FROM HEALTH DISPARITIES TO
HEALTH EQUITY
Annual Meeting
Directors of Health Promotion and Education
New Orleans, LA
August 10-11, 2010
Stephen B. Thomas, PhD.
Professor, Department of Health Services Administration
Director, Maryland Center for Health Equity
School of Public Health
The University of Maryland
sbt@umd.edu
www.healthequity.umd.edu
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
Craig S. Fryer, DrPH, Mary A. Garza, Ph.D.,
Stephen B. Thomas, Ph.D., Sandra C. Quinn, Ph.D. and James Butler, III, DrPH
www.healthequity.umd.edu
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
1. The Opportunity
2. The Challenge
3. The Framework
4. Danger and Opportunity
5. Where Do We Go From Here?
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
THE OPPORTUNITY
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
“America’s health needs to be
improved now, not five or ten years
from now” (2010, p. 1486).
David R. Williams, Mark B. McClellan, and Alice M. Rivlin
Beyond The Affordable Care Act: Achieving Real Improvements In
Americans’ Health Health Affairs 29, NO. 8 (2010): 1481–1488
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
VISION
To be a vibrant contributor to the
University of Maryland’s re-invigorated
land grant mission, which includes a
commitment to eliminate racial and
ethnic disparities and achieve health
equity.
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
According to Health People 2020:
Attending public launch of HP2020 at
George Washington University,
December 2, 2010:
Drs. James Butler III, Robert S. Gold,
Sandra Quinn, Adewale Troutman,
Stephen B. Thomas, Mary A. Garza and
Craig S. Fryer
“A health disparity is a particular
type of health difference that is
closely linked to …people who
have experienced greater social or
economic obstacles to health
based on their racial or ethnic
group, religion, socioeconomic
status, gender, mental health,
cognitive, sensory, or physical
disability, sexual orientation,
geography, or other characteristics
historically linked to discrimination
or exclusion.“
http://www.healthypeople.gov/2020/about/disparitiesAbout.as
px
Institute of Medicine Definition of Health Disparities
Differences, Disparities, and Discrimination:
Populations with Equal Access to Healthcare
SOURCE: Gomes and McGuire, 2001
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
In 2004, the CDC published “Actual Causes of Death in the United
States. 2000,” which identified tobacco (435,000 deaths; 18.1% of
total U.S. deaths) and poor diet and physical inactivity (400,000
deaths; 16.6% of total U.S. deaths) as the leading contributors to
loss of life (Mokdad,et al, 2004. Actual causes of death in the United States. 2000. J. Am. Med. Assoc)
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
THE CHALLENGE
SCHOOL OF PUBLIC HEALTH § CENTER FOR HEALTH EQUITY
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
Race the Power of an Illusion, PBS
http://www.pbs.org/race/000_General/000_00-Home.htm
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
Shariff-Marco, S., Klassen, A. C., & Bowie, J. V. (2010). Racial/Ethnic Differences in
Self-Reported Racism and Its Association With Cancer-Related Health Behaviors.
Am J Public Health, 100(2), 364-374.
 “… general racism was associated with smoking, binge
drinking, and being overweight or obese; health care
racism was associated with not being up to date with
screening for prostate cancer…. Associations between
general racism and lifestyle behaviors suggest that
racism is a potential stressor that may shape cancerrelated health behaviors... “ (p. 364)
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
Ford, C. and
Airhihenbuwa C. (2010).
Critical Race Theory,
Race Equity, and Public
Health: Toward
Antiracism Praxis.
American Journal of
Public Health, 100: S30S35.
 Ford, C. and
Airhihenbuwa C.
(2010). Critical Race
Theory, Race Equity,
and Public Health:
Toward Antiracism
Praxis. American
Journal of Public
Health, 100: S30S35.
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
THE FRAMEWORK
SCHOOL OF PUBLIC HEALTH § 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.
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
Third Generation Research:
A Color Blind Evidence Base
“Because limited race and
ethnicity data were
available, it is unknown if
the intervention had
differential effects for
different racial or ethnic
groups”
Task Force on Community Preventive Services recommended
interventions for prevention of obesity and tobacco use. Source:
Adapted from The Guide to Community Preventive Services
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
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
Fourth Generation Health Disparity Research
From the Public Health Critical
Race praxis perspective, four
key principles should inform
intervention research:
Health Equity Action Research Trajectory
HEART
1. The primacy of racialization,
2. Structural determinism,
3. Critical approaches, and
4. Intersectionality
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
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
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
Health Advocates In-Research and Research (H.A.I.R.)
Network of Black Barbershops & Beauty Salons
THE FAMILY HEALTH HISTORY
THE PEDIGREE: A GENETIC FAMILY HEALTH TREE
The goal of the session is to elicit a three-generation pedigree for
accurate risk assessment.
LESSONS FROM EVIDENCE BASED RESEARCH
 Focus on common risk factors for chronic
disease
 Pre-hypertension and Pre-Diabetes
• Smoking
• Obesity
• Stress
• Family health history
PROGRAM ACTIVITIES
Physical Activity
Nutrition Education & Guidance
Stress Management
Smoking Cessation
Family Health History
Self-Management of Chronic Disease
Referral to Medical Home
LIFESTYLE:
African American
women participate in
a community based
Water Aerobics
class.
The Healthy Black Family
Project, a Program of the
Maryland Center for
Health Equity
(NIH-NIMHD, P60)
Disease Prevention: "We have made some progress towards
eliminating health disparities. Yet there is much unfinished
business. We have to reexamine our strategy and
accelerate the pace through innovative, sustainable and
results-oriented approaches... " (Dr. John Ruffin, Director,
NIH-NIMHD, 2010)
DANGER AND OPPORTUNITY
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
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
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
WHERE DO WE GO FROM HERE ?
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
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 project described was supported by Award
Number 7RC2MD004766 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.
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
THANK YOU VERY MUCH !