health equity considerations for virginia's african american children
DESCRIPTION
Health Equity Considerations for Virginia's African American Children: The Importance of Social Determinants of HealthPrepared by Cheza Garvin, PhD, MPH, MSW, Assistant Professor and Academic Director, Consortium for Infant and Child Health (CINCH). Presented by Keisha Cutler, MPH, Assistant Director, CINCH, Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical SchoolTRANSCRIPT
Prepared by Cheza Garvin, PhD, MPH, MSWAssistant Professor and Academic Director,
Consortium for Infant and Child Health (CINCH)
Presented by Keisha Cutler, MPH, Assistant Director, CINCH
Department of Pediatrics, Division of Community Health & Research, Eastern Virginia Medical School
African American children and youth have higher* rates of….:Poverty Overweight/obesity (girls) Injuries from violence (boys)High school dropoutsAsthma (uncontrolled) Infant mortality and low birth weight
*Rates are usually in comparison to caucasian peers, sometimes to general population, income groups or other communities of color.
And higher risks of Type II diabetesEnvironmental toxin exposuresAdverse effects of exposure to tobacco
smoke And lower rates of
Academic achievementEmployment and incomeTwo-parent families
Etc.
Definitions from Virginia Department of Health:“Health equity is achieving the highest level of
health for all people” If health inequity derives from disparities that are
systemic, avoidable, and unjust, then it is encumbent upon us to create and maintain a system that will prevent these inequities from occurring.
Why is this important? “A chain is only as strong as its weakest
link”Common sentiment expressed to encourage
team building, what about building a healthy community?
• Health equity cannot be achieved if any group is left out, marginalized, disenfranchised, if health status gaps are not closed….
Social Determinants underlie most health inequitiesWe tend to focus on health conditions:
overweight/obesity, asthma, injuries, infant mortality, etc. Lots of “bootstrap theory” for success, focusing
only on individual behavior. This is important, butWe also need to focus on the world into which
we are bringing our children – the social, economic and physical environment they face
Support community strengths, mitigate deficits
Health care access and quality Economics/Income Education and school/workforce preparedness Employment/working conditions Transportation: public, private, walking,
biking, etc. Exposure to toxins Healthy food access: proximity, cost, quality
Healthy, walkable, built environment Pollution-free (limited) environment Freedom from discrimination/racism/unfair
bias Housing: construction, air quality, location,
etc. Safety (from crime and hazards) Social integration and expression (belonging) Civic engagement: having a say, community
investment
Cohen & Swift, 1998
Asthma treatment for 12 year-old delayed due to high co-pay, inadequate health insurance (MD)
14 year old girl assumed to be sexually active by clinic doctor, even though she had never been sexually active and resented the stereotype (DC)
Mother of toddler describes triage nurse as condescending and disrespectful, likely class and race-biased, refuses to return to that source of medical care (Hampton Roads, VA)
All African Americans, All with health impacts
Demographics Population: 100,565; households: over 38,000; African American:
53% 25,854 children, of whom 51% are below 200% of Federal Poverty
Guidelines and 36% live in high poverty 74% of school children are African American in public housing or
neighborhoods with barriers to safe places to play and healthy eating
Food Only 10 grocery stores, lots of corner stores with few fresh food
options One farmer’s market, downtown, once a month, summer only
Play and Fitness One main public park with a children’s playground and athletic
areas, 32 total parks, 15 with some play equipment 8 recreation centers, most in disrepair and in high crime areas
Built Environment Suburban design of “drivability”, not walkability
Health High overweight (>65%), obesity (>29%) rates, not known for
children yet
What does it mean for a low-income mother of three, without a car, to shop for healthy food when the grocery store is several miles away and takes three buses to get there? Meanwhile, the corner store is a two minute walk away and easy to get to after working all day.
If you see two children, ages 6 and 11, playing in the street in a neighborhood where the local gang members are known to harass and/or try to enlist kids, what do you feel?
Is that a mirage, or is it a light at the end of the tunnel?
Long, lonely road ahead or are there many sources of expertise and support for these efforts?
CDC Initiatives REACH (Racial and Ethnic Approaches to Community
Health) Steps to Health ACHIEVE (Action Communities for Health, Innovation, and
EnVironmental changE) Robert Wood Johnson Foundation Initiatives
Active Living by Design (ALD) Communities Creating Healthy Environments (CCHE)
W. K. Kellogg Foundation Initiatives Place Matters Food and Fitness
Other Federal Initiatives Champion Program Communities Putting Prevention to Work
Action Communities for Health, Innovation, and EnVironmental changE (ACHIEVE) Bringing community leadership together to
develop and implement policies that favorably impact health
Portsmouth ACHIEVEs Recently awarded ACHIEVE community grant
via CINCH from National Association of Chronic Disease Directors (NACDD)
Accomack County ACHIEVE Recently awarded ACHIEVE community grant
via the YMCA of Hampton Roads from YMCA-USA Alexandria ACHIEVE
ACHIEVE award from previous year via health department from National Association of City and County Health Officials (NACCHO)
Unnatural CausesFour hours of film from California NewsreelExploring policy, systems and environmental
causes of health inequitiesCommunity dialogues to raise awareness and
prompt change Place Matters
W. K. Kellogg Foundation funded national initiative coordinated by the Joint Center for Political and Economic Studies Health Policy Institute
Goal to eliminate health disparities by addressing social determinants of health
ChampionBodyWorks in Hampton RoadsBreastfeeding at Work
BMI AssessmentsBMI 4KidzObesity prevention in Portsmouth
ACHIEVEAlexandria, Accomack and Portsmouth
Communities Putting Prevention to Work (CPPW)Application pending for Accomack and Alexandria
Instill health and safety considerations into land use and planning decisions.
Improve safety and accessibility of public transportation, walking, and bicycling.
Enhance opportunities for physical activity. Enhance availability of healthy products and reduce
exposure to unhealthy products in underserved communities.
Increase housing quality, affordability, stability, and proximity to resources.
Improve air, water, and soil quality. Prevent violence using a public health framework.
Provide high-quality, affordable health coverage for all.
Institute culturally and linguistically appropriate screening, counseling, and health care treatment.
Monitor health care models/procedures that are effective in reducing inequities in health and data documenting racial and ethnic differences in care outcomes.
Provide health care resources in the heart of the community and promote a Medical Home model.
Strengthen the diversity of the health care workforce to ensure that it is reflective and inclusive of the communities it is serving.
Establish sustainable funding mechanisms to support community health and prevention.
Collaborate with multiple fields to ensure that health, safety, and health equity are considered in every relevant decision, action, and policy.
Provide technical assistance and tools to support community-level efforts to address determinants of health and reduce inequities.
Tackle the inequitable distribution of power, money, and resources—the structural drivers of the conditions of daily life that contribute to inequitable health and safety outcomes—and especially address race, racism, and discrimination in institutions and polices; racial and socioeconomic segregation; and socioeconomic conditions.
Improve access to quality education and improve educational outcomes.
Invest in early childhood.
ACHIEVE Opportunity to change city codes and enhance school and
recreation regulations to promote healthy environments and prevent childhood smoking and exposure to tobacco smoke
BMI 4Kidz Portsmouth Health Department purchased equipment to
easily and non-intrusively collect body mass index (BMI) measures to help assess needs and guide overweight and obesity prevention interventions
Very few comprehensive approaches to tracking BMI in VA
Champion Body Works Program Training the trainers to teach parents methods of
promoting healthy food and physical activity for their children
Portsmouth YMCA Swim Gym All second graders learn to swim – equipment and
supplies provided
Call to Action for communities, organizations, government and electorate
Furthering Partnerships Implementation of best practices Working “upstream” to change policy
(prevention) to avoid “downstream” patching of problems after they occur. This is systems change.
Would a round table be more
inclusive, more inviting, more
effective for communication?Who gets a vote? Civic
engagement is more than
the voting booth.
Can co
mm
unity
-
base
d or
ganiz
ation
s
be in
clude
d? W
hat
abou
t par
ents
and
child
ren/
yout
h?
Safe Routes
to School in
Walkable Built
Environments
Easy access to Healthy Food Options
Equal access and support for high Educational Achievement
Greater Economic Opportunity
Physical Fitness for Life, Safe Play Places
Elimination of Racism & Discrimination
Full access to High Quality Health Care
Ease of
Transportation
Housing (e)quality