Health Equity and the Elimination of
Cardiovascular Disease Disparities
Leandris C. Liburd, PhD, MPH
Associate Director for Minority Health and Health
Equity
Centers for Disease Control and Prevention
October 18, 2012
Office of the Director
Office of Minority Health & Health Equity
CDC’s
Office of Minority Health (OMH)
CDC's Office of Minority Health (OMH)
was established by the CDC Director
on August 8, 1988 as a small
coordination office, set up in response
to Secretary Heckler‘s 1985 landmark
report on minority health.
Patient Protection and Affordable Care
Act, PL 111-148 (2010)
Select Provisions Related to Minority Health and Health
Disparities
“The heads of the Centers for Disease Control and
Prevention, Health Resources and Services
Administration, Substance Abuse and Mental Health
Services Administration, Agency for Healthcare
Research and Quality, Food and Drug Administration,
and the Centers for Medicare and Medicaid Services
shall establish an office to be known as the Office of
Minority Health. “
Office of Minority Health and Health Equity
Mission
To accelerate the work of CDC and its
partners
in improving health
by eliminating health disparities,
promoting conditions conducive to health,
and achieving health equity.
Presentation Objectives


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Provide an overview of the Office of Minority
Health and Health Equity’s Strategic Priorities
(2012 – 2015)
Define health disparities, health equity, health
inequities, and the social determinants of health
Explore how achieving health equity will reduce
disparities in heart disease and stroke
particularly among African Americans
Pose questions that will inform the continued
development, implementation, and refinement of
population-based strategies to reduce CVD and
stroke
OMHHE’s Strategic Priorities
• Reframe eliminating health disparities as achievable
• Facilitate the implementation of policies across
CDC that promote the elimination of health
disparities
• Assure implementation of proven strategies across
CDC programs that reduce health disparities
in communities at highest risk
• Advance the science and practice of health equity
• Collaborate with national and global partners to
promote the reduction of health inequalities
2011 CDC Health Disparities and
Inequalities Report (CHDIR)
Program Response
to the 2011 CDC Health Disparities and Inequalities
Report (CHDIR)
Health Equity Matters
E-Newsletter
http://www.cdc.gov/minorityhealth/newsletter/current.htm
l
Conversations in Equity
Blog
http://blogs.cdc.gov/healthequity/
What’s the
Defining Health Disparities
Health disparities are differences in health outcomes
and their determinants between segments of the
population, as defined by social, demographic,
environmental, and geographic attributes.
Health disparities adversely affect groups of
people who have systematically experienced
greater obstacles to health based on their
racial or ethnic group;
 religion;
 socioeconomic status;
 gender;
 age;
 mental health;
 cognitive, sensory, or physical disability;
 sexual orientation or gender identity;
 geographic location;
 or other characteristics historically linked to
discrimination or exclusion.

Defining Health Equity
Health Equity is attainment of the
highest level of health
for all people.
Defining Health Equity
Health Equity is attainment of the
highest level of health
for all people.
Achieving health equity
requires valuing everyone equally
with focused and ongoing societal efforts to address
avoidable inequalities, historical and contemporary
injustices, and the elimination of health and
healthcare disparities.
Defining Health Inequities
Health inequities are those health disparities that
are avoidable and unfair.
Social Determinants of Health
Conditions in the social, physical, and economic
environment in which people are born, live, work and age
that influence health outcomes.
Environment
Neighborhood
Education
Transportation
Health Care
Social Context
Jobs
Food Security
Cardiovascular Disease Disparities

In the 45–74 age group, black women and men have
much higher coronary heart disease (CHD) and stroke
mortality than women and men of the three other races:
Women
Men
Black
White Black
White
37.9
19.4
61.5
41.5
Died of stroke,% 39.0
17.3
60.7
31.1
Died of CHD, %
Findings from the CDC Health Disparities and Inequalities Report – United States,
2011
The “big five” CVD risk factors + 3
Diet [high fat, high sodium]
 Physical [in]activity
 Cigarette smoking
 [uncontrolled] high blood pressure
 [high] cholesterol
 Diabetes
 Depression
 Psychosocial stress

Social determinants of heart disease & stroke

Saturation of fast food restaurants, vendors of
alcoholic beverages, and vendors of tobacco
products

Limited opportunities for recreational physical
activity

Limited access to major grocery chains,
farmers’ markets, and whole-food markets

Aggressive marketing of unhealthy products

Chronic stress
Reducing health disparities in
cardiovascular disease


Surveys and surveillance
systems: large-scale
community-based
designed to monitor the
health status of minority
populations
Strategies : communityspecific, culturally
tailored that include
system, environmental,
and individual level
interventions
http://www.cdc.gov/Features/dsREACHUS/

Current CDC activities:
Heart Disease and Stroke
Atlases, WISEWOMEN,
and Racial and Ethnic
Approaches to Community
Health (REACH), Million
Hearts
Reducing health disparities in
cardiovascular disease
Individual level interventions:
 healthy diet
 regular physical activity
 not smoking
 healthy weight;
 adherence to medication
CDC Division of Heart Disease and Stroke Prevention
Reducing health disparities in
cardiovascular disease
System and community interventions:
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Continuing education health care providers
Health promotion programs that use community
health workers
Health communications campaigns
Focus is on tobacco-free living
Focus on sodium and trans fats in the food supply
TRANS
FAT
http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_aian.htm
Moving toward Health Equity…
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In addition to monitoring the health status of
minority populations, how might we monitor and
report on the social determinants of heart disease
and stroke?
In contemporary, culturally diverse communities,
how can we engage community members in
identifying, implementing and evaluating strategies
to reduce heart disease and stroke?
How can our communications campaigns represent
heart healthy living in more inviting ways?
How can we accelerate our understanding of how
cultures change and use this knowledge to promote
heart health?
“It is in justice that the ordering of society is centered.”
Aristotle
Thank You For Your Time
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Office of the Director
Office of Minority Health & Health Equity
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Health Equity and the Elimination of Cardiovascular Disease