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Reducing Reducing Health Health
Disparities Disparities through through
PreventionPreventionFrameworks, Frameworks,
Successes, and Successes, and Strategies Strategies
www.preventioninstitute.orgwww.preventioninstitute.org
Jeremy CantorJeremy Cantor, , MPH MPH
Program ManagerProgram Manager
March 7, 2007 March 7, 2007 The California Partnership for The California Partnership for Access to TreatmentAccess to TreatmentSacramento, CASacramento, CA
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Carolyn Porco, of the Space Science Carolyn Porco, of the Space Science Institute, discussing a moon of Institute, discussing a moon of
Saturn. New York Times, 3/10/2006Saturn. New York Times, 3/10/2006
““We have found We have found an environment that an environment that
is potentially suitable is potentially suitable for living organisms.”for living organisms.”
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Is this a suitable environment?Is this a suitable environment?
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African Americans are four times
more likely to die of asthma.American Indians and Alaska Natives are 2.6 times more
likely to have diabetes.
The percentage of Hispanic children living below the poverty line is
three times that of white children.
African American children are five times more likely to be poisoned by lead.
High School Graduation rates: 53% Hispanic, 51% Native American, 50% African American
A Sample of DisparitiesA Sample of Disparities
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ROOT ROOT FACTORSFACTORS
DISPARITIDISPARITIES ES IN IN
HEALTHHEALTH
The Trajectory of Health DisparitiesThe Trajectory of Health Disparities
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DISPARITIDISPARITIES ES IN IN
HEALTHHEALTH
DISPARITIDISPARITIES ES ININ
HEALTHHEALTH
ROOT ROOT FACTORSFACTORS
ENVIRONMENTENVIRONMENTAL AL
FACTORSFACTORS
& BEHAVIORAL& BEHAVIORAL
The Trajectory of Health DisparitiesThe Trajectory of Health Disparities
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HEALTHHEALTH
BEHAVIORBEHAVIORBEHAVIORBEHAVIOR
ENVIRONMENTENVIRONMENT
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DISPARITIDISPARITIES ES ININ
HEALTHHEALTH
DISPARITIDISPARITIES ES ININ
HEALTHHEALTH
ROOT ROOT FACTORSFACTORS
ENVIRONMENTENVIRONMENTAL AL
FACTORSFACTORS
& BEHAVIORAL& BEHAVIORAL MEDICALMEDICALSERVICESSERVICES
The Trajectory of Health DisparitiesThe Trajectory of Health Disparities
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Not the primary determinant of healthNot the primary determinant of health
Treats one person at a timeTreats one person at a time
Often comes late; can’t always restore Often comes late; can’t always restore healthhealth
Medical Care Alone Medical Care Alone Cannot Reduce DisparitiesCannot Reduce Disparities
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No epidemic has ever been resolved by
paying attention to the treatment of the
affected individual.
George W. Albee
““
””
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A Key A Key Opportunity Opportunity
for for PreventionPrevention
DISPARITIDISPARITIES ES ININ
HEALTHHEALTH
DISPARITIDISPARITIES ES ININ
HEALTHHEALTH
ROOT ROOT FACTORSFACTORS
ENVIRONMENTENVIRONMENTAL AL
FACTORSFACTORS
& BEHAVIORAL& BEHAVIORAL MEDICALMEDICALSERVICESSERVICES
The Trajectory of Health DisparitiesThe Trajectory of Health Disparities
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HEALTHHEALTH
BEHAVIORBEHAVIORBEHAVIORBEHAVIOR
ENVIRONMENTENVIRONMENT
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HEALTHHEALTH
BEHAVIORBEHAVIORBEHAVIORBEHAVIOR
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Is it just Is it just behavior?behavior?
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9
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It is unreasonable to expect It is unreasonable to expect
that people will change their that people will change their
behavior behavior easilyeasily when so many when so many
forces in the social, cultural, forces in the social, cultural,
and physical environment and physical environment
conspire against such change.conspire against such change.
““
””Institute of MedicineInstitute of Medicine
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What’s wrong with this picture?
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Causes of DeathCauses of Death
Heart Heart DiseaseDisease
CancerCancer
StrokeStroke
DiabetesDiabetes
Injuries & ViolenceInjuries & Violence
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The same The same injuries and injuries and
illnesses only illnesses only more somore so
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Let’s take a step back...
Causes of DeathActual
Causes of Death
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Heart DiseaseHeart Disease
CancerCancer
StrokeStroke
DiabetesDiabetes
InjuriesInjuries
& Violence& Violence
Diet & Diet &
Activity Activity
PatternsPatterns
TobaccoTobacco
Alcohol Alcohol
& Drugs& Drugs
Making Links to Actual Causes of DeathMaking Links to Actual Causes of Death
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CommunitCommunity Factorsy Factors
Actual Actual CausesCauses
Let’s take anotherstep back...
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Elements of Community HealthElements of Community Health
PeoplPeoplee
PlacPlacee
EquitableEquitableOpportunityOpportunity
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PeoplePeople
PlacPlacee
EquitableEquitableOpportunityOpportunity
Community Health FactorsCommunity Health Factors
EQUITABLEEQUITABLEOPPORTUNITYOPPORTUNITY
Racial justiceRacial justice
Jobs & local ownershipJobs & local ownership
EducationEducation
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PeoplePeople
PlacPlacee
EquitableEquitableOpportunityOpportunity
Community Health FactorsCommunity Health Factors
PEOPLEPEOPLE Social Networks & trustSocial Networks & trust
Participation & Participation & willingness to act for the willingness to act for the common goodcommon good
Acceptable behaviors & Acceptable behaviors & attitudesattitudes
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PeoplePeople
PlacPlacee
EquitableEquitableOpportunityOpportunity
Community Health FactorsCommunity Health Factors
PLACEPLACE Look, feel & safety Look, feel & safety
Parks & open spaceParks & open space
Getting aroundGetting around
HousingHousing
What’s sold and how it’s What’s sold and how it’s promotedpromoted
Air, water, soil Air, water, soil
Arts & cultureArts & culture
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What’s Sold and PromotedWhat’s Sold and Promoted
VS.VS.
Industry Low-Wealth High-Wealth Group Neighborhood Neighborhood
Bars/Taverns
727
26 24
35 11
SupermarketsCarry-out eating places
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Social Networks & trustSocial Networks & trust
Participation & willingness to act Participation & willingness to act for the common goodfor the common good
Acceptable behaviors & Acceptable behaviors & attitudesattitudes
Racial justiceRacial justice
Jobs & local ownershipJobs & local ownership
EducationEducation
What’s sold & how What’s sold & how it’s promotedit’s promoted
Look, feel & safety Look, feel & safety
Parks & open spaceParks & open space
Getting aroundGetting around
Housing Housing
Air, water, soil Air, water, soil
Arts & cultureArts & culture
Elements of Community HealthElements of Community Health
THE PEOPLETHE PEOPLE
THE PLACETHE PLACEEQUITABLE EQUITABLE OPPORTUNITOPPORTUNITYY
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Build Build on Our Success on Our Success
(what’s right with (what’s right with this picture)this picture)
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A local coalition established A local coalition established a rubberized jogging path a rubberized jogging path around the cemeteryaround the cemetery
More than 1,000 people a More than 1,000 people a day use the new pathday use the new path
Nearness to walking paths Nearness to walking paths appears to have a significant appears to have a significant impact on physical activity impact on physical activity for adults. for adults.
Improved Opportunities Improved Opportunities for Walking and Joggingfor Walking and Jogging
Boyle Heights, CaliforniaBoyle Heights, California
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““Small things like the jogging Small things like the jogging path make a huge difference path make a huge difference in how community residents in how community residents
see themselves and the see themselves and the community.”community.”
Community AdvocateCommunity Advocate
Improved Opportunities Improved Opportunities for Walking and Joggingfor Walking and Jogging
Boyle Heights, CaliforniaBoyle Heights, California
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Child Restraint and Safety Belt UseChild Restraint and Safety Belt Use
Smoking PreventionSmoking Prevention
Minimum Drinking Age LawsMinimum Drinking Age Laws
Childhood VaccinationsChildhood Vaccinations
Motorcycle and Bicycle Helmet LawsMotorcycle and Bicycle Helmet Laws
Reduced Lead Levels in ChildrenReduced Lead Levels in Children
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NORMSNORMSsanction behaviorsanction behavior
attitudes, beliefs,
attitudes, beliefs, ways of beingways of being
based in based in culture & traditionculture & tradition
taken for grantedtaken for granted
more than a habitmore than a habit
behavior shapersbehavior shapers
communicate regularity communicate regularity
in behaviorin behavior
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Source: www.sfgov.orgSource: www.sfgov.org
Changing NormsChanging NormsToward a Community SolutionToward a Community Solution
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Norms Do ChangeNorms Do Change
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Necessary StrategiesNecessary Strategies
Reducing Disparities Reducing Disparities through Preventionthrough Prevention
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Influencing Policy & LegislationInfluencing Policy & Legislation
Changing Organizational PracticesChanging Organizational Practices
Fostering Coalitions & NetworksFostering Coalitions & Networks
Educating ProvidersEducating Providers
Promoting Community EducationPromoting Community EducationStrengthening Individual Knowledge & SkillsStrengthening Individual Knowledge & Skills
The Spectrum of PreventionThe Spectrum of Prevention
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Working Across the SpectrumWorking Across the Spectrum
Shut down 200 liquor stores Shut down 200 liquor stores in 3 yearsin 3 years
An average 27% reduction in An average 27% reduction in crime within a four-block radius crime within a four-block radius of each closed liquor outletof each closed liquor outlet
South L.A., CaliforniaSouth L.A., California
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A good solution A good solution solvessolvesmultiplemultipleproblems.problems.
Prevention InstitutePrevention Institute
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A Good SolutionA Good Solution
Fruit and vegetable Fruit and vegetable consumption increases consumption increases
for each supermarket for each supermarket in a census tract in a census tract (Morland, et al, 2002)(Morland, et al, 2002)
Upper Falls Community: Rochester, New YorkUpper Falls Community: Rochester, New York
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““If we do not change direction,If we do not change direction,
we are likely to end upwe are likely to end up
where we are headed.”where we are headed.”
Chinese ProverbChinese Proverb
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www.preventioninstitute.orgwww.preventioninstitute.org