1. Community Health Analytics, Inc. Pulling Together for Community Health
CHAI
Community Health Analytics, Inc. Pulling Together for Community Health

2. Conceptual Failures: In Eliminating Health Disparities
Bill Jenkins, MS, PhD, MPH
CEO, Community Health Analytics (CHAI)
Co-Director , Minority Health Project,
Adjunct Professor of Epidemiology
University of North Carolina at Chapel Hill

3. Understanding the Problem
Why did the puritans come to America?
Why was there a civil war?
Has Infant Mortality Changed in the last 100 Years?

4. Infant Mortality Rate and Ratio by Ethnicity 1935-2007

5. Infant Mortality
The black/white infant mortality rate ratio has not decreased for the past 100 years? Why?
Since 1995 we have seen a slight increase. Why?

7. From Minority Health to Health Disparities
Minority Health Iniatives
The Civil Rights Movement: The worst from of inequality…sick and tired…. Community Health Centers (Harvard, MIT, Howard)
The first EEO Officers of the PHS (HSMHA) “The 12”… GUARD, Minority Concerns, MPH at Howard
If only they knew….The health of black America….The Heckler Report
1991 HD: Race or Racism (ACE, SER, ASA, APHA)…SAAPHI the beginning…Train, Advocate, Participate

8. Number of Papers with Health Disparities in the Title
   
1998 (10)             1997 (11)             1996 (9)             1995 (1)             1994 (1)             1993 (3)             1992 (2)             1991 (1)             1990 (1)             1989 (1)             1987 (1)
                2010 (399)             2009 (281)             2008 (188)             2007 (153)             2006 (144)             2005 (82)             2004 (69)             2003 (57)             2002 (39)             2001 (33)
2000 (9)             1999 (15)

9. The persistence of the Problem
Why have we seen increases in some health disparities since 1954? For example, CHD.
"Of all the forms of inequality, injustice in health care is the most shocking and inhumane. ...” ML King, Jr

10. persistence of the Problem
Our solutions to health disparities are often based on our assumptions about other problems, not on our understanding of health disparities: for example, new innovations often increase health disparities, health care and genetics have little impact on health disparities …

11. Model African American Health disparities EQUALS Racism 30%
Quality Care &
Biology 10%
Socio-economic
Status
30% + +
Culture 30% +
EQUALS
African American Health disparities

12. Focus on the problems which can make the difference : Not Genes or Health Care
Social justice supports the development of more “minority” physicians, and public health scientists, but it won’t necessarily make a difference
All homosapiens are of african decent

13. Focus on the problems which can make the difference Socio-Economic Status
SES remains perhaps the most powerful force producing health disparities – it is massive, multi-factorial, and complex
There is no will to solve this problem head on, however there are solutions which go un- and under utilized – head start, community participatory activities
We can overcome the effects of low SES by targeted interventions using social supports

14. Focus on the problems which can make the difference: Culture
competitive dance…
The problem of health care utilization is much less accessibility of health care than acceptability of health care
Racial data has largely been changed to ethnic data already, but most people have not noticed
Solving the problem of health disparities requires that we address the problems of Culture. - including issues of trust, competing risks, internalized racism….

15. Focus on the problems which can make the difference - Racism
Racism remains a pervasive force in America today. Although more benign, it remains a major determanent of health and health policy in America. The most deleterious form of racism is subtle and complex as it interacts with socio-economic status, culture and a host of political and other factors – white privilege.
There is no social force more pervasive, yet so misunderstood than racism. It creates the illusion that there is something called “race” and then establishes assumptions to support it. It is so powerful a concept that even those who are disadvantaged by it, accept it – the use of race supports racism, especially when used by African-Americans.

16. Racism, cont’d
But , the worst form of racism is internalized Melanin does not immunize against racism Previous oppression does not protect against current discrimination

18. ETHNIC CATERGORIES Hispanic Black/Asian White
Hispanic/lATINO
Mexican
Porto Rican
Cuban
Central American, pleas specify _____________________________
South American, please specify _____________________________
Caribean, please specify _____________________________
European (White) ___
Eastern ___
Western ___
Other ___
please specify ______________ 
African (Black) ___
African American ___
African Immigrant ___
Afro-Caribean ___
Asian ___
Chinese
Japanese
East Indian
South Asian
Which ethnicity (race) do you most identify? ____________________________

19. The Problem
Race says the problem/factor is that people look differently from each other Racism says the problem/factor is that people are treated differently because of the way they look Dream: people will one day be judged by the content of they character and not the color of their skin

20. A continuing struggle Federalists vs Slavers Unionists vs Confederates
Re-Constructionists vs Klu Klux Klan
Intergrationists vs Segregationists
Social Liberals vs Social Conservatives
(Black Lives Matter vs Tea Party)

21. Who can make a difference?
One person can make a difference
But forming a small group can make a big difference

22. Corporate Vs Servant Leadership
Corporate Leadership: Corporation services the leader, so clients serve the Corporation
Servant Leadership: Leader serves the Corporation , so the Corporation serves clients

26. Age Adjusted Death Rate Ratio
1950
1960
1970
1980
1990
2000
2002
Heart Ds
1.0
1.1
1.2
1.3
Stroke
1.4
1.5
Cancer
0.9
2.6
Diabetes
2.0
2.2
2.1
HIV
---
3.2
8.3
8.6
Homicide
10.9
9.6
9.4
5.8
6.6
5.7
5.6

27. Greed … is Good Greed is right. Greed works.
Greed clarifies, cuts through, and
captures the essence of the evolutionary spirit. 
Greed, in all of its forms -- greed for life,
for money, for love, for knowledge -- has marked the upward surge of mankind. 
And, greed will save that malfunctioning corporation called the USA.

28. eThNIC/rACE European (White) ___ Eastern ___ Western ___
Other ___ please specify _________________________
African (Black) ___
African American ___
African Immigrant ___
Afro-Caribean ___
Asian ___
Chinese
Japanese
East Indian
South Asian
Native American (Indian)
Alaskan Native
Eastern Tribal
Western Tribal
Urban (no specific tribe)
Hispanic
Mexican
Porto Rican
Cuban
Central American, please specify _____________________________
South American, please specify _____________________________
Caribean, please specify ____________________________
Which ethnicity (race) do you most identify? ____________________________
eThNIC/rACE