Disparities, Inequality, and Inequity

DISPARITY = INEQUALITY and implies
differences between individuals or population
groups (UN-equal)

INEQUITY refers to differences which are
unnecessary and avoidable but, in addition, are
also considered unfair and unjust
Tips for Staying Health:
A Lifestyle Approach
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Don’t smoke. If you do, stop.
Eat a balanced diet, include fruits/vegetables.
Keep physically active.
If you drink, do so in moderation.
Cover up in the sun and protect your children.
Practice safe sex.
Participate in appropriate health screenings.
Drive defensively; don’t drink and drive.
Manage your stress.
Maintain social ties.
Health Outcomes by Race
5
Boston
Neighborhoods
6
Place Matters
Asthma Hospitalizations for
Children under Age 5, by
Neighborhood
2006, 2007, 2008 Combined
7
8
9
10
11
12
13
Infant Mortality in Boston by
Race
Infant Mortality and Cigarette
Smoking
Per 1,000 Live Births
14
13.2
12
9.2
10
8
6
4
2
0
African American NonSmokers
NCHS 2002
White American
Smokers
Infant Mortality and Prenatal Care
Per 1,000 Live Births
14
12.7
12
10
7.1
8
6
4
2
0
African Americans 1st
Trimester Prenatal Care
NCHS 2002
White Americans
Prenatal Care After 1st
Trimester or None
Racial & Ethnic Disparities
Infant Mortality & Education
Per 1,000 Live Births
10.2
6.8
African Americans White Americans <9
16+ years of
schooling
years of schooling
NCHS 2002
Racial & Ethnic Disparities
Infant Mortality & Household Income
Per 1,000 Live Births
16.6
11.2
African Americans
White Americans
with Household
with Household
Income $35,000+
Income <$10,000
Tips for Staying Healthy:
A Social Determinants Approach
1.
2.
3.
4.
5.
6.
7.
8.
Don’t be poor. If you can, stop. If you can’t, try not too
be poor for too long.
Don’t have poor parents.
Don’t live in a poor neighborhood.
Own a car – but use only for weekends and walk to work.
Practice not losing your job and don’t become
unemployed.
Don’t be illiterate.
Avoid social isolation.
Try not to be part of a socially marginalized group.
Social Determinants of Health Inequities
Education
Job
Opportunity
Socioeconomic
Status
Racism
Environmental
Exposure
Health Behaviors
Access to
Health Services
Safe and Affordable
Housing
Reducing Violence
Health
Outcomes
States using the “Reactions to Race” module
2002 to 2009 BRFSS
Arkansas, California, Colorado, Delaware, District of Columbia, Florida, Indiana,
Massachusetts, Michigan, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina,
Ohio, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, Washington, Wisconsin
General health status and “race”

Being perceived as White is associated with better
health



Even within non-White self-identified “race”/ethnic groups
Even within the same educational level
Being perceived as White is associated with higher
education
Percent Women Reporting
Discrimination
Racial & Ethnic Disparities
Low Birth Weight & Racism
20
18
16
Collins 2000
20%
14
12
P < 0.01
10
8
12%
6
4
2
0
<1,500 g
> 2,500 g
Birthweight
What is racism?
A system of advantage based on race.
David Wellman, Portraits of White Racism
Levels of Racism
INTERNALIZE
D
INTERPERSONAL
MICRO
LEVEL
INSTITUTIONAL
MACRO
LEVEL
Adopted from the Applied Research Center
STRUCTURAL
Our tasks

Put racial justice/racial equity on the agenda


Name racism as a force determining the distribution of
other social determinants of health
Routinely monitor for differential exposures,
opportunities, and outcomes by “race”
4-year Graduation Rate:
Grades 9-12 Boston, 2006
Percentage of High School Students
90%
80%
70%
60%
83%
71%
59%
56%
Boston
Black
51%
50%
40%
30%
20%
10%
0%
Massachusetts Department of Education
White
Asian
Latino
“Pilot Program Aims to Reduce
Infant Deaths”
In an effort to drive
down the
disproportionately
large number of
deaths among black
and Latino infants in
Boston, city leaders
yesterday unveiled a
campaign to provide
housing, counseling,
and other critical
support for pregnant
women who are
homeless or living on
the edge.
Jamaica Plain Equity Collaborative
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Brookside, Martha Eliot
and Southern Jamaica
Plain Health Centers
Bromley Health TMC
JPNDC
ESAC
Hyde Square Task Force
Teen Empowerment
Spontaneous
Celebrations
Tree of Life/Arbol De
Vida
March and Rally February
2010, 2011
Youth Racial Healing &
Reconciliation Project
Documenting the Work
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Taking it to the JP Community
Loretta Ross Educating Us About a
Frame…
http://www.youtube.com/watch?v=82vl34mi4Iw
Thank You!
Questions/Feedback???
Abigail Ortiz , MSW, MPH
Southern Jamaica Plain Health Center
640 Centre Street
Jamaica Plain, Ma 02130
(617) 983-4104 land
(857) 203-1202 cell
aortiz3@partners.org