Community Organizing for Health Equity

Luis Manriquez, MDAssistant Clinical Professor WSU Elson S Floyd College of Medicine

Regional Organizer, Health Equity CircleCo-Director Health Equity Organizing, IAF-NW

Montana Primary Care Association 5/1/2019

Disclosure

Dr. Manriquez declares that he has no financial interest, arrangement or affiliation with any organization providing

commercial support for this activity.

What is Health Equity?

Genetic/ Epigenetic

Inheritance

Behavioral factors

Exercise

diet

smoking

Social Determinants

Healthcare

Neighborhood Housing

Employment

Education

Determinants of Equity

Onion model adapted from Camara Jones

Racism

SexismAbleism

Gender Identity

Homophobia

Classism

Healthy food

Urban/rural

What is Health Equity?

Genetic/ Epigenetic

Inheritance

Behavioral factors

Exercise

diet

smoking

Social Determinants

Healthcare

Neighborhood Housing

Employment

Education

Determinants of Equity

Onion model adapted from Camara Jones

Racism

SexismAbleism

Gender Identity

Homophobia

Classism

Healthy food

Urban/rural

Odds Against Tomorrow2012 report on health inequities in Spokane

• 13.5 year difference in mean age of deathbetween non-Hispanic white and Native Americans

• This is because of the social determinants of health and social determinants of equity

• Nearly 18 year difference in life expectancy from Southgate to Riverside (downtown)

Social Determinants of Health

• 1. As a determinant of health, medical care isinsufficient for ensuring better health outcomes.

• 2. How do we intervene without medicalizing SDoH?

• 3. What (new) data are needed?

Magnan, S. 2017. Social determinants of health 101 for health care: five plus five. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC.https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five.

Social Determinants of Health

• 1. Improve daily living conditions

• 2. Tackle the inequitable distribution of power, money, resources

• 3. Measure and understand the problem and assess the impact of action

Magnan, S. 2017. Social determinants of health 101 for health care: five plus five. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC.https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five.

Community Health Center Roots

Community Health Center Roots

Community organizing

Broad based alliances of community institutions that come together to use their collective power to advance a vision of the common good

Community organizing

Community organizing for health

Our concept of health is to make social change, to build the institutions that make social change, and to keep it going.

We call it community health action-H Jack Geiger, MD

The doctors role in Health Equity

If “structural competency is taken to imply that physicians can change politically determined social determinants of health in the course of the clinical encounter,

I disagree

Health Equity Organizing

EducationHealth Equity Circle

Clinical trainingResidency curriculum

Clinical practiceClinic Based Organizing

Health Equity CircleNetwork of inter-professional student organizations in WA, OR, MT, WY

Tent city ordinanceHEC Lobby day

Residency Curriculum

Medical residency training programs

Cherry Hill Family MedicineOHSU Family Medicine

Best starts for kids: $392 million levy king county, most comprehensive approachto early childhood development in the nation

Clinic Based Organizing

Clinic as base for organizing staff, patientsand community organizations to address the social determinants of health

Country Doctor, SeattleOHSU Richmond clinic, Portland

Portland: $67 million increased funding for affordable housing

Questions?