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SCHOOL OF PUBLIC HEALTH CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using Data to Promote Health Equity and Address Disparities A Knowledge 4 Equity Conference Sheraton Hotel Silver Spring, MD November 13, 2012

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Page 1: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

SCHOOL OF PUBLIC HEALTH CENTER FOR HEALTH EQUITY

Toward a Fourth Generation of Disparities Research to Achieve Health Equity

National Conference on Using Data to Promote Health Equity and Address Disparities

A Knowledge 4 Equity ConferenceSheraton Hotel

Silver Spring, MDNovember 13, 2012

Page 2: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

Stephen B. Thomas, PhD.Professor, Department of Health Services Administration

Director, Maryland Center for Health Equity

School of Public Health

The University of Maryland

[email protected]

www.healthequity.umd.edu

Page 3: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

SCHOOL OF PUBLIC HEALTH CENTER FOR HEALTH EQUITY

COE Goals: 1.To establish and sustain a community engaged research enterprise on critical health disparities;

2.To raise the visibility of racial and ethnic health disparities and promising solutions with Marylanders; and

3.To facilitate action for change in the structural determinants of health in Maryland.

Page 4: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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

Photo Credit: Sandra Quinn

Page 5: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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

AFFORDABLE CARE ACT of 2010

Page 6: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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 CHALLENGE

Photo Credit: Sandra Quinn

Page 7: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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

Page 8: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

The Social Context of Health Disparities

The ultimate aim is to uncover social, cultural and environmental factors beyond the biomedical model and address a broad range of issues. This approach includes, but not limited to, breaking the cycle of poverty, increasing access to quality health care, eliminating environmental hazards in homes and neighborhoods, and the implementation of effective prevention programs tailored to specific community needs.

Page 9: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

National Institute on 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 MARYLAND CENTER FOR HEALTH EQUITY

Defining Health Disparities and Health Equity

Page 10: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

National Institute on 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 MARYLAND CENTER FOR HEALTH EQUITY

Health Disparities and Health Equity

• According to Healthy People 2020

• In contrast, a health disparity is “…a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.”

• Health Equity is “…the attainment of the highest level of health for all people.”

Page 11: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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 FRAMEWORK

Photo Credit: Sandra Quinn

Page 12: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

National Institute on 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 MARYLAND 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): 399-416.

Page 13: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

Infant Mortality Rates by Maternal Race/Ethnicity

Source: Centers for Disease Control and Prevention

Page 14: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

Disparities in Breast Cancer Incidence & Mortality

Female Breast Cancer

Incidence Rates by Race and Ethnicity, U.S., 1999–2007

Female Breast Cancer

Death Rates by Race and Ethnicity, U.S., 1999–2007

Source: Centers for Disease Control and Prevention

Page 15: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

National Institute on 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 MARYLAND CENTER FOR HEALTH EQUITY

AIDS Cases Among Adults and Adolescents by Race/Ethnicity

Last Modified: April 28, 2011Content Source:Divisions of HIV/AIDS PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Page 16: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

National Institute on 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 MARYLAND CENTER FOR HEALTH EQUITY

Page 17: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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): 399-416

The Health Equity Action Research Trajectory:

A Platform for 4th Generation Disparities Research

Page 18: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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

Page 19: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

2001 FEDERAL DHHS

TAKE A LOVED ONE TO THE DOCTOR DAY

4th GENERATION APPROACH:

TAKE A HEALTH PROFESSIONAL TO THE PEOPLE

Page 20: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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

Page 21: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using
Page 23: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

National Institute on 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 MARYLAND CENTER FOR HEALTH EQUITY

DANGER AND OPPORTUNITY

Photo Credit: Sandra Quinn

Page 24: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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): 399-416

Page 25: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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. 1994.The Social Contract from Hobbes to Rawls, New York: Routledge

Page 26: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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. 2010. The Science of Eliminating Health Disparities: Embracing a New Paradigm. American Journal of Public Health. 100:S8-S9

Page 27: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

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 projects described are supported by Award

Numbers 7RC2MD004766 and PG60MD000207 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.

Page 28: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

THANK YOU VERY MUCH !

Page 29: SCHOOL OF PUBLIC HEALTH  CENTER FOR HEALTH EQUITY Toward a Fourth Generation of Disparities Research to Achieve Health Equity National Conference on Using

Stephen B. Thomas, PhD.Professor, Department of Health Services Administration

Director, Maryland Center for Health Equity

School of Public Health

The University of Maryland

[email protected]

www.healthequity.umd.edu