Policy Development to Tackle Structural Origins of Health Inequities: Thoughts on Best Practices

PolicyDevelopmenttoTackleStructuralOriginsofHealthInequi=es:

ThoughtsOnBestPrac=ces

JimBloyd,MPHRegionalHealthOfficer,CookCounty

DepartmentofPublicHealthStrengtheningtheCapacityofPublicHealth

DepartmentstoAdvanceHealthEquityApril12,2016CDCTomHarkinGlobalCommunica=onsCenter,Atlanta,Georgia

Outline

•  CookCounty(Illinois)Context•  Whatisourcausalframework:‘nothingasprac=calasagoodtheory….’

•  ‘bestprac=ce’thoughtsonpolicytotacklehealthinequi=es

Cook County Department of Public Health 3

USFederalGovernmentcreatedwealthforwhitepeople1930’s…

RecordsoftheFederalHomeLoanBankBoard[FHLBB].(n.d.).[Webpage].Retrievedfromh]p://www.archives.gov/research/guide-fed-records/groups/195.html#195.

HomeequitystrippingofBlackandBrownneighborhoodstoday…

CookCountyDepartmentofPublicHealth 5

Source:CountyofCook,IllinoisvWellsFargoCaseNo:14-cv-9548(FiledNovember2014)

6

MapofChildOpportunityinCookCounty(Source:Diversitydatakids.org)ChildreninCookCountygrowupinneighborhoodswithstark,unfairdifferencesinopportunityforhealthydevelopment.Na=onally,40%ofBlackand32%ofHispanicchildrenliveinverylow-opportunityneighborhoodscomparedto9%ofWhitechildren.(Acevedo-Garcia,etal2015)

CookCountyDepartmentofPublicHealth 7Source:CenterforTaxandBudgetAccountability.(2015)h]p://bit.ly/1qB3qeA

PoorBlackchildrenexposedtoneighborhoodpovertymetroChicago

CookCountyDepartmentofPublicHealth 8Source:ChildrenLeiBehind(2007)h]p://diversitydata.sph.harvard.edu

PoorLa=nochildrenexposedtoneighborhoodpovertymetroChicago

CookCountyDepartmentofPublicHealth 9Source:ChildrenLeiBehind(2007)h]p://diversitydata.sph.harvard.edu

#16Shots#LaQuanMcDonald

CookCountyDepartmentofPublicHealth 10

CookCountyDepartmentofPublicHealth 11

12.24.2016#BlackChristmasMagMileChicagoProtest

CookCountyDepartmentofPublicHealth 12

Ourviewsinformpolicyandstrategy:Graham’ssimplifiedmodel

CookCountyDepartmentofPublicHealth 13

Source:Graham,H.(2007)Unequallives:HealthandsocioeconomicinequaliHes.

We have repeatedly referred to Hilary Graham’s warning about the tendency to conflate the social determinants of health and the social processes that shape these

determinants’ unequal distribution, by lumping the two phenomena together under a single label. Maintaining the distinction is

more than a matter of precision in language. As Graham argues, blurring these concepts

may lead to seriously misguided policy choices.

[emphasisadded]Source:Solar&Irwin(2010)p.47

CookCountyDepartmentofPublicHealth 14

Ourviewsinformpolicyandstrategy:WHOConceptualFramework

CookCountyDepartmentofPublicHealth 15

Source:Solar&Irwin(2010)AconceptualframeworkforacHononthesocialdeterminantsofhealth..

Publichealthvalues&ethicsshouldguidepolicydevelopment

•  SocialJus=ce•  HealthisaHumanRight&“humanshavearighttotheresourcesnecessaryforhealth”(p2PrinciplesoftheEthicalPracHceofPublicHealth)

•  Addressingfundamental&systemiccausesofhealth“ismoretrulypreven=ve”(PHLeadershipSociety2002p6)

•  CCDPHMission:“…toachieveheathequity”•  CCDPHWePLAN2020priority-Healthinequity

CookCountyDepartmentofPublicHealth 16

StructuralRacism:WePLAN2020Priority

CookCountyDepartmentofPublicHealth 17

www.cookcountypublichealth.orgh]p://www.cookcountypublichealth.org/about/weplan-feedbackWePLAN2020ForcesofChangeAssessmenth]p://bit.ly/1V5sKWRHealthIssuePriori=za=onProcessSummaryh]p://bit.ly/1VEKWF6

CCDPH @CookCoHealth Tell us if housing, health svcs, jobs, schools, transportation & recreation support healthy living in your community. http://ow.ly/RNBrE

June-October,2015:ForcesofChangeAssessmentJune-October:CommunityThemes&StrengthsAssessmentSeptember1:LocalPublicHealthSystemAssessmentMee=ngJune-October:CommunityHealthStatusAssessmentOctober2015-January2016:CommunityPartner&StrategyMee=ngs

CookCountyDepartmentofPublicHealth 18

4MAPPassessmentsplannedbyCCDPHstaffcommi]ees

FrameworkusedintheCCDPHForcesofChangeFocusGroups

CookCountyDepartmentofPublicHealth 19

CookCountyDPHjurisdic=onisfourDistricts4Focusgroups/loca=ons26people/mul=-sectorCityofChicago-(Grey)

CookCountyDepartmentofPublicHealth 20

Ques=onsusedinthe

CCDPHForcesofChange

FocusGroups

CookCountyDepartmentofPublicHealth 21

CookCountyDepartmentofPublicHealth 22

‘Pa]erns’Results

CookCountyDepartmentofPublicHealth 23

‘Power/Interests’Results

Iden=fy&confrontsystemsofprivilege,dominance

You don't even have to be aware of it to receive

the benefit. And the thing that's really slick

about whiteness, if you will, is that most of the

benefits can be obtained without ever doing

anything personally.

john powell Source: Interviewwithjohna.powelleditedtranscript(2003)CaliforniaNewsreel

CookCountyDepartmentofPublicHealth 24

CookCountyDepartmentofPublicHealth 25

CHECookCounty.org@CHECookCounty

Power, after all, is the heart of the matter—and

the science of health inequities can no more

shy away from this question than can physicists

ignore gravity or physicians ignore pain. Jason Beckfield & Nancy Krieger

Source: EpidemiologicReviews,31,152-77(2009) p. 169

CookCountyDepartmentofPublicHealth 26

Thankyou

CookCountyDepartmentofPublicHealth 27

JimBloyd,MPHRegionalHealthOfficerCookCountyDepartmentofPublicHealth15900S.CiceroAvenueOakForest,Illinois60452jbloyd@cookcountyhhs.org708-633-8314

Acknowledgements:•  FocusGroupPar=cipants•  DeyaGreer,MA,Na=onalAssocia=onof

County&CityHealthOfficials•  TiffanyHuang,MPH,Na=onalAssocia=onof

County&CityHealthOfficials•  JosephZanoni,PhD,UniversityofIllinoisat

Chicago,SchoolofPublicHealth