Serving The Underserved Facing Failure & Choosing Change
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Transcript of Serving The Underserved Facing Failure & Choosing Change
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SERVING THE UNDERSERVED POPULATIONS OF IL:
FACING FAILUREAND
CHOOSING CHANGE
Deleshia “Dyi” Kinney, M.D., M.A.T.
Health Care Advocatewww.drkinney.webnode.com
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ACKNOWLEDGEMENTS
2008IL WOMEN'S HEALTH CONFERENCE
IL Dept. of Public HealthSpecial Thanks to:
Brenda BlaskoMarbella Marsh
IL Dept. of Public Health
Ann Locke & Sandra WoodsSpringfield Urban League Health Initiative
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AGENDA
Pre-Test (5 min) Welcome / Overview of Objectives (10
min) Small Group discussion (if permissible)
(30 min) Review & Resources (5 min) Questions & Conclusions (10 min)
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OBJECTIVES
WHERE WE ARE NOW DEFINE THE PROBLEM DISCUSS PRACTICAL SOLUTIONS
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WHERE WE STAND
The Common Wealth Fund: The National Scorecard
The Agency for Health care Research & Quality (AHRQ):
National Healthcare Disparities Report
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National ScorecardDIMENSIONS OF HIGH PERFORMANCE
HEALTH SYSTEM (2006 – 2008)
Healthy Lives
Quality
Access
Efficiency
Equity
Overall Results
0 10 20 30 40 50 60 70 80
20072006
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National Scorecard
67 65
2006 2008
OVERALL
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National Scorecard
70 71
2006 2008
EQUITY
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AHRQDIMENSIONS OF QUALITY
Effectiveness of Care Patient Safety Timeliness Patient Centeredness Overall Results SPECIFIC CLINICAL CONDITIONS CARE TYPE SETTINGS
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AHRQ
2.3% 1.5%
1994-2005 1999 - 2005
OVERALL RATE OF IMPROVEMENT
AHRQ
National Health Disparities Report
Blacks 10 times new AIDS cases, greater proportion of children hospitalized for asthma
Asians 65+ more likely than whites to lack pneumonia immunization
AI/AN 2 times more likely to lack prenatal care
Hispanics 3 times the new AIDS cases
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Public Health“... the combination of science, practical skills, and values directed to the maintenance and improvement of the health of all the people. It is a set of efforts organised by society to protect, promote, and restore the people's health through collective and social action. ...but the goal remains the same - to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the populations.”
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CONCLUSION
SYSTEM IS BROKEN
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QUESTION #1
DEFINE:
UNDERSERVED
INEQUALITY
INEQUITY
HEALTH DISPARITIES
SPECIAL POPULATIONS
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U.S. Dept. of Health and Human Services
Medically Underserved Areasurban, rural, public, population groups,
facilities
Medically Underserved Populations
economic, linguistic, or cultural barriers
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Merriam Webster
Definition
They are under resourced, not having sufficient resources
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Often Forgotten Subpopulations
Don't forget subpopulations Migrant Workers & other immigrants Asian: Phillipinos, Chinese, Japanese,
Vietnamese etc. Middleasterners Women, children, elderly, low-income,
racial/ethnic minorities
CAN CHANGE
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HEALTH INEQUALITY
“…is the generic term used to designate differences, variations, and disparities in the health achievements and risk factors of individuals and groups…that need not imply moral judgment…
Refer to measurable differences in outcomes.
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HEALTH INEQUITY
“...health equity concerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable – and thus inherently unjust and unfair.”
Refers to stronger view that unfair differences could be changed if willing
QUESTION
GIVEN OUR WEALTH & MEDICAL ADVANCES WHY DOES THE U.S.
RANK 29TH IN LIFE EXPECTANCY?
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po
Definition: Definition
Definition: They are under resourced, not having sufficient resources
HEALTH / CLASS LADDER
Health Gradient Predictable
$$$$$$$$$$$$$$
Most HealthyMost Control
Least Healthy, Least Control, Most Stressed
$
Least Stressed
QUESTION
WHAT DETERMINES HEALTH?
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SOCIAL DETERMINANTS OF HEALTH
HEALTHPOLITICALPOLICY
SOCIETY
CHRONICSTRESS
INEQUALITY
CHOICES
CONTROL
RACISM
CONTROL
COMMUNITY RESOURCES
Food Access & Availability
Quality Education Good Transportation /
Planning Affordable Housing Good Jobs & Work
Opportunities
Business Investment & Development
Income & Wealth Social Supports Public Safety Green Spaces Recreational
RESPONSIBILITY
VS.
QUESTION
WHAT IS THE SOLUTION?
CHANGE
....our way of thinking about the problem. ...our way of thinking about solutions ...our approach to the problem. ....our approach to solutions. ...our public policies. ...our health care system
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CHANGE APPROACH
Conventional question: How can we promote healthy behavior? Health equity question: How can we target dangerous conditions and reorganize land use and transportation policies to ensure healthy spaces and places?
Conventional: How can we reduce disparities in the distribution of disease and illness? Health equity: How can we eliminate inequities in the distribution of resources and power that shape health outcomes?
Conventional: How can individuals protect themselves against health disparities? Health equity: What kinds of community organizing and alliance building are necessary to protect communities?
QUESTION
WHAT POLICIES AT THE LOCAL, STATE, AND FEDERAL LEVEL MIGHT
REDUCE SOCIAL AND ECONOMIC INEQUITIES?
CHANGE
SOCIAL POLICY
HEALTH POLICY
POTENTIAL POLICY
CURRENT 8 hr work day
Min. Wage Unemployment insuranceFree K-12 public educationAffirmative Action (limited) Social Security
POTENTIAL Guaranteed Paid
Vacation Living Wage Job training & Placement Paid Parental leave Housing Assistance Universal Health care
CHANGE POLICY
Promote Understanding of Social Determinants of Health
Improve income
Improve physical environment
Promote racial justice
Promote better working conditions
Improve children's health
Universal Health Care
Improve social inclusion
Food security and quality
Improve Education
Improve sustainable transportation
Improve Health Impact Assessment
WHERE TO START CHANGE
Encourage Civic Engagement
Stay connected!
Realize change isn't easy but NOT impossible.
CHANGE POLICY
Identify and connect
Organize
Form committee
Screen and discuss PBS series: unnatural causes
Identify existing struggles
Conduct an audit
Form community-wide coalition
Ask local PHD to conduct Health Impact Assessment for proposed ordinances
Provide local media with facts
Broaden discussion
Organize a forum
QUESTION FOR THOUGHT
If children received universal health care and it was implemented today would everyone receive necessary
care?
RESOURCES
Common Wealthfund
http://www.commonwealthfund.org
http://www.unnaturalcauses.org/
U.S. Department of Health and Human Services
http://www.ahrq.gov/
http://www.phac-aspc.gc.ca/sdh-dss/glos-eng.php
WHERE TO START CHANGE: you!!!!
THANK YOU !!!.
Women's Health
Gender Disparities Racial / Ethnic Disparities
Black women receive poorer quality of Care 53% of measures, 29 % show have worse access
Hispanic women receive poorer quality of care than non-Hispanic whites for 60% of measures, and poorer access for 87% of measures
Socioeconomic Disparities Services unique to women QOC poorer in 75%