Addressing Racial and Ethnic Disparities and Social Determinants of

Health When Integrating County Health and

Justice Systems Charleston County, S.C.

January 22, 2015

Health disparities and social determinants

Elizabeth A. Baker, PhD, MPH January, 2015 NACo Annual Conference, Charleston, SC

A story… • Evaluated a nursing home visiting program for low-income African

American families in the city of St. Louis, MO. • Intent was that would provide home care to infants sent home from

the hospital, but in fact they spent 90% of their time addressing issues such as: • utilities were turned off so there was no way to keep medications

cool in the refrigerator • no telephone to contact doctor with questions or set another

appointment • no transportation so even when there was another appointment

they missed it • The children visited were often readmitted shortly after discharge. • Infant mortality rate per 1,000: African American 16, White 5.3

Healthy People 2020: Overarching Goals • Attain high-quality, longer lives free of

preventable disease, disability, injury, and premature death.

• Achieve health equity, eliminate disparities, and improve the health of all groups.

• Create social and physical environments that promote good health for all.

• Promote quality of life, healthy development, and healthy behaviors across all life stages.

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

Health Disparities Differences in the incidence and prevalence of

health conditions and health status between groups, based on: Race/ethnicity Socioeconomic status Sexual orientation Gender Disability status Geographic location Combination of these

Health Inequities Differences in morbidity and mortality due to

the systematic and unjust distribution of social, economic, and environmental resources and conditions needed for health • Unequal employment opportunities and

pay/income • Discrimination based upon social status/other

factors • Unequal access to quality education, healthcare,

housing, transportation, other resources (e.g., car seats, grocery stores, places to be physically active)

Reference: Whitehead M. et al

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Healthy People 2020: Overarching Goals • Attain high-quality, longer lives free of preventable disease,

disability, injury, and premature death. • Achieve health equity, eliminate disparities, and improve the

health of all groups. • Create social and physical environments that promote good

health for all. • Promote quality of life, healthy development, and healthy

behaviors across all life stages.

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

Enhance equity through distributive justice • Distributive justice: equitable distribution of

social determinants - resources/assets and conditions. (Minkler, 2010)

• Social determinants of health: Life-enhancing

resources, such as food supply, housing, economic and social relationships, transportation, education and health care, whose distribution across populations effectively determines length and quality of life. (James, 2002)

Enhance equity through procedural justice • Procedural justice: equitable processes through which

everyone- including low-income communities, communities of color, rural residents, and other marginalized groups- can gain a seat at the table and stay at the table, having a real voice in decisions that affect their lives.

• “People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. At the heart of this process is [communities taking] ownership and control of their own endeavors and destinies.” Ottawa charter (1986)

Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008

Implications

• Continue to focus on the leaves. Medical and social service institutions often work primarily on the leaves, that is where they have expertise.

• Partner to work on the trunk: All sectors can: • create structures and processes to improve

coordination of the various services to the community and enhance agency relationships

• listen to the community to determine what is needed and how best to develop the structures to meet the needs

• help community members and agencies to feel that they are a valued part of the community and are essential in developing the solutions to improve health

Broader lessons learned/implications (con’t)

• Partner to work on the soil and the roots: All sectors can collaborate recognizing that these root issues influence a wide variety outcomes • Support policy changes: increase minimum wage,

improve transportation systems • Support programs: equip people for work available,

high standards of education for all and good (re)training, unemployment benefits

• Enhance structures: ensure all families have access to utilities

• Share information: map resources and provide information to the community at large

Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008

Additional data sources

www.nationalequityatlas.org - data to track conditions and changes http://livingwage.mit.edu/- living wage calculator

Disparities in Social Determinants of

Health and Justice

National Association of Counties January 2015

17

31

69

88

168

0

20

40

60

80

100

120

140

160

180

White Latino Native Am. Black

per 100,000 youth in the population

One Day Count National Detention Rates (2011)

Source: Sickmund, M., Sladky, T.J., Kang, W., and Puzzanchera, C. (2013) "Easy Access to the Census of Juveniles in Residential Placement." Online. Available: http://www.ojjdp.gov/ojstatbb/ezacjrp/

How to read the chart: For every 100,000 White youth 31 were detained. For every 100,000 Latino youth 69 were detained. For every 100,000 Native American youth 88 were detained. For every 100,000 Black youth 168 were detained.

In a one day count of detention in the US in 2011: •Latino youth were more than 2 times as likely as White youth to be detained. •Native American youth were nearly 3 times as likely as White youth to be detained. •Black youth were more than 5 times as likely as White youth to be detained.

Ja’isha Akins 19

Cost of Increased Incarceration State correctional spending increased fourfold:

1988 $11.7 billion 2008 $47.3 billion

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U.S. Demographics 22

Studies on Black Boys and Perceived Childhood by Police Officers

Black boys are seen by Police Officers as less “childlike” than their White peers Older More Culpable/Less Innocent

Childhood characteristics are

perceived as less relevant to Black boys

0.5

2.5

3.1

-0.9

4.6

2.3

-2

-1

0

1

2

3

4

5

White Black Latino

Mea

n ag

e ov

eres

timat

ion

(in y

ears

)

Over/Underestimation of Ages By Offense and Race/Ethnicity

Misdemeanor suspected Felony Suspected

Source: Goff, P.A., Jackson, et.al. The Essence of Innocence: Consequences of Dehumanizing Black Children. Journal of Personality and Social Psychology. February 2014.

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What does stress look like?

Flashbacks to the event

Disruptive, disrespectful or destructive behavior (“antisocial behavior”)

Physical complaints

Drug, alcohol, tobacco use

Suicidal thoughts/self-injurious behavior

Start fights

Have outbursts of anger

Develop unfounded fears

Refuse to go to school

Be unable to concentrate

Become quiet around friends, family, and teachers

Youth ages 12 - 17 Children ages 6 -11

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Source: Adapted from information provided by the Center for Youth Wellness.

25%

50%

90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percent of 9-16 year olds whoexperienced at least one

traumatic event

Prevelance of PTSD among JJPopulation (high end)

Juvenile Detainees whoreported having experienced at

least one traumatic incident

Prevalence of Trauma for Youth in the Justice System

Source: “Trauma Among Youth in the Juvenile Justice System: Critical Issues and New Directions,” National Center for Mental Health and Juvenile Justice (June 2007).

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Contact Us

W. Haywood Burns Institute 475 14th St. Suite 800 Oakland, CA 94612 www.burnsinstitute.org

(415) 321-4100

James Bell, Executive Director jbell@burnsinstitute.org or x101

Laura Ridolfi, Director of Policy & Research lridolfi@burnsinstitute.org or x108

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