071812handouts online - alabama department of public healthdhhs, hrsa, october 2010. barker...

7/13/2012

1

Changing Paradigms in Maternal and Child Health: Innovative Lessons from

the Life Course

Changing Paradigms in Maternal and Child Health: Innovative Lessons from

the Life Course

Produced by the Alabama Department of Public HealthVideo Communications and Distance Learning DivisionProduced by the Alabama Department of Public HealthVideo Communications and Distance Learning Division

Satellite Conference and Live WebcastWednesday, July 18, 2012

12:00 – 1:30 p.m. Central Time

Satellite Conference and Live WebcastWednesday, July 18, 2012

12:00 – 1:30 p.m. Central Time

FacultyFacultyCheri Pies, MSW, DrPH

Clinical ProfessorMCH and DrPH ProgramsSchool of Public Health

University of California, Berkley

Cheri Pies, MSW, DrPHClinical Professor

MCH and DrPH ProgramsSchool of Public Health

University of California, Berkley

Bina Shrimali, MPHHealth Equity Innovation Manager

Alameda County Public Health Department

Oakland, California

Bina Shrimali, MPHHealth Equity Innovation Manager


Oakland, California

AcknowledgmentsAcknowledgments• Drs. Michael Lu and Neal Halfon, UCLA

• Dr. Paula Braveman, UCSF

• Padmini Parthasarathy

• Amy Fine

• Milt Kotelchuck

• Drs. Michael Lu and Neal Halfon, UCLA

• Dr. Paula Braveman, UCSF

• Padmini Parthasarathy

• Amy Fine

• Milt Kotelchuck• Milt Kotelchuck

• Berkeley Media Studies Group

• Policylink

• Doak Bloss, Ingham County Health Department

• Staff of Alameda County Public Health Department

• Building Blocks Collaborative Partners

• Milt Kotelchuck

• Berkeley Media Studies Group

• Policylink

• Doak Bloss, Ingham County Health Department

• Staff of Alameda County Public Health Department

• Building Blocks Collaborative Partners

Context: A Snapshot of Alameda County, CA

Context: A Snapshot of Alameda County, CA

95%

100%

Percentage of Pregnant Women Receiving

First Trimester Prenatal CareAlameda County Trend

Trend Line shows increasing t l t

While Rates of Care Have Increased…While Rates of Care Have Increased…

70%

75%

80%

85%

90%

95%

90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10

prenatal care rates

1990 2010

…And Disparities Between Groups Have Decreased…

…And Disparities Between Groups Have Decreased…

90%95%

100%

Percentage of Pregnant Women Receiving First Trimester Prenatal Care by Race/Ethnicity

Alameda County Trend

White

60%65%70%75%80%85%

90-9

1

91-9

2

92-9

3

93-9

4

94-9

5

95-9

6

96-9

7

97-9

8

98-9

9

99-0

0

00-0

1

01-0

2

02-0

3

03-0

4

04-0

5

05-0

6

06-0

7

07-0

8

08-0

9

09-1

0

White

All Races

API

Latino

AfrAmer

7/13/2012

2

10%

12%

14%

Percentage of Low Birth Weight BabiesAlameda County Trend

…Pregnancy Outcomes Have Not Changed…

…Pregnancy Outcomes Have Not Changed…

0%

2%

4%

6%

8%

10%

90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10

…And They Remain Much Higher for African Americans

…And They Remain Much Higher for African Americans

11.5%

7 5%10.0%

12.0%

14.0%

Percentage of Low Birth Weight Babies by Race/Ethnicity, Alameda County 2008-2010

~ Two times higher rates among African Americans

than Whites or Latinos

7.1% 7.5%5.5% 6.2%

0.0%

2.0%

4.0%

6.0%

8.0%

All Races AfrAm Asian Latino White

And, Although Infant Mortality Is Decreasing Overall…

And, Although Infant Mortality Is Decreasing Overall…

8.0

10.0

Infant Mortality, Alameda County Trend

0.0

2.0

4.0

6.0

8.17

8

9

,000

Liv

e Infant Mortality Rate by

Race/Ethnicity Alameda County 2008-2010

…It’s Far From A Success Story.…It’s Far From A Success Story.

More than two times higher rates among African Americans

than Whites or Asians/PIs

4.32.9

4.5

3.1

0

1

2

3

4

5

6

All Races AfrAm Asian Latino White

mb

er o

f In

fan

t D

eath

s p

er 1

,B

irth

s

Paradigm ShiftParadigm Shift Where You Live Affects Your Health

Where You Live Affects Your Health

• Disinvested communities: poor

health status

– Limited/unsafe parks

• Disinvested communities: poor

health status

– Limited/unsafe parksp

– Crime

– Fast food restaurants

– Liquor stores

– Poor performing schools

p

– Crime

– Fast food restaurants

– Liquor stores

– Poor performing schools

7/13/2012

3



– Pollution and toxic exposures

– Limited public transportation

– Absence of high quality financial

– Pollution and toxic exposures

– Limited public transportation

– Absence of high quality financial– Absence of high quality financial

institutions

– Predatory lenders

– Absence of high quality financial

institutions

– Predatory lenders



• Communities of opportunity: good

health status

– Parks

• Communities of opportunity: good

health status

– Parks

– Safe/walkable streets

– Grocery stores

– Good schools

– Clean air

– Safe/walkable streets

– Grocery stores

– Good schools

– Clean air



– Public transportation

– Good jobs

– Strong local businesses

– Public transportation

– Good jobs

– Strong local businesses– Strong local businesses

– Financial institutions

– Strong local businesses

– Financial institutions

Health Inequities in Alameda CountyHealth Inequities in Alameda County

Place Matters: Differences in

Health Based on Where

You Live

Source: ACPHD CAPE Unit, with data from Alameda County vital statistics files, 2007-2009

Income Matters: Differences in Health Based on Neighborhood Poverty LevelsIncome Matters: Differences in Health

Based on Neighborhood Poverty Levels

82.379.5

76.6 76.180

85

cta

nc

ya

rs)

Life Expectancy at Birth by Neighborhood Poverty

65

70

75

<10.0% 10.0-19.9% 20.0-29.9% 30.0+%

Lif

e E

xp

ec

(in

ye

a

Neighborhood Poverty Group(% of residents living in poverty)

Source: ACPHD CAPE Unit, with data from Alameda County vital statistics files and American Community Survey, 2005-2009

Race Matters: Differences in Health Based on Race/Racism

Race Matters: Differences in Health Based on Race/Racism

80

85

ctan

cy

ars) White

6.5 years

Life Expectancy at Birth by Race

60

65

70

75

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

Lif

e E

xpe

(in

Yea

African American4 years

Source: ACPHD CAPE Unit, with data from Alameda County vital statistics files,1960-2009

2009

7/13/2012

4

Race, Income, and Place Impact Health


• Compared to a white child in the affluent Oakland Hills, an African-American born in high-poverty west Oakland is:


– As an infant:

• 1.5 times more likely to be born premature or low birth weight

• 7 times more likely to be born into poverty

– As an infant:

• 1.5 times more likely to be born premature or low birth weight

• 7 times more likely to be born into poverty





– As a child:

• 2.5 times more likely to be behind in vaccinations

• 4 times less likely to read at grade level

– As a child:

• 2.5 times more likely to be behind in vaccinations

• 4 times less likely to read at grade level





– As an adult:

• 5 times more likely to be hospitalized for diabetes

• 2 times more likely to die of heart disease

– As an adult:

• 5 times more likely to be hospitalized for diabetes

• 2 times more likely to die of heart disease



• Compared to a white child in the

affluent Oakland Hills, an African-

American born in high-poverty west

O kl d

• Compared to a white child in the

affluent Oakland Hills, an African-

American born in high-poverty west

O kl dOakland

– Cumulative impact

• 15 year difference in life

expectancy

Oakland

– Cumulative impact

• 15 year difference in life

expectancy

What is the Life Course Perspective?

What is the Life Course Perspective?

What Life Course IsWhat Life Course Is• Life Course is a theory or

perspective that seeks to understand, explain, and improve health and disease patterns across population groups

• Life Course is a theory or perspective that seeks to understand, explain, and improve health and disease patterns across population groupspopulation groups

• It is a theory, perspective, framework

• There is no single, definitive text

• It reflects a convergence of ideas, informed by multiple sources

population groups

• It is a theory, perspective, framework

• There is no single, definitive text

• It reflects a convergence of ideas, informed by multiple sources

7/13/2012

5

Is Life Course Old or New?Is Life Course Old or New?• We know that the same science is

also informing other fields:

– Barker Hypothesis – links LBW to increased risk of heart disease,

• We know that the same science is also informing other fields:

– Barker Hypothesis – links LBW to increased risk of heart disease, ,diabetes

– Felitti’s ACE Study – links early childhood adverse events to increased risk of obesity, heart disease, diabetes, depression

,diabetes

– Felitti’s ACE Study – links early childhood adverse events to increased risk of obesity, heart disease, diabetes, depression

Is Life Course Old or New?Is Life Course Old or New?– Neurons to Neighborhoods – early

environments, nurturing

relationships, parents are the

“active ingredients” in healthy

– Neurons to Neighborhoods – early

environments, nurturing

relationships, parents are the

“active ingredients” in healthy

brain development – from the

earliest ages forward

brain development – from the

earliest ages forward

Is Life Course Old or New?Is Life Course Old or New?– Lu/Halfon – link disparities in birth

outcomes to differential

developmental trajectories of the

mother, based on early life

– Lu/Halfon – link disparities in birth

outcomes to differential

developmental trajectories of the

mother, based on early life

experiences (programming) and

cumulative stress

– Epi-genetics – links environmental

triggers to gene expression

experiences (programming) and

cumulative stress

– Epi-genetics – links environmental

triggers to gene expression

Key QuestionsKey Questions• MCH Life Course literature focuses

on two key questions:

1. Why do health disparities exist

and persist across population

• MCH Life Course literature focuses

on two key questions:

1. Why do health disparities exist

and persist across population p p p

groups?

p p p

groups?

Key QuestionsKey Questions2. What are the factors that

influence the capacity of

individuals or populations to

reach their full potential for health

2. What are the factors that

influence the capacity of

individuals or populations to

reach their full potential for health

and well-being?and well-being?

Life Course PerspectiveLife Course Perspective• It is a way of looking at life not as

disconnected stages, but as an

integrated continuum

• Suggests that a complex interplay of

• It is a way of looking at life not as

disconnected stages, but as an

integrated continuum

• Suggests that a complex interplay of gg p p y

biological, behavioral, psychological,

and social protective and risk factors

contributes to health outcomes

across the span of a person’s life

gg p p y

biological, behavioral, psychological,

and social protective and risk factors

contributes to health outcomes

across the span of a person’s life

7/13/2012

6

Life Course PerspectiveLife Course Perspective

Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective.Matern Child Health J. 2003;7:13-30.

Key TermsKey Terms• Pathways and Trajectories

• Early Programming

• Risk and Protective Factors

• Pathways and Trajectories

• Early Programming

• Risk and Protective Factors

• Cumulative Impact

• Critical or Sensitive Periods

• Cumulative Impact

• Critical or Sensitive Periods

Early ProgrammingEarly Programming• Early experiences can program an

individual’s future health and

development

• Early experiences can program an

individual’s future health and

development

Early ProgrammingEarly Programming– This includes prenatal

programming as well as

intergenerational programming

(i.e. the health of the mother prior

t ti ) th t i t di

– This includes prenatal

programming as well as

intergenerational programming

(i.e. the health of the mother prior

t ti ) th t i t dito conception) that impact disease

or condition, or make an individual

more vulnerable or susceptible to

developing a disease or condition

in the future– Fine and Kotelchuck, Rethinking MCH: The Life Course Model as an Organizing Framework Concept Paper,

DHHS, HRSA, October 2010.

to conception) that impact disease

or condition, or make an individual

more vulnerable or susceptible to

developing a disease or condition

in the future– Fine and Kotelchuck, Rethinking MCH: The Life Course Model as an Organizing Framework Concept Paper,


Barker Hypothesis: Birth Weight and Coronary Heart Disease

Barker Hypothesis: Birth Weight and Coronary Heart Disease

Age Adjusted Relative Risk

Rich-Edwards JW, Stampfer MJ, Manson JE, Rosner B, Hankinson SE, Colditz GA et al. Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. Br Med Jr 1997;315:396-400.

Barker Hypothesis: Birth Weight and Insulin Resistance Syndrome

Barker Hypothesis: Birth Weight and Insulin Resistance Syndrome

Odds Ratio Adjusted for BMI

Barker DJP, Hales CN, Fall CHD, Osmond C, Phipps K, Clark PMS. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (Syndrome X): Relation to reduced fetal growth. Diabetologia 1993;36:62-67.

7/13/2012

7

Cumulative ImpactCumulative Impact• While individual episodes of stress

may have minimal impact in an

otherwise positive trajectory, the

cumulative impact of multiple

• While individual episodes of stress

may have minimal impact in an

otherwise positive trajectory, the

cumulative impact of multiple

stresses over time may have a

profound direct impact on health and

development– Fine and Kotelchuck, Rethinking MCH: The Life Course Model as an Organizing Framework Concept Paper,


stresses over time may have a

profound direct impact on health and

development– Fine and Kotelchuck, Rethinking MCH: The Life Course Model as an Organizing Framework Concept Paper,


Allostasis: Maintain Stability Through Change

Allostasis: Maintain Stability Through Change

McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9.

Allostatic Load: Wear and Tear from Chronic StressAllostatic Load: Wear and Tear from Chronic Stress

McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9.

Stressed vs. Stressed OutStressed vs. Stressed Out• Stressed = protective

– Increased cardiac output

– Increased available glucose

E h d i f ti

• Stressed = protective

– Increased cardiac output

– Increased available glucose

E h d i f ti– Enhanced immune functions

– Growth of neurons in

hippocampus and prefrontal cortex

– Enhanced immune functions

– Growth of neurons in


Stressed vs. Stressed OutStressed vs. Stressed Out• Stressed out = toxic

– Hypertension and cardiovascular

diseases

– Glucose intolerance and insulin

• Stressed out = toxic

– Hypertension and cardiovascular

diseases

– Glucose intolerance and insulinGlucose intolerance and insulin

resistance

– Infection and inflammation

– Atrophy and death of neurons in


Glucose intolerance and insulin

resistance

– Infection and inflammation

– Atrophy and death of neurons in


Bus doesn’t come; late to school

Bus doesn’t come; late to school DiscriminationDiscrimination

Physical and Mental Health ImpactsPhysical and Mental Health Impacts

Your Neighborhood or Job Shouldn’t Be Hazardous to Your Health

Your Neighborhood or Job Shouldn’t Be Hazardous to Your Health

No fresh food nearbyNo fresh food nearby

StressStressStressStressStressStress

Mold found in house

Mold found in house

YMCA summer

program full – nothing to

do

YMCA summer

program full – nothing to

do

Drug dealers live next door

Drug dealers live next door

Poor air quality – gets asthma

Poor air quality – gets asthma

Not enough

textbooks this year

Not enough

textbooks this year

StressStress StressStress StressStress

StressStressStressStress

7/13/2012

8

What We Have Learned from the Life Course PerspectiveWhat We Have Learned from the Life Course Perspective• Interventions that reduce risks and

increase protective factors can

change the health trajectory of

• Interventions that reduce risks and

increase protective factors can

change the health trajectory of

individuals and populationsindividuals and populations

Life Course Perspective in Practice:

Alameda County Public Health Department’s

Life Course Perspective in Practice:

Alameda County Public Health Department’sHealth Department s Building Blocks for

Health Equity Initiative

Health Department s Building Blocks for

Health Equity Initiative

1 in 3 Newborns Start Life in Poverty1 in 3 Newborns Start Life in Poverty

Source: CAPE, with data from vital statistics files, 2011

Health EquityHealth Equity• Everyone in Alameda County, no

matter where you live, how much

money you make, or the color of your

skin, should have opportunities to

• Everyone in Alameda County, no

matter where you live, how much

money you make, or the color of your

skin, should have opportunities to

lead a healthy, fulfilling

and productive life

lead a healthy, fulfilling

and productive life

Alameda County Life Course Initiative: Building Blocks for

Health Equity

Alameda County Life Course Initiative: Building Blocks for

Health Equity• Building Blocks for Health Equity (BB4HE)

increases community and health

department capacity to advance health

• Building Blocks for Health Equity (BB4HE)

increases community and health

department capacity to advance healthdepartment capacity to advance health

and social equity by mobilizing

partnerships, incubating projects, and

redesigning services -- all toward our

vision that ALL children in Alameda

County have the best start in life

department capacity to advance health

and social equity by mobilizing

partnerships, incubating projects, and

redesigning services -- all toward our

vision that ALL children in Alameda

County have the best start in life

Building Blocks Collaborative:Launched in September 2009

Building Blocks Collaborative:Launched in September 2009• Key Objectives

– Build a strong, engaged, multi-

sector collaborative

• Key Objectives

– Build a strong, engaged, multi-

sector collaborative

– Learn, share, and orient for a

paradigm shift

– Share resources and strengthen

work of BBC partners

– Learn, share, and orient for a

paradigm shift

– Share resources and strengthen

work of BBC partners

7/13/2012

9



– Innovate! Plant seeds for and

incubate new projects, redesign

the way we currently work

– Innovate! Plant seeds for and

incubate new projects, redesign

the way we currently work

Building Blocks Collaborative: Diverse and

Committed Organizations


Committed Organizations• What can we do together with the

resources we have?

• What can we do together with the

resources we have?

– First 5 Alameda County

– East Bay Regional Parks District

– Mandela Marketplace

– Berkeley Food and Housing Project

– First 5 Alameda County

– East Bay Regional Parks District

– Mandela Marketplace

– Berkeley Food and Housing Project




Committed Organizations– Urban Strategies Council, Alameda

County Community Assets

– Urban Strategies Council, Alameda

County Community Assets

Network

– Brighter Beginnings

– Lotus Bloom Family Resource

Center

Network

– Brighter Beginnings

– Lotus Bloom Family Resource

Center




Committed Organizations– Girls, Inc. of Alameda County

– Kaiser Permanente

– Girls, Inc. of Alameda County

– Kaiser Permanente

– Alameda Health Consortium

– Youth Uprising

– Lifelong Medical Care

– Alameda Health Consortium

– Youth Uprising

– Lifelong Medical Care




Committed Organizations– Centering Pregnancy

– Alameda County Sheriff

– Centering Pregnancy

– Alameda County Sheriff y

Department

– City of Oakland

– Attitudinal Healing Connection

y

Department

– City of Oakland

– Attitudinal Healing Connection




Committed Organizations– East Bay Asian Local Development

Corporation

– East Bay Asian Local Development

Corporation

– Tiburcio Vasquez Health Center

– West Oakland Health Center

– Alameda County Public Health

Commission

– Tiburcio Vasquez Health Center

– West Oakland Health Center

– Alameda County Public Health

Commission

7/13/2012

10




Committed Organizations– Alameda County Community Food

Bank

– Alameda County Community Food

Bank

– City of Berkeley Black Infant Health

Community Advisory Board

– Food Transportation Resource

Connection

– City of Berkeley Black Infant Health

Community Advisory Board

– Food Transportation Resource

Connection




Committed Organizations– Dig Deep Farms and Produce

– American Diabetes Association

– Dig Deep Farms and Produce

– American Diabetes Association

– UC Berkeley School of Public

Health

– UCSF Institute for Health Solutions

– Many more . . .

– UC Berkeley School of Public

Health

– UCSF Institute for Health Solutions

– Many more . . .

Building Blocks Collaborative:Bill of Rights


• All children in Alameda County have

a right to be born healthy and to:

– Be believed in

• All children in Alameda County have

a right to be born healthy and to:

– Be believed in

– Live, play, and grow in a clean,

safe place

– Receive a quality education

– Be loved by a caring adult

– Live, play, and grow in a clean,

safe place

– Receive a quality education

– Be loved by a caring adult



– Eat healthy food

– Explore nature

– Enjoy economic opportunity and

– Eat healthy food

– Explore nature

– Enjoy economic opportunity and– Enjoy economic opportunity and

financial security

– Access health care that promotes

well-being

– Enjoy economic opportunity and

financial security

– Access health care that promotes

well-being



– Be free from discrimination and

violence

– Be included and valued by a

– Be free from discrimination and

violence

– Be included and valued by a y

supportive community

y

supportive community

Building Blocks Collaborative: Project Planning Guiding Principles and Framework


• BBC Projects will:

– Have a clear link(s) to the Bill of

• BBC Projects will:

– Have a clear link(s) to the Bill of

Rights

– Be sustainable and build capacity

– Work toward systems change

Rights

– Be sustainable and build capacity

– Work toward systems change

7/13/2012

11


Building Blocks Collaborative: Project Planning Guiding Principles and Framework– Provide opportunity for broad buy-

in and involvement for community

d BBC

– Provide opportunity for broad buy-

in and involvement for community

d BBCand BBC

• Driven by community need;

building on BBC partner

strengths

and BBC

• Driven by community need;

building on BBC partner

strengths


Building Blocks Collaborative: Project Planning Guiding Principles and Framework– Be achievable, with greatest

likelihood of demonstrating

– Be achievable, with greatest

likelihood of demonstrating

successsuccess

Planning FrameworkPlanning Framework Problem: Lack of Healthy Food StoresProblem: Lack of Healthy Food Stores

Problem: Lack of Healthy Food StoresProblem: Lack of Healthy Food Stores Project: Food to Families Project: Food to Families • Provide “prescriptions” for fresh

food to families receiving health

services

• Families fill prescriptions at local

• Provide “prescriptions” for fresh

food to families receiving health

services

• Families fill prescriptions at localFamilies fill prescriptions at local

food businesses where local youth

are employed

Families fill prescriptions at local

food businesses where local youth

are employed

7/13/2012

12

Problem: Lack of Healthy Financial Services

Problem: Lack of Healthy Financial Services

• $3.89 million is stripped from

Oakland each year from payday

lenders

• $3.89 million is stripped from

Oakland each year from payday

lenders

Project: Alameda County Prosperity Project

Project: Alameda County Prosperity Project

• Financial awareness and education

• Policies that expand access to

non- predatory financial products

• Financial awareness and education

• Policies that expand access to

non- predatory financial productsp y pp y p

Internal Systems Change: Home Visiting / Family Support

System Design


System Design• Home visits provide an opportunity

to enhance protective factors and

• Home visits provide an opportunity

to enhance protective factors and

reduce risks

– Child health and development

– Strong families

– Parent health

reduce risks

– Child health and development

– Strong families

– Parent health


System Design


System Design• Kindergarten readiness third

grade test scores high school

• Kindergarten readiness third

grade test scores high school

graduation employment, poverty

status, health, incarceration, marital,

and parenting status

graduation employment, poverty

status, health, incarceration, marital,

and parenting status

StrengtheningFamilies Shared

Common Standards


System Design


System Design

Approach

BlendedFunding

Smooth TransitionsBetween Systems

TriageFamilies Based

On Needs

Outcomes

Community-Wide Perinatal System

What BBC Seeds Have Taken Root?


“Observing deep and amazing

connections and collaborations

within a multitude of agencies.”

“Observing deep and amazing

connections and collaborations

within a multitude of agencies.”

“Rich dialogue that bridges

individual/family needs with

changing/broader community

conditions.”

“Rich dialogue that bridges

individual/family needs with

changing/broader community

conditions.”

7/13/2012

13



“Growing relationships. The BBC

has given me the opportunity to

meet and come to know so many

“Growing relationships. The BBC

has given me the opportunity to

meet and come to know so many

people representing so many

opportunities to enrich and set

the right course for our children,

their families, and the community.”

people representing so many

opportunities to enrich and set

the right course for our children,

their families, and the community.”



“Bill of Rights brought a

broader purpose to our work.”

“Bill of Rights brought a

broader purpose to our work.”

Framing the ProblemFraming the Problem• What questions are we asking?

• How do these questions define the

problem?

H d th d fi iti f th

• What questions are we asking?

• How do these questions define the

problem?

H d th d fi iti f th• How does the definition of the

problem define the solution?

• How does the definition of the

problem define the solution?

Flipping the QuestionFlipping the Question• How can we teach people how to eat

more healthful meals?

• What policies and practices will

increase the

• How can we teach people how to eat

more healthful meals?

• What policies and practices will

increase the

availability of

food stores in

west Oakland?

availability of

food stores in

west Oakland?

Number of Food Stores, West Oakland

1940 2000

# o

f S

tore

s

Flipping the Question Flipping the Question • How can we get more women’s

health services to ensure healthy

births?

• How can current systems be

• How can we get more women’s

health services to ensure healthy

births?

• How can current systems beHow can current systems be

realigned and transformed to create

conditions for families and children

to be healthy?– Doak Bloss, Ingham County Health Department

How can current systems be

realigned and transformed to create

conditions for families and children

to be healthy?– Doak Bloss, Ingham County Health Department

Take Home MessagesTake Home Messages• Today’s experiences and exposures

determine tomorrow’s health

• Health trajectories are particularly

affected during critical or sensitive

• Today’s experiences and exposures

determine tomorrow’s health

• Health trajectories are particularly

affected during critical or sensitive g

periods

• The broader environment – biologic,

physical, and social – strongly

affects the capacity to be healthy

g

periods

• The broader environment – biologic,

physical, and social – strongly

affects the capacity to be healthy

7/13/2012

14

Take Home MessagesTake Home Messages• Inequality in health reflects more

than genetics and personal choice– Fine, Kotelchuck, Adess, Pies 2009

• Inequality in health reflects more

than genetics and personal choice– Fine, Kotelchuck, Adess, Pies 2009

Thank You!Thank You!

Cheri Pies, MSW, DrPH

Clinical Professor

MCH and DrPH Programs

School of Public Health

Cheri Pies, MSW, DrPH

Clinical Professor

MCH and DrPH Programs

School of Public Health

UC Berkeley

[email protected]

510 – 643 – 1250

UC Berkeley

[email protected]

510 – 643 – 1250

Thank You!Thank You!

Bina Shrimali, MPH

Health Equity Innovation Manager


Bina Shrimali, MPH

Health Equity Innovation Manager


[email protected]

510 – 268 – 7078

[email protected]

510 – 268 – 7078

071812handouts online - alabama department of public healthdhhs, hrsa, october 2010. barker...

Documents