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Structural Ways to Advance Health Equity MPHA
June 4, 2014
Vayong Moua, MPA
Senior Advocacy and Health Equity Principal
Center for Prevention, Blue Cross and Blue Shield of MN
“Of all the forms of
inequality, injustice in
health care is the most
shocking and inhumane.”
― Martin Luther King Jr.
Spirit Catches You and You Get Up!
Blood Money Bleeding Blue
“The Minnesota Settlement has
been recognized as one of the
most important public health
events of the second half of the
20th Century” - C. Everett Koop, U.S. Surgeon General
1982-1989
Center for Prevention: OUR HISTORYAugust 1994
Blue Cross and the State
of MN file a historic
lawsuit against tobacco
manufacturers
January 1998
Tobacco trial
begins
May 1998
Blue Cross
announces
landmark
settlement
with the
tobacco
industry
November 2001
Blue Cross files
plan to use tobacco
settlement
proceeds to reduce
tobacco use and
improve health
July 2002
Class action
lawsuit filed
against Blue
Cross; plan
put on hold
September 2005
Court approves
end of related
lawsuit
January 2006
Blue Cross
launches
Prevention
Minnesota, a
statewide
initiative to
improve the
health of all
Minnesotans
‘94 ‘98 ‘01 ‘02 ‘05 ‘06 ‘07
October
2007
Freedom to
Breathe law
goes into
effect
‘12
Spring 2013
Working to pass a significant
increase in the tobacco tax
Funding 13 new Health Equity
in Prevention contracts
‘10
May 2010
MN Complete
Streets
legislation signed
June 2010
Nice Ride MN
launches in
Minneapolis
WE ARE IN THE BUSINESS OF…
> Creating healthy communities
> Changing norms, attitudes and behaviors through public awareness initiatives
> Reducing health inequities
> Advocating for policy changes
> Evaluating and continually improving our work
This requires an INNOVATIVE APPROACH
7
This is what we’re up against!
9
WHO IS THE TARGET AUDIENCE?
Social Determinates Or Political Determinants of Health?
Reframing Health: Pulling Togetherhttp://www.youtube.com/watch?v=E2AKhdOge3E
Courageous Conversations: EQ and Cultural Competence
Layers of Racism
Internalized—The set of private beliefs, prejudices, and ideas that individuals have about the
superiority of whites and the inferiority of people of color. Among people of color, it manifests as
internalized oppression. Among whites, it manifests as internalized racial superiority.
Interpersonal—The expression of racism between individuals. It occurs when individuals
interact and their private beliefs affect their interactions.
Institutional—Discriminatory treatment, unfair policies and practices, inequitable opportunities
and impacts within organizations and institutions, based on race, that routinely produce racially
inequitable outcomes for people of color and advantages for white people. Individuals within
institutions take on the power of the institution when they reinforce racial inequities.
Structural—A system in which public policies, institutional practices, cultural representations,
and other norms work in various, often reinforcing ways to perpetuate racial group inequality. It
is racial bias among institutions and across society. It involves the cumulative and compounding
effects of an array of societal factors including the history, culture, ideology and interactions of
institutions and policies that systematically privilege white people and disadvantage people of
color.
> *Adapted from Applied Research Center
Structural Inequities: Race Conscious and Beyond
Structural Racism
“ Structural racism — the normalization of historical,
cultural, institutional and interpersonal dynamics that
routinely advantage white people while producing
cumulative and chronic adverse outcomes for people of
color and American Indians — is rarely talked about.
Revealing where structural racism is operating and
where its effects are being felt is essential for figuring
out where policies and programs can make the greatest
improvements.”
---MDH’S Advancing Health Equity Report
Color Blind = Just Blind
Tragedy and Triumph
> Central Corridor Light Rail
> SHIP’s Evolution
> Tobacco Control and Sacred Use of Tobacco
> Complete Streets …but for who and where?
> Big Tobacco and Big Food/Beverage
(Triangulation of Priorities)
> Tobacco Tax and Health Equity
Unatural and Unacceptable Causes
Our Predisposition for Structural Change
Hello…we already get it!
>Socio-ecological Model
>Social Determinants of Health
>PSE Changes
HiAP = Upstream Alignment and Connectivity
HEALTH EQUITY IN ALL POLICIES (HIAP)
• 21
The Master Framework
HEALTH
BEHAVIORS
INDIVIDUALPerceived
social norms∙ Peers
∙ Family
∙ Culture
Attitudes∙ Benefits
∙ Susceptibility
Self-efficacy∙ Barriers
∙ Skills
Knowledge
SOCIAL
Communities∙ Neighborhoods
Organizations∙ Schools
∙ Worksites
∙ Faith-based
∙ Clinics Family/Friends∙ Traditions
Communications∙ TV
∙ Radio
∙ Internet
∙ Newspaper
STRUCTURAL
Physical environment• Transportation and
Infrastructure
• Roads/bike paths
∙ Convenience stores
Policy environment∙ Health policies
∙ Laws and enforcement
∙ Economic policies
∙ Social policies
Industry∙ Marketing
∙ Lobbying
∙ Practices
∙ Products
Demographics
Biology
Culture∙ Social norms
∙ Behavior
∙ Tobacco Use
∙ Exposure to SHS
∙ Physical Activity
∙ Healthy Eating
HEALTH
OUTCOMES
Decrease
cardiovascular
risk
Decrease
cancer risk
Health Equity By Design: (Un) Common Good
> Embed Health Equity Criteria in projects,
plans, programs, and policies
> Local and Regional PSE
> Community Organizing and Coalition Building
Among Unusual Suspects
> Interrogate Common Good/Population Health
Health in All Policies (HiAP)
Recommendations from National Prevention Council, US Surgeon General
• Facilitate collaboration among diverse sectors (e.g., planning, housing, transportation, energy, education, environmental regulation, agriculture, business associations, labor organizations, health and public health) when making decisions likely to have a significant effect on health.
• Include health criteria as a component of decision making (e.g., policy making, land use and transportation planning).
• Conduct comprehensive community health needs assessments
and develop state and community health improvement plans.
Structural Inequities Requires Structural Equity
> Health Impact Assessments: Healthy Corridor
for All
> Seattle King County Equity Ordinance
> EXECUTIVE ORDER S-04-10
> HiAP and/or Equity Cabinet in MN?!
> HiAP Toolkit (for and from MN)
Full Integration: Universal Design and Cultural Tailoring
Health Equity: 5p’s
–Principles
–Plans
–Projects
–Practices
–Policies
Structural Opportunities: Fight for Equity in Process and Outcome
> Move MN (Active and
Equitable
Transportation)
> Thrive 2040 (and beyond)
> SHIP 3.0
> Food Charter
> Comprehensive Plans
> Municipal/County policies
> DHS’s Cultural and Ethnic
Communities Council
> Equity Cabinet plus
> HiAP Toolkit Underway
>Leverage MDH’s
Health Equity
Report
34
Solutions for Most Vulnerable= Solutions for All
Transportation Equity: About 1/3 of Americans Do Not Drive
This includes:
>21% of Americans over 65.
>All children under 16.
>Many low income Americans
who cannot afford automobiles.
>Community members who
choose not to or cannot drive Dan Burden, pedbikeimages.org
36
HEALTH EQUITY AND TRANSPORTATIONThe Transportation Prescription
“ For too long now, our
transportation decision
making has failed to address
the impacts that our
infrastructure network has on
public health and equity.”
-Congressman James Oberstar
Community Competence: Early, Often, and Authentic Engagement of Diverse Communities
MDH’s Recommendations for Advancing Health Equity throughout Minnesota
1: Advance health equity through a health in all policies approach across all sectors
2: Continue investments in efforts that currently are working to advance
health equity
3: Provide statewide leadership for advancing health equity
4: Strengthen community relationships and partnerships to advance health
equity
5: Redesign MDH grant-making to advance health equity.
6: Make health equity an emphasis throughout MDH
7: Strengthen the collection and analysis of data to advance health equity
Next steps: Air and Ground Support for MDH
Establish the Minnesota Center for Health Equity
Implement the Advancing Health Equity
recommendations
Convene and coordinate a cabinet-level health
equity effort
Change Equation
Sick and Tired of being Sick and Tired…time for action
1. Prioritize, centralize, and integrate health equity
throughout
2. Focus on mutual capacity building
3. ID key PSE changes to advance Heq in process
/outcome through cross cultural alliances
4. Counter and reframe popular notions that
perpetuate status quo: Create the (un)common
good
Quantum Civics: Be the Policy Maker
Question Bank
> How is it that a nation legally committed to equal opportunity
for all—regardless of race, creed, national origin, or gender—
continually reproduces patterns of racial inequality?
> Why, in the world’s wealthiest country, is there such enduring
poverty among people of color?
> How is it that in our open, participatory democracy, racial
minorities are still underrepresented in positions of power and
decision making?
> Why does Minnesota have some of the worst inequities in
health, education, housing, employment, etc. ? What conditions
allow this to happen and be maintained?
Resources
STRUCTURAL RACISM AND COMMUNITY BUILDING:https://www.aspeninstitute.org/sites/default/files/content/docs/rcc/aspen_structural_racism2.pdf
MDH’s Advancing Health Equity Report:http://www.health.state.mn.us/divs/chs/healthequity/
Forthcoming: Health in All Policies Toolkit (BCBS of MN and PHLC)
THANK YOU
45
Vayong Moua, MPA
Senior Advocacy and Health Equity
Principal
1750 Yankee Doodle Road, s113
Eagan, MN 55121
651-662-9530
Vayong_moua@bluecrossmn.com
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