community organizing for health equitycommunity organizing for health equity. luis manriquez, md....
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Community Organizing for Health Equity
Luis Manriquez, MDAssistant Clinical Professor WSU Elson S Floyd College of Medicine
Regional Organizer, Health Equity CircleCo-Director Health Equity Organizing, IAF-NW
Montana Primary Care Association 5/1/2019
Disclosure
Dr. Manriquez declares that he has no financial interest, arrangement or affiliation with any organization providing
commercial support for this activity.
What is Health Equity?
Genetic/ Epigenetic
Inheritance
Behavioral factors
Exercise
diet
smoking
Social Determinants
Healthcare
Neighborhood Housing
Employment
Education
Determinants of Equity
Onion model adapted from Camara Jones
Racism
SexismAbleism
Gender Identity
Homophobia
Classism
Healthy food
Urban/rural
What is Health Equity?
Genetic/ Epigenetic
Inheritance
Behavioral factors
Exercise
diet
smoking
Social Determinants
Healthcare
Neighborhood Housing
Employment
Education
Determinants of Equity
Onion model adapted from Camara Jones
Racism
SexismAbleism
Gender Identity
Homophobia
Classism
Healthy food
Urban/rural
Odds Against Tomorrow2012 report on health inequities in Spokane
• 13.5 year difference in mean age of deathbetween non-Hispanic white and Native Americans
• This is because of the social determinants of health and social determinants of equity
• Nearly 18 year difference in life expectancy from Southgate to Riverside (downtown)
Social Determinants of Health
• 1. As a determinant of health, medical care isinsufficient for ensuring better health outcomes.
• 2. How do we intervene without medicalizing SDoH?
• 3. What (new) data are needed?
Magnan, S. 2017. Social determinants of health 101 for health care: five plus five. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC.https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five.
Social Determinants of Health
• 1. Improve daily living conditions
• 2. Tackle the inequitable distribution of power, money, resources
• 3. Measure and understand the problem and assess the impact of action
Magnan, S. 2017. Social determinants of health 101 for health care: five plus five. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC.https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five.
Community Health Center Roots
Community Health Center Roots
Community organizing
Broad based alliances of community institutions that come together to use their collective power to advance a vision of the common good
Community organizing
Community organizing for health
Our concept of health is to make social change, to build the institutions that make social change, and to keep it going.
We call it community health action-H Jack Geiger, MD
The doctors role in Health Equity
If “structural competency is taken to imply that physicians can change politically determined social determinants of health in the course of the clinical encounter,
I disagree
Health Equity Organizing
EducationHealth Equity Circle
Clinical trainingResidency curriculum
Clinical practiceClinic Based Organizing
Health Equity CircleNetwork of inter-professional student organizations in WA, OR, MT, WY
Tent city ordinanceHEC Lobby day
Residency Curriculum
Medical residency training programs
Cherry Hill Family MedicineOHSU Family Medicine
Best starts for kids: $392 million levy king county, most comprehensive approachto early childhood development in the nation
Clinic Based Organizing
Clinic as base for organizing staff, patientsand community organizations to address the social determinants of health
Country Doctor, SeattleOHSU Richmond clinic, Portland
Portland: $67 million increased funding for affordable housing
Questions?