Presentation by Adewale Troutman, MD, MPH, MA at the 2009 Virginia Health Equity Conference - Provides an overview of the health equity and social justice framework that is gaining support nationally as a paradigm to understand and address the root causes of health inequity. Highlights specific strategies being led by the National Association of County and City Health Officials (NACCHO) and the Louisville Metro Health Department to promote health equity.

1. Richmond Virginia

2. ADEWALE TROUTMAN , M.D., M.P.H., M.A. THE TROUTMAN GROUP Building Health Equity Through Social Justice :Theory and Practice

3. The Troutman Group

4. A Case Study; But Why

7. Foundation for Discussion The Troutman Group

19. Market Justice vs. Social Justice

22. Traditional/Market Approach to Health Underlying assumptions Social Justice/Human Rights Approach To Health Alternative assumptions Health is a medical concept Health is a social concept Health is what you get from a health service Health is what you get from meeting basic needs General approach: acceptance of risk as a fact of life General approach: activist perspective to creating conditions for health Health promotion: education of individuals about healthy choices Health promotion: conduct health impact assessments; policy change Causes of inequity: genes, bad behavior, lifestyle, accident Causes of inequity: racism, class exploitation, sexism

23. 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

24. The Nature of the Problem; An Inequitably Unhealthy America The Troutman Group

25. 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

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

29. Traditional/Market Approach to Health Key Features Social Justice/Human Rights Approach to Health Key Features Addresses symptoms, short term, through programs and services Addresses root causes, long term, macro forces through organizing for social change Promotes ‘magic medical bullets’ and technology Promotes the meeting of basic needs Promotes interventions delivered through health services Promotes public works to free people from miserable living conditions Identifies charity and international aid as only sources of funds for health Identifies redistribution and economic justice as sources of funds for health Maintains the status quo of extreme concentrations of wealth and power Demands a fair and rational international economic order Focuses on individual behavior and tends to blame victims Focuses on structural poverty and violence and tends to blame the ‘system’ Personal responsibility and individual rights Social responsibility to protect the common good Tracking and monitoring: individual demographics, disease rates Tracking and monitoring: social conditions, investments in neighborhood infrastructure, processes, structures, institutions, historical trends in exposures

33. Changing the Questions TRADITIONAL SOCIAL JUSTICE What interventions are necessary to address health disparities? What generates health inequity in the first place? Why is there inequality? How can we reduce inequity in the distribution of disease and illness? How can we eliminate inequity in the distribution of disease and illness? What social programs and services are necessary to address health inequity? What types of institutional and social change is necessary to tackle health inequity? How can individuals protect themselves against health disparities? What kind of collective action is necessary to tackle health inequity? How can we promote healthy behavior? How can we reorganize land use and transportation policies to ensure healthy spaces and places?

34. Vital Statistics: The Troutman Group

35. The Center for Health Equity

37. 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

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

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

43. Increased Neighborhood Access The Troutman Group

45. From the Dinner Table to the Policy Table

47. Health Policy Is Social Policy

48. 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.

50. Building a Social Movement

52. www.who.int/social_determinants

54. The Power of One

58. “ Resistance is futile” The Borg Barriers to Implementing a Health Equity Framework

59. Leadership

60. Communications and Media

61. Building Strategic Alliances and Coalitions

62. Workforce Development

63. Policy Analysis, Development and Advocacy

64. Beyond the Surveillance Function: Active Data Collection and Analysis

65. Community Collaboration

66. T here are obvious barriers to institutionalizing social justice into a local health department, especially for a new local health official (LHO).

67. H ow does one engage board of health members to become invested in health equity issues when they may not see that there is a problem in their specific area (e.g., some members come from a financially stable, predominantly upscale area of our county & do not see the relevance to them)?

68. Tackling health equity and social justice are risky initiatives involving much opposition. Although, the risk isn't apparent until the community and the agency behind the initiative become effective and/or making a great impact. Do you find leaders "truly" willing to go far enough to push the policy/system change to make a difference in health equity even with great opposition? or are the leaders just willing to dabble in community program development to say they are addressing health disparities?

69. Funding

70. Why are you on my turf? ( Silos at all levels )

71. Are you willing to take the risk?

73. Is the organization representing true dramatic change or a modified view of the status quo? Where is profit in our hierarchy of values ?

76. The Troutman Group

77. 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