Transcript Stephen B. Thomas, PhD. Professor, Department of Health Services Administration Director, Maryland Center for Health Equity School of Public Health The University of Maryland [email protected] www.healthequity.umd.edu www.twitter.com/umdhealthequity.

Stephen B. Thomas, PhD.
Professor, Department of Health Services Administration
Director, Maryland Center for Health Equity
School of Public Health
The University of Maryland
[email protected]
www.healthequity.umd.edu
www.twitter.com/umdhealthequity
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
Architects of Community Engaged Research
Drs. Craig S. Fryer, Mary A. Garza, Stephen B. Thomas, Sandra C. Quinn and James Butler, III
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
COE Goals:
1.To establish and sustain a
community engaged research
enterprise on critical health
disparities;
2.To raise the visibility of racial
and ethnic health disparities
and promising solutions with
Marylanders; and
3.To facilitate action for change
in the structural determinants
of health in Maryland.
NIH-NIMHD PG20MD000207
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
THE OPPORTUNITY
Photo Credit: Sandra Quinn
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
AFFORDABLE CARE ACT of 2010
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
Maryland Health Improvement & Disparities
Reduction Act of 2012
Signed into Law by Governor Martin O’Malley on April 10, 2012.
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
THE CHALLENGE
Photo Credit: Sandra Quinn
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
Polarization and belief dynamics in the Black and White
communities: An agent-based network model from the data
Grim, P., THOMAS, S.B., Fisher, S., Reade, C., Singer, D.J., Garza, M.A., Fryer, C.S., &
Chatman, J. (2012). Polarization and belief dynamics in the Black and White communities: An
agent-based network model from the data. Artificial Life, 13, 186-193.
Personal History Matters
Benjamin Thomas, BS
Lucille W. Thomas, RN
Personal History Matters
Thomas Family circa 1958
Columbus, Ohio
“…Ruby Bridges, the first black child to attend an allwhite elementary school in the South.”
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
“…The people who ran the study at Tuskegee diminished the
stature of man by abandoning the most basic ethical
precepts. They forgot their pledge to heal and repair. They had
the power to heal the survivors and all the others and they did
not. Today, all we can do is apologize.…”
President William Jefferson Clinton
The White House
May 16, 1997
http://www.cdc.gov/tuskegee/clintonp.htm
Bioethics Principle of Justice
“…Who ought to receive the benefits of
research and bear its burdens? This is a
question of justice, in the sense of "fairness in
distribution" or "what is deserved.” An injustice
occurs when some benefit to which a person is
entitled is denied without good reason or
when some burden is imposed unduly….”
The Belmont Report, April 18, 1979
The Social Context of
Health Disparities
The ultimate aim is to uncover social,
cultural and environmental factors
beyond the biomedical model and
address a broad range of issues. This
approach includes, but not limited to,
breaking the cycle of poverty,
increasing access to quality health
care, eliminating environmental
hazards in homes and neighborhoods,
and the implementation of effective
prevention programs tailored to
specific community needs.
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
Defining Health Disparities and
Health Equity
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
Institute of Medicine Definition of Health Care Disparities
Differences, Disparities, and Discrimination:
Populations with Equal Access to Healthcare
SOURCE: Gomes and McGuire, 2001
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
Definition: Health Disparities
• According to Healthy People 2020
• “ health disparity is “…a particular type of health
difference that is closely linked with social, economic,
and/or environmental disadvantage.”
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
Definition: Health Equity
• According to Healthy People 2020
• Health Equity is “…the attainment of the highest level of
health for all people.”
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
Health Equity & Disparity Combined
According to Health People 2020:
“The concepts of health equity and health disparity
are inseparable in their practical implementation.
Policies and practices aimed at promoting the goal of
health equity will not immediately eliminate all health
disparities, but they will provide a foundation for
moving closer to that goal. ”
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
AIDS Cases Among Adults and Adolescents by Race/Ethnicity
Last Modified: April 28, 2011
Content Source:Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
Schulman, K. A., J. A. Berlin, et al. (1999). "The effect of race and sex on physicians’
recommendations for cardiac catheterization." N Engl J Med 340(8): 618-626.
CONCLUSION: “…Our findings suggest that the race and sex of a patient
independently influence how physicians manage chest pain…”
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
THE FRAMEWORK
Photo Credit: Sandra Quinn
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
Thomas, S. B., S. C. Quinn, et al. (2011). "Toward a Fourth Generation of
Disparities Research to Achieve Health Equity." Annual Review of Public
Health 32(1): 399-416.
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
The Health Equity Action Research Trajectory:
A Platform for 4th Generation Disparities Research
Thomas, S. B., S. C. Quinn, Butler, J., Fryer, C..S., Garza, M.A. (2011). "Toward a Fourth Generation of
Disparities Research to Achieve Health Equity." Annual Review of Public Health 32(1): 399-416
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
Key Foundations
1. Utilizing public health critical race praxis (PHCR)
as our conceptual framework,
2. Addressing structural determinants of health
through comprehensive multilevel interventions,
3. Utilizing comprehensive evaluation, and
4. Necessitating explicit attention to self-reflection
by the researcher.
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
Cultural Confidence
“…a lifelong process based on the individual’s selfreflection about their personal biases and prejudices. We
define a culturally confident person as someone who is
flexible and humble enough to admit ignorance and is
willing to be uncomfortable addressing complex
racialized issues.”
Thomas, S., Quinn, S., Butler, J., Fryer, C. & Garza, M. Fourth Generation Health Disparities Research:
Accelerating Innovations to Achieve Health Equity. Annual Review of Public Health. 2011. 32:399–416
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
Powers, M, Faden, R (2006). Social justice:
Moral foundation of public health and health policy. Oxford University
Press.
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
INNOVATIVE METHODS
Photo Credit: Sandra Quinn
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
2001 FEDERAL DHHS
TAKE A LOVED ONE TO THE DOCTOR DAY
4th GENERATION APPROACH:
TAKE A HEALTH PROFESSIONAL
TO THE PEOPLE
THE HEALTHY BLACK
FAMILY PROJECT
(2004-2012)
A Community-Based
Demonstration Project
Designed for Health
Promotion and Disease
Prevention
NIH-NIMHD PG60MD000207
HEALTHY BLACK FAMILY PROGRAM ACTIVITIES
Physical Activity
Nutrition Education & Guidance
Stress Management
Smoking Cessation
Family Health History
Self-Management of Chronic Disease
Referral to Medical Home
Ford, A., Reddick, K., Browne, M., Robins, A., THOMAS, S. & Quinn S. (2009). Beyond the cathedral: Building trust to engage
the African American community in health promotion & disease prevention. Health Promotion Practice, 10, 485-489.
Health Advocates In-Research and Research (H.A.I.R.)
Network of Black Barbershops & Beauty Salons
Linnan, L., THOMAS, S., D’Angelo,
H., & Ferguson, Y. (2012). African
American barbershops and beauty
salons: An innovative approach to
reducing health disparities through
community building and health
education In M. Minkler (Ed.),
(3rd Edition). New Brunswick,
NJ: Rutgers University Press.
SCHOOL OF PUBLIC HEALTH § MARYLAND CENTER FOR HEALTH EQUITY
DANGER AND OPPORTUNITY
Photo Credit: Sandra Quinn
National Institute on Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
The danger is to assume that:
1. racism is not relevant in the scientific pursuit of
solutions for the elimination of health disparities;
2. that some populations will always suffer premature
illness and death by virtue of their culture bound
lifestyle choices; and thus,
3. that the elimination of disparities is impossible and
health equity unachievable in a free market society.
Thomas, S. B., S. C. Quinn, Butler, J., Fryer, C..S., Garza, M.A. (2011). "Toward a
Fourth Generation of Disparities Research to Achieve Health Equity." Annual
Review of Public Health 32(1): 399-416
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
The opportunity is to recognize health
disparities as an issue of justice because specific
groups were subjected to systematic racial
discrimination and denied the basic benefits of
society, a violation of the social contract.
Boucher, David and Paul Kelly, eds. 1994.The Social Contract from Hobbes to Rawls,
New York: Routledge
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
ACHIEVING HEALTH EQUITY
“…we can no longer be victims of inaction. Our role as
scientists is to provide the knowledge and perspectives
for effective practice and policies… We have a moral
obligation in our society to do what is necessary to
improve health, and the health disparities research
community should be in the vanguard of that
movement” (Ruffin, 2010, p. S9).
Ruffin J. 2010. The Science of Eliminating Health Disparities: Embracing a New Paradigm.
American Journal of Public Health. 100:S8-S9
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
Acknowledgement & Disclaimer
 The projects described are supported by Award
Numbers 7RC2MD004766 and PG60MD000207 from
the National Institute on Minority Health And Health
Disparities (NIMHD).
 The content is solely the responsibility of the authors
and does not necessarily represent the official views
of the NIMHD or the National Institutes of Health.
National Institute of Minority Health and Health Disparities and Office of the Director, National Institutes of Health
American Reinvestment and Recovery Act RC2MD004766; Principal Investigators: Sandra Quinn & Stephen Thomas
THANK YOU VERY MUCH !
Stephen B. Thomas, PhD.
Professor, Department of Health Services Administration
Director, Maryland Center for Health Equity
School of Public Health
The University of Maryland
[email protected]
www.healthequity.umd.edu
www.twitter.com/umdhealthequity