place matters and health promotion

Place Matters and Health Promotion

University of Illinois at Chicago, School of Public Health, Health Inequities Class

Jim Bloyd, MPHCook County Department of Public Health

February 1, 2013

Outline

• Video Community Voice: Bonnie Rateree• Selected quotes on Health Promotion• Residential Segregation• Health Equity Report Cook County Place

Matters

“Six Voices” videos on

YouTube.com/ccplacematters

&Facebook.com/ccplacematter

s

Health Promotion Ethics

“We consider the normative ideal of health promotion to be that aspect of public health practice that is particularly concerned with the equity of social arrangements”

Carter et.al. (2012) Public Health Reviews

“We are dealing with serious food addictions. People in America are addicted to sugar they're addicted to fat they're addicted to salt and people don't feel satisfied with their food if they're not getting heavy doses of that…”“The food addictions are what is holding us back primarily And ignorance Part of that ignorance is deliberate. People don't want to know.”John Mackey, CEO Whole Fodes, National Public Radio Interview January 17, 2013 http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=169580493&m=169580893

Dorothy Nyswander

• “Have I not actually helped to maintain the status quo in these situations? Have I not taught people to accept those gifts approved by the establishment which would make life more bearable but which would not threaten the power of the establishment itself?”

Nyswander (1967) H Ed Monographs cited in Brown & Margo (1978)

LaVeist et.al. 2011 Health Affairs• “We further concluded that when social factors

are equalized, racial disparities are minimized. Policies aimed soley at health behavior change, bilogical differences among racial groups, or increased access to health care are limited in their ability to close racial disparities in health. Such policies must address the differing resources of neighborhoods and must aim to improve the underlying conditions of health for all.”

Metro Chicago: Poverty Composition of Neighborhoods of All Children

Source: Diversitydata.org, 2011

Metro Chicago: Poverty Composition of Neighborhoods of Poor Children

Source: Diversitydata.org, 2011

1930’s Home Owners Loan Corporation:

“HOLC initiated the practice of

redlining” (Jackson, 1980)

South Side Chicago HOLC Map: State sponsored segregation through finance

Gale Cincotta: The fight against redlining- a victory in 1977

• “Activists will need to do their homework. They'll need to figure out who owns what in order to target those who really have the power.”

Gail Cincotta Feb 1996 Illinois Issues photo National People’s Action

World Health Organization

• How to close the health equity gap? “Tackle the inequitable distribution of power, money and resources” World Health Organization

Slow Death (Sovereignty, Obesity, Lateral Agency)

• “I am focusing here on the way the attrition of the subject of capital articulates survival as slow death.” “In this scene some activity toward reproducing life is not identical to making it or oneself better, or to a response to the structural conditions of a collecive failure to thrive, but to making a less bad experience. It’s a relief.” Lauren Berlant (2007) Critical Inquiry

The individual, personal behavior approach is deceptive

CDC Web Page: “Healthy Weight- it’s not a diet, it’s a lifestyle!”

Source: CDC http://www.cdc.gov/healthyweight/healthy_eating/drinks.html

April 26, 2012 Cook County Place Matters 18

Cook County Place Matters is part of a National Initiative– W.K. Kellogg Foundation / Joint Center for Political and Economic Studies Health Policy Institute / CommonHealth Action

National Meeting in Chicago: July 25-27, 2012

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

Kathryn Bocanegra, LCSW ENLACE Chicago

Sheelah Muhammad, DN, MBA ‘Fresh Moves’

John Owens Centers for New Horizons

April 26, 2012 Cook County Place Matters 1

Vision

• To build a health equity movement that works to eliminate structural racism and creates the opportunity for all people of Cook County to live healthy lives.

April 26, 2012 Cook County Place Matters 1

Goals• raise awareness that inequitable

social conditions are the root causes of unfair health inequities

• build the power of residents and leaders from affected communities who support a fair distribution of society’s resources

• Policy advocacy that leads to neighborhood conditions that support and produce health

April 26, 2012 Cook County Place Matters 1

Health Equity

• ‘health differences which are socially produced, systematic in their distribution across the population and unfair’ (World Health Organization)

• Health inequities are a result of ‘systematically unequal distribution of power, prestige and resources among groups in society’ (WHO)

PLACE MATTERS emphasizes the social determinants of disease…

• Obesity is the toxic consequence of economic insecurity and a failing economic environment.

"...social justice has less to do with larger portions of broccoli and more to do with eroding minimum wage, lack of healthcare, and wholesale looting of the American economy. It is a shame that many of the current strategies for obesity management are based not around alleviating poverty but around recommending high-cost foods to low-income people. That approach will not work in the US or elsewhere." Drewnowski 'spotlight' 2008

Structural Racism

• the ways in which public policies and institutional practices contribute to inequitable racial outcomes

• privilege associated with 'whiteness' and the disadvantage of 'color'

• assumptions and stereotypes that are embedded in our culture that, in effect, legitimize racial disparities

• Undermines progress toward racial equitySource: Aspen Institute, http://www.racialequitytools.org/ci-issues-sr.htm

Structural Racism

• “To address structural racialization, we must understand the work that our institutions and policies are in fact doing, not what we want orhope for them to do.” (john powell)

Fam

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Inequities

DisparitiesHealthHealth

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Inequities

Disparities

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Conditions

Consequences

School Absence/Truancy

Grade Failure

Drop-OutF

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PlacePolicyNarrative

power

Life Expectancy by Census Tract and Municipality, Cook County and Chicago, (2003 – 2007)

April 26, 2012 Cook County Place Matters 1

April 26, 2012 Cook County Place Matters 1

April 26, 2012 Cook County Place Matters 1

Education

April 26, 2012 1Cook County Place Matters

Persistent poverty

April 26, 2012 1Cook County Place Matters

Findings• Gap in life expectancy of 14 years between

wealthy and poor areas of metro-Chicago• Residents with least access to chain

supermarkets and larger independent grocers live on average 11 years less then people with highest access

• Conditions of concentrated poverty make it more difficult for African Americans and Latinos to live healthy lives

• “Your zip code is more important than your genetic code”

PLACE MATTERS Recommendations

1. Improve daily living conditions/ tackle inequitable distribution of power, resources

2. Track health inequities3. Strengthen data collection on food access4. Implement public ‘seed money’ for food retail in

areas with low food access5. Ensure workplace justice for workers in the food

chain6. Address persistent poverty

Thank you!

Jim Bloyd, MPHjbloyd@cookcountyhhs.orgw) 708-633-831415901 S. Cicero Av Bldg B 3d FloorOak Forest IL 60452