what's health equity?

What’s Health Equity?2011 Health Equities Leadership InstituteFriday, April 1, 2011

Katherine D. EllingtonVice President, Program DevelopmentAmerican Medical Student Association#2011HELI

Wake Up

About Katherine

About Katherine @katellington

• New York City native from an African-American family with Southern roots, traditions and sensibilities

• Born and raised in Queens, one of the most racially and ethnically diverse communities in America

• Untraditional path to medical school

• Moving toward family medicine and community health

The conscious recognize the need for change, awakening the unconscious

is apart of that process.

Moments in Timefrom moments to movements

We saw a white, Catholic, Republican federal judge murdered on his way to greet a Democratic woman, member of Congress, who was... Jewish. Her life was saved initially by a Mexican-American college student... and eventually by a Korean-American combat surgeon… And then it was all eulogized and explained by our African-American president.

And... that's a remarkable statement about the country.

~Mark Shields PBS NewshourJanuary 14, 2011

Inspiration

What’s Health Equity?

OverviewDefinitions and framework“Unnatural Causes” clips and quizCounty Health Rankings Another story Implicit Association Test Dialgoue

1. novice2. advanced-beginner3. competent4. proficient5. expert

What is Health Equity?

A broad definition:The absence of socially unjust or unfair health disparities.

What is Health Equity?

HEALTH

“The presence of physical, psychological, social, economic and spiritual well being not merely the absence of disease or infirmity” (based on the WHO definition of health)

What is Health Equity?

EQUITY

An ethical concept based on fairness, distributive justice and, is normative.

What is Health Equity?“Health equity is the realization by ALL people of the highest attainable level of health. Achieving health equity requires valuing all individuals and populations equally, and entails focused and ongoing societal efforts to address avoidable inequalities by assuring the conditions for optimal health for all groups, particularly for those who have experienced historical or contemporary injustices or socioeconomic disadvantage.”

Unnatural Causes

What is Health Equity?

Health equity is the absence of systematic

disparities in the health (or its social determinants)

between more and less advantaged groups..

Racial and ethnic healthcare disparities

Pervasive Associated with systemic social

advantage/disadvantage Complex and interrelated factors Root causes are found upstream Requires fundamental changes in underlying social

and/or economic structures

Health Disparities

Differences, disparities and discrimination. Populations with equal access to healthcare. SOURCE: Gomes and McGuire, 2001.

Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Smedley BD, Stith AY, Nelson AR, eds. 2003 National Academies Press. Washington, DC.

Individual at the patient-provider level.

Healthcare sysems, polices and infrastructure

Health Disparities

Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. Smedley BD, Stith AY, Nelson AR, eds. 2003 National Academies Press. Washington, DC.

Finding 1-1: Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable.

Recommendations 2-1: Increase awareness of racial and ethnic disparities in healthcare among the general public and key stakeholders.

Recommendations 2-2: Increase healthcare providers’ awareness of disparities.

Health inequities have been defined as differences in health that are unnecessary, avoidable, unfair and unjust.

Whitehead,M. The concept and principles of equity in health. Int J Health Serv 1992;22:429-445. first published in Europe

Social Determinants of Health

The social determinants of health are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.

#sdoh

Social Determinants of Health

#sdoh

Social gradient exists, globally.

Unnatural Causes…is inequality making us sick

Social Determinants of Health

What about where your live, go to work, attend school and play?

There’s more to health than health care.

#sdoh

What’s Health Equity?

DISCUSSION

#2011HELI

#sdoh

#countyhealthrankings

#publichhealth

What’s Health Equity?

“The new public health operates out front, in the full light of day, connecting the dots, building partnerships, and creating collaborative relationships that reach far into every corner of the community.” President CEO Risa Lavizzo-Mourey, MD, MBA, Robert Wood Johnson Foundation

www.countyhealthrankings.org #2011HELI

#PublicHealth

What’s Health Equity?

DISCUSSION

What’s Health Equity?Another story

1. novice2. advanced-beginner3. competent4. proficient5. expert

What’s Health Equity?

Stephanie Summerville

http://www.charactersunite.com/

http://www.charactersunite.com/

Implicit Association ResearchThe Psychology of Blink: Level 2

Mental operations First level: higher, deliberate, rational, thoughtful Second level: lower, automatic, impulsive, unthinking

Implicit Association Research is a glimpse into “Level 2”

Unconscious cognition

We work to overcome Level 2 and IAT is a start

Implicit Association ResearchThe Psychology of Blink: Level 2

The Blink part comes from a reference to Greenwald's work in chapter three of Gladwell's book

Leading researcherso Anthony Greenwald, Ph.D., University of Washingtono Mahzarin Banaji, Ph.D., Harvard Universityo Brian Nosek, Ph.D., University of Viriginao Lisa Cooper, MD, MPH, Johns Hopkins

Project Implicit

Interactive studies that examine thoughts and feelings that exist either outside of conscious awareness or outside of conscious control

Educational and engaging experience

Project Implicit

A safe, secure, and well-designed virtual environment to investigate psychological issues and, at the same time, provide visitors and participants

Collaborative research effort between researchers at Harvard University, the University of Virginia, and University of Washington

What’s Health Equity?

DIALOGUE

What’s Health Equity?

Review Heal Equity, definedRacial and ethnic healthcare

disparitiesSocial determinants of healthCounty Health Rankings IAT

1. novice2. advanced-beginner3. competent4. proficient5. expert

What’s Health Equity?

CONCLUSION

When the end is the beginning…

What’s Health Equity?

Katherine D. Ellington

vpp@amsa.org

@katellington on Twitter

Katherine Ellington on Facebook

Phone: 347.993.7877

Skype/IM: ellkatd