Hiding in Plain Sight Whats Missing in Health Equity
compared to
white americans in the united states
there are
twice as likely number of african
americans
who will die from diabetes also
if you look at rates of diagnosis of
breast cancer
you’ll find that african-american women
although diagnosed at the same rates as
white women in the u.s
they are 40 percent more likely to die
when we look at rates of cervical cancer
in the united states
compared to white women hispanic women
are
60 percent more likely to be diagnosed
with advanced stage cervical cancer
why are these things important they’re
important because they affect
each and every one of us in some way
shape or form whether or not you belong
to any of those ethnic groups i am dr
kerry norris
i am the chief of health policy and
administration at the fulton dekalb
hospital authority
and i have worked on this for various
years over 17 years
health disparities are plaguing our
communities but what i propose
today is that the answer is hiding in
plain sight
let’s talk a little bit about how to get
to that answer
so we see various causes of death
throughout the united states these are
all the leading causes of death and when
you look at this you may say
oh well those all look like things that
are preventable they are
and with the work that we can do
together to address
the lack of prevention that we have to
also address
behavioral risk that people continue to
take
to also look at family history and
genetics of what people inherit from
each of their family members
and to also think about persons
environment
did you know that where you live
dictates whether or not you live
or die more so than your family history
your zip code is more important than
your genetic dna
think about that and think about where
people live
and how they live and how that affects
what they have access to
or what they don’t have access to
we also have to think about when we talk
about access
just giving a person insurance or giving
them transportation
is not enough access is a plethora of
things that have to work
together to form the in
the most perfect environment
for the person to get all that he or she
needs
also we’re going to talk about competing
interests
that means if i know that i have been
diagnosed with diabetes
and my insulin costs a lot of money but
i’m also thinking about what am i going
to feed my kids
how am i going to pay this light bill
and i’ve been sick for several days and
so i’ve missed some days off work
then how does that affect whether or not
i can actually
purchase my insulin and take care of
myself so when we have these competing
interests and i have to decide between
feeding my children and actually being
able to
move forward and take better care of
myself and stick with medication
adherence
then we really have to think about how
people are making these decisions and
what it is that they have to do when
they’re making these decisions
so here we can see across various
disparities and across various things
such as blood pressure
diabetes and stroke african americans
are more likely to
die at earlier ages than any other group
in the united states
we also have higher rates of actual
diagnosis why is that
let’s talk a little bit more about it
most people think when we are addressing
those disparities
and they think that when we are looking
at
gaps in access and gaps in health care
that the answer is equality just give
everybody the same amount of access just
give
everybody the same pair of shoes and it
should work
well as we know that doesn’t work and
this is the work that we’ve been doing
for several years
good work nothing to knock any of the
past researchers who’ve come before and
who’ve
done some really groundbreaking work
equality doesn’t work when it comes to
health disparities
we’ve got to think of it very very
differently
what works is equity if you see in the
picture
on your right hand side you’ll see that
with equity
you meet the person where they are to
ensure
that they have the same viewpoint to
ensure
that they have equal footing and that’s
what we need to think about
when we talk about equity but i propose
that this is a really good model
but there are some issues there as well
and the answer and the solution again
to health equity is in that picture but
it’s hiding
in plain sight
so what is it that we don’t see in the
picture
dr arlene geronimous out of the
university of michigan has stated
the stressors that impact people of
color are chronic
and repeated through their whole life
course so i want you to think about that
not the life course of oh when i become
an adult
now i have these bills i don’t want to
be a child anymore oh my aching back
none of those things but more so
when you are in your mother’s
belly whatever stress she experiences
you are subjected to that exact same
stress
and so as you can see here
stressors affect all parts of the body
system
and if a woman is pregnant and she’s
carrying a child there’s no way
that stress doesn’t have an effect early
on
on the fetus on the baby and then
it becomes something that leads them to
early disease
and early death
your body systems are stressed out
any type of trauma any type of chronic
stress and i’m not talking about just
atlanta traffic
we know that’s stressful and you find
ways to get around that
but let’s think about again you’re a
single parent or you’re paying bills or
you live in poverty or you’re trying to
get ahead
simple things you can’t feed your family
everybody’s always talking about all of
this great nutrition stuff and
go organic and buy organic and let’s get
it together and do better with our
nutrition and more physical activity
if i live in a neighborhood where it is
not safe for me to exercise outside
that’s an issue
there’s a problem if i don’t have
access to fresh fruits and vegetables if
i don’t have the money
to purchase fresh fruits and vegetables
it becomes an issue and a problem down
the road that then presents itself
in various forms of disease and later on
possibly disability or death
so what i want you to think about is
something that dr jeronimous proposed
which is called the weathering
hypothesis think of this tattered house
as the body of yourself
or the body of a parent or mother who’s
carrying a child
the storms of life continue to come
the challenges of life continue to come
and we have
absolutely no control over those things
bad things happen
all the time but when it’s chronic
and when it continually happens to
people
then we see that what happens is this
tattering it tears away at your very
frame it tears away
at your very being from your mental
health all the way down to your physical
health
so think of this house as your body
think of this house as the body of a
woman who is carrying a child as
as it tatters away at her and
the paint chips the shutters fall down
the roof has a leak you know the floor
the floorboards are lifting up then i
need you to consider
that all of those things are also
affecting any child that
she is carrying and you are subjected to
stress and trauma
in utero so before you even are
born these are the things that you are
dealing with
and that puts you at risk for early
death
and early disease which is what we see
in a lot of vulnerable populations and
minority populations
let’s move on when we think about
trauma again we’re still talking about
the child
we’re thinking about trauma that happens
to a parent let’s say a parent’s in an
abusive relationship
and they’re being physically or
financially abused
the mother’s pregnant she’s enduring all
of this
the child is experiencing trauma early
on
and then when the child is born they’re
then
experiencing the trauma of the household
the constant fighting the arguing the
fear
the anxiety that they develop all of
these things
and so it leads to mental health issues
which lead to physical health issues it
will manifest itself
physically and so consider that
as the child goes from birth to death
you get an early death because of the
exposure to trauma
constant complex compounded trauma
one on top of the other is not helpful
the effect of the stress on your body
leads to early
disease and early death
so when we think about that and we think
about this childhood trauma
and the long-term impact lots of people
have studied this
if you’ve heard of aces it looks at
traumatic events in a child’s life did
you lose a parent did you lose a
grandparent
were you sick early did you grow up in
poverty were you sexually abused
did you suffer any other type of verbal
abuse
in your household did you watch a parent
be abused
in the household so these are all things
that and we’re talking about
children who are still developing
mentally and physically
and when they are in that position and
they’re learning
fear and that fear is memorized in their
cells
and that fear is encapsulated in their
body
with no release and no way of knowing
how to
cope because we as adults don’t always
know how to cope
then again it sets in
it starts to become a problem with their
mental health where they may
develop ptsd you may have some type of
depression
you may have some anxiety disorders
things of that nature
which then lead to hypertension because
you’re always in this
state of anxiety and you’re always in
this state of oh my god what’s going to
happen
next and when that happens to you your
blood pressure shoots up when your blood
pressure shoots up then you’re at high
risk for diabetes
heart attack stroke you see where i’m
going with this
it’s important to pay attention to this
and so we see the common causes
we see that children who experience
trauma
are twice as likely to develop
depression and three times more likely
to develop anxiety
so i also want to talk a little bit
about access
because the access in and of itself for
children
of color there’s a disparity that’s
there as well white children are more
likely to have access to the mental
health treatment
early on to learn how to cope and to get
the intervention that’s needed
so that they don’t have some of the
early death
disability and also disease that we see
a lot in communities of color
so here’s what i want you to consider
again here we are with this equality
versus equity model
did you see what changed the
final picture shows that they changed
the fence
so it’s not wooden it’s a link chain
fence now
what’s the issue there they’re still
on the outside who thought that this was
still a solution
so what’s hiding in plain sight is the
fact that
in all of these pictures you are going
from
everybody’s equal we’re going to give
everybody the same box
to we’re going to meet the need of the
people
by giving them boxes that put them at
the same level
still doesn’t work and they couldn’t
figure out why
that doesn’t work but we’re meeting the
people with what they need if it’s money
we give that if it’s food
you know we have these farmers markets
and great interventions that are going
on in the community
if it’s physical activity we’re coming
up with various
programs in schools and in communities
to get people walking safer routes to
school
all kinds of great things nothing should
be taken away from those programs
but again the part that is missing is
they’re still on the outside of the
fence nobody’s addressed
the mental health issues nobody’s
addressed
that tattered house
that represents the child
who has been through enough trauma and
stress by the time that they’re five
or six without coping mechanisms
that they don’t know what to do and
they’re already on this life course
of having early death early disease
disability
is it fair is it right absolutely not
even if it’s not directly you it’s your
neighbors it’s your co-workers
it’s your employees for your company
it’s going to cost you a lot
in insurance it’s going to cost you a
lot of sick days
it’s going to cost you a lot of
productivity
so i think that when we look at these
pictures we don’t take away from
the models because of course everything
is stepwise what we learned
should be stepwise we should learn
from past examples past models things of
that nature
but what’s missing is the mental health
piece so i propose
that we go with what i like to call the
mr model
i took all the people out because people
were arguing over these pictures
what color are the people are they peach
are they brown
are they it doesn’t matter what matters
are the actual concepts what matters
is how the concepts are linked and
how we put those things together to then
address
what’s going on in communities so in the
mental health aspect
it would require that we address mental
health early on
you teach kids coping skills early on to
deal with
stressors and how to cope and how to
address
self-soothing works my grandson does it
he’s seven
sometimes he gets in trouble in class
because he goes to sue the other kids
because he wants to get up and say are
you okay it’s all right just breathe you
know things that his parents have taught
him
for when you know he’s stressed or
things are a bit much
for him that can be taught children know
how to meditate
they know how to center themselves and
be quiet and focus on their breathing
and everything else you have to teach
coping
you have to get mental health help
before that first
episodic break before they’re 19 or 21
and away at college or at their first
job and
there is a major break-in and someone
has to call you because they’ve been
admitted somewhere
you have to think about integrated care
every time you go for any type of
physical care
they should be checking on your mental
health and i mean something beyond that
one question they ask
all of us have you been sad the last 30
days
lady i’ve been sad my whole life what
are you talking about
because if it’s chronic stress and
chronic depression
you don’t see it as other people see it
you’re not gonna say oh that’s
depression you’re gonna say that’s been
my life my whole life
how’s it any different so think about
that
socioeconomic status sure
people can get great jobs they can
become educated they can get
insurance and access but if you are
not creating workforce development
programs
in those communities that are still
behind then you’ve got some work to do
transportation having access to get to
the doctor
or putting clinics in neighborhoods so
that people have
the access that they need so that goes
hand in hand with the access piece
and the basic need for housing
if people have a home they are more
likely to do better
they can focus they can concentrate they
can
get their actual insurance cards and
everything else at their address they
can receive services
they can have access to whatever
resources are in the neighborhood or
available to the neighborhood
i want you to think about this mr model
which is named after my son
we are our own study and
i want you to think how this moves
equity forward
for the mental health piece at earlier
stages in early intervention
and so the next time someone talks to
you about health disparities or anything
else i want you to say this to them so
right now we’re going to do something
i want you to look at your neighbor and
say neighbor
neighbor okay
i’m not feeling it i’m not hearing it
loud enough so we’re going to change
that we’re not going to say neighbor
turn to your neighbor and say mister
can i get some health equity
that is how you’re going to remember
this model mr can i get some health
equity
and for that i thank you for listening
today
you