Health Care Reform & Root Causes of Health Inequities

Jim Bloyd, MPH Cook County Department of Public Health

February 10, 2015

Chicago Forum for Justice In Health Policy: Can Reform Move Us Toward Health Equity?

Loyola University, Chicago, Illinois @CookCoHealth

#PLACEMATTERS @CCPLACEMATTERS

Reform Can move us toward health equity if we understand the origins of health inequities

and take power into account

Solar & Irwin, WHO (2010) For example p5

2015 STRATEGIC PLAN FINAL REPORT April

2011 • “To optimize health and achieve health equity for

all people and communities of Cook County through our leadership and collaborations….”

• “…we need to make significant changes in how we work…”

• “Because health depends causally on its environmental, economic, technological, informational, cultural and political contexts, social justice is prerequisite to achieving optimal and equitable public health.”

April 26, 2012 Cook County Place Matters 1

73.2

78.8 79.9 79.9

87.0

65

70

75

80

85

90

Less than 25k 25k - 35k 35k - 44k 44k - 53k Greater than53k

Lif

e e

xp

ec

tan

cy a

t b

irth

in

ye

ars

Median Income

Average Life Expectancy (2003-2007) by Median Income of Census Tract/Municipality (2009),

Cook County

Source: Life expectancy calculated by the VCU Center on Human Needs from 2003-2007 data provided by Cook County Health Department: Median

Income from 2009 Geolytics Premium Estimates.

13.8 Years

9.2 7.1 7.1

Recognition from Cook County, Illinois, Board President Toni Preckwinkle

• “it is shameful that we live in one of the wealthiest countries in the world and that a person’s life can be cut short by more than a decade because of factors outside her or his control.”

Cook County PLACE MATTERS

The Coverage Gap

• Supreme Court’s decision in 2012 allowed States to opt out of Medicaid Expansion

• Individuals below the FPL living in states that have not expanded Medicaid experience difficulty accessing affordable health coverage

• 4 million people fall into the coverage gap created by states’ not expanding Medicaid

• 85 percent of these individuals reside in the South, half are African American or Hispanic

#BlackLivesMatter median county income does not drive excess Black-White mortality

Krieger, etal (2015) harvardpublichealthreview.org

Education: Structural Racism

“Illinois has set up a structurally racist system of finance that selects African American and Latinos for very poor education.”

Ralph Martire, Education Finance Expert, Center for Tax and Budget Accountability

Education: US Civil Rights Title IX

All school districts can remove obstacles by following the Title IX Civil Rights that guarantees pregnant & parenting students equal education. ICAH.org/School

Housing: Nov 28, 2014: Cook County v. Wells Fargo, Inc.

• Staff paid to steer Blacks, Latinos, Women to hi-cost loans

• “ongoing discriminatory practice of ‘equity-stripping’”

• “maximizes lender profits” • “Defendant’s discriminatory

behavior maximized Defendant’s revenue and income”

• “actually resulting in foreclosure…the ultimate denial of housing”

• “violations continue to this very day”

• “segregation…provided an efficient means for Defendants to target potential borrowers”

Labor: The Chicago Restaurant Industry: Taking the Low Road to Profits

Restaurant Workers

& A Human

Rights Movement

Social Causes Can Be Linked to Health- Estimated Deaths,USA 2000

Source: Galea etal (2011) doi:10.2105/AJPH.2010.300086

Low Education

245,000

Racial Segregation

176,000

Low social support

162,000

Individual level poverty

133,000

Income inequality

119,000

Area level poverty

39,000

Acute Myocardial Inf

193,000

Cerebrovascular Disease

167,700

Lung Cancer 155,600

All diseases have two causes, one pathological the other political.

Rudolph Virchow (1821-1902)

Fair Housing Act Violations CC v. Wells Fargo

Education Financing

Labor Market: One Fair Wage, Tipped Income Laws; harassment; discrimination

Accountability for Police Shootings

Implementation of US Title IX Pregnant & Parenting Students Civil Right to Equal Education:

Distribution of Social Determinants of Health: access to.., exposures to.., levels of… Conditions…

Health Inequities in Cook County

Thank you Jim Bloyd, MPH Regional Health Officer

Cook County Department of Public Health

15900 S. Cicero Av., Oak Forest IL 60452

jbloyd@cookcountyhhs.org (708) 633-8314

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Facebook.com/CCPLACEMATTERS

Twitter @CCPLACEMATTERS

#PLACEMATTERS

To see this and other materials please check www.Slideshare.net/CookCountyPLACEMATTERS

Christopher, G., LaFronza, V., Burke, N. (2010). Place Matters: Building Partnerships among Communities and Local Health Departments. In Hofrichter, R., and Bhatia, R. (Eds.), Tackling Health Inequities through Public Health Practice: Theory to Action (pp. 458-474). Oxford: New York. Drewnowski, A. (2012). The economics of food choice behavior: Why poverty and obesity are linked. Nestlé Nutrition Institute Workshop Series, 73, 95-112. doi:10.1159/00034130 Joint Center For Political and Economic Studies (2012). PLACE MATTERS FOR HEALTH IN COOK COUNTY: Ensuring Opportunities for Good Health for All. http://jointcenter.org/sites/default/files/Place%20Matters%20for%20Health%20in%20Cook%20County.pdf (Accessed September 18, 2014). National Collaborative for Health Equity http:www.nationalcollaborative.org/ Health Equity & Leadership Exchange Network (HELEN) HealthEquityNetwork.org Twitter: @Helen4Equity Center for Tax and Budget Acccountability, Chicago www.CTBAonline.org Cook County Department of Public Health Strategic Plan 2015 Final Report http://www.cookcountypublichealth.org/files/pdf/CCDPH%202015%20Strategic%20Plan%20Final%20Report%20April%202011.pdf Solar, O., Irwin, A. A CONCEPTUAL FRAMEWORK FOR ACTION ON THE SOCIAL DETERMINANTS OF HEALTH social determinants of health discussion paper 2 (policy and practice). Geneva: World Health Organization, 2010.

RESOURCES & REFERENCES

Cook County PLACE MATTERS

STEERING COMMITTEE

Daniel Block, PhD Chicago State University

Jim Bloyd, MPH Cook County Department of Public Health

Sheila Castillo, MUPP Midwest Latino Health, Research, Training and Policy Center

Natalie Chadwell, MBA Resident Southern Cook County

Sheelah Muhammad, DN Root Cause

Linda Rae Murray, MD, MPH Past-President American Public Health Association; Adjunct

Faculty, University of Illinois, School of Public Health

Johnnie Owens, Jr. Centers For New Horizons

Tiffany Pryor, MSW Illinois Caucus for Adolescent Health

Bonnie Rateree Human Action Community Organization

Kathryn Saclarides Bocanegra, LCSW ENLACE Chicago

Reveca Torres Backbonesonline.org

Felipe Tendick-Matesanz ROC United

COMMUNICATIONS

Agnes Markos

Metro Chicago: Poverty Composition of Neighborhoods of Poor Children By Race

Source: Diversitydata.org, (2011, from 2000 Census Data)

Neighborhood poverty level

PLACE MATTERS Model

Source: G. Christopher, V. LaFronza, N. Burke (2010)

Child poverty more than 6 times greater in Harvey, IL vs. North Suburban Cook County

State sponsored segregation through finance-1930s HOLC Map

“Geography does the work of Jim Crow laws.” john powell