Category Archives: Disparities
Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.
The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.
Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.
Every two weeks the Agency for Health Care Research and Quality (AHRQ) releases an Innovations Exchange newsletter in order to share innovative health practices from around the country that can be adapted by other communities. The Innovations Exchange supports the Agency's mission to improve the quality of health care and reduce disparities.
The current issue focuses on school-based programs for youth at risk. According to AHRQ, many adolescents—particularly those in minority and low-income communities—lack access to health information, preventive care, and clinical services, leaving them at risk for untreated physical and mental health issues. School-based health care delivery, according to AHRQ, can improve access to care and address the needs of this vulnerable population.
The featured innovations for at risk youth include:
- A school-based program to reduce type 2 diabetes risk factors for children and young adults;
- An inner city school district's reproductive health services model;
- A school-based health center that improved access to mental health services, particularly for minorities.
The newsletter also features quality tools that schools can use to support HIV and STD prevention programs in schools and to facilitate school-based preventive, mental health, nutrition, and oral health services.
>>Read the latest issue of the AHRQ Innovations Exchange.
As research builds showing that where you live has a big impact on how healthy you are, organizations and businesses across the country are joining the dialogue on how to create healthier communities. Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it takes, to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.
Jason Q. Purnell, PhD, MPH, Assistant Professor at the Brown School of Social Work and Public Health at Washington University in St. Louis, was a panelist at the St. Louis Conversation on Community Health, along with Jackie Joyner-Kersee and others. Recently, Dr. Purnell shared his vision for community health, and the critical role of broad collaboration across sectors, with NewPublicHealth.
NewPublicHealth: What's your vision of a healthy community?
Jason Purnell: My vision for a healthy community includes the elimination of health disparities by race and ethnicity and socioeconomic status. It involves everyone, regardless of zip code or net worth, having the resources to lead full, productive lives. I follow the World Health Organization in its holistic focus on social, emotional, and physical well-being rather than a more narrow focus on disease prevention. A healthy community allows everyone in its boundaries to express their full potential; it allows them to participate in the life of the community, in life itself, to the fullest extent possible.
NPH: Your efforts have included collaboration across psychology, public health, oncology, and primary care. Similarly, the Conversation on Community Health series includes participants from across sectors. Why does public health require such broad collaboration?
The state of Maryland recently passes legislation to address health disparity issues through “health enterprise zones.” The legislation allows local non-profits, health agencies, and local health providers to work together to address this critical issue through innovative public health strategies including tax incentives, financial awards and capital improvement funding for physicians and health care organizations.
Lt. Governor Anthony Brown of Maryland played a key role in establishing the zones, and spoke about them in session at yesterday’s GOVERNING Summit on Healthy Living. Lt. Governor Brown gave some important background on his personal push to establish the health enterprise zones, explaining that his father was a doctor who “taught a lesson of service.” For decades, he said his father saw and cared for patients in some of the poorest neighborhoods in New York. “I saw the file cabinets of unpaid invoices. My father taught me we have a responsibility to serve and care for our neighbors.”
Brown told the audience that, “as we look at health reform, there are real opportunities to address disparities in health. As we expand access, we need to increase quality and equity. I believe we can eliminate health disparities.” NewPublicHealth had the opportunity to speak with Lt. Governor Brown about health enterprise zones.
NewPublicHealth: Is this the first time that a health enterprise zone has been implemented?
Health disparities and social equity were key issues addressed at last month’s American Public Health Association (APHA) annual meeting. Angela Glover Blackwell, founder and CEO of PolicyLink, a national research and action institute whose goal is to advance economic and social equity, participated in the APHA president’s panel on the topic, where a key part of the discussion focused on the language used to discuss health disparities in the United States.
NewPublicHealth followed up with Angela Glover Blackwell to get her insights on the language of health disparities.
NewPublicHealth: During the panel at the APHA meeting, you talked about the need to be mindful of the language we use when talking about improving health for all Americans. How should we be characterizing the issues?
Angela Glover Blackwell: It is certainly good to see that the health world, public health and beyond, is talking about health disparities. Because for many years this was not anything that people talked about and it was not a topic at the American Public Health Association or any of the other big main stream meetings where health professionals gathered. So it’s a good thing that people have begun to talk about health disparities.
But, health disparities really talks about things being unequal. That’s what disparity means—unequal, different. But I don’t think that disparity captures what the condition is, nor does it suggest what the solution is. What I have heard others say and I have taken it on myself is the term health inequities, because the term “inequities” suggests unjust, unfair, and not just different. When you call them health inequities you focus on a societal problem that needs to be corrected, not just studied. The goal becomes achieving health equity, just and fair health outcomes.
It’s time that we recognize that we have unequal, unjust, unfair health outcomes and that they are related to race, and income, and place and we need to get sharp strategies that move us towards being able to help all people reach their full potential.
NPH: Where do we need to take the conversation from here?
A host of sessions focused on health equity at this year’s American Public Health Association meeting. Panel topics varied greatly, from the effects of health inequity on education outcomes to creative marketing strategies for reaching vulnerable populations; but overall, a few key themes emerged:
- Health inequities must be addressed as locally as possible
- Prevention is crucial
- Organizations must strive for greater diversity, especially in leadership
- In fiscal crunches, health equity requires creativity and commitment
Read more about these themes below.
Inequities in health must be assessed and addressed on a local level, whether by region, city, neighborhood or even block-by-block.
The California Endowment started the conversation by covering the conference halls with images from their Health Happens Here campaign, which draws attention to the vast differences in life expectancy that can exist from one zip code to the next. [Read more in a Q&A with California Endowment president Robert Ross.]
Economic constraints cause many Latinos to settle in low-income neighborhoods that have limited access to affordable healthy food options, playgrounds and parks, and pedestrian and bike-friendly streets. Instead, these neighborhoods have fast food restaurants that offer primarily nutrient poor food and, limited resources for recreation which limit physical activity options.
“Latinos will tell you it’s too hard to get fruits and vegetables,” Said Dr. George R. Flores, MD, MPH, Board of Directors, Latino Coalition for a Healthy California at APHA 2012. “Inequality in the social and physical environments in Latino communities contributes to the obesity epidemic by failing to provide opportunities for healthy eating and physical activity.”
Latino populations on average have some of the highest rates of obesity, which can have the severe consequence of type 2 diabetes. The diets of Latino children are higher in fat and lower in fruits and vegetables.
Much attention has been paid on NewPublicHealth and elsewhere to the connection between education, health, economic opportunity, and even life expectancy. Sadly, when we consider the health and life trajectories for our young men of color in this country, it’s clear that we have a lot of work to do. Boys and young men of color are more likely to grow up in poverty, live in unsafe neighborhoods and attend schools that lack the basic resources and supports that kids need in order to thrive. In addition, actions that might be treated as youthful indiscretions by other young men often are judged more severely and result in harsher punishments that have lasting consequences. Only about half of African American, Hispanic and Native American boys graduate from high school on time with their cohort. Down the road, pathways to stable, productive employment can be limited – they commonly lack access to career and positive mentorship connections. And disparities in their access to and quality of health care services persist.
RWJF Program Officer Maisha Simmons attests that the options for our young men of color have been too limited for too long. That’s why today the Robert Wood Johnson Foundation (RWJF), through its Vulnerable Populations portfolio, launched the Forward Promise initiative to strengthen education opportunities, pathways to employment and health outcomes for boys and young men of color. A new Call for Proposals released by the initiative today will focus on the following areas:
- alternative approaches to harsh school discipline that do not push students out of school;
- solutions that focus on dropout prevention and increasing school graduation rates;
- mental health interventions that tailor approaches to boys and young men who have experienced and/or been exposed to violence and trauma; and
- career training programs that blend workforce and education emphases to ensure that students are college- and career-ready.
NewPublicHealth caught up with Maisha about the challenges facing young men of color and the quest for collaborative solutions.
NewPublicHealth: Paint us a picture of the health and quality of life of young men of color. What are some of the causes of the disparities that persist?
Maisha Simmons: If you look at the statistics around men of color, specifically African American men, they usually die sicker and younger than any other population in this country. There are a lot of variables, but what we’ve begun to focus on is, what are some of the non-traditional, non-medical factors that go into that?
So for us, we began to really focus on education, workforce and mental health issues and how they coincide with opportunities for health. When you look at young men and boys of color, their school outcomes are often worse. There are large number of young men not finishing school and they often don’t finish high school with their cohorts. We know the linkages between school and employment often have a collective impact on health outcomes.
NPH: What are some other experiences that influence the health and quality of life of young men of color?
Preterm babies are born at a higher rate in the US than in 130 other countries, including many poorer nations, according to a report released today, Born Too Soon: The Global Action Report on Preterm Birth, published by the March of Dimes and almost fifty other groups, including the World Health Organization.
Preterm birth (birth before 37 weeks completed gestation) is the leading cause of newborn death in the US—nearly half a million US babies are born too early each year. Babies who survive an early birth often have breathing problems, cerebral palsy, intellectual disabilities, and other lifelong problems. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants, and the costs exceed $26 billion each year. “While our country excels in helping preemies survive, we have failed to do enough to prevent preterm births and help more mothers carry their babies full-term," says Jennifer L. Howse, president of the March of Dimes.
The report also highlights health disparities for newborns in the US. The rate of preterm births for African American mothers is 18 percent; the rate for white mothers is 11 percent.
Worldwide, the new report finds that 15 million babies are born preterm each year, and more than one million die due to preterm complications. Of these babies, the report notes, three-quarters could be saved if current cost-effective interventions were made more widely available. Those interventions, according to Dr. Howse, include:
- Giving all women of childbearing age in the U.S. access to health care, including adolescents, and including care before, between, and during pregnancy
- Behavioral changes to reduce the risk of an early birth, such as not smoking during pregnancy
- Progesterone treatments for women who have had a previous preterm birth
- Better management of fertility treatments that result in multiple births
- Hospital quality improvement initiatives to reduce early inductions and Cesarean deliveries before a full 39 weeks of pregnancy unless medically necessary
“This report underscores the need for action to reduce premature birth in the U.S., and state and territorial health officials have a critical role in championing and implementing proven solutions,” says David L. Lakey, M.D., president of the Association of State and Territorial Health Officials and Commissioner of the Texas Department of State Health Services. “Interventions that promote full term, 39-week pregnancies and improve the health of babies can significantly reduce health care costs.” Reducing preterm births is Dr. Lakey’s Presidential Challenge during his term as ASTHO president.
In February, the Department of Health and Human Services announced “Strong Start," an initiative that includes funding for enhanced prenatal care and hospital quality improvement programs. And the March of Dimes has launched its “Healthy Babies Are Worth the Wait” campaign to let women know that if their pregnancy is healthy, it’s best to wait for labor to begin on its own rather than scheduling a delivery. Elizabeth Mason, MD, director of the Department of Maternal, Newborn, Child and Adolescent Health for the WHO says model practices in other countries that have reduced preterm births include creating medical homes for expectant mothers, reducing hospital infection rates and both prenatal care and care throughout a pregnancy to monitor for concerns.
Christopher Howson, PHD, Vice President for Global Programs at the March of Dimes Birth Defects Foundation, says the current worldwide rate of preterm births could be halved by 2025 if the recommended interventions are carried out. “That is eminently, eminently feasible,” says Howson.
Bonus Reading: For a state-by-state breakdown of preterm birth rates within the U.S., see the March of Dimes 2011 Premature Birth Report Card online at marchofdimes.com/prematurity.