peter a. gorski, m.d., m.p.a. childrens board of hillsborough county and university of south florida...
TRANSCRIPT
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Peter A. Gorski, M.D., M.P.A.Children’s Board of Hillsborough
County and University of South Florida
Envisioning Health Equity
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Social Determinants of Health and Wealth
Your neighborhood Physical, social, economic, educational
qualities
Your skin colorRace, ethnicity
Who’s your daddyParents’ education, income, health,
social capital
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Poverty Sickens
3
• Strong connections between child health and adult health
• Between child wealth and adult wealth• Between child wealth and adult health
– Regardless of child’s health condition – Regardless if social class changes from
childhood to adulthood• Childhood poverty gets biologically
embedded
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Epigenetics
Life Course PerspectiveBalance of stresses and supports across life
course exert cumulative influence on healthEspecially during sensitive periods of
development, powerful experience gets embedded into our biologyReforming DNA structure, gene expression
and brain chemistryConsequences to BMI, blood pressure,
immune function, memory, learning, attention and mental health
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Racial and Ethnic Disparities in Birth Outcomes: A Life Course Perspective
5Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course
perspective.Maternal Child Health J. 2003;7:13-30.
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Birth
Early Infancy
Late Infancy
Early Toddler
Late Toddler
Early Preschool
Late Preschool
Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs
Read
y to
lear
nStrategies to Improve
School Readiness Trajectories
“At Risk” Trajectory
“Delayed/Disordered ” Trajectory
“Healthy” Trajectory
Parent educationEmotional HealthLiteracy
Reading to child
Pre-school
Appropriate Discipline
Poverty
Lack of health services
Toxic Stress
Health Services
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Race is Not a Proxy for Poverty or Wealth
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Beyond (or Underneath) SES
African American infant mortality higher in more segregated cities even when controlling for SES
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SES? – Ask the Professionals
9NCHS 2002
6.8
10.2
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SES? – Ask the Africans
10
David RJ, Collins JW. Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. N Engl J Med. 1997 Oct 23;337(17):1209-14.
Birth weight distribution of African-born blacks is
more closely related to US-born whites than to
US-born blacks
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Pathogenesis (and Salutogenesis):
Complex Interaction between Biology and
Environment
This explains why many, if not all, of the chief public health killers have common root causes.
Degradation of personal dignity, social justice and community
I can only be as healthy as my neighbors
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Enhancing Public Health – A Provocative Perspective
Single disease prevention approach rarely worksTreating symptoms rather than root causes
Since inequities are at root of health disparities, we must work for the equitable distribution of conditions that promote health and healthy development – Social, educational, economic and environmental capital healthcare
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Even More Provocative
Compensatory or Disparities Model (Affirmative Health Action) flawedSee next slide
Equity Framework Health is a human right Every human being has intrinsic worth. Policies should be directed to what every person
needs and deserves to thrive and contribute
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Why Target Whole Communities?
14
• Health and well-being of each person depends on condition of all (see next slide)
• Cannot predict individual course based on group risk factors
• Cost burden of case-finding and treatment too high
• Moral weakness of accepting unequal outcomes
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Post-neonatal Infant Mortality(per 100,000 live births,1986)
15Wilkinson RG. Income distribution and life expectancy. BMJ.
1992;304:165-168.
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My Vision-Dream for the Health Equity Coalition
Expand public understanding of health equity framework
Forge strategic partnerships across the county’s public and private sectors – every decision impacts health
Document and demonstrate the correlation and causal association between social, economic, educational, environmental and healthcare equity and population health outcomes
Advocate for policies and practices that promote and create advantage for all citizens