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Best practices for health care volunteers

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Leah Carnine

on 14 July 2014

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Transcript of Best practices for health care volunteers

Accountability and best practices for clinic volunteers
Phoenix Allies for Community Health Mission & Vision
Objectives
1. Define terms such as privilege & oppression

2. Discuss health disparities and causes

3. Analyze our own social position, and those of our patients through an intersectional framework
4. Perform a self-assessment
5. Identify some ‘best practices’
6. Take steps towards integrating new knowledge and ‘best practices’ into our work as clinicians and students
Why this matters
As clinicians and students, we are entrusted to care for our patients, many of whom come from very different backgrounds than our own

Understanding the potential difference in our experience and backgrounds from many of our patients is important in order to cultivate a trusting and healing clinician-patient relationship
Points to consider
As we learn about bias and inequity, defensiveness, guilt, anger, and shame are emotions that many people experience

These feelings are a normal response when learning about these issues

If you experience any of these, consider taking some time to sit with the discomfort and reflect on why these feelings are arising

There are many resources available beyond this presentation

Definitions
Just like any field of study, this presentation has a lot of terminology that you may or may not be familiar with.
We will be defining terms and concepts in this section to help build a shared language around these issues.
The goal of this section is not to memorize definitions, but to try to understand how these issues affect us, our patients, and our patient interactions.
Oppression
OPPRESSION
“Society operates within a socially constructed hierarchy of difference where some people are valued and privileged and others are marginalized and exploited”
Source: Rainbow Network
some examples of oppression in this country
Migrants to this country are not allowed access to voting, social services, or social respect despite their contributions to this country
African Americans are incarcerated at approximately six times the rate of White Americans
NAACP Fact Sheet
Racism
,
sexism
,
heterosexism
,
ableism
, and
classism
can be systems of advantage or oppression- depending on your social position

RACISM
Privilege
PRIVILEGE
An often invisible right, advantage, or immunity granted or available only to one person or group of people
Merriam Webster Dictionary
Irrational race prejudice that is often caused by, and reflected in, institutional power.
Institutional racism leads to disproportionate unemployment, incarceration, homelessness, and poverty in communities of color
WHITE PERSON
A term used to describe people of European descent, developed in the U.S. in the 17th century
PERSON OF COLOR
White people experience privilege within racism
Examples of white privilege:
1. I can go shopping anywhere I want, and be pretty sure I won’t be followed, profiled, or harassed

2. I can be confident that if I need medical treatment, bank loans, or legal help, my race will not work against me
3. I can easily find posters, movies, TV shows, picture books, greeting cards, dolls, toys and children's magazines featuring people of my race
4. If a police officer pulls me over I can be sure I haven't been singled out and targeted because of my race
Source: Adapted from Peggy McIntosh's "Unpacking the Invisible Knapsack"
SEXISM
A system of advantage based on gender. The subordination of femininity by masculinity
Source: People's Institute
Men experience privilege within sexism
Examples of male privilege:
1. If I have a bad day or am in a bad mood, people aren’t going to blame it on my sex (or PMS)
2. I can walk alone at night without, or with less fear of being raped or otherwise harmed

3. If I choose to raise children, I will be praised for caring for my children, instead of being expected to be the full-time caretaker
4. I can choose to not care about my appearance without worrying about being criticized at work or in social situations
HETEROSEXISM
A social system that gives privilege and power to heterosexuals at the expense of LGBTQ peoples
LGBTQ:
Lesbian, gay, bisexual, trans & queer individuals
TRANSGENDER / TRANS
An umbrella term for persons whose gender identity does not conform to the sex to which they were assigned at birth
GENDER IDENTITY:
A person’s sense of and personal experience of being feminine, masculine or both
CISGENDER
Means having a biological sex that matches your gender identity and expression, resulting in other people accurately perceiving your gender
Source: Everyday feminism
Heterosexual and cisgender people experience privilege within heterosexism and transphobia
Some examples of cisgender privilege:
1. I can use public restrooms without fear of verbal abuse, physical intimidation, or arrest
2. Strangers don’t assume they can ask me what my genitals look like, how I have sex, or personal information about my body
3. If I end up in the emergency room, I do not have to worry that my gender will keep me from receiving appropriate treatment, or that all of my health issues will be seen as a result of my gender
ABLEISM
Discrimination or prejudice against individuals with disabilities
ABLE-BODIED
Individuals not living with a physically disabled, chronically ill, severely obese or otherwise physically limited experience.
Source: Webster dictionary
FAT PHOBIA
The systematic oppression and devaluing of people based on their weight and body size.
The Fat Phobia scale was developed to study and measure fat phobic attitudes, fat prejudice and stigmatization on behalf of individuals, including medical providers. Take a moment to take the survey:
Examples of Able-bodied Privilege
1. Others don’t get frustrated with me in public spaces for needing special accommodations or holding up lines

2. Public access to friends’ houses, doctor offices, parks, taxis and restaurants is easy for me
3. My ability or body size isn’t the butt of jokes in TV shows, radio shows and movies.
CLASSISM
"The systematic assignment of worth based on social class; policies and practices set up to benefit more class-privileged people at the expense of the less class-privileged people, resulting in drastic income and wealth inequality and causing basic human needs to go unmet”
Source: Class Action
Able-bodied people experience privilege within ableism
People with class privilege experience class privilege within classism
Examples of class privilege:
1. I can easily and readily access and choose to eat the foods that I think are most healthy for me
2. I can talk with my mouth full and dress in wrinkled clothes and not have people attribute this to the uncivilized nature of my social class
3. In the case of a medical emergency, I won’t have to decide against visiting a doctor or the hospital due to economic reasons
Source: Adapted from Everyday feminism
People don't belong to just one identity group or social location

Our identities are complex, fluid and multi-layered

As a result we can simultaneously be both victims and benefactors of systems of oppression


Some examples of intersections of privilege and oppression due to one’s social position include:
A white woman may experience white skin privilege as a white person, and oppression because of her female gender
Photo credit: Barni Quassim
A migrant woman from Mexico might experience oppression as a woman, as a person without legal documentation, and as a person of color

A disabled white transgender man might experience white privilege, and oppression due to ableism and transphobia in society
A gay Latino male might experience oppression as a gay person and as a person of color, and privilege as a male

Photo Credit: Chandra Narcia
Photo credit: Julie Gettys
Photo credit: Diane Ovalle
Phoenix Allies for Community Health (PACH)
By: Leah Jo Carnine

THE MISSION of PACH is to provide health care with respect and dignity to underserved and underinsured people with the help of medical volunteers and staff.

THE VISION: We envision a society that recognizes the right of all people to accessible health care and the knowledge it takes to prevent illness. We envision a community that supports a holistic approach to health care that encompasses the social, environmental, economic, and spiritual aspects of health.

Individuals in societies learn cultural and societal norms- including biases and stereotypes that we might not even be aware of
Health care providers can unconsciously contribute to health disparities by creating clinical relationships that maintain the biases that are learned in society

For example, A study at Mass general hospital revealed that physicians held unconscious subtle stereotypes and repeatedly were more likely to prescribe life-saving drugs for patients having heart attacks if they believed the patient was white, and were less likely to prescribe the drugs to Black patients. These physicians were horrified when they learned about their discrepancies in care, implying the potential harm of unconscious bias
This presentation aims to help us develop a better understanding and incorporate skills to begin to challenge the biases we might not even know that we have
Challenging unconscious bias, educating ourselves about social, cultural and economic barriers to health, and developing quality communication practices can allow us to provide better and more culturally relevant care for our patients
RACISM:
PEOPLE OF COLOR:
A term used to positively define ethnic and racial minorities
Source: Everyday feminism
Source: Everyday feminism
Image source: trinitylgbt.com
Source: Everyday feminism
All of these ‘isms’ play out in very tangible, though sometimes invisible ways
They lead to negative
stereotypes
of identity groups based on skin color, class, sexual orientation, gender identity and ability.
Even if we think we don’t buy into stereotypes, we might unconsciously do so.
Understanding these forms of oppression helps us identify stereotypes and biases so we can better challenge them in clinical practice.
CULTURE
“is a way of life. Culture is passed on from generation to generation through institutions, groups, interpersonal and individual behavior. To individuals, culture provides a sense of identity, belonging, purpose and world view. In a society, culture provides the basic values, assumptions, ways of thinking, styles of learning, language, ways of relating to each other, and basic world view”.
How do you define your culture?
What do we learn from American culture?
CULTURAL COMPETENCY
“Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situation”
Source: Office of Minority health
Beyond just competency, we are striving for cultural respect and anti-oppression in our health care work!
ANTI-OPPRESSION:
A perspective and life approach dedicated to recognizing and challenging institutional and personal forms of oppression
HEALTH DISPARITIES
HEALTH DISPARITIES:
“a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage, historically linked to discrimination or exclusion”
Healthy People 2020
Health disparities adversely affect:
People of color
Lesbian, gay, bisexual, transgender & queer people
People with disabilities
People who live in poverty

More examples of communities who have historically been marginalized by the medical system
Migrants
Drug users
People with mental health illnesses
People who work in the sex trade

There are many examples of institutional health disparities, here are just a few examples:
Infant mortality with African American populations is nearly twice the national average
Source: CDC
Mexican migrants are over four times more likely to have not received medical care in the past 2 years than whites
Source: Health disparities amongst Mexican Immigrants fact sheet
Latina women are approximately three times as likely to have diabetes than white women
Source: CDC
Incidence of asthma is roughly twice as high in African American, Puerto Rican and Latino youth than white youth
Source: CDC
People with disabilities are more than twice as likely to have diabetes than able-bodied people
Over 50% of Mexican migrants are without insurance or a source of health care
Institutional health disparities by race
Health disparities along racial lines demonstrates the way that
racism
- not biological differences between people of different skin colors- affects health outcomes.
An article published in 2013 in Psychology today lays out 6 major pathways where racism impacts health outcomes:
1. Neighborhood segregation
Segregation determines the quality of education and employment opportunities.

Segregation contributes to the creation of pathogenic neighborhoods and housing conditions.

Conditions linked to segregation can constrain healthy behaviors and encourage unhealthy ones.

Segregation can adversely affect access to high-quality health care.
Source: Psychology today
2. Institutional discrimination
“Does the stress of living in a white-dominated society make African Americans get sick and die younger than their white counterparts? Apparently, yes.
After decades of research, Arline Geronimus concludes that the long-term stress of living in a white-dominated society 'weathers' blacks, making them age faster than their white counterparts.”
Read more: http://www.psmag.com/health/racisms-hidden-toll-3643/
From "Racism's Hidden Toll":
3. Unconscious Bias
“Alexander Green at Massachusetts General Hospital once conducted a study. He had physicians evaluate patients and some of the physicians thought they were evaluating a white patient. And some of them thought they were evaluating a black patient. And what Greene found is that the higher the levels of subtle unconscious stereotypes the physicians held, the more likely they were to not prescribe the black patient with clot-busting drugs for a heart attack. The physicians didn't act in ways that were driven by animosity. In fact, when they saw the results, they were horrified. They weren't trying to treat the black patients badly. What was happening really, is someone complains of chest pain and you're having to judge: Is this person suffering from indigestion or about to have a heart attack? And in that kind of situation - where you're not completely sure - your biases can help play a very powerful role.”

Read more: http://wlrn.org/post/how-fight-racial-bias-when-its-silent-and-subtle
4. Internalized Racism
Internalized racism is the conscious or subconscious acceptance of the dominant society’s racist views, stereotypes and biases of one’s ethnic group.
It gives rise to patterns of thinking and behaving that can result in invalidating and hating oneself while simultaneously valuing the dominant culture
Internalized racism can result in negative health outcomes
Definition adapted from Suzanne Lipsky
5. Psycho-social Stressors
“In 2011, researchers found that African Americans who reported experiences of racial discrimination had higher odds of suffering from generalized anxiety disorder (GAD). An article on PsychCentral termed the phenomenon as "racial battle fatigue, saying that "exposure to racial discrimination is analogous to the constant pressure soldiers face on the battlefield.”
“Changes in DSM-5: Racism Can Cause PTSD Similar To That Of Soldiers After War”, Medical Daily News
Read more: http://www.medicaldaily.com/articles/15855/20130523/dsm5-racism-racial-trauma-post-traumatic-stress-disorder.htm
6. Racism & the environment
People of color and Indigenous people disproportionately live on land or in parts of cities where air, water, and food are contaminated because of uranium mining, nuclear testing, highways, refineries, etc.
Black Mesa Mine on Navajo reservation AZ
"Unnatural Causes: Is Inequality making us sick?"
Health Disparities: Poverty
Poverty is both a cause and a consequence of poor health. Poverty increases the chances of poor health. Poor health in turn traps communities in poverty
For example, diabetes rates are twice as high amongst people living in poverty as those with high incomes
Source: CDC
A 23-year study on the impacts of crack cocaine on gestation concludes with clear proof that “poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine”
Read more: http://articles.philly.com/2013-07-22/news/40709969_1_hallam-hurt-so-called-crack-babies-funded-study
Health Disparities: LGBTQ Communities
LGBTQ:
Lesbian, Gay, Bisexual, Transgender, Queer individuals
Lesbian, gay, bisexual, transgender and queer (LGBTQ) communities often provide social support and positive personal and group identities for members of the communities, but LTBTQ health is still affected by transphobia and heterosexism
Violence and threats of violence, isolation, invisibility and discrimination contribute to LGBTQ communities experiencing:
Higher levels of depression and suicide
Higher rates of alcohol, tobacco and other drug use
Greater risks for sexually transmitted infections

Additionally, because of discrimination, LGBTQ communities often receive less quality health care
Source: Rainbow Health Network
Health Disparities: Disability
According to Healthy People 2020, people with disabilities are more likely to:
Experience difficulties or delays in getting the health care they need
Not have had an annual dental visit
Not have had a Pap test within the past 3 years.
Not engage in fitness activities
Have high blood pressure and/or diabetes
Experience symptoms of psychological distress
Receive less social-emotional support
Have lower employment rates

Source: fifthfreedom.org
Conduct a Self- Assessment
Do a self- inventory:
1. Work to understand some of the dynamics at play in society and how you are affected or benefit from them.

2. Honestly explore values, beliefs, and attitudes about your culture and cultures different from your own.

3. Non-defensively engage other students, clinicians, and the larger community in this self-assessment.

In what ways do you experience privilege, in what ways do you experience oppression?
Do you have privilege:
As a white person?

As a person with economic and class privilege?

As an English speaker?

As a U.S. citizen?

As a person without a disability (“able-bodied privilege”)?

As a male?

As a cisgendered person?

Self- assessment questions
1. What privileges do we as clinicians and students have as a group?

2. How do these privileges affect our interactions with patients from different backgrounds in the clinic setting?
3. What social and economic contexts do our patients come from?
4. In what ways do these privileges and different experiences create a power dynamic in patient interactions?
Source: People's Institute
Developing Best Practices
1. Consider power dynamics inherent in patient-clinician interactions
POWER DYNAMICS
‘Power dynamics’ refers to ways that power is exercised in specific interactions
For example, have you ever gone to a Doctor’s office and had the him/her tower above you without making eye contact? If he/she tells you to do something, it might be hard to say "no". That is one example of how power can work in a specific setting
When we work across differences of privilege and oppression, there are numerous power dynamics that can impede our patient’s access to receiving comfortable and respectful care
How can you counter those power dynamics in patient-interactions?
Introduce yourself by name and role at clinic (student, nurse, PA).
Maintain eye contact.
Sit at same level as patient.
Ask for consent before all physical contact.
Ask for consent before discussing personal health information.
Ask for consent before giving advice.
If applicable, use interpreters appropriately (speak to patient not interpreter, etc.).
Be aware of the number of students, clinicians, and interpreters in the room with a patient at a time, and how lots of medical people can be overpowering.

2. Support patients in empowering themselves
Do not pity the patients you interact with.
Challenge paternalistic or condescending notions of “saving” them.
Respect people for their courageous and resilient acts of survival.
Respect people’s choices for how they take care of themselves and their families, often with limited resources and support.
Do not expect a pat on the back for your volunteer work.

3. Value Culture
Create an environment where people feel safe to express values, perceptions and experiences from their culture.
Respect the leadership of people from the community that we are serving.
Honor dietary choices, health practices, traditions, beliefs from the culture of the patient.
4. Meet people where they are at, use motivational interviewing
Respect people’s health choices and behaviors.
Acknowledge that the conditions of peoples lives are complex, and making healthy changes might not always be possible for them.
Don’t tell people what to do, what to eat, that they “have to” quit smoking, etc.
Do use motivational interviewing to find out what healthy changes are realistic and possible for the patient and ask them how you can support them in making those changes.
MOTIVATIONAL INTERVIEWING:
Motivational interviewing refers to a client-centered counseling technique that non-judgmentally engages a patient’s intrinsic motivation and strength in order to support them to change their behaviors
5. Learn about harm reduction
“Harm reduction focuses on promoting scientifically proven ways of mitigating health risks associated with drug use and other high risk behaviors” while respecting people’s choices to engage in these behaviors, examples include:
Needle exchanges to provide clean needles for IV drug users to reduce risk of transmitting blood-borne infections
Providing condoms for workers within the sex trade to reduce the risk of acquiring STI’s
This approach can be applied more broadly for health care providers working to meet patients where they are at.
Source: NCRHRC
6. Understand how historical and political differences between cultural groups impact relationships and experiences
Read, ask questions, and be open to learning about the culture and experiences of patients you are interacting with.
For example, why do migrants come to the U.S.? Learn about NAFTA and global policies that displace people from their native countries
7. Check your assumptions
We are taught many assumptions about people based on the color of their skin, the way they dress, their income level, their body size, their language, culture, gender, etc
Challenge assumptions you might make, for example:
Do not assume that if someone is overweight they are unhealthy or lazy.
Do not assume that because someone is from a community that suffers from disproportionate rates of illness, that they have that illness.
Do not assume that because someone is a migrant that he or she does not also speak English.
Do not assume, ask!

8. Honor the knowledge, experience and expertise of people from the community
People from the communities we are trying to serve are the best positioned and most equipped to support the health and wellness of their community.
The majority of the patients at PACH are undocumented migrants.
PACH works in partnership with the Promotor@s para el Bienestar, a group of mostly migrant women promoting health through community empowerment and organizing.
The Promotor@s are an incredible resource for many patients at the clinic.

Support the promotor@s:
Ask them questions about their work.
Volunteer with their health outreach project.
Let patients know about the Promotor@s as a resource for grassroots health and community empowerment.

Promatoras para el Bienestar conducting a neighborhood survey about health needs in the Garfield district
Case studies
Case study # 1
Jasmin, a 27 y.o. transgender female presents with lower back pain. She hasn’t had a “check-up” in seven years because she works part time and doesn’t have insurance. Her past medical history reveals she has been taking estrogen for the past 5 years, has high blood pressure, and is otherwise healthy.
Image source: Xion's story
Reflection questions
1. What barriers to health might this person experience?
2. What assumptions might we as clinicians and students make about this person?
3. What bias might we have interacting with this patient?
4. How can we best intercept those assumptions and biases to provide quality care?
Incorporating best practices
Do not refer to her as the sex she was assigned at birth, do respect her preferred pronoun
Do not insist on knowing or using her birth name, do use the name she provides at today’s visit,
Do follow her lead with what language she chooses to use about her gender and body parts
Do check your assumptions about her sexual practices, sexual orientation, health needs, etc.
Do respect her privacy around the sex she was assigned at birth and whether or not she has had sex re-assignment surgery
Only ask questions or perform physical exam techniques that are pertinent to her health, not to your curiosity!

Case study #2
Miguel, a 47 year old undocumented day laborer has not had consistent employment or health care since he came to the U.S. 15 years ago. He has been having intermittent chest pain for 6 months. His friend was deported from the hospital 2 years prior, and he is afraid if he seeks health services he will be turned over to immigration enforcement
Reflection questions
1. What barriers to health might this person experience?
2. What assumptions might we as clinicians and students make about this person?
3. What bias might we have interacting with this patient?
4. How can we best intercept those assumptions and biases to provide quality care?

Incorporating best practices
Do not ask about his documentation status
Do not use derogatory terms like “illegal” to describe the patient (to them or other volunteers)
Do not make assumptions that affect the quality of care you provide, for example
Denying him pain medications because he is assumed to be a “drug seeker”
Starting him on a medication instead of offering him a trial of MNT/lifestyle modification because you assume he is unable to take care of himself
Do keep his documentation/immigration status confidential and assure him of such
Do provide him with the same quality of care and services you would if he had health insurance
If he doesn’t speak English, use interpreters appropriately to perform a comprehensive H & P
Case study #3
Rena, a 74 year old female Navajo elder presents with progressive arthritis. She has been advised to have total knee replacement, but does not want the surgery because of mistrust of western medical ways. She says none of the providers she’s spoken with have respected her community healing practices or ceremony.
Reflection questions
1. What barriers to health might this person experience?
2. What assumptions might we as clinicians and students make about this person?
3. What bias might we have interacting with this patient?
4. How can we best intercept those assumptions and biases to provide quality care?
Incorporating best practices
Do not dismiss her concerns or questions about the western medical treatment approach
Do honor her traditional healing practices (but do not assume what she does and does not practice), and work with her to incorporate them into her medical treatment, including:
Traditional healers/medicine men
Natural or herbal remedies
Ceremony and prayer
Try to understand the role of elders in traditional Navajo culture.
Do honor the role of community and family in health and decision making in different cultures (which is different from individualism in U.S. dominant culture).
Case study #4
Maria, a 34 year old female presents for a routine check up. Her blood pressure is 128/90, and fasting blood sugar level is elevated on today’s visit. She has no current health complaints, but wanted to check her blood sugar because her father has diabetes.
Photo credit: Jeff Newton photography
Photo credit: 4.bp.blogspot
1. What barriers to health might this person experience?
2. What assumptions might we as clinicians and students make about this person?
3. What bias might we have interacting with this patient?
4. How can we best intercept those assumptions and biases to provide quality care?
Reflection questions
Incorporating best practices
Do not degrade or belittle her because of her body weight
Do not assume that her elevated blood glucose is due to her weight, or that she eats unhealthy food, or that she does not exercise
Do not tell her to “lose weight” as a substitution for necessary medical testing or treatment
Do challenge the idea that people get diabetes solely because of their dietary and exercise choices
Do think about how health disparities due to racism, sexism and poverty contribute to diabetes
Do ask questions about her diet and exercise, and use motivational interviewing to support her in making choices that are realistic and desirable for her
Case study #5
Denise, a 60 year old woman with cerebral palsy presents for a routine physical exam. She has been turned away from several other providers who claimed they were not equipped to deal with her disability.
Photo credit: Melanie Hoffman
Reflection questions
1. What barriers to health might this person experience?
2. What assumptions might we as clinicians and students make about this person?
3. What bias might we have interacting with this patient?
4. How can we best intercept those assumptions and biases to provide quality care?
Incorporating best practices
Do not speak to the patient’s companion or care giver1
Do speak directly to the patient
Do ask how you can best help them, and respect their answers
Do treat the whole person, not her condition or disability
Do allow time for history taking and a thorough physical exam
Do respect the patient’s privacy, and ask for consent at all steps of the history and physical exam
Do work on making your health facility accessible to people with wheel chairs and different levels of mobility (ramps, elevators, etc.)
Sources: Healthy People 2020 and Access to Medical Care curriculum
Please take a few more minutes to complete the post-training assessment quiz:
Please copy and paste the following link into your browser to complete the assessment:
References & more resources:
Rainbow Health Network: http://www.rainbowhealthnetwork.ca/files/SDOH%20Pamphlet.pdf
CDC 2011 report on health disparities http://www.cdc.gov/mmwr/pdf/other/su6001.pdf
How racism is bad for our health http://www.theatlantic.com/health/archive/2013/03/how-racism-is-bad-for-our-bodies/273911/
http://www.rainbowhealthontario.ca/about/mission.cfm
Fat Phobia Scale: http://www.yaleruddcenter.org/resources/bias_toolkit/toolkit/Module-1/1-08-SelfAssessmentTools/1-0808-FatPhobia.pdf
Poverty is worse on health than crack: http://articles.philly.com/2013-07-22/news/40709969_1_hallam-hurt-so-called-crack-babies-funded-study
Racisms hidden toll: http://www.psmag.com/health/racisms-hidden-toll-3643/
Melissa Harris-Perry show on racial health disparities: http://www.nbcnews.com/id/46979745/vp/51123883#51123883
Healthy People 2020: http://www.healthypeople.gov/2020/
http://prezi.com/6-ebu4kxnvfr/racism-intersectionality-allyship/
http://www.healthpovertyaction.org/policy-and-resources/the-cycle-of-poverty-and-poor-health/the-cycle-of-poverty-and-poor-health1/
Health Service Disparities among Mexican Immigrants, UC Davis: http://agcenter.ucdavis.edu/AgDoc/healthServicedisparities.pdf
Access to Medical Care for Individuals with Mobility Disabilities
Class Action: http://www.classism.org/about-class/class-definitions
NAACP Criminal Justice Fact Sheet: http://www.naacp.org/pages/criminal-justice-fact-sheet
People’s Institute (of survival and beyond): http://www.pisab.org/
Peggy McIntosh ‘Unpacking the invisible knapsack’
Healthcare stories: Disability Rights Education and Defense fund: http://dredf.org/healthcare-stories/2013/02/19/denise-sherer-jacobson/
Xion’s story (image) http://wamu.org/programs/metro_connection/12/09/21/xions_story_transgender_woman_tells_of_life_on_the_streets
Social Work Helper: http://www.socialworkhelper.com/2012/12/20/anti-oppressive-social-work-practice-in-mental-health/
American Public Health Association, “the problem with the phrase women and minorities”:http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2012.300750
NCHCH: what is harm reduction? http://www.nchrc.org/harm-reduction/what-is-harm-reduction/
Everyday Feminism:
http://everydayfeminism.com/2012/11/30-examples-of-class-privilege/
http://everydayfeminism.com/2012/12/30-examples-of-male-privilege/
http://everydayfeminism.com/2012/09/30-examples-of-cisgender-privilege/
http://everydayfeminism.com/2013/03/19-examples-of-ability-privilege/

Thank you for completing the PACH 'Accountability and best practices training!
All of this information on health disparities can be overwhelming. Part of understanding allows us to better identify and strive for
health equity
- where all people and communities- regardless of social position- have the opportunity to develop and maintain health
Privilege and oppression contribute to power dynamics
If you would like to take a break, now is a great time. Next comes developing best practices and incorporating what we've learned into case studies
http://bit.ly/12BMDrS
One thing to consider with all of these definitions is that there are many ways that people self- identify. For example, some people who originate from Mexico, Central or South America identify as
Hispanic
, and others identify as
Latino
, and others yet as
Chicano
. Also, some people whose families originate from Africa identify as
African Americans
, and others as
Blacks
. Further, some people identify as
Lesbians
, others as
Queer
, and others as
bisexual
. The most important thing is we cannot tell how someone self-identifies by looking at them, and it's best to mirror the language that they use to define them self.
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