The World Health Organization defines health equity as “the absence of unfair and avoidable or remediable differences in health services and outcomes among groups of people.” In Healthy People 2020, one of the goals set forth by the Centers for Disease Control and Prevention (CDC) is to “Achieve health equity, eliminate disparities, and improve the health of all groups.” While health equity is on the national agenda, do recent policies and health reforms move Illinois toward health equity? The forum brought together thought leaders to discuss health reform, to what degree it works toward health equity, and whether or not we are making progress on the social determinants of health. The event provided an opportunity to: Learn about Seattle & King County, Washington’s Health Equity ordinance, its positive impacts, and lessons from its implementation Explore how health departments can be effective in helping to implement effective health reform and ensure progress toward health equity Discuss both positive aspects and shortcomings of the Affordable Care Act vis-à-vis health equity Consider the growing role of medical-legal partnerships and how they can help address social and legal issues that negatively impact the health of low-income people

1. Health Care Reform & Root
Causes of Health Inequities
Jim Bloyd, MPH
Cook County Department of Public Health
February 10, 2015
Chicago Forum for Justice In Health Policy: Can Reform Move Us
Toward Health Equity?
Loyola University, Chicago, Illinois
@CookCoHealth
#PLACEMATTERS
@CCPLACEMATTERS

2. Reform Can move us toward health equity if
we understand the origins of health inequities
and take power into account
Solar & Irwin, WHO (2010) For example p5

3. 2015 STRATEGIC PLAN
FINAL REPORT April
2011
• “To 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
work…”
• “Because 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. April 26, 2012 Cook County Place Matters 1
73.2
78.8
79.9 79.9
87.0
65
70
75
80
85
90
Less than 25k 25k - 35k 35k - 44k 44k - 53k Greater than
53k
Lifeexpectancyatbirthinyears
Median Income
Average Life Expectancy (2003-2007) by Median
Income of Census Tract/Municipality (2009),
Cook County
Source: Life expectancy calculated by the VCU Center on Human Needs from 2003-2007 data provided by Cook County Health Department: Median
Income from 2009 Geolytics Premium Estimates.
13.8
Years
9.2
7.17.1

5. Recognition from Cook County, Illinois,
Board President Toni Preckwinkle
• “it is shameful that we
live in one of the
wealthiest countries
in the world and that
a person’s life can be
cut short by more
than a decade
because of factors
outside her or his
control.”

7. Cook County PLACE MATTERS

8. The Coverage Gap
• Supreme Court’s decision in
2012 allowed States to opt out
of Medicaid Expansion
• Individuals below the FPL
living in states that have not
expanded Medicaid
experience difficulty accessing
affordable health coverage
• 4 million people fall into the
coverage gap created by
states’ not expanding
Medicaid
• 85 percent of these individuals
reside in the South, half are
African American or Hispanic

9. #BlackLivesMatter median county income does
not drive excess Black-White mortality
Krieger, etal
(2015)
harvardpublic
healthreview.
org

10. Education: Structural Racism
“Illinois has set up a structurally racist system of
finance that selects African American and
Latinos for very poor education.”
Ralph Martire, Education Finance Expert,
Center for Tax and Budget Accountability

11. Education: US Civil Rights Title IX
All school
districts can
remove
obstacles by
following the
Title IX Civil
Rights that
guarantees
pregnant &
parenting
students
equal
education.
ICAH.org/Sch
ool

12. Housing: Nov 28, 2014: Cook
County v. Wells Fargo, Inc.
• Staff paid to steer Blacks, Latinos,
Women to hi-cost loans
• “ongoing discriminatory practice of
‘equity-stripping’”
• “maximizes lender profits”
• “Defendant’s discriminatory
behavior maximized Defendant’s
revenue and income”
• “actually resulting in
foreclosure…the ultimate denial of
housing”
• “violations continue to this very
day”
• “segregation…provided an efficient
means for Defendants to target
potential borrowers”

13. Labor: The Chicago Restaurant Industry:
Taking the Low Road to Profits

14. Restaurant
Workers
&
A Human
Rights
Movement

15. Social Causes Can Be Linked to
Health- Estimated Deaths,USA 2000Source: Galea etal (2011) doi:10.2105/AJPH.2010.300086
Low
Education
245,000
Racial
Segregation
176,000
Low social
support
162,000
Individual
level poverty
133,000
Income
inequality
119,000
Area level
poverty
39,000
Acute
Myocardial Inf
193,000
Cerebrovascular
Disease
167,700
Lung Cancer 155,600

16. All diseases have two causes, one
pathological the other political.
Rudolph Virchow (1821-1902)
Fair Housing Act Violations CC v.
Wells Fargo
Education Financing
Labor Market: One Fair Wage,
Tipped Income Laws;
harassment; discrimination
Accountability for Police
Shootings
Implementation of US Title IX
Pregnant & Parenting Students
Civil Right to Equal Education:
Distribution of Social
Determinants of
Health:
access to..,
exposures to..,
levels of…
Conditions…
Health
Inequities in
Cook County

17. Thank you
Jim Bloyd, MPH
Regional Health Officer
Cook County Department of Public Health
15900 S. Cicero Av., Oak Forest IL 60452
jbloyd@cookcountyhhs.org (708) 633-8314
Please follow Cook County PLACE MATTERS on Social Media
Facebook.com/CCPLACEMATTERS
Twitter @CCPLACEMATTERS
#PLACEMATTERS
To see this and other materials please check
www.Slideshare.net/CookCountyPLACEMATTERS

18. Christopher, G., LaFronza, V., Burke, N. (2010). Place Matters: Building
Partnerships among Communities and Local Health Departments. In
Hofrichter, R., and Bhatia, R. (Eds.), Tackling Health Inequities through Public
Health Practice: Theory to Action (pp. 458-474). Oxford: New York.
Drewnowski, A. (2012). The economics of food choice behavior: Why
poverty and obesity are linked. Nestlé Nutrition Institute Workshop Series,
73, 95-112. doi:10.1159/00034130
Joint Center For Political and Economic Studies (2012). PLACE MATTERS FOR
HEALTH IN COOK COUNTY: Ensuring Opportunities for Good Health for All.
http://jointcenter.org/sites/default/files/Place%20Matters%20for%20Health
%20in%20Cook%20County.pdf (Accessed September 18, 2014).
National Collaborative for Health Equity
http:www.nationalcollaborative.org/
Health Equity & Leadership Exchange Network (HELEN)
HealthEquityNetwork.org Twitter: @Helen4Equity
Center for Tax and Budget Acccountability, Chicago www.CTBAonline.org
Cook County Department of Public Health Strategic Plan 2015 Final Report
http://www.cookcountypublichealth.org/files/pdf/CCDPH%202015%20Strat
egic%20Plan%20Final%20Report%20April%202011.pdf
Solar, O., Irwin, A. A CONCEPTUAL FRAMEWORK FOR ACTION ON THE SOCIAL
DETERMINANTS OF HEALTH social determinants of health discussion paper 2
(policy and practice). Geneva: World Health Organization, 2010.
RESOURCES & REFERENCES

19. Cook County PLACE MATTERS
STEERING COMMITTEE
Daniel Block, PhD
Chicago State University
Jim Bloyd, MPH
Cook County Department of Public Health
Sheila Castillo, MUPP
Midwest Latino Health, Research, Training and Policy
Center
Natalie Chadwell, MBA
Resident Southern Cook County
Sheelah Muhammad, DN
Root Cause
Linda Rae Murray, MD, MPH
Past-President American Public Health Association; Adjunct
Faculty, University of Illinois, School of Public Health
Johnnie Owens, Jr.
Centers For New Horizons
Tiffany Pryor, MSW
Illinois Caucus for Adolescent Health
Bonnie Rateree
Human Action Community Organization
Kathryn Saclarides
Bocanegra, LCSW
ENLACE Chicago
Reveca Torres
Backbonesonline.org
Felipe Tendick-Matesanz
ROC United
COMMUNICATIONS
Agnes Markos

20. Metro Chicago: Poverty Composition of Neighborhoods
of Poor Children By Race
Source: Diversitydata.org, (2011, from 2000 Census Data)
Neighborhood poverty level

21. PLACE MATTERS Model
Source: G.
Christopher,
V. LaFronza,
N. Burke
(2010)

22. Child poverty more than 6 times greater in
Harvey, IL vs. North Suburban Cook County

24. State sponsored segregation through
finance-1930s HOLC Map
“Geography does the work of Jim Crow laws.”
john powell