Structural Trauma and Toxic Stress! Inter-generational Roots of Adult Health Inequities Tom´ as J. Arag´ on, MD, DrPH Health Officer, City & County of San Francisco Director, Population Health Division San Francisco Department of Public Health Faculty, UC Berkeley School of Public Health Member, Big Cities Health Coalition URL: http://populationhealth.science NACCHO Annual Conference, July, 2016 Tom´ as J. Arag´ on, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 1 / 16
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Structural Trauma and Toxic Stress! Inter-generational Roots of Adults Health Inequities
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Structural Trauma and Toxic Stress!Inter-generational Roots of Adult Health Inequities
Tomas J. Aragon, MD, DrPH
Health Officer, City & County of San FranciscoDirector, Population Health Division
San Francisco Department of Public HealthFaculty, UC Berkeley School of Public Health
Member, Big Cities Health CoalitionURL: http://populationhealth.science
NACCHO Annual Conference, July, 2016
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 1 / 16
Lifecourse Health Development—Variable trajectories
Source: Halfon N, Larson K, Lu M, Tullis E, Russ S. Lifecourse health development: past,present and future. Matern Child Health J. 2014;18(2):344-65. PubMed PMID: 23975451;
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 6 / 16
The Lifecourse Health Development of Adult InequitiesReconceptualizing Early Lifecourse Policies and Programs to Strengthen Lifelong Health
Source: Center for the Developing Child at http://developingchild.harvard.edu/
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 7 / 16
The Production of Trauma from ViolenceAdverse Community Experiences and Resilience—The Prevention Institute
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 8 / 16
The Kresge-inspired SFDPH LEAD InitiativePublic health leadership is “the practice of mobilizing people, organizations, andcommunities to effectively tackle tough public health challenges” (Begun & Malcolm)
Adpated from the Lean Transformation Framework(http://www.lean.org/WhatsLean/TransformationFramework.cfm)
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 9 / 16
We serve diverse, traumatized communities under chronic, toxic stress.Our diverse staff also come from these communities. Therefore, we needto design healing organizations. Here are six core principles of healing,trauma-informed systems:
1 Understanding trauma and stress
2 Compassion and dependability
3 Safety and stability
4 Collaboration and empowerment
5 Cultural humility and responsiveness
6 Resilience and recovery
For more information visit: http://www.t2bayarea.org.
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 10 / 16
Cultural/Racial HumilityAdapted Melanie Tervalon, Jann Murray-Garcıa, and Kenneth Hardy
In 1998, Melanie Tervalon and Jann Murray-Garcıa published agroundbreaking article that challenged the concept of “culturalcompetency” with the concept of “cultural humility.” Cultural humility iscommitting to lifelong learning, critical self-reflection, and personal andinstitutional transformation.
1 Commit to lifelong learning and critical self-reflection
2 Realize our own power, privilege, and prejudices
3 Cultivate humility and empathy for respectful partnerships
4 Acknowledge and validate our common humanity
5 Practice humble inquiry and deep listening
6 Promote institutional accountability
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 11 / 16
Black/African American Health Initiative, April, 2014San Francisco Health Network (SFHN)
BAAHI components
1 Collective impact
2 Workforce development
3 Cultural humility training
Collective impact
1 Heart health (focus: hypertension)
2 Behavioral health (focus: alcohol)
3 Women’s Health (focus: breast cancer)
4 Sexual Health (focus: Chlamydia)
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 12 / 16
Trauma-Informed Community Building (San Francisco)
TRAUMA INFORMED COMMUNITY BUILDINGA Model for Strengthening Community in Trauma Affected Neighborhoods
Weinstein, Wolin, Rose
Source:http://bridgehousing.com/PDFs/TICB.
Paper5.14.pdf
Tomas J. Aragon, MD, DrPH (SFDPH) Roots of Adult Health Inequities NACCHO, July, 2016 13 / 16