PHPB 301-01 All notes PDF

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Lecture notes from Monica Wendel's health equity class...

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PHPB 301-01 Wendel/ Jones Health Equity Notes  

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Need to check out Video intro, 2 minutes or less with: o Name o Where I’m from, info about you o What I’m hoping to get from this class o Something interesting that will help us remember you Read: Braveman Health disparities and carter-pokras for next class

Day 1 Objectives    

Distinguish b/w disparities and inequities Articulate a social ecological approach to health Discuss the diff b/w equality and equity Define how justice is related to equity

Health Disparities   

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Preventable differences: Risk, Exposure, Disease, Injury, Violence, Access, outcome Disparities refer to differences, in PH inequities refer to preventable differences Public health first looked at the individual level, then scaled up to the interpersonal level (interactions between people), then the organizational level above that (org rules and norms alters exposure), then the community level (factors such as safety within community altering your willingness to practice healthy habits), then is society (aka policy, affects all) this is called the social ecological model Social determinants of health o Policies and Programs o Health Factors  Health Behaviors (30%)  Tobacco use5  Diet and exercise  Alcohol and Drug Use  Sexual Activity  Clinical Care (20%)  Access to Care   Social and Economic Factors (40%)  Physical Environment (10%) o Health Outcomes  Length of life (50%)  Quality of life (50%) Equality- everyone benefits from the same supports (everyone gets the same height box to stand on) Equity- everyone gets the supports they need (everyone gets a different box that makes them end at the same height)

PHPB 301-01 Wendel/ Jones 

Justice- the cause(s) of the inequity was addressed (the wooden fence was replaced with a chain link fence so all can see regardless of the box)

Structural Determinants      

“Root causes’ of health inequities Structural determinants shape the social determinants of health experienced by people in their neighborhoods and communities Include the governing process, economic and social policies that impact pay, working conditions, housing, and education Dictate whether resources for health are distributed equitably throughout society (or unjustly through diff social groups) E.g: The “isms” racism, sexism, classism, heterosexism, etc; policy; law; governance Creates the context, facilitates the social determinants

Social determinants   

Circumstances in which people are born, grow, learn, etc which are shaped by factos beyond the control of the individual They are intermediate determinants of health, ‘down stream’ from the Structural Determinants E.g: income, wealth, edu, food, housing

Race an illusion notes  

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2002 study showed that race impacted health care treatment quality despite similar accesscontrolled factors (insurance status and income) Many factors play role in health care disparities including patients’ and providers’ biases, stereotypes, attitudes and expectations, geographic inequities, institutional/systemic issues (policies and practices that further cultural/linguistic barriers) Repeated race based discrimination  higher bp and more frequent diagnosis of hypertension Internalized racism among blacks who exhibit racial prejudice towards other blacks correlates with higher alcohol use and psych stress Regional housing segregation leaves effects such as overcrowding, environmental exposure, and increased levels of crime and violence Majority-minority communities have increased concentration of health risks o Safe parks, recreational facilities, alcohol and tobacco sources, etc. Non-immigrant regional segregation primarily stems from institutional dis. In the housing finance market and infrastructure policies the negative health and behavioral effects of internalized racism may help explain why advantaged minorities have poorer physical health than poor whites recent employ of Critical Race Theory to address the many form of structural inequality and their intersectional effects on health race based discrimination health impacts whites too o damages social trust and cohesion o limits contributions of marginalized groups o drains social resources

PHPB 301-01 Wendel/ Jones costed $1.24 trillion were drained b/w 2003 and 06 on (lost productivity/ tax revenues from premature death/illness as well as direct medical costs) KEY POINT TIED INTO CLASS: WORDS MATTER, OTHERING LANGUAGE DIRECTS THE NARRATIVE o

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Marginalized populations (The Power of Narrative) 

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War on Drugs o Reinstatement of mandatory minimum sentences for drug possession o Crack cocaine possession limit/sentence 100 times harsher than powder cocaine, other drugs o Drug addiction criminalized Public Health Crisis o Improve access to prevention, treatment, and recovery o Increase the availability and distribution of overdose-reversing drugs o Needle exchange programs for disease prevention o Support for cutting-edge research that advances our understanding of pain and addiction Marginalization is exclusion on the premise of one of various issues Intersectionality- Overlapping identities that affect outcomes and how rights are distributed

Why is necessary for us to understand disparities data? 

To see the proper narrative

Review  

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Distinction between disparity and inequity o Inequity is preventable difference, disparity is not Equality vs equity (and the role of justice) o Equity is making sure everyone gets the support they need o Equality is when everyone gers Social determinants of health o What you experience, i.e. income, food, housing Structural determinants of health o shape what you experience; i.e. policy, governance, racism, sexism Epigenetics- interaction of biological, behavioral, and environmental factors o A genetic predisposition does not equal a definite health outcome o Watch TEDTalk on Methylation Othering languageore Social identities, intersectionality, and marginalization Finding, interpreting, and explaining inequity data

Equity Strategies 1. Housing affordability 2. Rehab of older housing 3. Shared Equity

PHPB 301-01 Wendel/ Jones 4. Policies aimed at landlords Housing Affordability 

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US Dept of Housing and Urban Development (HUD) o HOME Investments Partnerships Program- Fed gives this money o states o National Housing Trust Fund- looks more at rehab existing properties o Section 8, Housing Choice Voucher ProgramFDIC monitors compliance

Rehab of older housing 

Targets existing structures that could be used o Habitability- is it livable o Safety (code)o Health  Asbestos  Lead Paint  Radon o Energy Efficiency o Accessibility

Shared Equity    

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Shared ownership programs create pathways to ownership (plus there are tax incentives) 2 parties share ownership of a property (one is principal resident, one is investor) Resident buys a portion of the property and pays rent in the rest, added to equity where the principle resident eventually buys out the investor Community Development Corps o Real estate development o Affordable housing strategies Ex: OneDC, Habitat for Humanity

Policies aimed at landlords  

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Indiv landlords vs corp landlords Policies target: o Maintenance o Rent control o Financial/ tax incentives Proposition 10 in California (2018 election)- to deal with housing shortage and price gouging o Blackstone- biggest property owner in the world o Restrictions on rent control- not a price ceiling(?), but looking at fair market value, putting a cap on how much it can increase- not saying that it cannot increase

What’s the diff b/w revitalization and gentrification? Food Deserts/Food Insecurity

PHPB 301-01 Wendel/ Jones  

Food desert- areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk, and other foods that make up a full and healthy diet Food insecurity- the disruption of food intake or eating patterns because of lack of money and other resources

Factors affecting     

lack of chain supermarkets lack of healthy, high quality foods in nearby food stores abundance of convenience/corner/liquor stores lack of transportation access to stores in West lou there is one supermarket for every 25,000 residents, compared to one per 12000

Is it all about access?      

Biological determinants- hunger, appetite, taste Economic- cost and income Physical- access, edu skills (e.g. cooking), and time Social- culture, family, peers and meal patterns Psychological- mood, stress, and guilt Attitudes, beliefs and knowledge about food

Food equity strategies    

Availability- food must be present in the community Access- physical, economical, and social access Useable- safe, nutritious, etc. Stability- need for food in ongoing (obviously) must be sustainable

_____________________________________________________________________________________ INEQUITY IN EDUCATION Best understood through four mechanisms    

History of edu in US History of Housing policy in US Curriculum content in US public schools School/edu policies that disadvantage minority students

Pre-Revo War   

No particular system for public education Literacy was specifically for affluent, white boys so they could be leaders in church or govt Public edu started in Mass. 1647 o Every town of 50 fams should have elementary school o 100 fams- Latin school o Goal: for Puritan children (white male kids) to learn to read the Bible

Post Declaration of Independence

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Jefferson proposed 2 track educational system- one for laborers and another for the learned… beginning a literate labor force Cont Cong (1785) reserved portion of land in towns for local schools: this became basis for land grant uni system o Assumed that Congress had right to sell/grant land already occupied by Native Americans 10th Amendment of the Constitution left edu up to states Affluent families paid for education, free/charity edu for poor (laborers) o Need for docile, obedient manual labor workforce st 1 free public high school in Boston in 1820

Anti-literacy laws  

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Slaves except in MD and KY were prohibited from being educated Specific state laws passed between 1829 and 1834 o Illegal to teach slaves to read and write o Punishable by fine AND prison for white person educating o Punishable by physical brutality and death for the slaves being educated Freed slaves and people of color were prohibited from edu in the North and South Resistance by educators who both challenged and found ways around the laws

Mid- 1800s 

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Seeking to “civilize” immigrants and Native Americans o Native American kids taken from parents sent to Indian Boarding Schools o Forced to learn English, convert to Christianity, adopt European customs o “Kill the Indian to save the man” Learn obedience and restraint Contribute to workforce and not social upheaval Reform schools combined edu and juvenile justice systems Immigrant communities fight for local control of public schools

Reconstruction   

Black Americans move to bring public edu to the South Post-Civil War, Black Americans living in South partner with white Republicans (NOT today’s version of republicans) to include free public education in state constitutions 1896 Plessy v Ferguson- separate but equal ruling recognizing legality of segregation

20th Century   

Smith-Hughes Act- federal funding for vocational education o Moves control from trade unions to big manufacturing corps 1924: Congress makes Native Americans US citizens for first time Great Migration of Black Americans from south to north/Midwest o Loss of black labor force in South o NAACP legal action over unequal teacher pay

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1945: GI Bill 1948: Educational Testing Service (ETS) formed 1954: Brown v Board separate but equal abolished GESEGREGATION o Ruby Bridges- 6 years old when segregation ended, had to go to white school, got death threats, her education was opposed o Little Rock 9- US had to send in National Guard to physically get 9 students to be allowed in school when state wouldn’t allow o Freedom Schools in New York o Miliken vs Bradley- can’t desegregate across school districts Federal Tribal Colleges Act establishes community college on every reservation 1979: US Dept of Edu established California: o Prop 187 (1994)- children of undoc immigrants banned from school o Prop 209 (‘96)- outlaws affirmative action in education, employment, and contracting o 1998- ballot to outlaw bilingual education

History of housing  

Understanding the difference between de jure (laws and policies) vs de facto (cultural preference) segregation Although there are no laws segregated anymore, it still affects where people live, safety of neighborhoods  cost/benefit of truancy vs criminal altercation

Curriculum in Public Schools  

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Important to look at what we teach kids about colonialism, Native Americans, slavery, Jim Crow laws, federal and state laws that enforce these things Education and School Policy Impact o Plessy v Ferguson (separate but equal) o Brown v Board (racial segregation unconstitutional in schools) o Local Property Taxes Funding Schools (disparate school funding by neighborhood) o Zero Tolerance o No Child Left Behind  Increased reliance on standardized testing o School resource officers  School to prison pipeline Does marginalization occur in US Educational curricula? o Data shows disproportionate suspension and expulsion o The case are also higher for boys of color o Also higher for American Indian students with disabilities out of school suspension

Summary  

Black students are more likely to be suspended from pre-K than white students Black students make up 18% of all preschoolers, 50% of all pre-K suspensions

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White students make up 43% of all pre-K enrollment and 26% of all those receiving suspensions “Black boys viewed as older, less innocent than whites” Black students represent 19% of students with disabilities and 35% of those with disabilities who are restrained at school When black students and white students commit similar infractions, black students are suspended and expelled three times more often than white students Black students make up 16% of student enrollment but represent 27% of students referred to law enforcement and 31% of students subjected to arrest. White students make up 51% of enrollment, 41% of students referred to law enforcement, and 39% of those arrested. School to prison pipeline o According to a 2015 report from the National Center for Education Statistics, there are more than 43,000 school resource officers and other sworn police officers, and an additional 39,000 security guards, working in the nation’s 84,000 public schools

Strategies that claim to improve education equity  

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Busing Magnet schools o Public school offering special instruction and programs not available elsewhere, designed to attract a more diverse student body from throughout a school district Charter schools o receives govt funding but operates independently of the established state school system (public asset privatization) School voucher/ school choice programs o A govt funded voucher redeemable for tuition fees at a school other than the public school that a student could attend free (comes from funds already allocated for public) Robin hood school funding HeadStart Free and Reduced Lunch Program School Inclusion programs Restorative justice programs o A system of CJ focused on the rehab of offenders through reconciliation with victims and the community at large Trauma informed education programs Fairness and inclusion- OECD

Looking at each of these strategies     

How does it work What actually happens? Who benefits? Who suffers? IN SUMMA: Can we fix education inequity without fixing other inequities?

ENVIRONMENTAL INEQUITY

PHPB 301-01 Wendel/ Jones Environmental Justice video     

1982- PCB in Warren County, North Carolina sparked protest, start of the movement for Environmental Justice High correlation between income, race, and location of hazardous waste facilities Penalties near sites of minority populations were lower than populations elsewhere 1994 Executive Order directs DOJ to address as appropriate disproportionately high effects of its programs and policies on low income and minority populations When 2 garbage collectors were crushed to death by a malfunctioning truck and the govt barely responded- 1,300 black male workers went on strike to demand recognition of their unions, better safety standards, and a decent wage

Environmental Policy   

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1955- Air Pollution Control Act is enacted, marks 1st federal legislation dealing with air pollution 1962- Silent Spring by Rachel Carson is published, first by the New Yorker in serial format and then later that year in book form 1963- Clean Air Act is enacted, marks first federal legislation dealing with air pollution; revised in 1970 to set regulations limiting the emission of harmful pollutants from stationary sources (like industrial facilities and power plants) as well as mobile sources (for transportation) 1/1/70- Natural Environmental Policy Act, among other things, establishes process for environmental assessments and environmental impact studies 4/22/70- first Earth Day 12/2/70- EPA est 1972- Clean Water Act (Adapted from Federal Water Pollution Control Amendments of 1948) focuses on surface water 1973- Endangered Species Act 1974- Safe Drinking Water Act- regulates groundwater, sets standard for all drinking water 1975- The first CAFE (Corporate Average Fuel Economy) standards are enacted as a response to the Oil Embargo from several years now 1990- Clean Air Amendments including the establishment of the Acid Rain Program- a marketbased system of tradable emissions permits to address emissions of acid rain causing SO2 and NOx Environmental justice- fair treatment and meaningful involvement of all people with respect to environmental policies, regulations, and laws In Louisville, correlation between areas where blood lead level was greater than 5 micrograms/dL and primarily African American and Hispanic/Latino populations o I’d be interested to see this compared to number of tests taken- comparable sample sizes? Probably yes, and still too high, but would be more thorough Significantly higher inpatient admission for asthma in Louisville among African Americans versus white vs Hispanic (looked at zipcode) o What about genetic predisposition to asthma? Still crazy high but would be interesting all things being equal (though they did control for location) Lead contaminated water and Top Golf were talked about Toxic Waste and Race at Twenty (2007) study found significant racial and socioeconomic disparities persist in the distribution of the nation’s commercial hazardous waste facilities

PHPB 301-01 Wendel/ Jones

CRIMINAL JUSTICE EQUITY 1. 2. 3. 4.

Review environmental justice discussion Review history of law enforcement in US Summarize arrest and incarceration patterns in US Discuss inequities in the US Criminal Justice System

History of Law Enforcement in...