Righting the Wrong of Social Injustice in Health

The Health-Wealth Connection SymposiumJune 23, 2010

Maxine Hayes, MD, MPHWashington State Department of Health

Mission of Public Health

Assure health, safety and quality of life for everyone!

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“Public Health ≠ Publicly Funded or Charity Medicine”

Philosophy behind Science:to discover truth

Philosophy behind Medicine: use that truth for a patient

Philosophy behind Public Health:use that truth for everyone

19941994Life expectancyLife expectancy

= = 7575 years years

25 of these years 25 of these years are due to are due to advances in public advances in public healthhealth

19001900Life expectancyLife expectancy

== 4545 yearsyears

Our Life Span Has Increased By 30 Our Life Span Has Increased By 30 Years Since 1900*Years Since 1900*

Our Life Span Has Increased By 30 Our Life Span Has Increased By 30 Years Since 1900*Years Since 1900*

*United States

Health OlympicsHealth Olympics 2002

UN Human Development Report 20

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WHY?

Not everyone has equal opportunity for health

Health Disparities vs. Inequities

• Disparity only defines differences between groups.

• Inequity describes the “causes” of disparities in the context of environmental conditions that are required to generate parity and equality.

Inequities result in disparities in health status that are “unfair, unjust, avoidable and unnecessary.”

“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”

Martin Luther King Jr. – March 25, 19662nd National Convention of the Medical Committee for Human Rights

“Nowhere are the divisions of race and ethnicity more sharply drawn than in the health of our people…no matter what the reason, racial and ethnic disparities in health are unacceptable in a country that values equality and equal opportunity for all.”

Bill Clinton – February 21, 1998

Healthy People 2010 addressed the need to eliminate disparities, but these disparities are

rooted in societal inequities manifested through institutional racism, income gaps, entrenched poverty and social injustice!

A new vision for Healthy People 2020 is needed.

Public health must not lose sight of the importance of attending to the social context of disease prevention and health promotion.

Equalizing opportunities to be healthy requires addressing the most important

social and economic determinants of health including not only health care,

but also living conditions in households and communities, working conditions, racism, and policies that affect any of

these factors

Source: Defining equity in health. J Epidemiol Community Health 2003, 57: 254-258

Social Justice

“When access to certain basic rights, such as good health, education, and fair and equal treatment has been distributed unevenly or denied to certain groups, the problem becomes an issue of social justice”

Healton & Nelson, 2004

The Health-Wealth Relationship is Real!

• Higher income = longer life•Low income = worse health•Less education = worse health•Lower income = more chronic disease

We Know What Determines Health

National Institutes of Health 2000

Institute of Medicine 2001

National Research Council 2001

Institute of Medicine 2000

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EnvironmentalEnvironmentalRiskRisk

Stress dueStress due

To SocialTo Social

FactorsFactors

InstitutionalizedInstitutionalized

Biases Biases (racism, sexism, (racism, sexism,

etc.)etc.)

Language andLanguage andOther CulturalOther Cultural

FactorsFactors

EconomicEconomicOpportunityOpportunityand Equityand Equity

EducationEducationBackgroundBackground

andandOpportunityOpportunity

Mental HealthMental Health

and Socialand Social

SupportSupport

Access to Access to

Health ServicesHealth Services

HealthHealthBehaviors andBehaviors and

PersonalPersonalRisk FactorsRisk Factors

Trust in HealthTrust in Health

System andSystem and

ResearchResearchSOCIAL

DETERMINANTS OF HEALTH

Determinants of Health

LIFE

SPAN

Multiple levels of influence HEALTHHEALTH

Access to Health Care – Access to Health Care – 10%10%

Environment – 20%Environment – 20%

Genetics – 20%Genetics – 20%

Healthy Behaviors – 50%Healthy Behaviors – 50%

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HealthHealthBehaviorsBehaviors

EnvironmentEnvironment

GeneticGeneticMakeupMakeup

HealthHealthCareCare

51%51%

22%22%

17%17%

10%10%

0%0% 20%20% 40%40% 60%60% 80%80% 100%100%

Source: McGinnis, et. al, 2002

What Influences Our Health?What Influences Our Health?

How We Spend Money

0.3%

2.5%

2.5%

97.4%

0% 20% 40% 60% 80% 100%

Health Care

Identify & Mitigate Health RiskFactors

Mitigate Environmental Hazards

Increase Healthy Behaviors

Source: Priorities of Government II, Summer 2004

How We Spend Our MoneyHow We Spend Our Money

TM

Social Environments and Health

Individuals and families are embedded within social, political, and economic systems that shape behaviors and constrain access to resources necessary to maintain health.

Greater emphasis is needed on public health interventions that involve communities, with the goal of collectively identifying resources, needs and solutions…

-- Institute of Medicine, Health and Behavior 2001

Inequalities Start Early

Stress in early life affects physical growth, emotional, social and cognitive development as well as later health and

health behaviors.

Birth/ Adolescence/ Work/ ElderlyChildhood Young Adult Career ParentalSocioeconomic Educational Occupation

RetirementResources Attainment & Income Income Health Health Health Health

Reaching for a Healthier Life , Facts on SES and Health in the U.S. MacArthur Foundation

Public Health Action:Speak Truth to Power!

Work with others to attack the “root causes” of disease, illness to assure

health.

Health Equity in ALL Policies!

Timing is Everything!

“We must all have the audacity to believe we can transform the current system”

Maxine Hayes, MD, MPH

References• Overcoming Obstacles to Health

– RWJ Foundation 2/2008• The Spirit Level – Richard

Wilkinson and Kate Pickett (Why Greater Equality Makes Societies Stronger)

• The Stakes for Women of Childbearing Age in Health Reform – CDC 8/10/2009 - MMWR

• Health Equity and Children’s Rights – Pediatrics, Volume 125, #4, 4/2010, 125; 838-849

• Building on a Life Course Perspective in Maternal Child Health – editorial, Maternal and Child Health Journal, Volume 7, no. 1, 3/2003

• Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective – Maternal and Child Health Journal, Volume 7, no. 1 3/2003

• Reaching for a Healthier Life, Facts on SES and Health in the U.S. – MacArthur Foundation