Affirma&velyFurtheringFairHousing:Apla8ormforhealthequityadvocates

JimBloyd,MPHRegionalHealthOfficer,CookCountyDepartmentofPublicHealth

ChicagoMetropolitanFairHousingConveningMay12,2017

FederalReserveBankofChicagoChicago,Illinois

WePLAN2020•  HealthEquity•  ChronicDisease•  BehavioralHealth

www.cookcountypublichealth.org@CookCoHealth

•  TheCollabora&veforHealthEquityCook

County(CHE)isasourceofleadershipandstrategicguidanceinimplemen&ngstrategiesdescribedinthisplan.www.checookcounty.org@CHECookCounty

Residential segregation by race/ethnicity and socioeconomic position

Inequalities in Resource distribution

Neighborhood physical environments Environmental exposures Food and recreational resources Built environment Aesthetic quality/natural spaces Services Quality of housing

Neighborhood social environments Safety/violence Social connections/ cohesion Local institutions Norms

Behavioral mediators

Stress

Health

Personal characteristics Material resources Psychosocial resources Biological attributes

Source: Diez Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186(1), 125-145.

Segrega&onisassociatedwithinequi&esin…

•  Prematuredeath/lifeexpectancy•  Sexualhealthstatus•  Violence•  Asthma•  Poorself-reportedhealth•  Infantmortality•  Diabetes•  Obesity,….

AverageLifeExpectancy(2003-2007)byMedianIncomeofCensusTract/Municipality(2009),

CookCounty

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 than 53k

Life

exp

ecta

ncy

at b

irth

in y

ears

MedianIncome 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.

13.8Years

8.2 7.17.1

5

SocialGradientExample:healthbyfamilyincomeandraceRWJFcitedbyMarmotandBell(2011)

ReducingtheBlack-WhiteInfantmortalitygap(BrownSpeights2017)

•  4,080BlackinfantlivessavedifBlackIMR=WhiteIMR

•  IL17thof35statesinreducingBlackIMR1999-2013

•  IL34thof35statesinequitableimprovementofIMratedispari&es1999-2013

•  YearILwouldachieveIMrateequalityoncurrenttrend:2030

Racialsegrega&onexposespoorBlackchildrentohighpovertyneighborhoodsbutnotpoorwhitechildrenDivesitydata.org“ChildrenLeeBehind:HowMetropolitanAreasAreFailingAmerica’sChildrenChartbook”

Racialsegrega&onexposesmorepoorLa&nochildrentohighpovertyneighborhoodsbutnotpoorwhitechildrenDivesitydata.org“ChildrenLeeBehind:HowMetropolitanAreasAreFailingAmerica’sChildrenChartbook”

MostBlackchildreninCookCountyliveinneighborhoodsofVeryLowChildOpportunity

54%

28%

10%5% 4%2%

10%

22%26%

39%

-10%

0%

10%

20%

30%

40%

50%

60%

VeryLow Low Moderate High Veryhigh

Black White Linear(Black) Linear(White)

MostLa&nochildreninCookCountyliveinneighborhoodsofLow/VeryLowChildOpportunity

32%36%

19%

8%5%

2%

10%

22%26%

39%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

VeryLow Low Moderate High Veryhigh

Hipanic/La&no White Linear(Hipanic/La&no) Linear(White)

“InmetropolitanChicago,BlacksandLa&nospayrela&velymore,intermsofhousingandtransporta&oncosts,toliveinneighborhoodswithopportuni&esforchildren.”Source:Diversitydatakids.orghjp://www.arcgis.com/apps/MapSeries/index.html?appid=13492fdd497c47a4bd14883ee78151e5

Neighborhoodopportunitylevels&costlevelsbyrace

Source:Diversitydatakids.orghjp://www.arcgis.com/apps/MapSeries/index.html?appid=13492fdd497c47a4bd14883ee78151e5

“Byfailingtocurbdiscrimina&onthatitsowndatadisclosed,theFederalReserveviolatedAfricanAmericans’legalandcons&tu&onalrights.”

Rothstein,R.(2017)p.111

References•  Bassej,M.(2016).Publichealthmeetsthe"problemofthecolorline"speechbydr.Marybassej.Retrievedfromhjp://www.huffingtonpost.com/

entry/racism-as-cause-of-poor-health_us_581a1376e4b01a82df6406d6•  BrownSpeights,J.S.(2017).State-levelprogressinreducingtheblack-whiteinfantmortalitygap.AmericanJournalofPublicHealth,107(5),775-782.•  Buffardi,A.L.,Thomas,K.K.,Holmes,K.K.,&Manhart,L.E.(2008).Movingupstream:Ecosocialandpsychosocialcorrelatesofsexuallytransmijed

infec&onsamongyoungadultsintheunitedstates.AmericanJournalofPublicHealth,98(6),1128-36.doi:10.2105/AJPH.2007.120451•  CookCountyDepartmentofPublicHealth.(2016a).WePLAN2020forcesofchangeassessment.CookCountyDepartmentofPublicHealth.(2016b).

WePLAN2020improvingcommunityhealthandhealthequityforsuburbancookcounty.OakForest,Illinois.•  DiezRoux,A.V.,&Mair,C.(2010).Neighborhoodsandhealth.AnnalsoftheNewYorkAcademyofSciences,(1186),125-145.doi:10.1111/j.

1749-6632.2009.05333.x•  diversitydata.org.(2007).ChildrenleJbehind:Howmetropolitanareasarefailingamerica'schildrenchartbook.Diversitydata.org.Retrievedfrom

hjp://diversitydata.sph.harvard.edu/Publica&ons/children_lee_behind_chartbook.pdf•  Diversitydatakids.org.(2017).Thehowaffordableisopportunity?Tool.[Pamphlet]Retrievedfrom

hjp://www.diversitydatakids.org/files/Images/StoryMaps/How%20Afford%20is%20Opp%20Learn%20More_Final.pdf•  Diversitydatakids.org,&KirwanIns&tute.(2014).Howtouseandinterpretthechildopporunityindexmaps.Retrievedfrom

hjp://www.diversitydatakids.org/files/CHILDOI/DOCS/DDK_KIRWAN_HOW_TO_USE_CHILDOI.pdf•  Freudenberg,N.,Franzosa,E.,Chisholm,J.,&Libman,K.(2015).Newapproachesformovingupstream:Howstateandlocalhealthdepartmentscan

transformprac&cetoreducehealthinequi&es.HealthEducaQon&Behavior,42(1S),46S-56S.doi:10.1177/1090198114568304Himmelman,A.T.,•  Berkowitz,B.,Christens,B.D.,Bujerfoss,F.D.,Lee,K.S.,Bowen,L.,...Francisco,V.T.(2017).Collabora&ngforequityandjus&ce:Movingbeyond

collec&veimpact.NonProfitQuarterly.Retrievedfromhjps://nonprofitquarterly.org/2017/01/09/collabora&ng-equity-jus&ce-moving-beyond-collec&ve-impact/?utm_source=Daily+Newswire&utm_campaign=bd6ae96ea8-EMAIL_CAMPAIGN_2017_01_09&utm_medium=email&utm_term=0_94063a1d17-bd6ae96ea8-12567505

References•  Jones,K.(2016).Asthmaandinjus&ceonchicago'ssoutheastside.HealthAffairs,35(5),928-931.doi:10.1377/hlthaff.

2015.0117•  Krieger,N.(2016).Livinganddyingatthecrossroads:Racism,embodiment,andwhytheoryisessen&alforapublichealth

ofconsequence.AmericanJournalofPublicHealth,106(5),832-3.doi:10.2105/AJPH.2016.303100•  McElwee,S.(2016).Howchicago'swhitedonorclassdistortscitypolicy.Retrievedfromhjp://www.demos.org/

publica&on/how-chicagos-white-donor-class-distorts-city-policy•  NACCHO.(2016).Healthinequity:Achargeforpublichealth.Washington,DC:Na&onalAssocia&onofCountyandCity

HealthOfficials.•  Na&onalResearchCouncilandIns&tuteofMedicine,Woolf,S.,&Aron,L.(2013).U.S.HealthininternaQonalperspecQve:

Shorterlives,poorerhealth.Washington,DC:TheNa&onalAcademiesPress.Retrievedfromhjp://www.nap.edu/openbook.php?record_id=13497

•  Rothstein,R.(2017).Thecoloroflaw:Aforgo\enhistoryofhowourgovernmentsegregatedamerica.NewYork:LiverightPublishingCorp

•  Rothstein,R.(2012).ACOMMENTONBANKOFAMERICA/COUNTRYWIDE’SDISCRIMINATORYMORTGAGELENDINGANDITSIMPLICATIONSFORRACIALSEGREGATION.EPIBriefingPaper.

•  Sampson,R.J.,Morenoff,J.D.,&Raudenbush,S.(2005).Socialanatomyofracialandethnicdispari&esinviolence.AmericanJournalofPublicHealth,95(2),224-32

•  Smedley,B.(2012).Thelivedexperienceofraceanditshealthconsequences.AmericanJournalofPublicHealth,102(5),933-935.doi:10.2105/AJPH.2011.300643

•  Smedley,B.,&Tegeler,P.(2016)."Affirma&velyfurtheringfairhousing":Apla8ormforpublichealthadvocates.AmericanJournalofPublicHealth,106(6),1013-1014.doi:10.2105/AJPH.2016.303175

ThankyouJimBloyd,MPHRegionalHealthOfficerCookCountyDepartmentofPublicHealth15900S.CiceroAvenueOakForest,Illinois60452708-633-8314jbloyd@cookcountyhhs.org