Addressing Racism as a Threat to the Health and Well-Being of Our Nation
1. Health begins where we
live, learn, work, and play
Addressing racism as a threat
to the health and well-being
of our nation
Camara Phyllis Jones, MD, MPH, PhD
Social Determinants of Health and Equity
Leadership Challenge
Fairfax, Virginia
September 17, 2012
2. Levels of health intervention
Source: Jones CP et al. J Health Care Poor Underserved 2009.
15. Addressing the Primary prevention
social determinants of health
Safety net programs and
secondary prevention
Medical care and
tertiary prevention
Source: Jones CP et al. J Health Care Poor Underserved 2009.
16. But how do disparities arise?
Differences in the quality of care received within the
health care system
Differences in access to health care, including
preventive and curative services
Differences in life opportunities, exposures, and
stresses that result in differences in underlying health
status
Source: Smedley BD, Stith AY, Nelson AR (editors). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
Washington, DC: The National Academies Press, 2002.
Source: Byrd WM, Clayton LA. An American Health Dilemma: Race, Medicine, and Health Care in the United States, 1900-2000.
New York, NY: Routledge, 2002.
Source: Phelan JC, Link BG, Tehranifar P. Social Conditions as Fundamental Causes of Health Inequalities. J Health Soc Behav
2010;51(S):S28-S40.
24. Differences in
Differences in access to care
exposures and
opportunities
Differences in quality of care
(ambulance slow or goes the wrong way)
Source: Jones CP et al. J Health Care Poor Underserved 2009.
25. Addressing the
social determinants of equity:
Why are there differences
in resources
along the cliff face?
Why are there differences
in who is found
at different parts of the cliff?
Source: Jones CP et al. J Health Care Poor Underserved 2009.
26. 3 dimensions of health intervention
Source: Jones CP et al. J Health Care Poor Underserved 2009.
27. 3 dimensions of health intervention
Health services
Source: Jones CP et al. J Health Care Poor Underserved 2009.
28. 3 dimensions of health intervention
Health services
Addressing social determinants of health
Source: Jones CP et al. J Health Care Poor Underserved 2009.
29. 3 dimensions of health intervention
Health services
Addressing social determinants of health
Addressing social determinants of equity
Source: Jones CP et al. J Health Care Poor Underserved 2009.
30. Determinants of health
Individual
behaviors
Source: Jones CP et al. J Health Care Poor Underserved 2009.
31. Determinants of health
Social determinants
of health (contexts)
Individual
behaviors
Source: Jones CP et al. J Health Care Poor Underserved 2009.
32. Determinants of health
Determinants
of health and
illness that are
Social determinants
outside of the of health (contexts)
individual
Individual
Beyond genetic behaviors
predispositions
Beyond individual
behaviors
Source: Jones CP et al. J Health Care Poor Underserved 2009.
33. Determinants of health
Determinants The contexts in
of health and which
illness that are individual
Social determinants
outside of the of health (contexts) behaviors arise
individual
Individual
Beyond genetic behaviors
predispositions
Beyond individual
behaviors
Source: Jones CP et al. J Health Care Poor Underserved 2009.
34. Determinants of health
Individual
resources
Education, Social determinants
occupation, of health (contexts)
income, wealth
Individual
behaviors
Source: CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the
Commission on Social Determinants of Health. Geneva: World Health Organization, 2008.
Source: Jones CP et al. J Health Care Poor Underserved 2009.
35. Determinants of health
Individual
resources
Education, Social determinants
occupation, of health (contexts)
income, wealth
Neighborhood
Individual
resources behaviors
Housing, food
choices, public
safety,
transportation,
parks and
recreation,
political clout
Source: CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the
Commission on Social Determinants of Health. Geneva: World Health Organization, 2008.
Source: Jones CP et al. J Health Care Poor Underserved 2009.
36. Determinants of health
Individual Hazards and
resources toxic exposures
Education, Social determinants Pesticides, lead,
occupation, of health (contexts) reservoirs of
income, wealth infection
Neighborhood
Individual
resources behaviors
Housing, food
choices, public
safety,
transportation,
parks and
recreation,
political clout
Source: CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the
Commission on Social Determinants of Health. Geneva: World Health Organization, 2008.
Source: Jones CP et al. J Health Care Poor Underserved 2009.
37. Determinants of health
Individual Hazards and
resources toxic exposures
Education, Social determinants Pesticides, lead,
occupation, of health (contexts) reservoirs of
income, wealth infection
Neighborhood Opportunity
Individual
resources behaviors structures
Housing, food Schools, jobs,
choices, public justice
safety,
transportation,
parks and
recreation,
political clout
Source: CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the
Commission on Social Determinants of Health. Geneva: World Health Organization, 2008.
Source: Jones CP et al. J Health Care Poor Underserved 2009.
38. Determinants of health
Structural determinants of context
Social determinants
of health (contexts)
Individual
behaviors
Source: Jones CP et al. J Health Care Poor Underserved 2009.
39. Determinants of health
Determine the
range of
observed contexts
Structural determinants of context
Social determinants
of health (contexts)
Individual
behaviors
Source: Jones CP et al. J Health Care Poor Underserved 2009.
40. Determinants of health
Determine the
range of
observed contexts
Structural determinants of context
Social determinants
of health (contexts)
Individual
behaviors
Determine the
distribution of
different populations
into those contexts
Source: Jones CP et al. J Health Care Poor Underserved 2009.
41. Determinants of health
Determine the Include economic
range of systems, racism,
observed contexts and other systems
Structural determinants of context of power
Social determinants
of health (contexts)
Individual
behaviors
Determine the
distribution of
different populations
into those contexts
Source: Jones CP et al. J Health Care Poor Underserved 2009.
42. Determinants of health
Determine the Include economic
range of systems, racism,
observed contexts and other systems
Structural determinants of context of power
Social determinants
of health (contexts)
Individual
behaviors
Determine the The social
distribution of determinants of
different populations equity
into those contexts
Source: Jones CP et al. J Health Care Poor Underserved 2009.
43. Addressing the social determinants
of HEALTH
Involves the medical care and public health systems,
but clearly extends beyond these
Requires collaboration with multiple sectors outside of
health, including education, housing, labor, justice,
transportation, agriculture, immigration, and
environment
Source: National Prevention Council. National Prevention Strategy. Washington, DC: U.S. Department of Health and Human
Services, Office of the Surgeon General, 2011.
Source: Jones CP, Jones CY, Perry GS, Barclay G. Addressing the Social Determinants of Children’s Health: A Cliff Analogy.
J Health Care Poor Underserved 2009;20(4)Suppl:1-12.
44. Addressing the social determinants
of EQUITY
Involves monitoring for inequities in exposures and
opportunities, as well as for disparities in outcomes
Involves examination of and intervention on the
mechanisms of power
Structures: the who?, what?, when?, and where? of
decision-making
Policies: the written how?
Practices and norms: the unwritten how?
Values: the why?
Source: Jones CP, Jones CY, Perry GS, Barclay G. Addressing the Social Determinants of Children’s Health: A Cliff Analogy.
J Health Care Poor Underserved 2009;20(4)Suppl:1-12.
45. Beyond individual behaviors
Address the social determinants of health,
including poverty, in order to achieve large and
sustained improvements in health outcomes
Address the social determinants of equity,
including racism, in order to achieve social justice and
eliminate health disparities
Source: Jones CP, Jones CY, Perry GS, Barclay G. Addressing the Social Determinants of Children’s Health: A Cliff Analogy.
J Health Care Poor Underserved 2009;20(4)Suppl:1-12.
46. Why racism?
To eliminate racial disparities in health, need examine
fundamental causes
“Race” is only a rough proxy for social class, culture, or genes
“Race” captures the social classification of people in our “race”-
conscious society
Hypothesize racism as a fundamental cause of racial
disparities in health
Source: Jones CP. “Race”, Racism, and the Practice of Epidemiology. Am J Epidemiol 2001;154(4):299-304.
47. What is racism?
A system
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
48. What is racism?
A system of structuring opportunity and assigning
value
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
49. What is racism?
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(which is what we call “race”)
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
50. What is racism?
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(which is what we call “race”), that
Disadvantages some individuals and communities
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
51. What is racism?
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(which is what we call “race”), that
Disadvantages some individuals and communities
Advantages other individuals and communities
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
52. What is racism?
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(which is what we call “race”), that
Disadvantages some individuals and communities
Advantages other individuals and communities
Saps the strength of the whole society through the waste of
human resources
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
53. Levels of Racism
Institutionalized
Personally-mediated
Internalized
Source: Jones CP. Levels of Racism: A Theoretic Framework and a Gardener’s Tale. Am J Public Health 2000;90(8):1212-1215.
54. Institutionalized racism
Differential access to the goods, services, and
opportunities of society, by “race”
Examples
Housing, education, employment, income
Medical facilities
Clean environment
Information, resources, voice
Explains the association between social class and “race”
Source: Jones CP. Levels of Racism: A Theoretic Framework and a Gardener’s Tale. Am J Public Health 2000;90(8):1212-1215.
55. Personally-mediated racism
Differential assumptions about the abilities, motives,
and intents of others, by “race”
Differential actions based on those assumptions
Prejudice and discrimination
Examples
Police brutality
Physician disrespect
Shopkeeper vigilance
Waiter indifference
Teacher devaluation
Source: Jones CP. Levels of Racism: A Theoretic Framework and a Gardener’s Tale. Am J Public Health 2000;90(8):1212-1215.
56. Internalized racism
Acceptance by the stigmatized “races” of negative
messages about our own abilities and intrinsic worth
Examples
Self-devaluation
White man’s ice is colder
Resignation, helplessness, hopelessness
Accepting limitations to our full humanity
Source: Jones CP. Levels of Racism: A Theoretic Framework and a Gardener’s Tale. Am J Public Health 2000;90(8):1212-1215.
57. Levels of Racism: A Gardener’s Tale
Source: Jones CP. Levels of Racism: A Theoretic Framework and a Gardener’s Tale. Am J Public Health 2000;90(8):1212-1215.
58. Who is the gardener?
Power to decide
Power to act
Control of resources
Dangerous when
Allied with one group
Not concerned with equity
Source: Jones CP. Levels of Racism: A Theoretic Framework and a Gardener’s Tale. Am J Public Health 2000;90(8):1212-1215.
59. Measuring institutionalized racism
Scan for evidence of “racial” disparities
“Could racism be operating here?”
Routinely monitor opportunities as well as outcomes by “race”
Identify mechanisms
“How is racism operating here?”
Structures: the who?, what?, when?, and where?
of decision-making
Policies: the written how?
Practices and norms: the unwritten how?
Values: the why?
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
60. “Reactions to Race” module
Six-question optional module on the Behavioral Risk
Factor Surveillance System since 2002
“How do other people usually classify you in this country?”
“How often do you think about your race?”
Perceptions of differential treatment at work or when seeking
health care
Reports of physical symptoms or emotional upset as a result of
“race”-based treatment
61. States using the “Reactions to Race” module
2002 to 2011 BRFSS
Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Indiana,
Kentucky, Massachusetts, Michigan, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina,
Ohio, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, Washington, Wisconsin
62. States using the “Reactions to Race” module
Arkansas 2004
California 2002
Colorado 2004
Connecticut 2010
Delaware 2002 2004 2005
DC 2004
Florida 2002
Georgia 2010
Indiana 2009
Kentucky 2010
Massachusetts 2006 2008
Michigan 2006
Mississippi 2004
Nebraska 2008 2009
New Hampshire 2002
New Mexico 2002
North Carolina 2002
Ohio 2003 2005 2011
Rhode Island 2004 2007 2010
South Carolina 2003 2004
Tennessee 2005
Vermont 2008
Virginia 2008
Washington 2004
Wisconsin 2004 2005 2006
63. States using the “Reactions to Race” module
Arkansas 2004
California 2002
Colorado 2004
Connecticut 2010
Delaware 2002 2004 2005
DC 2004
Florida 2002
Georgia 2010
Indiana 2009
Kentucky 2010
Massachusetts 2006 2008
Michigan 2006
Mississippi 2004
Nebraska 2008 2009
New Hampshire 2002
New Mexico 2002
North Carolina 2002
Ohio 2003 2005 2011
Rhode Island 2004 2007 2010
South Carolina 2003 2004
Tennessee 2005
Vermont 2008
Virginia 2008
Washington 2004
Wisconsin 2004 2005 2006
64. Socially-assigned “race”
How do other people usually classify you in this
country? Would you say:
White
Black or African-American
Hispanic or Latino
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Some other group
65. Socially-assigned “race”
On-the-street “race” quickly and routinely assigned
without benefit of queries about self-identification,
ancestry, culture, or genetic endowment
Ad hoc racial classification, an influential basis for
interactions between individuals and institutions for
centuries
Substrate upon which racism operates
Source: Jones CP, Truman BI, Elam-Evans LD, Jones CA, Jones CY, Jiles R, Rumisha SF, Perry GS. Using “socially assigned race”
to probe White advantages in health status. Ethn Dis 2008;18(4):496-504.
66. General health status
Would you say that in general your health is:
Excellent
Very good
Good
Fair
Poor
67. General health status by socially-assigned "race", 2004 BRFSS
100
80
60
percent of respondents
40
20
58.3 43.7 41.2 36.1
0
White Black Hispanic AIAN
Report excellent or very good health
68. General health status by socially-assigned "race", 2004 BRFSS
100
80
60
percent of respondents
40
20
58.3 43.7 41.2 36.1
0
White Black Hispanic AIAN
Report excellent or very good health
69. General health status by socially-assigned "race", 2004 BRFSS
Report fair or poor health
100
13.9 21.5 20.9 22.1
80
60
percent of respondents
40
20
58.3 43.7 41.2 36.1
0
White Black Hispanic AIAN
Report excellent or very good health
70. General health status and “race”
Being perceived as White is associated with better
health
72. Self-identified “race”
Which one or more of the following would you say is
your race?
White
Black or African-American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Other
Which one of these groups would you say best
represents your race?
73. Self-identified “race”/ethnicity
Hispanic
“Yes” to Hispanic/Latino ethnicity question
Any response to race question
White
“No” to Hispanic/Latino ethnicity question
Only one response to race question, “White”
Black
“No” to Hispanic/Latino ethnicity question
Only one response to race question, “Black”
American Indian/Alaska Native
“No” to Hispanic/Latino ethnicity question
Only one response to race question, “AI/AN”
74. Two measures of “race”
How usually classified by others
White Black Hispanic AIAN ...
White
98.4 0.1 0.3 0.1 1.1
26,373
How self-identify
Black
0.4 96.3 0.8 0.3 2.2
5,246
75. Two measures of “race”
How usually classified by others
White Black Hispanic AIAN ...
White
98.4 0.1 0.3 0.1 1.1
26,373
How self-identify
Black
0.4 96.3 0.8 0.3 2.2
5,246
Hispanic
26.8 3.5 63.0 1.2 5.5
1,528
76. Two measures of “race”
How usually classified by others
White Black Hispanic AIAN ...
White
98.4 0.1 0.3 0.1 1.1
26,373
How self-identify
Black
0.4 96.3 0.8 0.3 2.2
5,246
Hispanic
26.8 3.5 63.0 1.2 5.5
1,528
77. General health status, by self-identified and socially-assigned "race", 2004
100
80
percent of respondents
60
58.6
53.7
39.8
40
20
0
Hispanic-Hispanic Hispanic-White White-White
Report excellent or very good health
78. General health status, by self-identified and socially-assigned "race", 2004
100
Test of H0: That there is no difference in proportions
reporting excellent or very good health
80
Hispanic-Hispanic versus White-White
p < 0.0001
percent of respondents
60
58.6
39.8
40
20
0
Hispanic-Hispanic White-White
Report excellent or very good health
79. General health status, by self-identified and socially-assigned "race", 2004
100
Test of H0: That there is no difference in proportions
reporting excellent or very good health
80
Hispanic-Hispanic versus Hispanic-White
p = 0.0019
percent of respondents
60
53.7
39.8
40
20
0
Hispanic-Hispanic Hispanic-White
Report excellent or very good health
80. General health status, by self-identified and socially-assigned "race", 2004
100
Test of H0: That there is no difference in proportions
reporting excellent or very good health
80
Hispanic-White versus White-White
p = 0.1895
percent of respondents
60
58.6
53.7
40
20
0
Hispanic-White White-White
Report excellent or very good health
81. Two measures of “race”
How usually classified by others
White Black Hispanic AIAN ...
White
98.4 0.1 0.3 0.1 1.1
26,373
How self-identify
Black
0.4 96.3 0.8 0.3 2.2
5,246
Hispanic
26.8 3.5 63.0 1.2 5.5
1,528
AIAN
47.6 3.4 7.3 35.9 5.8
321
82. Two measures of “race”
How usually classified by others
White Black Hispanic AIAN ...
White
98.4 0.1 0.3 0.1 1.1
26,373
How self-identify
Black
0.4 96.3 0.8 0.3 2.2
5,246
Hispanic
26.8 3.5 63.0 1.2 5.5
1,528
AIAN
47.6 3.4 7.3 35.9 5.8
321
83. General health status, by self-identified and socially-assigned "race", 2004
100
80
percent of respondents
60
58.6
52.6
40
32
20
0
AIAN-AIAN AIAN-White White-White
Report excellent or very good health
84. General health status, by self-identified and socially-assigned "race", 2004
100
Test of H0: That there is no difference in proportions
reporting excellent or very good health
80
AIAN-AIAN versus White-White
p < 0.0001
percent of respondents
60
58.6
40
32
20
0
AIAN-AIAN White-White
Report excellent or very good health
85. General health status, by self-identified and socially-assigned "race", 2004
100
Test of H0: That there is no difference in proportions
reporting excellent or very good health
80
AIAN-AIAN versus AIAN-White
p = 0.0122
percent of respondents
60
52.6
40
32
20
0
AIAN-AIAN AIAN-White
Report excellent or very good health
86. General health status, by self-identified and socially-assigned "race", 2004
100
Test of H0: That there is no difference in proportions
reporting excellent or very good health
80
AIAN-White versus White-White
p = 0.3070
percent of respondents
60
58.6
52.6
40
20
0
AIAN-White White-White
Report excellent or very good health
87. Two measures of “race”
How usually classified by others
White Black Hispanic AIAN ...
White
98.4 0.1 0.3 0.1 1.1
26,373
How self-identify
Black
0.4 96.3 0.8 0.3 2.2
5,246
Hispanic
26.8 3.5 63.0 1.2 5.5
1,528
AIAN
47.6 3.4 7.3 35.9 5.8
321
> 1 race
59.5 22.5 3.8 5.3 8.9
406
88. Two measures of “race”
How usually classified by others
White Black Hispanic AIAN ...
White
98.4 0.1 0.3 0.1 1.1
26,373
How self-identify
Black
0.4 96.3 0.8 0.3 2.2
5,246
Hispanic
26.8 3.5 63.0 1.2 5.5
1,528
AIAN
47.6 3.4 7.3 35.9 5.8
321
> 1 race
59.5 22.5 3.8 5.3 8.9
406
89. General health status and “race”
Being perceived as White is associated with better
health
Even within non-White self-identified “race”/ethnic groups
90. General health status and “race”
Being perceived as White is associated with better
health
Even within non-White self-identified “race”/ethnic groups
Even within the same educational level
91. General health status and “race”
Being perceived as White is associated with better
health
Even within non-White self-identified “race”/ethnic groups
Even within the same educational level
Being perceived as White is associated with higher
education
92. Key questions
Why is socially-assigned “race” associated with self-
rated general health status?
Even within non-White self-identified “race”/ethnic groups
Even within the same educational level
Why is socially-assigned “race” associated with
educational level?
93. Racism
A system of structuring opportunity and assigning
value based on the social interpretation of how we look
(which is what we call “race”), that
Disadvantages some individuals and communities
Advantages other individuals and communities
Saps the strength of the whole society through the waste of
human resources
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
Source: Jones CP, Truman BI, Elam-Evans LD, Jones CA, Jones CY, Jiles R, Rumisha SF, Perry GS. Using “socially assigned race” to probe
White advantages in health status. Ethn Dis 2008;18(4):496-504.
94. What is [inequity] ?
A system of structuring opportunity and assigning
value based on [fill in the blank]
95. What is [inequity] ?
A system of structuring opportunity and assigning
value based on [fill in the blank], that
Disadvantages some individuals and communities
Advantages other individuals and communities
Saps the strength of the whole society through the waste of
human resources
96. Many possible axes of inequity
“Race”
Gender
Ethnicity
Labor roles and social class markers
Nationality, language, and legal status
Sexual orientation
Disability status
Geography
Religion
These are risk markers
97. ICERD: International Convention on the
Elimination of all forms of Racial Discrimination
International anti-racism treaty adopted by the UN
General Assembly in 1965
http://www2.ohchr.org/english/law/cerd.htm
US signed in 1966
US ratified in 1994
2nd US report submitted to the UN Committee on the
Elimination of Racial Discrimination (CERD) in 2007
http://www2.ohchr.org/english/bodies/cerd/docs/AdvanceVersion
/cerd_c_usa6.doc
98. CERD Concluding Observations
14-page document (8 May 2008) available online
http://www.state.gov/documents/organization/107361.pdf
Concerns and recommendations
Racial profiling (para 14)
Residential segregation (para 16)
Disproportionate incarceration (para 20)
Differential access to health care (para 32)
Achievement gap in education (para 34)
99. Our goal: To expand the conversation
Health services
100. Our goal: To expand the conversation
Health services
Social determinants
of health
101. Our goal: To expand the conversation
Health services
Social determinants
of health
Social determinants
of equity
Source: Jones CP et al. J Health Care Poor Underserved 2009.
103. Barriers in moving the nation
to care about social justice
A-historical culture
The present as disconnected from the past
Current distribution of advantage/disadvantage as happenstance
Systems and structures as givens and immutable
Narrow focus on the individual
Self-interest narrowly defined
Limited sense of interdependence
Limited sense of collective efficacy
Systems and structures as invisible or irrelevant
“Myth of meritocracy”
Role of hard work
Denial of racism
Two babies: Equal potential or equal opportunity?
104. Moving the nation
Changing opportunity structures
Understand the importance of history
Challenge the narrow focus on the individual
Expose the “myth of meritocracy”
Acknowledge existence of systems and structures
View systems and structures as modifiable
Break down barriers to opportunity
Build bridges to opportunity
Transform consumers to citizens
Intervene on decision-making processes
Valuing all people equally
Break out of bubbles to experience our common humanity
Embrace ALL children as OUR children
105. Unpublished allegories
Dual Reality: A Restaurant Saga
Conveyor Belt: Stages of Anti-racism
Japanese Lanterns: Colored Perceptions
Understanding This Bus We Are On
Bicycles on a Hill: Equal Opportunity?
Bus Seating: The Permanence of Privilege
Bus Survey: Who Counts?
Airplane Seating: Invisible Tether
Source: Jones CP, unpublished allegories developed for course “Race” and Racism, Harvard School of Public Health, 1994 to 2000.
106. Resources
National Partnership for Action to End Health
Disparities
Office of Minority Health, US Department of Health and Human
Services
http://www.minorityhealth.hhs.gov/npa/
National Stakeholder Strategy for Achieving Health Equity
HHS Action Plan to Reduce Racial and Ethnic Health Disparities
Regional Health Equity Councils
http://minorityhealth.hhs.gov/npa/templates/browse.aspx?lvl=1&
lvlid=42#1
107. Resources
Healthy People 2020
http://www.healthypeople.gov/2020/default.aspx
Overarching goals:
Attain high-quality, longer lives free of preventable disease,
disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the
health of all groups.
Create social and physical environments that promote good
health for all.
Promote quality of life, healthy development, and healthy
behaviors across all life stages.
42 topic areas, including 13 new ones
108. Resources
National Prevention Strategy
National Prevention, Health Promotion, and Public Health Council
http://www.healthcare.gov/prevention/nphpphc
109. Resources
US-Brazil Joint Action Plan to Eliminate Racial and
Ethnic Discrimination and Promote Equality
Five-year bilateral agreement signed in 2008
http://www.state.gov/p/wha/rls/2008/111446.htm
http://www.state.gov/p/wha/rt/social/brazil/index.htm
Areas of focus
Civil society engagement
Economic opportunities and labor
Education
Environmental justice
Health
Justice
110. Resources
CDC Racism and Health Workgroup
rahw@cdc.gov
Communications and Dissemination
Education and Development
Global Matters
Liaison and Partnership
Organizational Excellence
Policy and Legislation
Science and Publications
111. Resources
Race: The Power of an Illusion
California Newsreel
http://www.pbs.org/race
http://newsreel.org/video/RACE-THE-POWER-OF-AN-ILLUSION
RACE – Are We So Different?
American Anthropological Association
http://www.understandingrace.org/home.html
112. Resources
3rd World Conference Against Racism, Racial
Discrimination, Xenophobia and Related Intolerance
Convened by the United Nations in Durban, South Africa in 2001
http://www.un.org/WCAR/
Durban Declaration and Programme of Action
http://www.un.org/WCAR/durban.pdf
113. Resources
Unnatural Causes: Is Inequality Making Us Sick?
California Newsreel
http://www.unnaturalcauses.org
Closing the gap in a generation: Health equity through
action on the social determinants of health
WHO Commission on Social Determinants of Health
http://www.who.int/social_determinants/thecommission/finalrep
ort/en/index.html
114. Resources
World Conference on Social Determinants of Health
Convened by the World Health Organization in Rio de Janeiro,
Brasil in 2011
http://www.who.int/sdhconference/en/
Rio Political Declaration on Social Determinants of
Health
http://www.who.int/sdhconference/declaration/en/
115. Resources
International Convention on the Elimination of all
forms of Racial Discrimination (ICERD)
Adopted by the United Nations General Assembly in 1965
http://www2.ohchr.org/english/law/cerd.htm
Committee to Eliminate Racial Discrimination (CERD)
Office of the United Nations High Commissioner for Human Rights
http://www2.ohchr.org/english/bodies/cerd/
116. Resources
2007 USA State Department report to the CERD
http://www2.ohchr.org/english/bodies/cerd/docs/AdvanceVersion
/cerd_c_usa6.doc
2007 NGO shadow reports to the CERD
http://www2.ohchr.org/english/bodies/cerd/cerds72-ngos-
usa.htm
2008 CERD Concluding Observations to the USA
http://www.state.gov/documents/organization/107361.pdf
117. Resources
Report of the Secretary’s Task Force on Black and
Minority Health
Margaret M. Heckler, Secretary
U.S. Department of Health and Human Services
http://collections.nlm.nih.gov/ext/heckler/8602912V1/PDF/86029
12V1.pdf
Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care
Brian D. Smedley, Adrienne Y. Stith, Alan R. Nelson, Editors
Institute of Medicine of the National Academies
http://www.nap.edu/openbook.php?isbn=030908265X
118. Resources
The Gardener’s Tale podcast
CityMatCH Health Equity and Social Justice Action Group
http://www.citymatch.org/UR_tale.php
International Coalition of Cities Against Racism
United Nations Educational, Scientific and Cultural Organization
http://www.unesco.org/new/en/social-and-human-
sciences/themes/human-rights/fight-against-
discrimination/coalition-of-cities/
120. Policies of interest
Policies allowing segregation of resources and risks
Policies creating inherited group disadvantage
Policies favoring the differential valuation of human
life by “race”
Policies limiting self-determination
Source: Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
121. Policies allowing segregation of
resources and risks
Redlining, municipal zoning, toxic dump siting
Use of local property taxes to fund public education
122. Policies creating inherited group
disadvantage
Lack of social security for children
Estate inheritance
Lack of reparations for historical injustices
123. Policies favoring the differential
valuation of human life by “race”
Curriculum
Media invisibility / hypervisibility
Myth of meritocracy and denial of racism
126. Achieving health equity
“Health equity” is assurance of the conditions for
optimal health for all people
Achieving health equity requires
Valuing all individuals and populations equally
Recognizing and rectifying historical injustices
Providing resources according to need
Health disparities will be eliminated when health
equity is achieved
Source: Jones CP 2010, adapted from the National Partnership for Action to End Health Disparities
127. Our tasks
Put racism on the agenda
Name racism as a force determining the other social determinants
of health
Routinely monitor for differential exposures, opportunities, and
outcomes by “race”
128. Our tasks
Ask , “How is racism operating here?”
Identify mechanisms in structures, policies, practices, norms, and
values
Attend to both what exists and what is lacking
129. Our tasks
Organize and strategize to act
Join in grassroots organizing around the conditions of people’s
lives
Identify the structural factors creating and perpetuating those
conditions
Link with similar efforts across the country and around the world
131. What is racism?
“Racism includes racist ideologies, prejudiced attitudes,
discriminatory behavior, structural arrangements and
institutionalized practices resulting in racial inequality
as well as the fallacious notion that discriminatory
relations between groups are morally and scientifically
justifiable;
“it is reflected in discriminatory provisions in legislation
or regulations and discriminatory practices as well as in
anti-social beliefs and acts;
Source: United Nations Educational, Cultural, and Scientific Organization, 1978.
132. What is racism?
“it hinders the development of its victims, perverts those
who practice it, divides nations internally, impedes
international co-operation and gives rise to political
tensions between peoples;
“it is contrary to the fundamental principles of
international law and, consequently, seriously disturbs
international peace and security.”
Source: United Nations Educational, Cultural, and Scientific Organization, 1978.