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Health Equity

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Travis Wojciechowski

on 15 July 2014

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Transcript of Health Equity

Health Equity
Afflicted Populations
Definitions
Questions?
Determinants of
Policy
Systems
Environment
Data Driving Equity
Practices for Advancing Health Equity
Health
Health Disparity
A population-based difference in health outcomes.
Health Equity
When every person has the opportunity to realize their health potential - the highest level of health possible for that person - without limits imposed by structural inequities.
Health Inequity
A health disparity based in inequitable, socially-determined circumstances.
Structural Inequities
Structures or systems of society - such as finance, housing, transportation, education, social opportunities, etc. - that are structured in such a way that they
benefit one population unfairly
(whether intended or not).
Structural Racism
The normalization of an array of dynamics -- historical, cultural, institutional and interpersonal -- that routinely advantage white people while producing cumulative and chronic adverse outcomes for people of color and American Indians.
Public health is what we, as a
society
, do
collectively
to
assure the conditions in which people can be healthy. -IOM
Because health inequities are socially-determined,
change is possible
.
Health equity means achieving the conditions in which all people have the opportunity to attain their highest possible level of health.
Ask: What creates health?
peace
shelter
education
food
income
stable ecosystem
sustainable resources
social justice
equity
etc.
American Indians
African Americans
Children
Persons with mental
health challenges
LGBTQ
Immigrants
Refugees

Asian-Pacific Islanders
Hispanics/Latinos
Rural Minnesotans
Women
Older Minnesotans
Persons with disabilities
And more…
Health Inequity: Race
Health inequities in Minnesota are significant and persistent, especially by race:
In Minnesota, an African American or American Indian infant has
more than twice
the chance of dying in the first year of life as a white infant.
-Minnesota Department of Health-
"Back of the Envelope" Conceptual Model
Health Inequity
If we are not all healthy together,
none of us is as healthy as
we could be.
East Central Minnesota
% Population of Color
2000
Recent Data
7.0%
9.7% (2012)
2.9%
5.1% (2012)
3.6%
5.5% (2012)
6.9%
9.8% (2012)
3.4%
4.3% (2012)
Individuals (2013 Pop.)
2,505 people
1,948 people
2,956 people
2,852 people
687 people
~11,000 people
Data Source: http://www.mncompass.org/
...but there's more to this story than race.
Health Inequities
Health Disparities
Disparities
Inequities
Policy, Systems, and Environment
Health equity is a feature not of
persons
,
but of
systems
.
Access to economic, education, and political opportunities.
The capacity to make decisions and affect change for themselves, their families, and their communities.
Social and environmental safety in the places they live, learn, work, worship, and play.
Culturally-competent and appropriate health care when the need arises.
For healthy outcomes of persons to be possible, systems need to be in place to assure every person has:
Clinical Setting Inequities: LGBTQ
1:6 LGBTQ persons in Minnesota report discrimination by a health care provider because of their sexual orientation or gender identity.
Source: http://www.rainbowhealth.org/files/1013/6318/9525/VoicesofHealth_Rainbow_Health_Initiative.pdf
Administrative
: 32% reported discrimination
Includes: administrative or clinical staff such as a front desk, scheduling, or security person
Supporting Medical Staff
: 43% reported discrimination
Includes: nurse, paramedic, medical assistant, or laboratory person
Primary Care Provider
: 45% reported discrimination
Includes: doctor, dentist, nurse practitioner, physician’s assistant, or pharmacist
Mental Health Care Provider
: 29% reported discrimination
Includes: psychiatrist, counselor, therapist, or social worker
4 keys to successful use of data for addressing health inequities:
Making the data useful: analysis, interpretation, and application
Dissemination of results
Community engagement
Skilled workforce
"Redlining" Minneapolis
Infant Mortality Rates
Minneapolis (2001-2010)
Side-by-Side Comparison
Notice a trend?
"Redlining was used across the US from 1930s - 1970s. The practice of arbitrarily denying or limiting financial services to specific neighborhoods, generally because of its residents are people of color or are poor."
Green
= Best
Blue
= Still Desirable
Yellow
= Declining
Red
= Hazardous
... "but that's Minneapolis..."
Policies, Systems, and Environments
Our Framework:
Top-down and bottom-up are equally vital.

"I believe that the history of public health might well be written as a record of successive redefinings of the unacceptable."

--Geoffrey Vickers, Harvard School of Public Health, 1958
Tobacco Use and Exposure
Disparity?
Inequity.
Health in All Policies Approach
..."again, that's Minneapolis..."
Central Corridor Light Rail - Green Line
Master Pedestrian Plan
Master Bicycle Plan
Where to locate new roads
Public transit options in rural MN
Freeway exit locations
Populations of Color
American Indians
Socio-economic Status (SES)
Others
...
Designing for Chronic Disease Prevention
to Consider:
Transportation
Greater Minnesota
"Designing transportation policy with health equity
considerations can promote health and economic mobility."
-Advancing Health Equity, MDH-
Air Quality
Asthma
Birth Defects
Cancer
Carbon Monoxide Poisoning
Chemicals in People: Biomonitoring
Childhood Immunizations
Childhood Lead Poisoning
Chronic Obstructive Pulmonary Disease
Minnesota County Profiles
Developmental Disabilities
Drinking Water Quality
Environmental Tobacco Smoke
Heart Attacks
Heat-Related Illness
Health Insurance
Obesity
Pesticide Poisonings
Poverty & Birth Outcomes
Smoking
Barriers
time consuming
labor intensive
investment of resources
creating meaningful indicators
sharing of resources
ensuring usability and accessibility to stakeholders
legal considers for data privacy
etc.

Changes in systems and processes for data collection, analysis, and dissemination:

e.g. Women have more breast cancer than men.
(i.e. persistent health disparities that cannot be explained by bio-genetic factors.)
Tarlov AR. Public policy frameworks for improving population health.
Ann N Y Acad Sci 1999; 896: 281-93.

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Photo: http://www.metrotransit.org/metro-blue-line
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Photo Credit: http://www.walklive.org/how-we-help/photo-visions/
1.
Minnesota Department of Health. Commissioner's Office. Advancing Health Equity in Minnesota: Report to the Legislature. By Melanie Peterson-Hickey, Jeanne Ayers, et.al., 3 Feb. 2014. Web.
2.
Raymond, Jeannette, and Dorothy Bliss. "Advancing Health Equity in Minnesota. Training the Presenter.” Webinar, Minnesota Department of Health. 29 May 2014.
3.
Martin-Rogers, Nicole. Mille Lacs County Area Community Health Data Book--Detailed Results from the 2013 Central Minnesota Community Health Survey. Saint Paul, Wilder Research, Apr. 2014. Web.
4.
Centers for Disease Control and Prevention. Prevention Status Reports 2013: Tobacco Use—Minnesota. Atlanta, GA: US Department of Health and Human Services; 2014.
5.
Schroeder, Janelle. Mille Lacs County 2013 Community Assessment. Milaca: Community and Veteran Services, 2014. Print.
6.
The Health of Minnesota: Part One--Figures. Minnesota Department of Health, Center for Health Statistics, Apr. 2012. Web.
7.
Voices of Health: A Survey of the LGBTQ Health in Minnesota. Rainbow Health Initiative, 2012. Web.

partnersinhealthyliving@gmail.com
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Source: Slide by Linda Rudolf, MD, Public Health Institute via Dr. Michael Oaks MN Public Health Association 2014 Keynote Presentation
References
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Full transcript