1. Righting the Wrong of Social Injustice in Health The Health-Wealth Connection Symposium June 23, 2010 Maxine Hayes, MD, MPH Washington State Department of Health

2. Mission of Public Health Assure health, safety and quality of life for everyone!

3. 3 “Public Health ≠ Publicly Funded or Charity Medicine”

4. Philosophy behind Science: to discover truth Philosophy behind Medicine: use that truth for a patient Philosophy behind Public Health: use that truth for everyone

5. 1994 Life expectancy = 75 years 25 of these years are due to advances in public health 1900 Life expectancy = 45 years Our Life Span Has Increased By 30 Years Since 1900* *United States

6. Health Olympics

7. WHY?

8. Not everyone has equal opportunity for health

9. Health Disparities vs. Inequities Disparity only defines differences between groups. Inequity describes the “causes” of disparities in the context of environmental conditions that are required to generate parity and equality.

10. Inequities result in disparities in health status that are “unfair, unjust, avoidable and unnecessary.”

11. “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.” Martin Luther King Jr. – March 25, 1966 2 nd National Convention of the Medical Committee for Human Rights “Nowhere are the divisions of race and ethnicity more sharply drawn than in the health of our people…no matter what the reason, racial and ethnic disparities in health are unacceptable in a country that values equality and equal opportunity for all.” Bill Clinton – February 21, 1998

12. Healthy People 2010 addressed the need to eliminate disparities, but these disparities are rooted in societal inequities manifested through institutional racism, income gaps, entrenched poverty and social injustice! A new vision for Healthy People 2020 is needed.

13. Public health must not lose sight of the importance of attending to the social context of disease prevention and health promotion.

14. Equalizing opportunities to be healthy requires addressing the most important social and economic determinants of health including not only health care, but also living conditions in households and communities, working conditions, racism, and policies that affect any of these factors Source: Defining equity in health. J Epidemiol Community Health 2003, 57: 254-258

15. Social Justice “When access to certain basic rights, such as good health, education, and fair and equal treatment has been distributed unevenly or denied to certain groups, the problem becomes an issue of social justice” Healton & Nelson, 2004

16. The Health-Wealth Relationship is Real! Higher income = longer life Low income = worse health Less education = worse health Lower income = more chronic disease

17. We Know What Determines Health National Institutes of Health 2000 Institute of Medicine 2001 National Research Council 2001 Institute of Medicine 2000

18. 18 EnvironmentalRisk Stress due To Social Factors Institutionalized Biases (racism, sexism, etc.) Language and Other Cultural Factors EconomicOpportunity and Equity EducationBackgroundandOpportunity Mental Health and Social Support Access to Health Services Health Behaviors and Personal Risk Factors Trust in Health System and Research SOCIAL DETERMINANTS OF HEALTH

19. Determinants of Health LIFESPANLIFESPAN Multiple levels of influence HEALTH Access to Health Care – 10% Environment – 20% Genetics – 20% Healthy Behaviors – 50%

20. 20 HealthBehaviors Environment GeneticMakeup HealthCare 51% 22% 17% 10% 0%20%40%60%80%100% Source: McGinnis, et. al, 2002 What Influences Our Health?

21. How We Spend Our Money

22. TM

23. Social Environments and Health Individuals and families are embedded within social, political, and economic systems that shape behaviors and constrain access to resources necessary to maintain health. Greater emphasis is needed on public health interventions that involve communities, with the goal of collectively identifying resources, needs and solutions… -- Institute of Medicine, Health and Behavior 2001

24. Inequalities Start Early Stress in early life affects physical growth, emotional, social and cognitive development as well as later health and health behaviors.

25. Birth/Adolescence/Work/Elderly ChildhoodYoung AdultCareer Parental SocioeconomicEducationalOccupationRetirement ResourcesAttainment& IncomeIncome HealthHealthHealthHealth Reaching for a Healthier Life, Facts on SES and Health in the U.S. MacArthur Foundation

26. Public Health Action: Speak Truth to Power! Work with others to attack the “root causes” of disease, illness to assure health.

27. Health Equity in ALL Policies!

28. Timing is Everything!

29. “We must all have the audacity to believe we can transform the current system” Maxine Hayes, MD, MPH

30. References Overcoming Obstacles to Health – RWJ Foundation 2/2008 The Spirit Level – Richard Wilkinson and Kate Pickett (Why Greater Equality Makes Societies Stronger) The Stakes for Women of Childbearing Age in Health Reform – CDC 8/10/2009 - MMWR Health Equity and Children’s Rights – Pediatrics, Volume 125, #4, 4/2010, 125; 838-849 Building on a Life Course Perspective in Maternal Child Health – editorial, Maternal and Child Health Journal, Volume 7, no. 1, 3/2003 Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective – Maternal and Child Health Journal, Volume 7, no. 1 3/2003 Reaching for a Healthier Life, Facts on SES and Health in the U.S. – MacArthur Foundation