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Peter A. Gorski, M.D., M.P.A. Childrens Board of Hillsborough County and University of South Florida Envisioning Health Equity.

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Presentation on theme: "Peter A. Gorski, M.D., M.P.A. Childrens Board of Hillsborough County and University of South Florida Envisioning Health Equity."— Presentation transcript:

1 Peter A. Gorski, M.D., M.P.A. Childrens Board of Hillsborough County and University of South Florida Envisioning Health Equity

2 Social Determinants of Health and Wealth Your neighborhood Physical, social, economic, educational qualities Your skin color Race, ethnicity Whos your daddy Parents education, income, health, social capital

3 Poverty Sickens 3 Strong connections between child health and adult health Between child wealth and adult wealth Between child wealth and adult health –Regardless of childs health condition –Regardless if social class changes from childhood to adulthood Childhood poverty gets biologically embedded

4 Epigenetics Life Course Perspective Balance of stresses and supports across life course exert cumulative influence on health Especially during sensitive periods of development, powerful experience gets embedded into our biology Reforming DNA structure, gene expression and brain chemistry Consequences to BMI, blood pressure, immune function, memory, learning, attention and mental health

5 Racial and Ethnic Disparities in Birth Outcomes: A Life Course Perspective 5 Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Maternal Child Health J. 2003;7:13-30.

6 Birth Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Ready to learn Strategies to Improve School Readiness Trajectories At Risk Trajectory Delayed/Disordered Trajectory Healthy Trajectory Parent education Emotional Health Literacy Reading to child Pre-school Appropriate Discipline Poverty Lack of health services Toxic Stress Health Services

7 Race is Not a Proxy for Poverty or Wealth

8 Beyond (or Underneath) SES African American infant mortality higher in more segregated cities even when controlling for SES

9 SES? – Ask the Professionals 9 NCHS

10 SES? – Ask the Africans 10 David RJ, Collins JW. Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. N Engl J Med Oct 23;337(17): Birth weight distribution of African-born blacks is more closely related to US-born whites than to US-born blacks

11 Pathogenesis (and Salutogenesis): Complex Interaction between Biology and Environment This explains why many, if not all, of the chief public health killers have common root causes. Degradation of personal dignity, social justice and community I can only be as healthy as my neighbors

12 Enhancing Public Health – A Provocative Perspective Single disease prevention approach rarely works Treating symptoms rather than root causes Since inequities are at root of health disparities, we must work for the equitable distribution of conditions that promote health and healthy development – Social, educational, economic and environmental capital healthcare

13 Even More Provocative Compensatory or Disparities Model (Affirmative Health Action) flawed See next slide Equity Framework Health is a human right Every human being has intrinsic worth. Policies should be directed to what every person needs and deserves to thrive and contribute

14 Why Target Whole Communities? 14 Health and well-being of each person depends on condition of all (see next slide) Cannot predict individual course based on group risk factors Cost burden of case-finding and treatment too high Moral weakness of accepting unequal outcomes

15 Post-neonatal Infant Mortality ( per 100,000 live births,1986 ) 15 Wilkinson RG. Income distribution and life expectancy. BMJ. 1992;304:

16 My Vision-Dream for the Health Equity Coalition Expand public understanding of health equity framework Forge strategic partnerships across the countys public and private sectors – every decision impacts health Document and demonstrate the correlation and causal association between social, economic, educational, environmental and healthcare equity and population health outcomes Advocate for policies and practices that promote and create advantage for all citizens


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