Transcript Improve Health Care for African American Women

Racine LIHF
Social Determinants of Health
June 25, 2010
Pull yourself up by your
bootstraps?
A conceptual framework for addressing disparities:
Broadening the focus
Economic & Social
Opportunities and Resources
Living & Working Conditions
in Homes and Communities
Medical
Care
Personal
Behavior
HEALTH
Robert Wood Johnson Foundation Commission to Build a Healthier America www.commissiononhealth.org
A Life Course Approach:
Overarching Strategies
(Lu, Kotelchuk, Hogan, Jones, Jones, Halfon, 2008)



Improve Heath Care for African
American Women
Strengthen African American Families
and Communities
Reduce Allostatic Load
Improve Health Care for
African American Women


Provide
Interconception care
for women with
prior adverse
outcomes
Increase access to
preconception care


Improve the quality
of prenatal care
Expand healthcare
access over the life
course
Strengthen African American
Families and Communities


Strengthen father
involvement
Enhance systems
coordination and
integration for family
support services


Create reproductive
social capital in
African American
communities
Invest in community
building and urban
renewal
Reduce allostatic load


Close the education
gap
Reduce poverty
among African
American families


Support working
mothers and families
Undo racism
Public Views:
Determinants of Health
(Robert, Booske, Rigby, Rohan, 2008, WMJ)



WI public believes that health practices,
access to health care and health insurance
are the most important factors affecting
health.
WI public believes that health insurance
should be a high government priority.
Social determinants seen as less important to
health and public may be less likely to
support government policies to improve social
determinants.
External Factors Vs. Right
Choices
(Aubrun, Brown, Grady, Research Report for the Louisville Center for Health Equity, 2007)



Qualitative evaluation to understand what
“average” Louisville residents think about
health, health disparities and needed actions.
Sought to understand discrepancies between
what PH wants people to understand, and
what the public currently believes.
Right choices = People’s health -outcomes are determined by their own
choices and actions
ABC’s for Healthy Babies


Campaign designed
to ignite a paradigm
shift in how
individuals &
communities
respond to
disparities in birth
outcomes
Funded by DHFS
with support from
WPP


Focus groups in 5
local areas with
highest AA Infant
Mortality
65% mothers, 23%
fathers, 11%
grandmothers
Key Findings


Mothers and fathers believe that during
pregnancy the role of the father is to
help reduce stress in the mother’s life.
Fathers in Milwaukee believe that
jobs/employment are important
changes needed to help African
American women have healthier babies.
Prevention is more than access to
healthcare

“Everyone is focused on health behaviors
these days, but the environment people are
constrained within far exceeds the effect of
any individual change. Our program can link
kids to asthma specialists and ensure they
have the right medicines and resources like
bed covers, but at the end of the day, if they
go home to neglected buildings that are
roach infested, and moldy housing, we will
not be able to stabilize their asthma.” Jacqueline
Martinez, Northern Manhattan Community Voices
Joint Center For Political and
Economic Studies
What really makes us healthy?






Environmental quality
Built Environment and
Infrastructure
Public safety
Geographic Access to
Opportunities
throughout a region
Health Services
Community and Public
Support Services
Employment, Income,
Wealth and Assets
 Neighborhood Economic
Characteristics
 Cultural Characteristics
 Social Support and
Networks
 Community Leadership
and Organization
 Reputation of the
Neighborhood
Joint Center for Political
and

Economic Studies
Preventive Care is: Creating
Compassionate and Reciprocal
Environments (CARE)


Emphasis must be on CARE
Rebuilding bonds between people is a
powerful tool to promote health and well
being
Definitions: Compassionate and
Reciprocal
-Compassionate: Deep awareness of the
suffering of another coupled with the wish
to relieve it; sympathetic consciousness of
others' distress together with a desire to
alleviate it (Merriam-Webster Online. 15 September 2009)
-Reciprocal: Shared, felt, or shown by
both sides
100 Acts of Intentional Acts of Kindness:
Building Reproductive Social Capital in Los
Angeles (Jones, Lu, et al. 2010)



Maternal stress is an important risk factor for
LBW and preterm birth
Social support has been proposed as a
strategy to offset maternal stress, but has
shown only mixed outcomes
Social capital extends support to include
networks, civic engagement, local identity
and solidarity and trust/reciprocal help
Reproductive Social Capital



The features of social organization that
facilitate reproductive health in a
community
The degree of social connectedness of
the pregnant woman to her community
The quantity and quality of social
connections
Jones, Lu et al Ethnicity and
Disease 2010
Methods



55 pregnant or postpartum AA women in Los
Angeles, CA were recruited from local clinics,
CBO’s and FBO’s
6 focus groups for initial discussion and 9
focus groups for confirmation of themes and
final selection
Participants were asked to “name 5 things
you wish someone close to you would do
(would have done) to make your pregnancy
better and 5 things a strange could do…”
Results



About half (53%) wished that someone close,
particularly their husband or partner, could be
more supportive
Requests for support also included
attendance at prenatal appts (22%), walking
(16%), talking (15%), or massages (9%)
Instrumental support was requested including
meal prep (26%), housecleaning (22%),
transportation (22%) and childcare (11%)
Dissemination



Posters and fans with 100 Acts of Intentional
kindness printed and distributed to churches,
beauty and barber shops and clinics.
100 Acts for New Mothers and 100 Acts
Toward Oneself were completed using similar
methods.
Feedback from community conference
attendees indicated 86% endorsement
How do we experience stress in
our bodies?
APA 2008 Survey Stress in
America
PARENTING AND STRESS



Mothers report higher stress levels and
poorer stress management skills than fathers.
More than half of all mothers (54 percent)
report extreme stress levels during periods of
high stress compared to 46 percent of
fathers.
Two-thirds of mothers (69 percent) say family
responsibilities are a significant source of
stress compared to 52 percent of women
without children.
“Race/Ethnicity” and Stress


Hispanics and Blacks are more likely
than Whites to say the economy,
housing costs and job stability are
significant sources of stress.
Whites are more likely to say they
manage their stress extremely well (31
percent versus 24 percent of Hispanics
and 27 percent of Blacks)
Part 3: Some ideas










Ask me how was my day
Ask me is there anything I need
Be supportive and faithful
Don’t stare at other girls in front of me
Don’t offer me extra food
Don’t talk about my weight
Fix me a meal
Take me to the doctor
Don’t break up with me during my pregnancy
Let me sit down at the bank until its my turn at the
teller line
Keys to Happiness




Social Connections: Having 5 or more
friends beyond immediate family
Optimism: Optimistic explanatory styles
Appreciation: Gratitude, expressing
appreciation, and savoring/mindfulness
Purpose: Having a life purpose,
especially one that is broader than self.
OHanlon, B (2009 - Positive
Psychology Practical Apps)
3 Good Things

Participants are asked to write down
three things that went well each day,
every night, for one week. Participants
are asked to provide a causal
explanation for each good thing.
Seligman et al
The Buddha is reported to
have said

"It is possible to travel the whole world
in search of one who is more worthy of
compassion than oneself. No such
person can be found."
Step Back/Step Forward
DISCUSSION




What has the exercise demonstrated about
the starting line?
What does the exercise reveal about the role
of government in wealth accumulation?
How does the exercise help me rethink my
own beliefs about my economic status and
that of my family?
What connections can I make between health
and wealth now?
How work
shapes health
Physical aspects of
work and the
workplace
Psychosocial aspects
of work and how work
is organized
Work-related
resources and
opportunities
Exposure to
hazards
Stress
Access to
nutrition,
physical
activity,
housing,
medical care
Physical
and
mental
health
How income shapes health
Income represents resources and opportunities:






Medical care
Nutrition & physical activity
Housing and neighborhood conditions
Social support
Ways to reduce/buffer stress
Children’s education
RWJ Social Determinants
Commission
How education shapes health
Educational
attainment
Educational
attainment
Health knowledge,
literacy & behaviors
Work
Working
conditions
 Exposure to hazards
 Control / demand imbalance
 Stress
Workrelated
resources
 Health insurance
 Sick leave
 Retirement benefits
 Other benefits
Income
Educational
attainment
 Nutrition
 Exercise
 Drugs & alcohol
 Health/disease management
HEALTH
HEALTH
 Housing
 Neighborhood environment
 Nutrition
 Stress
Sense of control
 Work-related factors
 Health-related behaviors
 Stress
Social standing
 Social & economic resources
 Stress
Social support
 Social & economic resources
 Health-related behaviors
 Family stability
 Stress
HEALTH
HEALTH
How social advantage shapes health in
childhood and later in life
Higher levels of
parents’
education
Higher levels of
parents’ education
Increased family
income
Good role models
for children and
lower exposure to
unhealthy
conditions such as
secondhand smoke
Healthier
behaviors by
parents
Better jobs and
increased family
income
Resources to cope
with stressors (e.g.,
child care,
transportation,
health insurance
Affordability of good
housing, a safe
neighborhood with
access to
recreational
opportunities and
nutritious diet
Decreased levels of
chronic stress
experienced by
children
RWJ Social Determinants
Commission
Positive effects on
neuroendocrine
systems that can lead
to lesser risks for
developing chronic
disease such as heart
disease and diabetes
What’s missing?

Assets and wealth
Considering income and
education is not enough: the
impact of racism

Structural racism tracks people by race into different
socioeconomic opportunities




Job opportunities
Educational opportunities
Options for where to live  schools, jobs, housing quality
In addition, living in a society with a legacy of
discrimination can harm health through pathways
involving stress


Not only overt incidents
Constant vigilance
RWJ Social Determinants
Commission
Levels of Racism



Internalized
Personally Mediated
Institutionalized: structures, policies, practices,
and norms resulting in differential access to the
goods, services, and opportunities of society by
“race.” Institutionalized racism is normative,
sometimes legalized, and often manifests as
inherited disadvantage.
Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.
KEYS TO SUCCESS










Trust
Empowerment
Culture and History
Focus on Causes
Community Investment and Expertise
Trusted Organizations
Community Leaders
Ownership
Sustainability
Hope
Reach U.S. -Finding Solutions to Health Disparities, CDC 2008
Decline of the Manufacturing
Sector


Between 1970 and 1990, Black were
just as likely as other racial/ethnic
groups to have manufacturing jobs.
Since the early 1990’s and by 2007,
Blacks were 15% less likely to have a
job in manufacturing.
Simply put…

Love is patient; love is kind; love is not
envious or boastful or arrogant or rude.
It does not insist on its own way; it is
not irritable or resentful; it does not
rejoice in wrongdoing, but rejoices in
the truth. It bears all things, believes all
things, hopes all things, endures all
things, love never fails. (1 Corinthians
13: 4-7)