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Health equity coalition vision
- 1. Peter A. Gorski, M.D., M.P.A. Children’s Board of Hillsborough County and University of South Florida Envisioning Health Equity
- 2. Social Determinants of Health and Wealth Your neighborhood Physical, social, economic, educational qualities Your skin color Race, ethnicity Who’s your daddy Parents’ education, income, health, social capital
- 4. Between child wealth and adult wealth
- 5. Between child wealth and adult health
- 6. Regardless of child’s health condition
- 7. Regardless if social class changes from childhood to adulthood
- 9. Racial and Ethnic Disparities in Birth Outcomes: A Life Course Perspective 5 Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.Maternal Child Health J. 2003;7:13-30.
- 10. Pre-school Ready to learn Health Services Appropriate Discipline Reading to child Parent education Emotional Health Literacy Late Preschool Late Infancy Late Toddler Birth Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Early Infancy Early Toddler Early Preschool Strategies to Improve School Readiness Trajectories Toxic Stress Lack of health services “Healthy” Trajectory Poverty “At Risk” Trajectory “Delayed/Disordered ” Trajectory
- 11. Race is Not a Proxy for Poverty or Wealth
- 12. Beyond (or Underneath) SES African American infant mortality higher in more segregated cities even when controlling for SES
- 13. SES? – Ask the Professionals 9 10.2 6.8 NCHS 2002
- 14. SES? – Ask the Africans 10 Birth weight distribution of African-born blacks is more closely related to US-born whites than to US-born blacks 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.
- 15. 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
- 17. Treating symptoms rather than root causes
- 18. Since inequities are at root of health disparities, we must work for the equitable distribution of conditions that promote health and healthy development –
- 19. Social, educational, economic and environmental capital
- 22. Cannot predict individual course based on group risk factors
- 23. Cost burden of case-finding and treatment too high
- 26. Forge strategic partnerships across the county’s public and private sectors – every decision impacts health
- 27. Document and demonstrate the correlation and causal association between social, economic, educational, environmental and healthcare equity and population health outcomes
- 28. Advocate for policies and practices that promote and create advantage for all citizens
Editor's Notes
- This may be particularly important for MCH, where one developmental stage often gets disconnected from another. In perinatal health, we focus so much on events occurring in the 9 months of pregnancy we forget that there are a great deal of life course influences on perinatal outcomes, and a great deal of perinatal influences on life course outcomes. For example, in explaining the Black-White gap in infant mortality, for decades we searched for maternal risk factors during pregnancy rather than looking at the mothers’ cumulative life course experiences. The danger of focusing solely on risk factors during pregnancy is not only that it doesn’t adequately explain the disparities, but more importantly it can misguide public health interventions and policies. For two decades we thought if we could get women universal access to good quality prenatal care, then we can do something about reducing infant mortality and racial disparities in this country. Many of us recognize now that to expect prenatal care, in less than nine months, to reverse all the cumulative disadvantages and inequities over the life course of the woman, may be expecting too much of prenatal care. If we as are serious as a nation about improving birth outcomes and reducing disparities, we have to start taking care of women not only during pregnancy, but before pregnancy and between pregnancies and indeed, across the entire life course of women and families.
- And that African American women with more than 16 years of schooling still have higher infant mortality than White women with less than nine years of schooling. Think about this. These are African American women who have graduated from college, and gone on to graduate schools, medical schools, law schools, business schools to get their MD’s and JD’s, and MBA’s. We are talking about African American doctors and lawyers and business executives. And they still have higher infant mortality than White women who never went to high school in the first place.