Public Health 101
Module IV: Social & Health Equity
Developed by:
Alameda County Public Health Department Community Assessment Planning & Education Unit
Janet Brown, Dana Cruz Santana, Sandi Galvez, and Katherine Schaff
Learning Objectives

Increase awareness of:
Historical and
Current Policies

Social
inequities
Health
inequities
Learn how ACPHD is planning to take
action and find solutions
Barnga

In five tricks, your goal is to win as many tricks as
possible.

You will have 5 minutes to study the rules on your
handout.

The rules will then be taken away and
NO VERBAL OR WRITTEN COMMUNICATION IS
ALLOWED.

You may gesture or draw pictures.

Goal: Get to the winning table
Barnga
Remain silent and write on your half sheet
of paper:

How or what were you feeling?

How did you interpret others’ behavior?

What can you learn about yourself from this
activity?
Barnga—After the Activity


What does this simulation demonstrate
or explain?
How do you think this relates to
“inequity?”
What Is Social Inequity?
Social inequity excludes people
from full and equal participation in
society.
Social Inequities
Root Causes of Health Inequities
Health Inequities
Segregation
Housing
Income & Employment
Transportation
Air Quality
Physical Activity & Neighborhood Conditions
Access to Healthcare
Education
Food Access & Liquor Stores
Criminal Justice
Social Relationships & Community Capacity
Social Inequities
ACPHD’s
Approach to
Achieving
Health
Equity
Policy Change
HEALTH
EQUITY
Institutional
Change
Data and
Research
Community
Capacity
Building
Segregation
“It is often easier to become outraged by
injustice half a world away than by oppression
and discrimination half a block from home.”
–Carl T. Rowan
Author and journalist
Racially Restrictive Covenant
Historical Forces Have Left a Legacy
of Racism and Segregation
Historical Roots of
Present-Day Inequities
Discriminatory mortgage
underwriting by the
FHA/VA
Redlining practices
by banks and home
insurance agents
Racial steering
and block-busting
practices by
real estate agents
Disinvestment and
concentrated poverty
in urban centers
Middle class and white
flight to the suburbs
Displacement caused
by federal highway
construction and other
urban renewal projects
Segregation and Health
Low-income, segregated areas typically have:
Higher density of freeways and other highly
traveled roadways
More sources of toxins
Lower municipal service levels  lower
quality of life
Reduced access to transportation,
quality education, affordable housing,
adequate parks, and grocery stores
Health
• Physical
• Mental
Finding Solutions
Sample policy recommendations:
 Ensure equitable government
infrastructure spending by
neighborhood
 Reduce low-density-only zoning to
make more homes affordable
Video Clip—Invisible Wall
Invisible
Wall
Video Clip—Invisible Wall


What stood out for you? How did
you feel?
What are the implications for people
living in the area today?
Invisible Wall Today
Bristol Blvd.
(Last San Leandro street before
Oakland city limit)
107th Avenue in Oakland
(Last street before San Leandro city
limit)
San Leandro Today



Asians (29%) & Latinos (27%) each make up
a greater percentage of the population in San
Leandro than non-Hispanic whites*
African American residents make up about
12% of the population
Discussion


What is the story behind this demographic shift?
What are the implications for ACPHD? Creekside?
Health equity?
*Census 2010 accessed at http://sanleandro.patch.com/articles/census-finds-san-leandro-bigger-and-more-diverse
What issues
of equity are
being raised
in the
cartoons
and/or
Occupy
movement?
Finding Solutions
Occupy movement’s public health messages
 Social factors are related to health:
e.g., housing, income inequity

Forming policy solutions
e.g., “move your money”, “end corporate
personhood”
Transportation
“My feet is weary, but my soul is rested.”
–Mother Pollard,
Montgomery Bus
Boycott Participant
Unequal Public Transit Subsidies
Transportation and Health
Access to health-related
goods and services
(e.g., health care, healthy foods)
Access to employment
Transportation
Highway and transitrelated air pollution
Vehicle miles traveled
and climate change
Noise pollution
Physical activity levels and
pedestrian/bicyclist injuries
Health
• Physical
• Mental
Finding Solutions


Airport Connector – Urban Habitat vs.
BART regarding civil right laws
Measure VV parcel tax to preserve low
cost bus passes for youth, seniors and
the disabled passed with the support of
16 local organizations
Effects of Social Inequities
Social Inequities
Body
Mind
Spirit
Effects of Social Inequities
“When the symbols, rituals, rites of one’s culture lose their
legitimacy and power to compel thought and action, then
disruption occurs within cultural orientation and reflects itself as
pathology in the psychology of the people belonging to that
culture.” (Nobles, et al., 1987)
Not Quite Home: The Psychological
Effects of Oppression


Ken Hardy’s article
“Home isn’t just a place to sleep and hang
your clothes; it is also a state of being, a
sense of intrinsically fitting in to the
community around you and being welcomed,
invited, accepted and free to be
complete…Home is the spirit we hope to find
in others; an end to being pushed out in the
cold because of some difference that is
deemed unacceptable.”
Source: http://www.d.umn.edu/sw/cw/documents/NotQuiteHome_000.pdf
Impact of Social Inequities on WellBeing





Psychological homelessness: result of
oppression and injustices by racism
Historical legacy of colonization
Guilt, anger, self-hate & powerlessness
Fear and depression
Isolation, break up of families, loss of
identity and destruction of culture
When the External Becomes Internal
How Health Inequities Get Inside the Body
Physical and Mental Health Impacts
Transportation
Housing
Stress
Stress
Stress
Stress
Stress
Increased
commute
times
Lack of
access to
stores,
jobs,
services
Segregation
Stress
Poor air
quality
Stress
Stress
Crime
Poor quality
Education
Impact on Native
American Health


As you think about the video we just saw, what
scenes stand out for you?
How do you think this impacts us in accomplishing
our mission of “optimal health and well-being of
all people?”
Group Discussion



Do you recognize aspects of
psychological homelessness from your
youth? As an adult?
Which observations have you made that
you would consider manifestations of
psychological homelessness?
How can we address this condition in
ACPHD’s health equity work?
Example organization addressing
psychological homelessness


Instituto Familiar de la Raza, Inc. in San
Francisco’s Mission District
http://ifrsf.org/blog/about-us/philosophy/
What Is Health Inequity?
Health Disparities
“A difference in rates of illness,
disease, or conditions among
different populations.”
–UW, Robert Wood Johnson & NACCHO
Health Inequities
Health inequities are “differences
in health which are not only
unnecessary and avoidable but, in
addition, are considered unfair and
unjust.”
–Margaret
Whitehead
Department of Public Health
University of Liverpool
Place Matters
Health Inequities by Where People Live
Income Matters
Health Inequities by Neighborhood Poverty
Source: Alameda County Vital Statistics files and American Community Survey, 2005-09
Race and Racism Matter
Health Inequities by Race/Ethnicity
5.9 years
2.3 years
Note: White and African American defined regardless of Latino origin.
Source: Alameda County Vital Statistics files, 1960-2009
7.9 years
Racial Wealth Divide
Source: Pew Research Center tabulations of 2008 Survey of Income and Program
Participation and various U.S. Census Bureau P70 Current Population reports, 2011.
Racial Wealth Divide
For every 1$ that the median White family has the US, the typical
Black family has 5¢ and the typical Latino family has 6¢.
Whites
Blacks
Source: Pew Research Center tabulations of 2008 Survey of Income and Program
Participation and various U.S. Census Bureau P70 Current Population reports, 2011.
Latinos
The Truth About the Economy
Moving Forward
Determinants of Health
Levels of Interventions
Socio-Ecological (society)
Discriminatory
Beliefs (Isms)
???
Institutional
Power
Social
Inequities
Policy
Advocacy
Comm.
Capacity
Building
Medical Model (individuals)
Risk
Factors &
Behaviors
Disease
&
Injury
Patient Clinics
Education
Mortality
Emergency
Rooms
ACPHD Work Moving Forward
ACPHD’s role in addressing a social and health
inequities
 What is one useful thing that you learned or
thought about today?
 What is one thing that you can collectively do to
address social and health inequities?
ACPHD Strategic Plan
1. Transform our organizational culture and align our daily
work to achieve health equity
2. Enhance Public Health communications internally and
externally
3. Ensure organizational accountability through measurable
outcomes and community involvement
4. Support the development of a productive, creative, and
accountable workforce.
5. Advocate for policies that address social conditions
impacting health.
6. Cultivate and expand partnerships that are community
driven and innovative.
Resources




Life and Death from Unnatural Causes: Health and
Social Inequity in Alameda County:
http://www.acphd.org/data-reports/reports-bytopic/social-and-health-equity/life-and-death-fromunnatural-causes.aspx
ACPHD’s Social & Health Equity Web page
http://www.acphd.org/social-and-health-equity.aspx
The National Association of County and City Health
Officials’ Social Justice page
http://www.naccho.org/topics/justice/index.cfm
Reaching for a Healthier Life: Facts on Socioeconomic
Status and Health in the U.S.
www.macses.ucsf.edu/downloads/Reaching_for_a_He
althier_Life.pdf
Resources (cont.)


Spirit of 1848 listserv
http://www.spiritof1848.org/listserv.htm
Social Determinants of Health: The Solid Facts. WHO
http://www.euro.who.int/document/e81384.pdf

Why Place Matters: Building the Movement for Healthy
Communities. PolicyLink.
http://www.policylink.org/documents/WhyPlaceMattersrep
ort_web.pdf

Unnatural Causes http://www.unnaturalcauses.org

Occupy Public Health http://occupypublichealth.org
10 Things to Know about Health
1. Health is more than health care.
2. Health is tied to the distribution of resources.
3. Racism imposes an added burden.
4. The choices we make are shaped by the choices we have.
5. High demand + low control = chronic stress.
6. Chronic stress can be deadly.
7. Inequality – economic and political – is bad for our health.
8. Social policy is health policy.
9. Health inequities are not natural.
10. We all pay the price for poor health.
–Unnatural Causes