Woot! I'm teaching a class for the University's Public Health Institute.
It's an expansion and adaption of my standard training, but the U's resources (and the expectations for an MPH for-credit class) made it possible for me to do a lot more with the learning. With benefits for us all! See next post.
Here's a list of our readings and a description of the final assignment that will be featured in the next post.
Assignment: Making the Case
Identify a relevant (to your interests and our class focus) resource: research study, news article, case study, etc. The resource should:
- Provide insight on the relationship between place and health
- Illuminate the intersection with structural/systemic racism, racial disparities
- Include a link to the resource
- Less than 300 word description
Reading List
James, A. (2009). The impact of racism on birth outcomes for African American women. Action
ReplyDeletelearning collaborative on racism and infant mortality. Retrieved from http://vimeo.com/30391428.
There are several medical issues today that are a direct result of social ills. Systemic racism might top the charts as one of the largest contributors to poor maternal health and thus high infant mortality for those citizens in the United States that are not white. The most prominent example of this is African American women’s, particularly in the south, ability to deliver their children in a hospital was strictly forbidden until the civil rights act. Though large examples, like access to hospitals during pregnancy, are harder to find these days, African American mothers are still twice as likely to lose their infant before the age of one to death as White mothers. Through the life course perspective researchers describe this difference in birth outcomes through the experiences of the child’s parents. Chronic stress, hopelessness, persistent racial and ethnic discrimination in the health care system as well as other systems that these African American individuals interacted with all contributed to the high infant mortality of African American citizens in the United States. The researcher demonstrates several different ways that this systemic racism has played out, from the large example of the GI bill and African American citizens unable to access this important resource to the more implicit example of news articles post-Katrina that describe black men as “looting” a store, while white men were described as “finding food to stay alive” from the same store. Living each day in a society where non-white individuals are told, reminded and reminded again that they are second class citizens continues to contribute to poor health outcomes including high incidents in infant mortality.
Cassandra Rohlik
cassandra.rohlik@gmail.com
Barclay, E. (2013). Can Star Power Make New Orleans' Food Deserts Bloom? NPR: Food For Thought. Retrieved from
ReplyDeleteFood security and sustainability in the community setting holds my interest, and that led me to looking into food deserts. “A food desert is defined an area where the nearest grocery store is more than 10 miles away” (Barclay, 2013). Those people that are not close, in proximity, to grocery stores have little or no access to any facilities that offer the fresh affordable foods needed to maintain a healthy diet. However, as stated in Barclay’s NPR article, “grocery stores alone won’t make the food desert bloom” (2013). The whole system, in regards to the places where food deserts are located, needs to be observed for the health of the community. Various celebrities have gotten involved in the battle against food deserts, but they are coming up against multiple challenges. They have put in private funds, as well as grants awarded through the Obama Administration’s Healthy Food Financing Initiative, but the financing is still not complete. A team of individuals, including the local bankers, had to be convinced of the importance of opening a grocery store. Transportation also had to be provided or figured out so as to provide many a chance to get to the store. The issue of food deserts is a widely stretching issue where the focus is not only on location and geographic access, but also on economic security. This article very lightly discusses the effect of living in certain places with regards to health. It is important to realize that geographic access and economic security are only pieces of the food desert issue.
Katelyn Wuebbolt
kwuebbolt@gmail.com
The Warmth of Other Suns is a “life-changer” … a book I wish everyone would read so we could collectively gain greater understanding on race and disparity. Isabel Wilkerson describes America, 1915-1970, the time of the Great Migration of blacks from the South to the North as “a thousand hurts and killed wishes … that led to a final determination by each fed-up individual, which, added to millions of others, made up what could be called a migration.” The book brings to life a significant part of our country’s history and gives us perspective on our society today.
ReplyDeleteThe stories shared through Wilkerson’s narrative made me wonder how the Great Migration lives on today. How did this movement of a group of people, all the same skin color, affect the growing cities of the north? What impact did these communities have on their culture … the one they left behind and the one they strived to create? How did these developing communities affect job opportunities? Health? Through the book, we understand how communities within pockets of our country came to exist. But what do they look like today?
Many blacks migrated to Chicago. The article, “Neighborhood, not income, linked to Chicago health disparities” (http://thegrio.com/2012/07/31/neighborhood-not-income-linked-to-chicago-health-disparities/) describes the conditions many still experience today. The article references how geographic communities struggle with poverty, which influences a number of other related issues, such as job growth, community development and health. Each appears to influence the other. The article concludes that “we need to tackle the structures and systems that create and perpetuate inequality to fully close racial and ethnic health gaps.”
Readings like these inspire us to look outward … to be aware of disparities related to race and determine what role each of us has in addressing this issue.
http://www.startribune.com/local/minneapolis/163306966.html
ReplyDeleteThis story is about a local co-op investing in a community in Minnesota. I believe this has to do with health disparities because this specific community in Minneapolis has high rates of illness and rates of obesity. This is a story of creating change by investing and empowering a community. If we are going to decrease the health disparities we need to connect local business and agencies and communities. We can discuss health disparities but if we create an environment where youth and families can make positive decisions for their families it takes away that barrier. If youth and families can feel pride in their community and see organizations build and want to be a part of where they live that creates a healthier and more positive environment. Stories like this make me believe in the change that can come to a population and community and that we are all connected and it is not just them or us, we are all in this together.
Ruchi Kaushik
ReplyDeleteJune 20, 2013
PubH 7200
Public Health Institute 2013
Part 1 – Making the Case
http://www.nyrnaturalnews.com/health/2011/10/place-not-race-determines-how-healthy-you-are/
This article describes a study conducted by Johns Hopkins Bloomberg School of Public Health that revealed that where one lives, rather than one’s race, is far more instrumental in one’s health. Investigators examined a racially integrated, low-income neighborhood and discovered that poverty and lack of access had a greater effect on health risk than race. Researchers point out that other studies fail to account for the fact that much of the US is segregated and, hence, race has appeared to play a factor in health disparities.
This study differs in that it assesses a racially integrated neighborhood of families with similar income and education. In essence, they compared white and black Americans exposed to the same set of socioeconomic, social and environmental factors.
The article cites another study that found reduced rates of morbid obesity and diabetes in low income women who had moved from higher-poverty to lower-poverty neighborhoods. The investigators concluded that low-income neighborhood environments contributed to poor health, over race.
In both studies, recommendations were made to policymakers to “address differing resources of neighborhoods” and “that improving the environments of low-income urban neighborhoods might improve the duration and quality of life for the residents and lower health care expenditures.”
Although the article utilizes the word “race” quite frequently, the authors openly discuss that race is not as important a factor as it has been previously believed to be. There is much discussion about racially integrated neighborhoods which allows the idea of a blended community to flourish. Description of individual choice and behavior is notably absent, and recommendations to policy-makers to drive collaborative change are notably present.
Joint Center for Political and Economic Studies (November 2012). Place matters for health in Baltimore: Ensuring opportunities for good health for all. Retrieved from http://www.jointcenter.org/research/place-matters-for-health-in-baltimore-ensuring-opportunities-for-good-health-for-all
ReplyDeleteAll Americans deserve to be able to live, play, and work in environments that are safe and conducive to their maintaining healthy lives. However, the epidemiologic study described in the link above shows that in Baltimore, Maryland, people of color, particularly African Americans, do not have the same opportunities that the white race has to choose a healthy lifestyle due to the fact of where they live. The authors reported the startling fact that between 2005-2009, people who lived in areas with the highest life expectancy lived an average of 30 years longer than those living in areas with the lowest life expectancy. And you guessed correctly: the areas with the lowest life expectancy were all predominantly black in population. Low life expectancy in these same areas were also highly correlated with high poverty rates, low educational attainment levels, and high neighborhood risk characteristics (such as high rates of street violence, drug and alcohol activity, building vacancies, and liquor stores per capita). How do these area characteristics relate to low life expectancy, which is a measure of the health of a population? Think about how good a choice you can make for your health when you have are on a fixed income and have to decide whether to eat or take your blood pressure medicine. When you know the streets of your neighborhood are not safe after dark so you can’t go for an evening run? Where the closest grocery store that sells food that isn’t “convenient,” pre-packaged, or full of preservatives is two miles away and you do not have a car, nor does the city offer a viable public transportation alternative to get there? The study even found that, in 2009, across all quintiles of income levels, black mortgage applicants were up to three times as likely to have their mortgage application denied compared to white applicants. Accordingly, even black citizens of these lower life expectancy communities who try to move to different areas battle against lending practices that make it hard for them to do so. The summary of all these factors help explain how black citizens of Baltimore end up living in communities that do not provide them the same opportunities to improve their own health.
http://scholar.harvard.edu/files/davidrwilliams/files/2012-elucidating_the_role-williams.pdf
ReplyDeleteThe article I read was ‘Elucidating the Role of Place in Health Care Disparities: The Example of Racial/Ethnic Residential Segregation’ by K White, J Haas and D Williams, 2012. It presents a conceptual framework describing the role of racial residential segregation on health care disparities. This conceptual framework is built on the results of numerous research articles published between the period 1998 – 2011. It looks at how the neighbourhood, health care, provider and individual factors affect the differences in health care access, utilization and the quality of preventive, diagnostic, therapeutic and long-term care services. Using these parameters, the authors have constructed a framework to show the linkages between them. The model suggests that racial segregation as the cause of health care disparities and tries to find mechanisms through which it acts. The article also mentions how segregation in the health care facilities contributes to increasing the disparities.
The article also emphasizes the need of using spatial analysis to link health care access to racial segregation.
The conceptual framework highlights the influence of segregation in shaping access, utilization, and quality of health care services across the entire spectrum of clinical care.
The article concludes that to achieve the goal of ‘Healthy People 2020’ and a comprehensive health reform, there is need to conduct more in-depth research on mechanisms of segregation that affect health care access, utilization and quality of care.
This article is very much relevant to our discussions of getting to the root of the problem. And it can also be the elephant for bringing the issue into prominence. Presenting such cause and effect frameworks, one can not only try to understand racism and segregation but also try to reduce it.
Nehal Shah
nehalshah30@gmail.com
In a 2009 Minnesota Public Radio news story reported by Lora Benson, titled “Income, ZIP code, education are good indicators of health” investigators from Wilder Research described the disturbing patterns observed in the health data they collected on Twin Cities neighborhoods. Wilder’s executive director Paul Mattessich explained that living in certain ZIP codes in the Twin Cities could mean a shorter life span for some people by as many as 5-8 years. Wilder researchers point to the cumulative effect of the social determinants of health or in other words factors that include both community assets and deficits and that play a role in shaping the health of the community. The absence or lack of community assets such as spaces for safe physical activity, easy access to transportation, high quality food and education were contributing to the health disparities seen between affluent communities and less affluent communities where greater percentages of people of color reside. One of the Wilder researchers pointed to poor and working class neighborhoods such as North Minneapolis, Frog Town, and Phillips where there are greater percentages of people of color and contrasted these communities with affluent suburbs such as Eden Prairie, Edina and Minnetonka where most of the residents are white. In 2009, during a nationwide H1N1 influenza break out, local neighborhood-based health disparities were clearly reflected in the data collected by Children’s Hospital in south Minneapolis. In a three-month period between April-June of 2009, the hospital experienced 700 flu cases and of those cases, 81% were non-white. In a normal flu season, the number of cases is usually split evenly between white children and children of color. Researchers and public health officials expressed concern about this huge increase and disparity and wished to know more about what strategies to employ to reduce the disparity, particularly in future outbreaks.
ReplyDeleteMy reaction to this news story is that it was framed in such a way that did a fairly good job of avoiding the elephant. While race was mentioned a few times, the issues were discussed from broader, environmental perspectives. Researchers were looking into how education and income contributes to determining one’s zip code, which then contributes to one’s health--factors that apply to people from all backgrounds. For Americans who find race too sensitive a topic to discuss or who wish not to consider race, a story framed in this way may not be too hard for them to digest. Thomas LaVeist, director of the Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health summed up his research quite well in regard to a study he co-led on place-based health disparities: "When people are living in a similar type of environment and they behave similarly, they tend to have similar health outcomes.” Framing the research in this way emphasizes the environmental factors and structures and avoids the elephants.
I wanted to share the Louisville Metro Health Equity Report found here: http://www.louisvilleky.gov/NR/rdonlyres/29925903-E77F-46E5-8ACF-B801520B5BD2/0/HERFINALJAN23.pdf
ReplyDeleteThis is a metro-wide report focusing on the social determinants of health- everything from income to food access to parks and physical activity. "Where we live shouldn't determine how long we live" writes Anneta Arno, Director of the Center for Health Equity in the introduction to the report. Though a bit long, overall this publication is a superior example of a city understanding the complexity and systemic nature of the health of its residents. Additionally, the data is presented in a way that is compelling, mostly elephant-avoidant and full of fascinating maps focusing on the root causes of health.
The report is an excellent read from cover to cover. Some of the findings include that areas considered food deserts have mortality rates 2 to 3 times that of the total metro rates and that some of the poorest neighborhoods have life expectancies 10 years shorter than those of the total metro. I particularly enjoyed the "tree" graphics on page four, a visual representation how health outcomes are high when community assets are strong. The report even includes a section on structural racism and Louisville history, which gives some insight into the metro health inequities. This is a great report that should certainly be shared and serve as a model for how other cities approach framing the health of their citizens.
See the report on the right side of page and the video at the bottom of the page: http://www.kingcounty.gov/exec/equity.aspx
ReplyDeleteThis is a report published by King County of Washington (where Seattle is located) that is entitled, “Equity and Social Justice Annual Report”. The report does a fantastic job at outlining most of the causes of social inequities including health disparities leading to the problems discussed in class, as well as outlining how to address these inequities in a comprehensive manner. Topics such as geographic impact on health and well being (e.g. food deserts) are included. I found that in the video they still utilize elephants when pointing out problems including things like “obesity” and “making good choices” even though the overall approach and delivery is pretty good.
In the video and report they don't really come out and call it racism but they imply it by giving statistics to highlight higher percentage of minorities having problems. Then again, I wonder if they are implying racism still occurs or are they are actually inadvertently providing elephants readers can use to “blame” minorities for poor choices versus highlighting their environment as leading to their predicament? The terms segregation and discrimination, even from a historical perspective do not occur in the report. One mention of institutional racism is given. This kind of leaves it up to the reader to decide what are the determinants of health outcomes, race and choices or the environment? They do provide the notion of geography (and differences in race proportions therein) and health outcomes pretty well nailed, which is good. They avoid calling it racism and instead say social inequities, maybe this is their way of avoiding “racism” itself as an elephant.
I couldn't just use one resource to come to my conclusions so here is an article about historical discrimination in Seattle, which has clearly fostered the current situation of disparity:
http://www.seattle.gov/cityarchives/Exhibits/Openhous/default.htm
If you look at racial redlining (e.g. restrictive covenants) used back in the 60's in Seattle, they match up with current minority distributions. In the King County Social Inequities report they link current distribution with social inequities. It's pretty easy to see the link between institutional racism and modern social inequities.
Here is another video about racial dispersion in Seattle, though the speaker plays it pretty safe:
http://slog.thestranger.com/slog/archives/2011/02/24/the-racial-history-of-seattle
The speaker almost slips and says Asians were “less discriminated against”, but catches himself and says it in a different way. It seems as though calling out institutional racism and discrimination is still taboo even in a progressive place like Seattle.
In the current pandemic period, many people are doing racism what is learned in a public health class?
ReplyDelete