Pioneering Community Based Change to Achieve Health Equity

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1 Pioneering Community Based Change to Achieve Health Equity Plenary Presentation: The Pioneering Healthier Communities Conference Renaissance Mayflower Hotel July 25-27, 2011 Washington, DC

2 Stephen B. Thomas, PhD. Professor, Department of Health Services Administration Director, Maryland Center for Health Equity School of Public Health The University of Maryland

3 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 Craig S. Fryer, DrPH, Mary A. Garza, Ph.D., Stephen B. Thomas, Ph.D., Sandra C. Quinn, Ph.D. and James Butler, III, DrPH

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5 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 1. The Opportunity 2. The Challenge 3. The Framework 4. Danger and Opportunity 5. Where Do We Go From Here?

6 THE OPPORTUNITY

7 Disease Prevention: "We have made some progress towards eliminating health disparities. Yet there is much unfinished business. We have to reexamine our strategy and accelerate the pace through innovative, sustainable and results-oriented approaches... " (Dr. John Ruffin, Director, NIH-NIMHD, 2010)

8 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 VISION To be a vibrant contributor to the University of Maryland s re-invigorated land grant mission, which includes a commitment to eliminate racial and ethnic disparities and achieve health equity.

9 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 2010 Affordable Care Act also expands the efforts of the U.S. Preventive Services Task Force an independent panel of internists, family physicians, pediatricians, gynecologists/obstetricians, nurses, and behavior specialists that reviews the effectiveness of preventive services and publishes recommendations for clinical preventive services.

10 THE CHALLENGE

11 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 History of Research Abuses The Infamous Cases

12 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

13 THE FRAMEWORK

14 Institute of Medicine Definition of Health Disparities Differences, Disparities, and Discrimination: Populations with Equal Access to Healthcare SOURCE: Gomes and McGuire, 2001

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16 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 In 2004, the CDC published Actual Causes of Death in the United States. 2000, which identified tobacco (435,000 deaths; 18.1% of total U.S. deaths) and poor diet and physical inactivity (400,000 deaths; 16.6% of total U.S. deaths) as the leading contributors to loss of life (Mokdad,et al, Actual causes of death in the United States J. Am. Med. Assoc)

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18 A health disparity is a particular type of health difference that is closely linked to people who have experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, mental health, cognitive, sensory, or physical disability, sexual orientation, geography, or other characteristics historically linked to discrimination or exclusion."

19 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 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):

20 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 Third Generation Research: A Color Blind Evidence Base Task Force on Community Preventive Services recommended interventions for prevention of obesity and tobacco use. Source: Adapted from The Guide to Community Preventive Services Because limited race and ethnicity data were available, it is unknown if the intervention had differential effects for different racial or ethnic groups

21 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 Ford, C. and Airhihenbuwa C. (2010). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. American Journal of Public Health, 100: S30- S35. Ford, C. and Airhihenbuwa C. (2010). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. American Journal of Public Health, 100: S30- S35.

22 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

23 SCHOOL OF PUBLIC HEALTH CENTER FOR HEALTH EQUITY Fourth Generation Health Disparity Research From the Public Health Critical Race praxis perspective, four key principles should inform intervention research: Health Equity Action Research Trajectory HEART 1. The primacy of racialization, 2. Structural determinism, 3. Critical approaches, and 4. Intersectionality 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): 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

24 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 INNOVATION

25 Health Advocates In-Research and Research (H.A.I.R.) Network of Black Barbershops & Beauty Salons

26 LESSONS FROM EVIDENCE BASED RESEARCH Focus on common risk factors for chronic disease Pre-hypertension and Pre-Diabetes Smoking Obesity Stress Family health history

27 THE FAMILY HEALTH HISTORY

28 THE PEDIGREE: A GENETIC FAMILY HEALTH TREE The goal of the session is to elicit a three-generation pedigree for accurate risk assessment.

29 PROGRAM ACTIVITIES Physical Activity Nutrition Education & Guidance Stress Management Smoking Cessation Family Health History Self-Management of Chronic Disease Referral to Medical Home

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32 DANGER AND OPPORTUNITY

33 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 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):

34 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 The Social Contract from Hobbes to Rawls, New York: Routledge

35 WHERE DO WE GO FROM HERE?

36 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 The Science of Eliminating Health Disparities: Embracing a New Paradigm. American Journal of Public Health. 100:S8-S9

37 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 project described was supported by Award Number 7RC2MD 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.

38 THANK YOU VERY MUCH!

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