Health equity Flashcards
Health equity
the attainment of the highest level of health for all people
additionally, no one is disadvantaged from attaining the highest level of health, because of social position or other socially determined circumstance s
-healthy people and cdc
Health Inequity
difference in health outcomes, rooted in social and structural inequities that are avoidable, unfair and unjust
-NACCHO and PBHC
Health disparities
the metrics we use to measure progress toward achieving health equity
-paul braveman
determinant of health
social and economic factors 40%
health behaviors 30%
genes and biology is 10%
clinical care 10%
physical environment 10%
social factors attributable deaths
-low education (highest deaths) 245,000
-racial segregation
-low social support
-poverty (individual and -area)
-income inequality
-Acute MI
-cerebrovascular disease
-lung cancer
social determinants of health
1 education access and quality
- health care access and quality
- economic stability
4.neighborhood and environment
- social and community context
economic stability
-employment
-income
-expenses
-medical bills
-support
-debt
neighborhood and physical environment
-housing
-transportation
-safety
-parks
-playgrounds
-walkability
-zip code and geography
education
literacy
language
early childhood education
vocational training
higher education
food
hunger
access healthy options
community and social context
social integration
support systems
community engagement
discrimination
stress
health care system
-health coverage
-provider availability
-provider linguistic and
-cultural competency
-quality of care
Health Outcomes
Mortality, Morbidity, Life Expectancy, Health Care Expenditures, Health Status, Functional Limitations
WHO Commission on the Social Determinants of Health
The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.
The structural roots of health inequities lie within education, taxation, labor and housing markets, urban planning, government regulation, health care systems, all of which are powerful determinants of health, and ones over which individuals have little or no direct personal control but can only be altered through social and economic policies and political processes.”
Health Impact Pyramid
increasing population impact will: decrease the counseling and education, clinical interventions, long lasting protection interventions, changing the context to make individuals default decisions healthy
there is a increasing need of individual effort needed in these areas
inequality
unequal access to opportunities
equality
evenly distributed tools and assistance
equity
is the customs and tool used to address inequality
justice
fixing a system to offer equal access to both tools and opportunities
institutional racism
occurs on a level of institutions.
This is when policies, practices, and systems within institutions create and sustain racialized outcomes, either intentionally or unintentionally.
racial equity
both an outcome and a process. we achieve RACIAL EQUITY when race no longer determines outcomes
we apply racial equity when those most impacted by racism are involved in decisions that impact their lives
intersectionality
refers to a view of seeing different forms of inequalities and work together and exacerbate(worsen) each other, for example inequalities based on race, sexuality, gender, class, etc. can simultaneously affect an individuals
structural racism
Occurs underneath, all around, and across institutions and society.
Cumulative and compounded effects of factors that systematically privilege white people and disadvantage people of color
key indicator of the health & well-being of a society
Maternal Mortality
Out of 11 of the most industrialized & high income countries, the US has the highest rates of
maternal mortality and this rate is continuing to grow.
66% to 80%
pregnancy related deaths in the US can be prevented.
U.S. 2020= 23.8 deaths per 100K births
3 measures to describe maternal deaths in US
Pregnancy-associated mortality: Deaths during pregnancy and up to 1 year after, regardless of cause
Pregnancy-related mortality: Death during and up to a year after, from any cause related to pregnancy or its effects
***Maternal mortality:Death during or within the last 42 days of pregnancy, from any cause related to pregnancy or its management
Non -Hispanic blacks- maternal mortality
have highest death rates, worsening each year
the maternal morality rates have increased every year for all races
YES
While maternal mortality rates are the highest in all age groups. Women ≥40 have the highest of all.
TRUE, 40 and older have highest mortality rates
black women face 3x the mortality risk than whites
Maternal mortality rate for Black women:
55.3 deaths per 100,000 live births
Maternal mortality rate for women aged ≥ 40:
107.9 deaths per 100,000 live births
About 7.8 times higher than the rate for women under age 25
Common causes of maternal death for Black Women compared to non black women are
-Cardiomyopathy,
-thrombotic pulmonary embolism,
-hypertensive disorders
stats for black women vs white women
-Postpartum cardiomyopathy, preeclampsia & eclampsia were 5 times higher…
-Obstetric embolism were 2.3 times higher…
-Obstetric hemorrhage were 2.6 times higher…
Why do disparities exists?
- structural racism: legalizing and normalizing of system placed by society (workplace, healthcare systems and schools) reinforce racists agendas.
- implicit bias: Unintentional association towards a group of people, which affects judgements, decisions & behaviors
- Underlying chronic conditions- more likely to experience conditions like hypertension diabetes and cardiovascular disease
- Variations in healthcare quality: there is a smaller percentage of OB GYNs and nurses who are black
common misconceptions- people will interpret health inequities in 3 frames of status quo
- personal responsibility
unfortunate but not unjust - nothing can be done
overcoming resistance requires creating opportunities for people to challenge their own assumptions
Redlining & Housing Segregation
Redline and Housing Segregation: housing segregation contributes to disparities in health, income, jobs, education
BECUASE fha WOULD refuse the african american morgages they had to live in segregated proverty areas.
Federal Housing Administration, which was established in 1934, furthered the segregation efforts by refusing to insure mortgages in and near African-American neighborhoods — a policy known as “redlining.”
At the same time, the FHA was subsidizing builders who were mass-producing entire subdivisions for whites — with the requirement that none of the homes be sold to African-Americans.
In fact, when African-Americans tried to buy homes in all-white neighborhoods or in mostly white neighborhoods, property values rose because African-Americans were more willing to pay more for properties than whites were, simply because their housing supply was so restricted and they had so many fewer choices.
On the maps these areas where african americans lived were marked red
Math Scores Fell in Nearly Every State, and Reading Dipped on National Exam
We need to be doing something to target our resources better at those students who have been just historically underserve.
The pandemic laid bare the deep and troubling inequalities that dominate many aspects of American life — especially in education.
In fourth grade, for both math and reading, students in the bottom 25th percentile lost more ground compared with students at the top of their class, leaving the low-performing students further behind.
And Black and Hispanic students, who started out behind white and Asian peers, experienced sharper declines than those groups in fourth-grade math.
Black and Hispanic students are more likely to attend schools segregated in poverty, and those schools stayed remote for longer than wealthier schools did during the pandemic, deepening divide.
the lack of access to in person class further worsened inequalities of education for colored students.
PROBLEMS WITH overturned rode vs wade
Black, Hispanic, women have more limited access to health care, which affects women’s access to contraception and other sexual health services that are important for pregnancy planning.
Many women of color also report discrimination/ These factors have contributed to medical mistrust, which some women cite as a reason that they may not access contraception.
In addition, inequities across broader social and economic factors such as income, housing, and safety and education — that drive health, often referred to as social determinants.
women across racial and ethnic groups DID NOT WANT the Supreme Court to overturn the Roe v. Wade decision and oppose criminalizing clinicians who provide abortion services. BECAUSE WOMEN CAN MAKE OWN DECISIONS.
Dobbs v. Jackson Women’s Health Organization- up to each state to make laws NOT FEDERAL ANYMORE
BLACKS AND INCARCERATION
Our jails and prisons are filled with people who have been targeted by overpolicing for conduct related to homelessness, substance use, and mental health.
Too many people of color have been killed at the hands of the police.
Many people who can’t pay court fines and fees or bail for minor violations face license suspensions and jail time, essentially criminalizing poverty.
Prosecutors perpetuate an unjust system that imprisons more people than anywhere in the world.
FACTORS OF INCARATION
GEOGRAPHY: roughly half of all people incarcerated in local jails are in smaller cities and rural communities.
state level: the story of U.S. incarceration has been one of remarkable growth
WOMEN: women of color single moms low income.
the number of women held in local jails and prisons has grown exponentially in the last several decades, outpacing rates of growth for men.
RACISM: People of color―and Black people in particular―are incarcerated at strikingly higher rates than white people in jails and prisons across the country.
