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Tackling health inequities by focusing on structural
determinants Jim Bloyd, MPH June 29, 2016
Advancing the Work: A Social Determinants of Health
Toolkit for Reducing Infant Mortality
Cook County Department of Public Health
1$ Minimum wage increase in 2014 would have likely resulted in 518 fewer post neo-natal deaths; 2790 fewer LBW births (Komro et al 2016 AmJPH)
Leaders of CHE Cook County May 25, 2016 join march at Oak Brook McDonalds shareholder meeting in #FightFor15 and a Union. Photo: Jim Bloyd
Cook County Department of Public Health
Structural Racism: WePLAN2020 Priority
www.cookcountypublichealth.org http://www.cookcountypublichealth.org/about/weplan-feedback WePLAN2020 Forces of Change Assessment http://bit.ly/1V5sKWR Health Issue Prioritization Process Summary http://bit.ly/1VEKWF6
Cook County Department of Public Health
Public Health Leadership Society (2002)
“…addressing the fundamental causes rather than more proximal causes is more truly preventive.”
Cook County Department of Public Health
Public Health Departments should:
• Use social epidemiology • Understand community
power structure • Maximize and work with
grassroots power • Emphasis on human rights • Monitor and track
institutions that create inequities
• Democratize data
Source: Public Health Accreditation Board (2014) http://www.phaboard.org/wp-content/uploads/FINAL_Annual-Report-Section-II-Guidance-Explanations-of-Terms-February-2014.pdf
Cook County Department of Public Health
Inequity in the conditions of daily lives is shaped by deeper
social structures and processes.
World Health Organization, 2008
Cook County Department of Public Health
We have repeatedly referred to Hilary Graham’s warning about the tendency to
conflate the social determinants of health and the social processes that shape these determinants’ unequal distribution, by
lumping the two phenomena together under a single label. Maintaining the distinction is
more than a matter of precision in language. As Graham argues, blurring these concepts
may lead to seriously misguided policy choices.
[emphasis added] Source: Solar & Irwin (2010) p.47
Cook County Department of Public Health
Structural Determinants of health inequities
• “…structural mechanisms are those that generate stratification and social class divisions in the society and that define individual socioeconomic position within hierarchies of power, prestige and access to resources. Structural mechanisms are rooted in the key institutions and processes of the socioeconomic and political context.”
Cook County Department of Public Health
Social Determinants of health
• material circumstances;
• psychosocial circumstances;
• behavioral and/or biological factors; and
• the health system itself. Source: WHO, 2010
Cook County Department of Public Health
All diseases have two causes, one pathological the other
political. Rudolph Virchow (1821-1902)
Fair Housing Act Violations CC v. Wells Fargo
Education Financing
Minimum wage; One Fair Wage, Tipped Income Laws; sick leave
Accountability for Police Shootings
Implementation of US Title IX Pregnant & Parenting Students Civil Right to Equal Education:
Distribution of: Killings by police; Education quality; Income; working conditions; exposure to sexual assault & harassment
Health Inequities in Cook County
Cook County Department of Public Health
Structural inequities to inequities in health outcomes (Graham 2007 modified)
Inequities in the Labor Market
Inequities in the Safety Net
Inequities in the Education System
SOCIAL STRUCTURAL INEQUITIES (EXAMPLES)
INEQUITIES IN SOCIAL POSITION (EXAMPLES)
Inequities linked to sexuality
Race /ethnic inequities
Gender inequities
Social economic inequities
Inequities in health
Behavioral inequities
Environmental inequities
INEQUITIES IN INTERMEDIARY FACTORS
INEQUITIES IN HEALTH OUTCOMES
Cook County Department of Public Health
Power and Health Inequities
“Power, after all, is the heart of the matter—and the
science of health inequities can no more shy away from
this question than can physicists ignore gravity or
physicians ignore pain.”
Jason
Beckfield & Nancy Krieger
Source: Epi + demos + cracy: Linking political systems and priorities to the magnitude of health inequities--evidence, gaps, and a research agenda. Epidemiologic Reviews, 31, 152-77. p. 169
Cook County Department of Public Health
Contact Information
Jim Bloyd, MPH Regional Health Officer
Community Epidemiology & Health Planning
708-633-8314
cookcountypublichealth.org
Cook County Department of Public Health
Social Causes Can Be Linked to Health- Estimated Deaths,USA
2000 Source: Galea etal (2011) doi:10.2105/AJPH.2010.300086
Low Education
245,000
Racial Segregation
176,000
Low social support
162,000
Individual level poverty
133,000
Income inequality
119,000
Area level poverty
39,000
Acute Myocardial Inf
193,000
Cerebrovascular Disease
167,700
Lung Cancer 155,600
Cook County Department of Public Health
Source: Center for Tax and Budget Accountability. (2015) http://bit.ly/1qB3qeA
Cook County Department of Public Health
Child poverty more than 6 times greater in Harvey, IL vs. North
Suburban Cook County
Cook County Department of Public Health
Metro Chicago: Most poor children of color live in concentrated poverty,
while most poor white children do not Source: Diversitydata.org, (2011, from 2000 Census Data)
Neighborhood poverty level
Cook County Department of Public Health
Housing: Nov 28, 2014: Cook County v. Wells Fargo, Inc.
• Staff paid to steer Blacks, Latinos, Women to hi-cost loans
• “ongoing discriminatory practice of ‘equity-stripping’”
• “maximizes lender profits” • “Defendant’s discriminatory
behavior maximized Defendant’s revenue and income”
• “actually resulting in foreclosure…the ultimate denial of housing”
• “violations continue to this very day”
• “segregation…provided an efficient means for Defendants to target potential borrowers”
Cook County Department of Public Health
CCDPH Strategic Plan (2011)
• “To optimize health and achieve health equity for all people and communities of Cook County through our leadership and collaborations….”
• “…we need to make significant changes in how we work…”
• “Because health depends causally on its environmental, economic, technological, informational, cultural and political contexts, social justice is prerequisite to achieving optimal and equitable public health.”
