Gail C. Christopher, DN Vice President for Policy & Senior Advisor W.K. Kellogg Foundation 5 th Annual Conference Extending Our Reach: Integrative Healthcare for All Boston, MA August 7, 2015

Place Matters Project of the National Collaborative for Health Equity em

SHORTER LIVES, POORER HEALTH: THE NATIONAL RESEARCH COUNCIL/INSTITUTE OF MEDICINE REPORT Steven H. Woolf, MD, MPH Center on Society and Health Virginia Commonwealth University

Overview of Comparison Group  17 comparable high- income nations  Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, the United Kingdom, and the United States

Disability Drug-related Deaths Infant Mortality & Low Birth Weight Infant Mortality & Low Birth Weight Obesity & Diabetes Cardiovascular Disease Chronic Lung Disease Injuries & Homicides Adolescent Pregnancy & STIs HIV & AIDS Nine Areas of US Health Disadvantage

Determinants of Health Individual Behaviors  Caloric intake  Drug use  Sexual practices  Driver safety  Firearm possession Social Factors  Low income/poverty  Education  Social mobility  Incarceration  Single-parent households The Environment  Physical environment  Social environment Health Systems  Insurance and access barriers  Weak primary care  Coordination and errors

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NATIONAL PREVENTION STRATEGY

Our Vision, Our Mission Vision We envision a nation that marshals its resources to assure that all children have an equitable and promising future — a nation where all children thrive. Mission The W.K. Kellogg Foundation supports children, families and communities as they strengthen and create conditions that propel vulnerable children to achieve success as individuals and as contributors to the larger community and society.

Children experience double jeopardy when they live in BOTH poor families and poor neighborhoods percent

Stressed vs. Stressed Out  Stressed Increased cardiac output Increased available glucose Enhanced immune functions Growth of neurons in hippocampus & prefrontal cortex  Stressed Out Hypertension & cardiovascular diseases Glucose intolerance & insulin resistance Infection & inflammation Atrophy & death of neurons in hippocampus & prefrontal cortex

Allostatic Load McEwen BS, Lasley EN. The end of stress: As we know it. Washington DC: John Henry Press. 2002

Allostasis Chikanza IC, Grossman AB. Reciprocal interactions between the neuroendocrine and immune systems during inflammation. Rheum Dis Clin N Am 2000;4:

Racism and Health: Mechanisms  Institutional discrimination can restrict socioeconomic attainment and group differences in SES and health.  Segregation can create pathogenic residential conditions.  Discrimination can lead to reduced access to desirable goods and services.  Internalized racism (acceptance of society’s negative characterization) can adversely affect health.  Racism can create conditions that increase exposure to traditional stressors (e.g. unemployment).  Experiences of discrimination may be a neglected psychosocial stressor.

Lead in Drinking Water Sources (Source: Edwards, 2009) 15

Definition of Life Course Core principles of a life course approach to Maternal and Child Health A life course approach is based on a theoretical model that takes into consideration the full spectrum of factors that impact an individual’s health, not just at one stage of life (e.g. adolescence), but through all stages of life (e.g. infancy, childhood, adolescence, childbearing age, elderly age). Life course theory shines light on health and disease patterns – particularly health disparities – across populations and over time. Life course theory also points to broad family, social, economic and environmental factors as underlying causes of persistent inequalities in health for a wide range of diseases and conditions across population groups AMCHP

Definition of Life Course (continued) A life course approach encourages a focus on health across the lifetime and includes the following components: A stages of life theory that takes into consideration factors that impact an individual’s health and development through all stages of life from preconception health into infancy, and through childhood, adolescence, and childbearing years into older age. The influence of family, environmental, biological, economic, behavioral, social and psychological impacts on health outcomes across the lifespan. There are critical or sensitive periods of risk that can particularly impact exposures and experiences during particular sensitive developmental periods in early life that may influence health and disease patterns and outcomes later in life. The potential cumulative effects of these influences on health outcomes, i.e. that health at any given state of life is a function of experiences at prior stages of life, and you cannot understand adult health without addressing child health. Health promotion and prevention interventions can be targeted at different stages in life. Connections exist between life stages, i.e., the relationship between adolescence and the two life stages that border it: childhood and adulthood. Efforts should be coordinated both across life stages and across the life span. AMCHP

IM Interventions Supported by Evidence  Mindfulness Practices  Functional Foods  Manual Therapies and Body Work  Physical Activity  Wellness Education

Community ↑Protective Factors ↓Risk Factors ↑Agency for Individuals and Groups ↓Segregation ↑Compassion, Empathy Belonging