the opportunity the challenge the framework danger and opportunity where do we go from here?

FROM HEALTH DISPARITIES TO HEALTH EQUITY

Annual Meeting

Directors of Health Promotion and EducationNew Orleans, LA

August 10-11, 2010

Stephen B. Thomas, PhD.Professor, Department of Health Services Administration

Director, Maryland Center for Health Equity

School of Public Health

The University of Maryland

[email protected]

www.healthequity.umd.edu

National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas

SCHOOL OF PUBLIC HEALTH CENTER FOR HEALTH EQUITY

Craig S. Fryer, DrPH, Mary A. Garza, Ph.D.,

Stephen B. Thomas, Ph.D., Sandra C. Quinn, Ph.D. and James Butler, III, DrPH

www.healthequity.umd.edu



1. The Opportunity2. The Challenge3. The Framework4. Danger and Opportunity5. Where Do We Go From Here?

THE OPPORTUNITY



“America’s health needs to be improved now, not five or ten years

from now” (2010, p. 1486).

David R. Williams, Mark B. McClellan, and Alice M. RivlinBeyond The Affordable Care Act: Achieving Real Improvements In Americans’ Health Health Affairs 29, NO. 8 (2010): 1481–1488



VISION

To be a vibrant contributor to the University of Maryland’s re-invigorated land grant mission, which includes a commitment to eliminate racial and ethnic disparities and achieve health equity.

According to Health People 2020:

“A health disparity is a particular type of health difference that is closely linked to …people who have experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, mental health, cognitive, sensory, or physical disability, sexual orientation, geography, or other characteristics historically linked to discrimination or exclusion.“

http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx

Attending public launch of HP2020 at George Washington University, December 2, 2010: Drs. James Butler III, Robert S. Gold, Sandra Quinn, Adewale Troutman, Stephen B. Thomas, Mary A. Garza and Craig S. Fryer

Institute of Medicine Definition of Health Disparities

Differences, Disparities, and Discrimination:

Populations with Equal Access to Healthcare

SOURCE: Gomes and McGuire, 2001



In 2004, the CDC published “Actual Causes of Death in the United States. 2000,” which identified tobacco (435,000 deaths; 18.1% of total U.S. deaths) and poor diet and physical inactivity (400,000 deaths; 16.6% of total U.S. deaths) as the leading contributors to loss of life (Mokdad,et al, 2004. Actual causes of death in the United States. 2000. J. Am. Med. Assoc)

THE CHALLENGE



Race the Power of an Illusion, PBShttp://www.pbs.org/race/000_General/000_00-Home.htm



Shariff-Marco, S., Klassen, A. C., & Bowie, J. V. (2010). Racial/Ethnic Differences in Self-Reported Racism and Its Association With Cancer-Related Health Behaviors.

Am J Public Health, 100(2), 364-374.

“… general racism was associated with smoking, binge drinking, and being overweight or obese; health care racism was associated with not being up to date with screening for prostate cancer…. Associations between general racism and lifestyle behaviors suggest that racism is a potential stressor that may shape cancer-related health behaviors... “ (p. 364)



Ford, C. and Airhihenbuwa C. (2010). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. American Journal of Public Health, 100: S30-S35.

Ford, C. and Airhihenbuwa C. (2010). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. American Journal of Public Health, 100: S30-S35.

THE FRAMEWORK



Thomas, S. B., S. C. Quinn, et al. (2011). "Toward a Fourth Generation of Disparities Research to Achieve Health Equity." Annual Review of Public Health 32(1): 399-416.



“Because limited race and ethnicity data were available, it is unknown if the intervention had differential effects for different racial or ethnic groups”

Task Force on Community Preventive Services recommended interventions for prevention of obesity and tobacco use. Source: Adapted from The Guide to Community Preventive Services

Third Generation Research: A Color Blind Evidence Base



Fourth Generation Health Disparity Research

From the Public Health Critical Race praxis perspective, four key principles should inform intervention research:

1.The primacy of racialization, 2.Structural determinism,3.Critical approaches, and 4.Intersectionality

Health Equity Action Research TrajectoryHEART

Thomas, S. B., S. C. Quinn, Butler, J., Fryer, C..S., Garza, M.A. (2011). "Toward a Fourth Generation of Disparities Research to Achieve Health Equity." Annual Review of Public Health 32(1): 399-416



INNOVATION

Health Advocates In-Research and Research (H.A.I.R.)Network of Black Barbershops & Beauty Salons

THE FAMILY HEALTH HISTORY

THE PEDIGREE: A GENETIC FAMILY HEALTH TREEThe goal of the session is to elicit a three-generation pedigree for

accurate risk assessment.

LESSONS FROM EVIDENCE BASED RESEARCH

Focus on common risk factors for chronic disease

Pre-hypertension and Pre-Diabetes•Smoking•Obesity•Stress•Family health history

PROGRAM ACTIVITIES

Physical ActivityNutrition Education & Guidance

Stress ManagementSmoking Cessation

Family Health HistorySelf-Management of Chronic Disease

Referral to Medical Home

Disease Prevention: "We have made some progress towards eliminating health disparities. Yet there is much unfinished business. We have to reexamine our strategy and accelerate the pace through innovative, sustainable and results-oriented approaches... " (Dr. John Ruffin, Director, NIH-NIMHD, 2010)

LIFESTYLE:

African American women participate in a community based Water Aerobics class.

The Healthy Black Family Project, a Program of the Maryland Center for Health Equity (NIH-NIMHD, P60)

C:\Users\sbthomas\Videos\UOM-CHE-HBN-EPISODE2-060911.mov

DANGER AND OPPORTUNITY



The danger is to assume that:1. racism is not relevant in the scientific pursuit of

solutions for the elimination of health disparities;

2. that some populations will always suffer premature illness and death by virtue of their culture bound lifestyle choices; and thus,

3. that the elimination of disparities is impossible and health equity unachievable in a free market society.

Thomas, S. B., S. C. Quinn, Butler, J., Fryer, C..S., Garza, M.A. (2011). "Toward a Fourth Generation of Disparities Research to Achieve Health Equity." Annual Review of Public Health 32(1): 399-416



The opportunity is to recognize health disparities as an issue of justice because specific groups were subjected to systematic racial discrimination and denied the basic benefits of society, a violation of the social contract.

Boucher, David and Paul Kelly, eds. 1994.The Social Contract from Hobbes to Rawls, New York: Routledge

WHERE DO WE GO FROM HERE ?



ACHIEVING HEALTH EQUITY

“…we can no longer be victims of inaction. Our role as scientists is to provide the knowledge and perspectives for effective practice and policies… We have a moral obligation in our society to do what is necessary to improve health, and the health disparities research community should be in the vanguard of that movement” (Ruffin, 2010, p. S9).

Ruffin J. 2010. The Science of Eliminating Health Disparities: Embracing a New Paradigm. American Journal of Public Health. 100:S8-S9



Acknowledgement & Disclaimer The project described was supported by Award

Number 7RC2MD004766 from the National Institute on Minority Health And Health Disparities (NIMHD).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMHD or the National Institutes of Health.

THANK YOU VERY MUCH !

the opportunity the challenge the framework danger and opportunity where do we go from here?

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