenda BlaskoMarbella Marsh

IL Dept. of Public Health

Ann Locke & Sandra WoodsSpringfield Urban League Health Initiative

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AGENDA

Pre-Test (5 min) Welcome / Overview of Objectives (10

min) Small Group discussion (if permissible)

(30 min) Review & Resources (5 min) Questions & Conclusions (10 min)

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OBJECTIVES

WHERE WE ARE NOW DEFINE THE PROBLEM DISCUSS PRACTICAL SOLUTIONS

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WHERE WE STAND

The Common Wealth Fund: The National Scorecard

The Agency for Health care Research & Quality (AHRQ):

National Healthcare Disparities Report

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National ScorecardDIMENSIONS OF HIGH PERFORMANCE

HEALTH SYSTEM (2006 – 2008)

Healthy Lives

Quality

Access

Efficiency

Equity

Overall Results

0 10 20 30 40 50 60 70 80

20072006

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National Scorecard

67 65

2006 2008

OVERALL

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National Scorecard

70 71

2006 2008

EQUITY

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AHRQDIMENSIONS OF QUALITY

Effectiveness of Care Patient Safety Timeliness Patient Centeredness Overall Results SPECIFIC CLINICAL CONDITIONS CARE TYPE SETTINGS

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AHRQ

2.3% 1.5%

1994-2005 1999 - 2005

OVERALL RATE OF IMPROVEMENT

AHRQ

National Health Disparities Report

Blacks 10 times new AIDS cases, greater proportion of children hospitalized for asthma

Asians 65+ more likely than whites to lack pneumonia immunization

AI/AN 2 times more likely to lack prenatal care

Hispanics 3 times the new AIDS cases

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Public Health“... the combination of science, practical skills, and values directed to the maintenance and improvement of the health of all the people. It is a set of efforts organised by society to protect, promote, and restore the people's health through collective and social action. ...but the goal remains the same - to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the populations.”

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CONCLUSION

SYSTEM IS BROKEN

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QUESTION #1

DEFINE:

UNDERSERVED

INEQUALITY

INEQUITY

HEALTH DISPARITIES

SPECIAL POPULATIONS

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U.S. Dept. of Health and Human Services

Medically Underserved Areasurban, rural, public, population groups,

facilities

Medically Underserved Populations

economic, linguistic, or cultural barriers

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Merriam Webster

Definition

They are under resourced, not having sufficient resources

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Often Forgotten Subpopulations

Don't forget subpopulations Migrant Workers & other immigrants Asian: Phillipinos, Chinese, Japanese,

Vietnamese etc. Middleasterners Women, children, elderly, low-income,

racial/ethnic minorities

CAN CHANGE

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HEALTH INEQUALITY

“…is the generic term used to designate differences, variations, and disparities in the health achievements and risk factors of individuals and groups…that need not imply moral judgment…

Refer to measurable differences in outcomes.

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HEALTH INEQUITY

“...health equity concerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable – and thus inherently unjust and unfair.”

Refers to stronger view that unfair differences could be changed if willing

QUESTION

GIVEN OUR WEALTH & MEDICAL ADVANCES WHY DOES THE U.S.

RANK 29TH IN LIFE EXPECTANCY?

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po

Definition: Definition

Definition: They are under resourced, not having sufficient resources

HEALTH / CLASS LADDER

Health Gradient Predictable

$$$$$$$$$$$$$$

Most HealthyMost Control

Least Healthy, Least Control, Most Stressed

$

Least Stressed

QUESTION

WHAT DETERMINES HEALTH?

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SOCIAL DETERMINANTS OF HEALTH

HEALTHPOLITICALPOLICY

SOCIETY

CHRONICSTRESS

INEQUALITY

CHOICES

CONTROL

RACISM

CONTROL

COMMUNITY RESOURCES

Food Access & Availability

Quality Education Good Transportation /

Planning Affordable Housing Good Jobs & Work

Opportunities

Business Investment & Development

Income & Wealth Social Supports Public Safety Green Spaces Recreational

RESPONSIBILITY

VS.

QUESTION

WHAT IS THE SOLUTION?

CHANGE

....our way of thinking about the problem. ...our way of thinking about solutions ...our approach to the problem. ....our approach to solutions. ...our public policies. ...our health care system

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CHANGE APPROACH

Conventional question: How can we promote healthy behavior? Health equity question: How can we target dangerous conditions and reorganize land use and transportation policies to ensure healthy spaces and places?

Conventional: How can we reduce disparities in the distribution of disease and illness? Health equity: How can we eliminate inequities in the distribution of resources and power that shape health outcomes?

Conventional: How can individuals protect themselves against health disparities? Health equity: What kinds of community organizing and alliance building are necessary to protect communities?

QUESTION

WHAT POLICIES AT THE LOCAL, STATE, AND FEDERAL LEVEL MIGHT

REDUCE SOCIAL AND ECONOMIC INEQUITIES?

CHANGE

SOCIAL POLICY

HEALTH POLICY

POTENTIAL POLICY

CURRENT 8 hr work day

Min. Wage Unemployment insuranceFree K-12 public educationAffirmative Action (limited) Social Security

POTENTIAL Guaranteed Paid

Vacation Living Wage Job training & Placement Paid Parental leave Housing Assistance Universal Health care

CHANGE POLICY

Promote Understanding of Social Determinants of Health

Improve income

Improve physical environment

Promote racial justice

Promote better working conditions

Improve children's health

Universal Health Care

Improve social inclusion

Food security and quality

Improve Education

Improve sustainable transportation

Improve Health Impact Assessment

WHERE TO START CHANGE

Encourage Civic Engagement

Stay connected!

Realize change isn't easy but NOT impossible.

CHANGE POLICY

Identify and connect

Organize

Form committee

Screen and discuss PBS series: unnatural causes

Identify existing struggles

Conduct an audit

Form community-wide coalition

Ask local PHD to conduct Health Impact Assessment for proposed ordinances

Provide local media with facts

Broaden discussion

Organize a forum

QUESTION FOR THOUGHT

If children received universal health care and it was implemented today would everyone receive necessary

care?

RESOURCES

Common Wealthfund

http://www.commonwealthfund.org

http://www.unnaturalcauses.org/

U.S. Department of Health and Human Services

http://www.ahrq.gov/

http://www.phac-aspc.gc.ca/sdh-dss/glos-eng.php

WHERE TO START CHANGE: you!!!!

THANK YOU !!!.

Women's Health

Gender Disparities Racial / Ethnic Disparities

Black women receive poorer quality of Care 53% of measures, 29 % show have worse access

Hispanic women receive poorer quality of care than non-Hispanic whites for 60% of measures, and poorer access for 87% of measures

Socioeconomic Disparities Services unique to women QOC poorer in 75%