1. Dr. Adewale Troutman presented on creating health equity and addressing social determinants of health such as socioeconomic status, racism, education, and the built environment. 2. He argued that achieving health equity requires addressing unfair health differences between social groups through social and political action rather than just focusing on individual behavior. 3. Some of the policies and strategies he proposed included improving daily living conditions in disadvantaged areas, enacting policies that promote social justice, and building a social movement for health equity.

1. COMMUNITY ISSUES FORUM PORTLAND OREGON OCTOBER 8, 2009 ADEWALE TROUTMAN, M.D., M.P.H., M.A. THE TROUTMAN GROUP Creating Health Equity; Social Justice, Human Rights and the Social Determinants of Health

2. The Troutman Group

3. A Case Study; But Why

5. Vital Statistics: The Troutman Group

7. TRADITIONAL SOCIAL JUSTICE How can we address risky behavior and target vulnerable populations? How can we target the health depriving conditions and policies that make people vulnerable? Why do people smoke? What economic policies and social conditions predispose people to the stress that encourages smoking? How can we create more green space, bike paths, and farmers’ markets in disadvantaged neighborhoods? What policies and institutional practices by government and corporations discourage access to transportation, recreational resources, and access to nutritious foods in neighborhoods where population is poorest? How can we promote greater personal responsibility for health? How can we create social responsibility and public accountability to protect the public good? How do we treat the consequences of health inequity? How does the prioritization of profit over human need and ecological sustainability affect health inequity? Overarching social justice questions: Why do those who make decisions that negatively affect health make those decisions? Why do they have that power?

8. Let’s get on the same page.

19. Market Justice vs. Social Justice

22. Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death… www.who.int/social_determinants

27. A New Direction

28. Looking upstream, finding the causes of he causes. The Troutman Group

31. The Power of Poverty The Troutman Group

33. The Troutman Group

34. The Troutman Group

35. The Elephant in the Room: Racism The Troutman Group

45. “ Patients” experiencing symptoms of heart disease, from Schulman et al. (1999)

46. “ Patients” experiencing symptoms of heart disease, from Schulman et al. (1999)

47. Place Matters The Troutman Group

48. Tell me how a man died and I’ll tell you where he lived Aristotle The Troutman Group

49. The role of residential segregation; “The metropolitan areas with the highest segregation levels have the most unequal geographies of opportunity” Delores Acevedo-Garcia et al The Troutman Group

51. Housing The Troutman Group

53. Cotter Lane The Troutman Group

54. Park DuValle The Troutman Group

55. Park DuValle The Troutman Group

56. Education The Troutman Group

57. In El Salvador, if mothers had no education their babies have 100 chances in 1000 of dying in their first year of life; if mothers have at least secondary education the infant death rate is a quarter of that (World Bank 2006) The Troutman Group

60. www.who.int/social_determinants

62. The Center for Health Equity The Troutman Group

63. The Troutman Group

64. The Importance of Leadership and Political Will The Troutman Group

65. The Troutman Group

66. The CHE is dedicated to a civic process that builds social engagement, autonomy and movement to strengthen communities and influence public policy in an effort to Create Health Equity

67. The Center focuses its work to eliminate health inequities due to race, ethnicity and socioeconomic status

71. Strategy 3: Expand access to and distribution of healthy food. The Troutman Group

72. Increased Neighborhood Access The Troutman Group

73. From the Dinner Table to the Policy Table

74. Health Policy Is Social Policy

79. The Troutman Group

80. A fragmented non system of sick care where inequity is common, prevention and wellness are after thoughts and outcomes correlate to societal status The Troutman Group

81. Universal access to a single standard of high quality care National Health Insurance Single Payer The Troutman Group

82. Health in All Policies addresses the effects on health across all policies such as agriculture, education, the environment, fiscal policies, housing, and transport . It seeks to improve health and at the same time contribute to the well-being and the wealth of the nations through structures, mechanisms and actions planned and managed mainly by sectors other than health. Thus HiAP is not confined to the health sector and to the public health community, but is a complementary strategy with a high potential towards improving a population’s health, with health determinants as the bridge between policies and health outcomes.

83. Phillis Wheatley Students present Photo-voice Exhibits on Health Policy Issues

85. If my community were healthy it would look like, no people littering, people riding bikes, no people dealing drugs, kids playing at the park, no gunshots, parents and kids walking their dogs, no people smoking, parents taking their baby’s in a stroller to the park to walk them around the park. Denzel: age 10

86. My neighborhood has many train tracks and a really big factory that does something, I don’t know what. There is a church, a community center but there is no store close to where I live. D’coreyan: age 10

87. Every day I go to the community center on the side of it, they are selling drugs or showing off their guns and sometimes I am scared to walk pass because I think they will shoot me. Michael: age 10

90. Building a Social Movement

94. The Troutman Group

95. Are You Willing to Take the Risk?

96. Adewale Troutman, M.D.,M.P.H. The Troutman Group 5109 Forrest Grove Place Louisville, KY 40059 [email_address] 502 544 8570 www.thetroutmangroup.org The Troutman Group