Community Health Through Social jus·ticeˈjəstis/noun: 1. just behavior or treatment. ......
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Community Health Through Social Justice Adewale Troutman, MD, MPH, MA, CPH June 2016 University of Wisconsin From Practice to Populations
Transcript of Community Health Through Social jus·ticeˈjəstis/noun: 1. just behavior or treatment. ......
Community Health Through Social Justice
Adewale Troutman, MD, MPH, MA, CPH June 2016
University of Wisconsin From Practice to Populations
Born in to One of these little boys felt that he could change the world
Poverty Racial Tension Urban Ghetto Segregation Domestic Violence Alcoholism Abandonment Single Parent School guidance counselor
Proving them wrong Bronx Community College- Girlfriend Lehman College- Sports Physical Education Major and Teacher SUNY Albany-Black Studies Major Counselor New Jersey Medical School Family Practice South Carolina Residency FQHC Emergency Medicine Newark, NJ Public Health Dept Atlanta, Louisville Academia University of Louisville, University of South Florida
I BELIEVED THAT I HAD THE POWER TO CHANGE THE WORLD
WHAT DO YOU BELIEVE?
Power of ONE
• Martin Luther King, Malcolm X • Angela Davis, Gloria Steinem • Steve Jobs, Mark Zuckerberg • Tiananmen Square “Tank Man” • Nelson Mandela, Steven Biko • Harvey Melk, Ellen • Mother Teresa, Gandhi • Oprah • Jeffrey Canada
We are All Connected • Health-Communicable Diseases
– HIV – Bird Flu – SARS, MERS – West Nile Virus – Zika Virus – Ebola Virus
• Natural Disasters – Tsunami, Earthquakes, Flooding • Technology- Internet, Facebook, Dating Apps • Economy- Asian, EU, Greece, China • New Physics-Depak Chopra’s Molecular Science • Humanity- Shootings in Ferguson, Charleston, SC, Baltimore
Girls in Nigeria, Wars in Iraq, Syria, Israel, Gaza, Afghanistan
“We are all Connected by the great circle of life” Mufasa The Lion King
The Value of Framing…
The questions you ask determines • your analysis of the issue • how you prioritize it • your policy choices • resource allocation • your allies and your enemies • define when an issue has been resolved
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Reframing
• Health vs. Healthcare • Individual (Medical Model) vs. Population Health • Market Justice vs. Social Justice • Rights vs. Privileges • Behavioral/Genetic Determinants vs. Social
Determinants • Creating Health Equity vs. Eliminating Health
Disparities
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Health inequities, “the unfair and avoidable differences in health between groups of people within countries and between countries (WHO, 2016),” stem from the social determinants of health and result in stark differences in health and health outcomes.
Defining Health Inequities
Other terms used to describe such differences reflect the countries in which they are used. For example: United States - “disparities” often denotes racial or ethnic disparities (HHS, 2016) involving structural racism and other forms of unfair and unjust discrimination that create gaps in health among segments of the population. United Kingdom - “inequalities” is typically used to describe differences in health among groups based on socioeconomic conditions (Marmot and Allen, 2014).
Terms Used to Describe Differences
HEALTH EQUITY- Disparities eq·ui·ty ekwitē/noun: 1. the quality of being fair or impartial; fairness; impartiality: the equity of Solomon. 2. something that is fair and just:
Synonyms: disinterest, equitableness, impartiality, fair-mindedness, fairness, justness, evenhandedness, objectivity;
justice, probity. worth value Antonyms: bias, discrimination, inequity, injustice, partiality, partisanship, prejudice, unfairness, unreasonableness;
injustice.
When all people have "the opportunity to 'attain their full health potential' and no one is 'disadvantaged from achieving this potential because of their social position or other socially determined circumstance'”
The realization by ALL people of the highest attainable level of health.
Achieving Health Equity
– Valuing all individuals and populations equally – Focused and ongoing societal efforts – Assuring the conditions for optimal health – Addressing historical or contemporary injustices and socioeconomic disadvantage
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SOCIAL JUSTICE-Market Justice • jus·ticeˈjəstis/noun: 1. just behavior or treatment. The quality of being just; righteousness, equitableness, or moral rightness: to
uphold the justice of a cause. 2. rightfulness or lawfulness, as of a claim or title; justness of ground or reason:
snonyms: fairness, justness, fair play, fair-mindedness, equity, evenhandedness, impartiality, objectivity,
neutrality, disinterestedness, honesty, righteousness, morals, morality
Injustice in terms of the distribution of wealth, opportunities, and privileges within a society
The application of principles of justice and fairness to the broadest definition of society
www.who.int/social_determinants
Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death…
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“There can be no hope for the spread of freedom, democracy and human dignity unless
we treat health as a basic human right”.
Keynote address to the 7th Conference of European Ministers, WHO
HUMAN RIGHTS-Privileges
• noun plural • : are moral principles or norms[1] that describe certain standards of
human behavior, and are regularly protected as legal rights in municipal and international law.[2] They are commonly understood as inalienable[3] fundamental rights "to which a person is inherently entitled simply because she or he is a human being,"[4] and which are "inherent in all human beings"[5] regardless of their nation, location, language, religion, ethnic origin or any other status.[
• A higher order of right s that are MORALLY based and UNIVERSAL that belongs to all persons equally.
Health is a Basic Human Right Not a Privilege
Preamble to the constitution of the World Health Organization
states The enjoyment of the highest standard of health is one of the fundamental rights of every human
being without distinction of race, religion, political belief, economic or social condition
• “If we could but recognize our common humanity, that we do belong together, that our destinies are bound up in one another’s, that we can be free only together, that we can survive only together, that we can be human only together, then a glorious world would come into being where all of us lived harmoniously together as members of one family, the human family.”
Desmond Tutu
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Who is on the bank of the river? And, what are they doing?
“The web of causation” Nancy Kreiger
Finding the balance The Troutman Group
Bystander Intervention
• The one who does nothing • The one who jumps in • The one who teaches • The one who goes upstream to find the source • The one who is directing traffic • The one who wants to meet about it!
What ever we are doing, it must involve
Social Determinants
Social Determinants of Health
• Socioeconomic Status – Education – Occupation – Income
• Housing- Zip code • Built Environment • Food- Security, Desert • Political Power • Racism & Discrimination
• Early Life • Social Exclusion • Work • Unemployment • Social Support • Addiction • Stress • Transport • The Social Gradient
Dealing with the social determinants of health may yield
greater and more sustainable returns The Troutman Group
WATER SCIENCE AND TECHNOLOGY BOARD
A Framework for Educating Health Professionals to
Address the Social Determinants
of Health
BOARD ON GLOBAL HEALTH
The WHO (2015) defines Social Determinants of Health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”
Defining the Social Determinants of Health
Without addressing the underlying causes of disease and ill health, the risk of perpetuating a cycle of inequity, disparity, and inequality will remain for generations to come.
Addressing the Social Determinants of Health
Let’s talk about a few……
• HOUSING- Hope 6, Place Matters (Zip codes/Genetic code)
• POLITICAL POWER-Flow of resources, prioritization of
issues, importance of voting, Living wage
• RACISM-Camara Jones, Historical Perspective, Mississippi State University
Purpose Built Communities
• Based on efforts in Atlanta’s East Lake district
• Purpose Built Communities uses integrative strategies including cradle-to-college educational opportunities, mixed-income housing, early child development programs, employment support and recreational opportunities
• Community engagement and philanthropy
• Key: addressing all of the challenges faced by disadvantaged communities simultaneously
• Purpose Built Communities in Atlanta, New Orleans, Indianapolis, Charlotte, among others
Implementing the Purpose Built Model
Strong local leadership. A proven national model. Best in class partners.
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East Lake Meadows, Atlanta - 1995 Safety
• 18x national crime rate
• 90% of families victims of a felony each year
• $35 million a year drug trade
Housing
• 100% public housing
• 1400 residents in 650 apartments
• 40% of units unlivable
Employment
• 13% employment
• 59% of adults on welfare
• Median income of ~$4,500
Education
• One of lowest performing schools in Georgia
• 5% of 5th graders meet state math standards
• 30% graduation rate
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Villages of East Lake - Present Housing
• High-quality, privately managed housing
• Mixed-income (50% public housing, 50% market rate)
• 1400 residents in 542 apartments
Safety
• 73% reduction in crime
• 90% lower violent crime
Employment
• 75% employment in public housing, remainder in job training, elderly or disabled
• Median income of ~ $15k in public housing households
Education
• ~1500 in Pre-K through 10th
• 98% meet or exceed state standards
• A top performing school in Atlanta and the state
Principles in Action
• Generate awareness at all levels • Proper framing • Blended curriculum • The power of policy • “Contributing” to community cohesion • Support for “Community Health” • Learn from successes local, national, global
4 RECOMMENDATIONS 3 Framework Recommendations
Education Community Organization
1 Building the Evidence Recommendation
THE FRAMEWORK
CONCEPTUAL MODEL
Principles in Action
• Generate awareness at all levels • Proper framing • Blended curriculum • The power of policy • “Contributing” to community cohesion • Support for “Community Health” • Learn from successes local, national, global
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“It is often easier to become outraged by injustice half a world away than by oppression and discrimination half a block from home.”
–Carl T. Rowan Author and journalist
Principles in Action
• Generate awareness at all levels • Proper framing • Blended curriculum • The power of policy • “Contributing” to community cohesion • Support for “Community Health” • Learn from successes local, national, global
Health in All Policies
Addresses the effects on health across all policies such as agriculture, education, the environment, fiscal policies,
housing, and transport. It seeks to improve health and at the same time contribute to the well-being and the
wealth of the nations through structures, mechanisms and actions planned and managed mainly by sectors other than health. Thus HiAP is not confined to the
health sector and to the public health community, but is a complementary strategy with a high potential towards
improving a population’s health, with social determinants as the bridge between policies and health
outcomes.
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Who is around the table? • Hospitals- Major part of health System, outside hospital
walls
• Faith Based- Respect , Active role in Community, standing on religious beliefs (Large Mega Churches, smaller, older churches)
• Dept. of Transportation- • Dept. of Housing-Air quality, sidewalks , street lights
• Chamber of Commerce- Business involvement
• University Systems- Academia and Research, Education of next generation
WHO ELSE?
To do this work, YOU must be willing to let COMMUNITY drive ….
Collaborations The active and planned participation of diverse
organizations, groups and individuals in a collective effort to define and address issues in the
community
Partnerships Partnerships and collaboration suggest relatively
structured and formal relationships that are focused on achieving specific, collective goals
Collective Consciousness
The set of shared beliefs, ideas and moral attitudes which operate as a unifying force within society
Priorities and Best Practices
Educational Attainment -55Degrees Kalamazoo Promise Economic Development Charlie Johnson-Truckers Racial Discrimination and Social Injustice -Undoing Racism-Boston
Community Convening
Integrating “Unnatural Causes: Is Inequality Making Us Sick” into all community dialogue
To do this work, YOU must see yourself as a strong LEADER
• Difficult Conversations • Breakdown Silos • Bring about change in Power Structure • Put FEAR on the back burner • Don’t be bound by funding only • Consider your sandboxes (who has taken their toys) • Give up control • Move away from your desk. Get out of your Office/
Classroom/Pulpit/Statehouse • Don’t tolerate “lip service” • Upset the status quo
Take Risks
IT’S TIME TO START A MOVEMENT!!!!!!
From the labor movement to the civil rights movement to the women’s
movement, to the gay and lesbian movement, it has been the actions of people most impacted by injustice that transformed our society’s systems and institutions, as well as our hearts and minds.
By cultivating a movement perspective, we choose to leave behind a more narrow vision and strategy that is based on our organizational needs/capacity and take on an expansive vision and align strategies towards common movement goals.
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Come on Community Organizers What’s on your placard?
What Action will you take?
Build a Health Equity and Social Justice Movement
Throughout history, social movements have brought about the most significant changes for racial, economic and gender justice. • SOCIAL MOVEMENTS DEFINED
• Sustained groupings that develop a frame or narrative based on shared
values, • that maintain a link with a real and broad base in the community, and
that build for a long-term transformation in systems of power.
Movement Building is the long-term, coordinated effort of individuals and organized groups of people to intentionally spark and sustain a social movement.
– Organizing for big change /transformational change – Developing collective consciousness around the issue ( A common voice ) – Common Vision of Hope
Builders Act…..that’s what they do! • As movement builders, our job is to know our terrain – the bigger context we
are working in – in order to understand our unique role, given our particular mission and gifts.
• Movement builders constantly engage core allies, the public, and people in positions of power to address systemic problems and promote alternative visions or solutions.
• As movement builders we need to reach beyond what we think is politically
feasible or culturally possible at the moment so that we can take a bold, fierce stand to address root causes in inequity, violence, and ecological destruction.
• .
What did they do?.........
• Got involved • Allowed passion to take over • Raised their voice • Organized • Cared for one another • Stood for diversity and inclusion • Knew that their lives mattered • Had a collective consciousness • Felt they had the POWER to CHANGE THE
WORLD
4 RECOMMENDATIONS
3 Framework Recommendations Education Community Organization
1 Building the Evidence Recommendation Funding and Investment
It’s Over to You
• Know what you have to offer and leave here willing to share that beyond your SILO
• Strive for a Collective Consciousness • See YOURSELF as an Engaged, Committed Leader • Find Political will, it takes courage • Redefine your personal and professional values • Remember the POWER OF ONE is real • Remember this has to be a MOVEMENT that
moves • Be willing to take a risks, ask tough questions
RISK To laugh is to risk appearing the fool, To weep is to risk being called sentimental. To reach out to another is to risk involvement. To expose feelings is to risk showing your true self. To place your ideas and your dreams before the crowd is to risk their loss. To love is to risk not being loved in return, To live is to risk dying, To hope is to risk despair, To try is to risk failure But risks must be taken, because the greatest risk in life is to risk nothing. The person who risks nothing, does nothing, has nothing, is nothing, and becomes nothing. He may avoid suffering and sorrow, but he simply cannot learn, feel, change, grow or love. Chained by his certitude, he is a slave; he has forfeited his freedom. Only the person who risks is truly free. Often attributed to the poet and thinker, Leo Buscaglia, the real author of this inspirational verse is Janet Rand. Poems
UPDATE on The boy who thought he could change the world and his
Mother…
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Adewale Troutman, M.D.,M.P.H. MA, CPH The Troutman Group
President/CEO
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[email protected] 502 544 8570
www.thetroutmangroup.org
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