Transcript Slide 1
Center for Health Equity November, 12-13, 2007 Louisville, Kentucky
Social Disparities in Health: Challenges and Opportunities
David R. Williams, PhD, MPH Florence & Laura Norman Professor of Public Health Professor of African & African American Studies and of Sociology Harvard University
3 2.5
2 1.5
1 0.5
0 There Is a Racial Gap in Health in Early Life: Minority/White Mortality Ratios, 2000
B/W ratio AmI/W ratio API/W ratio Hisp/W ratio
<1 1-4
Age
5-14 15-24
There Is a Racial Gap in Health in Mid Life:
Minority/White Mortality Ratios, 2000 2.5
2 1.5
1 0.5
0 25-34 35-44
Age
45-54 55-64
B/W ratio AmI/W ratio API/W ratio Hisp/W ratio
There Is a Racial Gap in Health in Late Life:
Minority/White Mortality Ratios, 2000 1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
65-74 75-84
Age
85+
B/W ratio AmI/W ratio API/W ratio Hisp/W ratio
400 300 200 100 700
Age-Adjusted Heart Disease Death Rates for Blacks and Whites, 1950-2000
600 White Black 500 1950 1960 1970
YEAR
1980 1990 2000
300
Age-Adjusted Cancer Death Rates for Blacks and Whites, 1950-2000
White Black 250 200 150 100 1950 1960 1970
YEAR
1980 1990 2000
Diabetes Death Rates 1955-1995
50.0
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
12.6
White Am Ind Am Ind/W Ratio 17.0
10.4
24.3
8.6
24.4
11.7
46.4
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1955 1975
Year
1985 1995 Source: Indian Health Service; Trends in Indian Health 1998-99
90 80 70 60 50 40 30 20 10 0
Life Expectancy at Birth, 1900-2000
47.6
33.0
69.1
60.8
71.7
64.1
76.1
69.1
77.6
71.9
White Black 1900 1950 1970
Year
1990 2000
SAT Scores by Income Family Income More than $100,000 $80,000 to $100,000 $70,000 to $80,000 $60,000 to $70,000 $50,000 to $60,000 $40,000 to $50,000 $30,000 to $40,000 $20,000 to $30,000 $10,000 to $20,000 Less than $10,000 Source: (ETS) Mantsios; N=898,596 Median Score 1129 1085 1064 1049 1034 1016 992 964 920 873
SES: A Key Determinant of Heath
• • • • •
Socioeconomic Status (SES) usually measured by income, education, or occupation influences health in virtually every society.
SES is one of the most powerful predictors of health, more powerful than genetics, exposure to carcinogens, and even smoking.
The gap in all-cause mortality between high and low SES persons is larger than the gap between smokers and non-smokers.
Americans who have not graduated from high school have a death rate two to three times higher than those who have graduated from college.
Low SES adults have levels of illness in their 30s and 40s that are not seen in the highest SES group until after the ages of 65-75.
Percentage of Persons in Poverty Race/Ethnicity 30 25 20 25.3
26.6
15 10 16.1
10.7
9.3
5 0 White U.S. Census 2006 Black AmI/AN NH/PI Race Asian 21.5
16.8
Hisp.
Any 2+ races
Racial/Ethnic Composition of People in Poverty in the U.S. 2+ races, 2.6% Hisp. Any 23.9% White 46.1% Asian, 3.6% NH/PI, 0.17% AmI/AN, 1.6% U.S. Census 2006 Black 23.1%
Relative Risk of Premature Death by Family Income (U.S.)
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
<10K 10-19K 20-29K 30-39K 40-49K 50-99K 100+K Family Income in 1980 (adjusted to 1999 dollars) 9-year mortality data from the National Longitudinal Mortality Survey
Percent of persons with Fair or Poor Health by Race, 1995
Racial Differences Race/Ethnicity Percent B-W H-W B-H White 9.1
8.2
6.0
2.2
Black 17.3
Hispanic 15.1
Poor=Below poverty; Near poor+<2x poverty; Middle Income = >2x poverty but <$50,000+ Source: Parmuk et al. 1998
Percent of Women with Fair or Poor Health by Race and Income, 1995 Household Income Poor Near Poor Middle Income High Income White 30.2
17.9
9.2
5.8
Black 38.2
26.1
14.6
9.2
Hispanic 30.4
24.3
13.5
7.0
SES Difference 24.4
29.0
23.4
Poor=below poverty; Near Poor=<2x poverty; Middle Income=>2x poverty but <$50,000; High Income=$50,000+ Source: Pamuk et al. 1998
Race/Ethnicity and SES
• Race and SES reflect two related but not interchangeable systems of inequality • In national data, the highest SES group of African American women have equivalent or higher rates of infant mortality, low birth weight, hypertension and overweight than the lowest SES group of white women
Infant Death Rates by Mother’s Education, 1995
3 20 18 16 14 12 10 8 6 4 2 0 2.5
2 1.5
1 0.5
0
White Black B/W Ratio
Education 14 12 10 8 6 4 2 0 20 Infant Mortality by Mother’s Education, 1995 NH White Black Hispanic API AmI/AN 18 17.3 16 9.9 6 5.7 12.7 6.5 14.8 5.9 5.5 7.9 5.1 12.3 5.4 5.1 5.7 4.2 11.4 4.4 4 <12 12 13-15 Years of Education 16+ 1. All indicators of SES are non-equivalent across race. Compared to whites, blacks receive less income at the same levels of education, have less wealth at the equivalent income levels, and have less purchasing power (at a given level of income) because of higher costs of goods and services. 2. Health is affected not only by current SES but by exposure to social and economic adversity over the life course. 3. Personal experiences of discrimination and institutional racism are added pathogenic factors that can affect the health of minority group members in multiple ways. Income All White Black $79,400 $7,500 Hispanic $9,750 Excl. Hm. Eq. 22,566 1,166 1,850 Poorest 20% 24,000 57 500 2 nd Quintile 48,500 5,275 5,670 3 rd Quintile 4 th Quintile 59,500 92,842 11,500 32,600 11,200 36,225 Richest 20% 208,023 Orzechowski & Sepielli 2003, U.S. Census 65,141 73,032 Wealth of Whites and of Minorities per $1 of Whites, 2000 Household Income White B/W Ratio Hisp/W Ratio Total Poorest 20% 2 nd Quintile 3 rd Quintile 4 th Quintile Richest 20% $ 79,400 $ 24,000 $ 48,500 $ 59,500 $ 92,842 $ 208,023 9¢ 1¢ 11¢ 19¢ 35¢ 31¢ 12¢ 2¢ 12¢ 19¢ 39¢ 35¢ Source: Orzechowski & Sepielli 2003, U.S. Census African Americans were more likely than whites to experience the following hardships 1: 1. Unable to meet essential expenses 2. Unable to pay full rent on mortgage 3. Unable to pay full utility bill 4. Had utilities shut off 5. Had telephone shut off 6. Evicted from apartment 1 After adjustment for income, education, employment status, transfer payments, home ownership, gender, marital status, children, disability, health insurance and residential mobility. Bauman 1998; SIPP • Institutional discrimination can restrict economic attainment and thus differences in SES and health. • Segregation creates pathogenic residential conditions. • Discrimination can lead to reduced access to desirable goods and services. • Internalized racism (acceptance of society’s negative beliefs) can adversely affect health. • Racism can lead to increased exposure to traditional stressors (e.g. unemployment). • Experiences of discrimination may be a neglected psychosocial stressor. “..Discrimination is a hellhound that gnaws at Negroes in every waking moment of their lives declaring that the lie of their inferiority is accepted as the truth in the society dominating them.” Martin Luther King, Jr. [1967] • Pairs of young, well-groomed, well-spoken college men with identical resumes apply for 350 advertised entry-level jobs in Milwaukee, Wisconsin. Two teams were black and two were white. In each team, one said that he had served an 18-month prison sentence for cocaine possession. • The study found that it was easier for a white male with a felony conviction to get a job than a black male whose record was clean. Source: Devan Pager; NYT March 20, 2004 Criminal Record No White 34% Black 14% Yes Source: Devan Pager; NYT March 20, 2004 17% 5% • • • • • • • • • In your day-to-day life how often do the following things happen to you? You are treated with less courtesy than other people. You are treated with less respect than other people. You receive poorer service than other people at restaurants or stores. People act as if they think you are not smart. People act as if they are afraid of you. People act as if they think you are dishonest. People act as if they’re better than you are. You are called names or insulted. You are threatened or harassed. In the study of Women’s Health Across the Nation (SWAN): -- Everyday Discrimination was positively related to subclinical carotid artery disease (IMT; intima media thickness) for black but not white women -- chronic exposure to discrimination over 5 years was positively related to coronary artery calcification (CAC) Troxel et al. 2003; Lewis et al. 2006 • Well-documented increase in discrimination and harassment of Arab Americans after 9/11/2001 • Arab American women in California had an increased risk of low birthweight and preterm birth in the 6 months after Sept. 11 compared to pre-Sept. 11 • Other women in California had no change in birth outcome risk pre-and post-September 11 Lauderdale, 2006 Environment 20% Behavior 50% Genetics 20% Medical Care 10% U.S. Surgeon General, 1979 Needed Behavioral Changes • Reducing Smoking • Improving Nutrition and Reducing Obesity • Increasing Exercise • Reducing Alcohol Misuse • Improving Sexual Health • Improving Mental Health Reducing Inequalities I Reducing Negative Health Behaviors? *Changing health behaviors requires more than just more health information. “Just say No” is not enough. *Interventions narrowly focused on health behaviors are unlikely to be effective. *The experience of the last 100 years suggests that interventions on intermediary risk factors will have limited success in reducing social inequalities in health as long as the more fundamental social inequalities themselves remain intact. House & Williams 2000; Lantz et al. 1998; Lantz et al. 2000 Successful interventions require a coordinated and comprehensive approach: • The active involvement of professionals and volunteers from many organizations (government, health professional organizations, community agencies and businesses) • The use of multiple intervention channels (media, workplaces, schools, churches, medical and health societies) Warner 2000 The use of multiple interventions – • Efforts to inform the public about the dangers of cigarette smoking (smoking cessation • programs, warning labels on cigarette packs) Economic inducements to avoid tobacco use • (excise taxes, differential life insurance rates) Laws and regulations restricting tobacco use (clean indoor air laws, restricting smoking in public places and restricting sales to minors) Even with all of these initiatives, success has been only partial Warner 2000 Effective Policies to reduce inequalities in health must address fundamental non-medical determinants. WHY? An individual’s chances of getting sick are largely unrelated to the receipt of medical care Where we live, learn, work and play determine our opportunities and chances for being healthy Social Policies can make it easier or harder to make healthy choices SES is linked to: *Exposures to health enhancing resources *Exposures to health damaging factors *Exposure to particular stressors *Availability of resources to cope with stress Health practices (smoking, poor nutrition, drinking, exercise, etc.) are all socially patterned Making Healthy Choices Easier Factors that facilitate opportunities for health: • Facilities and Resources in Local Neighborhoods • Socioeconomic Resources • A Sense of Security and Hope • Exposure to Physical, Chemical, & Psychosocial Stressors • Psychological, Social & Material Resources to Cope with Stress Redefining Health Policy Health Policies include policies in all sectors of society that affect opportunities to choose health, including, for example, • Housing Policy • Employment Policies • Community Development Policies • Income Support Policies • Transportation Policies • Environmental Policies 1. Segregation determines quality of education and employment opportunities. 2. Segregation can create pathogenic neighborhood and housing conditions. 3. Conditions linked to segregation can constrain the practice of health behaviors and encourage unhealthy ones. 4. Segregation can adversely affect access to high quality medical care. Source: Williams & Collins , 2001 • • • • • Blacks are more segregated than any other racial/ethnic group. Segregation is inversely related to income for Latinos and Asians, but is high at all levels of income for blacks. The most affluent blacks (income over $50,000) are more highly segregated than the poorest Latinos and Asians (incomes under $15,000). Thus, middle class blacks live in poorer areas than whites of similar SES and poor whites live in much better neighborhoods than poor blacks. African Americans manifest a higher preference for residing in integrated areas than any other group. Source: Massey 2004 Residential Segregation and SES A study of the effects of segregation on young African American adults found that the elimination of segregation would erase black white differences in Earnings High School Graduation Rate Unemployment And reduce racial differences in single motherhood by two-thirds Cutler, Glaeser & Vigdor, 1997 • • In the 171 largest cities in the U.S., there is not even one city where whites live in ecological equality to blacks in terms of poverty rates or rates of single-parent households. “ The worst urban context in which whites reside is considerably better than the average context of black communities .” p.41 Source: Sampson & Wilson 1995 Proportion of Black & Latino Children in Poorer Neighborhoods Than Worst Off White Children 100 90 80 70 60 50 40 30 20 10 0 76% 69% 86% 74% 57% 44% All Metro Areas 5 Metro Areas High Segr. Neighborhood 5 Metro Areas Low Segr. Black Latino American Apartheid: South Africa (de jure) in 1991 & U.S. (de facto) in 2000 100 90 80 70 60 50 40 30 20 10 0 90 85 82 81 80 80 77 66 Sou th A fr ic a D etr oi t M ilw au ke e N ew Y or k C hi cago N ew ar k C le ve lan d U .S . Source: Massey 2004; Iceland et al. 2002; Glaeser & Vigitor 2001 Reducing Inequalities II Address Underlying Determinants of Health • Improve conditions of work, re-design workplaces to reduce injuries and job stress • Enrich the quality of neighborhood environments and increase economic development in poor areas • Improve housing quality and the safety of neighborhood environments Neighborhood Renewal and Health - I • A 10-year follow-up study of residents in 5 neighborhood types in Norway found that changes in neighborhood quality were associated with improved health. • The neighborhood improvements: a new public school, playground extensions, a new shopping center with restaurants and a cinema, a subway line extension into the neighborhood, a new sports arena & park, and organized sports activities for adolescents. • Residents of the area that had experienced these dramatic improvements in its social environment reported improved mental health 10 years later • This effect was not explained by selective migration Dalgard and Tambs 1997 Neighborhood Renewal and Health - II • Neighborhood improvement in a poorly functioning area in England was linked to improved health and social interaction. • Improvements: housing was refurbished (made safe & sheltered from strangers), traffic regulations improved, improved lighting & strengthening of windows, enclosed gardens for apartments, closed alleyways, and landscaping. Residents involved in planning process. • One year later: – Levels of optimism , belief in the future, identification with their neighborhood, trust in other neighbors, and contact between the neighbors had all increased. – Symptoms of anxiety and depression had declined. Halpern, 1995 • The Moving to Opportunity Program randomized families with children in high poverty neighborhoods to move to less poor neighborhoods. • It found, three years later, that there were improvements in the mental health of both parents and sons who moved to the low poverty neighborhoods. Leventhal and Brooks-Gunn, 2003 • Improve living standards for poor persons and households • Increase access to employment opportunities • Increase education and training that provide basic skills for the unskilled and better job ladders for the least skilled • Invest in improved educational quality in the early years and reduce educational failure • A study conducted in the early 1970s found that mothers in the experimental income group who received expanded income support had infants with higher birth weight than that of mothers in the control group. • Neither group experienced any experimental manipulation of health services. • Improved nutrition, probably a result of the income manipulation, appeared to have been the key intervening factor. Kehrer and Wolin, 1979 • A natural experiment assessed the impact of an income supplement on the mental health of American Indian children. • It found that increased family income (because of the opening of a casino) was associated with declining rates of deviant and aggressive behavior. Costello et al. 2003 Year White Black 1968 1978 Change % Change 2,119.7 1,738.2 -381.5 18.0 2,919.8 2,331.8 -588.0 20.1 Cooper et al., 1981b Year White Black 1968 1978 Change % Change 75.0 77.8 2.8 3.7 67.9 73.6 5.7 8.4 Cooper et al., 1981b Cents 0.62 0.61 0.6 0.59 0.58 0.57 0.56 0.55 0.54 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 Year Source: Economic Report of the President, 1998 Indicator 1980 1991 1. 2. 3. Excess Deaths (Blacks) Infant Mortality Black/White Ratio, Males Black/White Ratio, Females Life Expectancy Black/White Gap, Males Black/White Gap, Females 59,000 1.9 2.0 6.9 5.6 66,000 2.1 2.3 8.3 5.8 Source: NCHS, 1994 . 80 75 75.3 75.3 75.4 75.6 75.6 75.9 White 76.1 76.3 Black 76.5 70 69.5 69.3 69.1 69.1 68.9 68.8 69.1 69.3 69.6 65 60 1984 1985 1986 1987 1988 Year 1989 1990 1991 1992 NCHS, 1995 Income All Childhood Poverty, U.S., 1996 Percent of Children Under Age 18 Poor 20.5 Near Poor Economically Vulnerable 22.7 43.2 White, non-Hispanic Asian or Pacific Islander Black, non-Hispanic 11.1 19.5 39.9 19.7 16.4 28.1 30.8 35.9 68.0 Hispanic 40.3 Source: U.S. Census Bureau (Pamuk et al. 1998) 31.7 72.0 Compared to children raised by 2 parents those raised by a single parent are more likely to: • grow up poor • drop out of high school • be unemployed in young adulthood • not enroll in college • have an elevated risk of juvenile delinquency and participation in violent crime. McLanahan & Sandefur 1994; Sampson 1987 • Economic marginalization of males (high unemployment & low wage rates) is the central determinant of high rates of female-headed households. • Marriage rates are positively related to average male earnings. • Marriage rates are inversely related to male unemployment. Bishop 1980; Testa et al. 1993; Wilson & Neckerman 1986 Country Spain Italy Mexico France Ireland Germany United States United Kingdom Sweden Source: UNICEF (United Nations Children’s Fund), 2000 2 3 4 8 8 10 19 20 21 % Children Child Poverty (%) 1 Parent HH 1 Parent Other 32 22 28 26 48 51 55 46 7 12 20 26 6 14 6 16 13 2 Child Poverty Rates Country Netherlands Spain Sweden Canada Italy United States Before Taxes 16.0 21.1 23.4 24.6 24.6 26.7 Australia France United Kingdom 28.1 28.7 36.1 Poland Source: UNICEF (United Nations’ Children’s Fund), 2000 44.4 After Taxes 7.7 12.3 2.6 15.5 20.5 22.4 12.6 7.9 19.8 15.4 Investments in early childhood programs in the U.S. have been shown to have decisive beneficial effects Larry Schweinhart High/Scope Educational Research Foundation www.highscope.org 123 young African-American children, living in poverty and at risk of school failure. Randomly assigned to initially similar program and no program groups. 4 teachers with bachelors’ degrees held a daily class of 20 25 three- and four-year-olds and made weekly home visits. Children participated in their own education by planning, doing, and reviewing their own activities. Those who received the program had better academic performance (more likely to graduate from high school) Program recipients did better economically (higher employment, annual income, savings & home ownership) The group who received high-quality early education had fewer arrests for violent, property and drug crimes The program was cost effective : A return to society of $17 for every dollar invested in early education _____________________________________________________________________ Schweinhart & Montie, 2005 1. 2. 3. 4. 5. 6. Religion & Health: Potential Mechanisms Religious institutions can provide support, intimacy, a sense of connectedness and belonging Religious beliefs and values can provide systems of meaning to interpret and re-interpret stress Religious beliefs can provide feelings of strength to cope with adversity By encouraging moderation in all things and reducing risk taking behavior, religious involvement can reduce exposure to stress. Religious participation can discourage negative health behaviors (tobacco, alcohol, drugs, risky sexual practices) Religious institutions can generate stress: time demands, role conflicts, social conflicts, criticism • • Religion and Adolescent Risk Behavior Religious high school seniors are less likely than their non-religious peers to – Carry a weapon (gun, knife, club) to school – Get into fights or hurt someone – – – – Drive after drinking Ride with driver who had been drinking Smoke cigarettes Engage in binge drinking (5 or more drinks in a row) – Use marijuana Religious seniors were more likely to – Wear seat belts – – – Eat breakfast, green vegetables and fruit Get regular exercise Sleep at least 7 hours per night Wallace and Forman 1998; Monitoring the Future Study U.S. Life Expectancy at Age 20 by Religious Attendance 70 60 50 40 30 20 56.1 46.4 10 0 Never Hummer et al. 1999 60.1 57.9 <1 week 63.5 52.4 1/week 63.4 60.1 > 1/week White Black 1. Several aspects of some religious services are distinctive in the provision of opportunities to articulate and manage personal and collective suffering. 2. T he expression of emotion and active congregational participation can promote “collective catharsis” in ways that facilitate the reduction of tension and the release of emotional distress. 3. There are parallels between all the key elements of formal psychotherapy and the rituals of some religious services. Griffith et al. (1980); Gilkes (1980): Pargament et al. (1983) The RWJF Commission to Build a Healthier America is a national, comprehensive effort to raise awareness about the large socio economic status (SES) differences in health among Americans and then seek practical, common-ground solutions to improve the health of all. • Increase awareness about the relationships between social factors and health, and how these relationships have produced large inequalities in health among Americans • Generate concern and motivate efforts to address the problem of health inequalities based on socioeconomic status and race/ethnicity • Foster and inform constructive public discourse about ways to reduce these health inequalities • Identify and prioritize the adoption of public and private policies and interventions to reduce social inequalities and thereby improve the health of Americans overall • RWJF Foundation Board and Staff • Central Office : George Washington University, Dept. of Health Policy • Research Arm : Center on Social Disparities in Health, UCSF • Communications Partners : – Burness Communications – Health 360 Strategies -- a service of Chandler Chicco Agency and Mehlman Vogel Castagnetti, Inc Raise awareness and identify areas for action by – Targeting decision-makers in public and private sector – Reaching beyond health care to non-traditional allies and advocates – Making academic research on social inequalities more accessible to policy makers – Conducting work in a resolutely nonpartisan fashion – Designing a plan that is sustainable, flexible and relevant • Message testing – Qualitative research to identify how to approach topic in ways that resonate with the public and key stakeholders • Polling – Public opinion data collection to gauge the public’s knowledge of health disparities and to monitor change over time • Interviews with key stakeholders – Interviews with key policymakers, stakeholders, and influentials for their impressions and input • Scanning the environment – Tracking what is being done on poverty/disparity issues and assessing opportunities • Recruiting Commissioners – Nationally recognized persons – Diverse backgrounds – Networks to broad constituencies – Non-partisan and bi-partisan – Demonstrated leadership and commitment to improving life for all Americans • Commission meetings & Special Events • Field Hearings • Reports • Storybank Development • Outreach • Website • Raising awareness across the country • Taking the message beyond Capitol Hill to real communities • Listening to and learning from real people and communities who face the problem of social inequalities every day • Highlighting promising potential solutions • Two Year life • December 2007 launch • Ongoing activities in 2008 and 2009 • Culminating in actionable recommendations that policy makers can embrace • At the Center on Social Disparities in Health, UCSF – Paula Braveman, Susan Egerter – Tabashir Sadegh-Nobari, Veronica Pedregon, Mercedes Dekker, Kristen Marchi • Catherine Cubbin (UCSF & UT), Mah-j Soobader (MA) • Demographer Elsie Pamuk (WA) • Economists Bob Schoeni (U Michigan) & Will Dow (UC Berkeley) • Steven Woolf (Virginia Commonwealth U) • Sociologist David Williams (Harvard) • GWU Dept. Health Policy: Wilhelmine Miller, Marsha Lillie Blanton • Epidemiology, demography, economics, sociology, public policy, health policy • Background literature searches for discussions and briefings; scientific support for planned communications efforts • Analyses of recent national population-based data sources to measure differences in health by income, education, and race or ethnic group • This information has not been available since Health US 1998 • Used as basis for estimates of monetary costs of inequalities • Will be presented at public launch in DC Analyses of health inequalities: • By income and/or education • By racial or ethnic group And: • Socioeconomic differences within racial/ethnic groups and • Racial/ethnic differences within each socioeconomic group • Show that both SES and racial/ethnic group must be considered, separately and together – Linked but also distinct • Presents new evidence of health inequalities across income, education, and racial/ethnic groups • Estimates economic costs of health inequalities • Reviews literature documenting lasting impact of physical and social environments on a child’s health and chances of becoming a healthy adult • Examines roles of personal and societal responsibilities for health • Offers a framework for seeking solutions • When: December 5, 2007 • Where: Union Station (Columbus Room) Washington, DC • What: Formal announcement of the Commission. Release of the Commission’s First Report A serious commitment on the part of the RWJ Foundation to: • Explore the factors that influence health • Raise public awareness of social inequalities in health • Provide meaningful recommendations to spur action so that millions of people will have a chance to lead healthier lives 1. 2. 3. 4. Health officials and organizations cannot improve health by themselves Improving health and reducing inequalities in health is not just about more health programs, it is about a new path to health All policy that affects health is health policy Health officials need to work collaboratively with other sectors of society to initiate and support social policies that promote health and reduce inequalities and health 1. 2. 3. 4. 5. Inequalities in health are created by larger inequalities in society. SES and racial/ethnic disparities in health reflect the successful implementation of social policies. Eliminating them requires political will for and a commitment to new strategies to improve living and working conditions. Our great need is to begin in a systematic and comprehensive manner, to use all of the current knowledge that we have . Now is the time Edmund Burke, British PhilosopherWhy Race Still Matters
Race/Ethnicity and Wealth, 2000
Median Net Worth
Race and Economic Hardship 1995
Racism: Potential Mechanisms
Perceived Discrimination: Experiences of discrimination may be a neglected psychosocial stressor
MLK Quote
Discrimination Persists
Percent of Job Applicants Receiving a Callback
Every Day Discrimination
Everyday Discrimination and Subclinical Disease
Arab American Birth Outcomes
Determinants of Health in the U.S.
Changes in Smoking Over Time -I
Changes in Smoking Over Time -2
Moving Upstream
WHY?
Centrality of the Social Environment
SES and Health Risks
Policy Implications
Since the socio-political environment and SES is a key determinant of health, improving social and economic conditions is critical to improving health and reducing health disparities
Policy Area
Place Matters!
Geographic location determines exposure to risk factors and resources that affect health.
How Segregation Can Affect Health
Segregation: Distinctive for Blacks
Racial Differences in Residential Environment
Neighborhood Change and Health
Reducing Inequalities III Address Underlying Determinants of Health
Increased Income and Health
Income Change and Health
Economic Policy is Health Policy In the last 50 years, black-white differences in health have narrowed and widened with black-white differences in income
Changes in Mortality Rates per 100,000 Population, Age 35-74, Between 1968 and 1978 (Men)
Changes in Life Expectancy at Birth Between 1968 and 1978 (Women)
Median Family Income of Blacks per $1 of Whites
Health Status Changes, 1980-1991
U.S. Life Expectancy at Birth, 1984-1992
Policy Area
Reducing Childhood Poverty Challenges and Opportunities
Family Structure and SES
Determinants of Family Structure
Policy Matters
The High/Scope Perry Preschool Study to Age 40
High/Scope Perry Preschool
Results at Age 40
Building on Resources
We Need to Better Understand How Resilience Factors and Processes Can Affect Health and how to Build on the Strengths and Capacities of Communities
Religious Services as Therapy?
RWJF Commission to Build a Healthier America
Overall Goal
Key Objectives
Commission Infrastructure
Approach
Background Activities: Setting the Stage
Setting the Stage - II
Commission Activities
Commission Meetings & Field Hearings
Commission Timeline
Multidisciplinary Research Team
Research Activities So Far
Social (Socioeconomic and Racial and Ethnic) Differences in Health
Report from RWJF to the Commission
Research Efforts Guided by a Framework for Seeking Solutions
Save the Date
Summary
Conclusions -I
Conclusions -II
A Call to Action
“The only thing necessary for the triumph [of evil] is for good men to do nothing.”