Health Equity Training Journal
The “Journey to Health Equity” training journal is intended to help NBCCEDP and CCRCP Awardees prepare for the 30th anniversary event on health equity and continue capacity building after the event.
The journal can be completed on your own schedule. Learn more about the intent of the health equity journal before, during, and after the event in the resources below.
NBCCEDP Award Recipients,
Throughout my 14 years in CDC’s Program Services Branch (PSB), I have seen how NBCCEDP award recipients put their hearts into serving those who would not otherwise receive the breast and cervical cancer services they need – those with low incomes, those who were uninsured, or underinsured. Because of you, thousands of people have received screening and diagnostic services through the program, and many were referred to treatment. You have made efforts to “meet people where they are,” and we have learned that “meeting them where they are” isn’t just about their location or space; it’s about the context in which they “are.”
As we continue to address barriers like limited or spotty transportation, lack of childcare, and limited clinic hours, we need to truly understand those contexts that still limit access to services despite our best efforts to date. More recently, the ongoing COVID-19 pandemic has drawn attention to the importance and urgency of increasing efforts toward health equity.
Literature and expansive research on health inequity and social injustice have existed for some time. This information on equity can appear infinite and overwhelming, so we culled out a manageable portfolio of information and resources that we believe will be useful to you as public health practitioners and partners and placed it within this journal. You will receive a section of the journal each week. We ask that you work on each section when you receive it, because the next section will soon be on its way.
Among the resources in the journal are webinars that we held earlier in the peer-to-peer series on addressing the needs of the LGBTQ community and the National Association of Chronic Disease Director’s (NACDD) podcast series, ‘Race Toward Health,’ which you may have accessed already.
The journal is part of a framework, known as “Ready, Set, Go.” This journal is meant to get you READY for your journey toward health equity. The weekly journal sections will lead into the 30th-anniversary meeting on October 6-7, 2021. At the meeting, we will discuss program accomplishments through the years and share strategies and activities that can take us closer to equity. The meeting will be a place to make sure peers and partners have the same information, resources, and tools to SET goals and strategies. The work we do beyond the meeting will allow us to GO get the health equity work done.
Because the journal provides a foundation of shared knowledge, I encourage all PSB and NACDD staff who work directly with our cancer programs to complete the exercises and the Going Deeper activities. This journal is meant to take us further down the path – we call it a journey – of understanding, empathy, and compassion, enabling us to better work toward equity. The activities, examples, exercises, and questions offer opportunities and methods to acknowledge, question, facilitate discussion, broaden views, and identify opportunities for improvement.
As we implement strategies to work toward equity, we will continue to support your journey with more calls, webinars, and resources, including a categorized list of additional resources. Let us know what you need. You are closest to the action, setting the vision for your programs, and on the ground paving our way into the future. You are truly our greatest assets – 30 years ago, today, and going forward. Without your efforts, equity cannot exist. Thank you for taking this journey with us.
I also offer sincere gratitude to all who contributed to the recognition of the 30th anniversary.
Melonie Thomas, MBA
NBCCEDP 30th Anniversary Chair
The Journal
Journal
Instructions
Instructions
Part 1: Grounding:
Exploring the Impact of Racism on Health
Exploring the Impact of Racism on Health
Part 2: Unpacking:
Examining Biases and Challenging Self
Examining Biases and Challenging Self
Part 3:
The Social Intersections of Health
The Social Intersections of Health
Resources
Journal
Instructions
Instructions
This journal is designed to help navigate important chronic disease prevention and health promotion work to improve lives in communities most in need. The journal will guide us toward a deeper understanding of ourselves and our work through the lens of health equity.
Different organizations are going to be at different places in the journey. Some have already started health equity work and are well on the way in this journey. Many may just be getting started. And still others are wondering what it is, how it is different from what we are already doing, and why it is needed. Wherever you and your organization are on this path, take steps to advance your work in health equity. This journal can help inform your work.
The work is complex, without quick fixes. The journal guides us toward new ways of thinking and modes of operating. It guides us away from norms where we may feel proficient and comfortable, but that keep us from broadening our programmatic view. The journal asks us to be honest with ourselves and others and be open to the need for change. When you feel challenged, lean in, despite difficulty and discomfort, with the goal of program improvement for the benefit of the communities that need to be served.
Throughout the journal, some terms are bold. These terms can be found in the resources tab of this journal. The list of terms provides a common language for programmatic use and mutual understanding.
We are excited to be on this journey with you!
We are working to advance equity, save lives, and strengthen communities. That is our collective charge. That is our common goal. That is our shared responsibility. We must commit to doing this work every day and doing it better than before.
How do we go about doing that? First, we must have a shared vision for what it means to achieve it. Health equity is achieved when everyone has a fair and just opportunity to attain their highest level of health. Achieving health equity is not going to happen by accident. Advancing health equity requires continual, vigorous effort. This work requires that we dig deep within ourselves to search for the ways in which our own thoughts, beliefs, and attitudes may be overlooking or even creating barriers to health.
It also requires that we implement strategies so that our work can be intentional. Guidance to that end involves programs doing the following:
- Continually collaborate with the local community being served; consider the people, community assets, challenges, partners, and solutions.
- Engage all staff in the planning and monitoring of equity strategies and goals and provide the support they need to understand their role in achieving equity.
- Assess and consider the impact of all activities and whether these practices or policy actions increase, decrease, or have no impact on equity for the population(s) of focus.
This journal offers opportunities to dive deeper into health equity work. Self-reflection is an important aspect of the journey, so this journal provides a foundation by grounding you in equity concepts and allowing space for thoughtful personal and professional reflection. The format moves away from simply learning about equity to providing opportunity and encouragement for introspection and application.
The journal at a glance:
- Journal entries should take no more than 45 minutes.
- Each journal entry will prompt us to Read a short article, Watch a short video, or Listen to a podcast.
- After either reading, watching, or listening to the resource, the next step is to Reflect by responding to the questions included in the section.
- Each entry includes a Resonance section that allows for deeper exploration of our thoughts about the resource watched, listened to, or read. For each section of the journal, we ask you to answer the following:
- My Moment of Challenge. What about the resource has challenged your thinking?
- My “Aha!” Moment. What was something new that you read, watched, or heard?
- My Moment of Hope. What concepts have inspired you?
- Each segment includes a Going Deeper section that will allow exploration of the topic more fully through additional resources. Please be mindful of your time. It is more important to get through all the sections than it is to go deeper on some and not get through all sections.
Some of the content included in this journal may be inappropriate for you. If a topic invokes feelings of past trauma or harm, please take care of yourself in ways that feel appropriate. Self-assessment includes knowing when you need self-care. If you need to put the journal down for a while or skip an activity, do so.
Part 1: Grounding:
Exploring the Impact of Racism on Health
Exploring the Impact of Racism on Health
View a message about beginning your Journey to Health Equity from NACDD Health Equity experts Robyn Taylor and Tiffany Pertillar.
As we begin this journey, it is important that we lay the foundation for addressing the impact of racism on health and explore social constructs, ways of thinking that were socially created and accepted but don’t reflect reality (i.e., race). Part 1 of this journal is designed to help frame your work and prepare you for the rest of this journey. In this section, you will receive insight from several thought leaders on this topic and begin to understand how racism has been a driving factor in creating and perpetuating health inequities in this country.
As we seek to achieve health equity together, we commit to and ask that you also be committed to:
- Considering and acknowledging the traumatic impact the nation’s history has had on the health of certain groups within our society.
- Challenging ourselves by examining how our beliefs, biases, and ideologies may be impacting our work within some communities.
- Uprooting systems and policies at local, state, and national levels that are creating or intensifying disparities.
- Holding ourselves and others accountable to the work of advancing health equity.
Before getting started, take a moment to contemplate and complete the statement below. We will ask you to complete it again later in this journal.
Health equity is important to me because:
Time Needed: 45 minutes
We will begin to explore the concept that racism is a public health issue and learn how the Centers for Disease Control and Prevention (CDC) is working to build a healthier country by addressing systemic racism and its impact on health. This will provide a solid foundation and fresh perspective for the work that is to come.
One step in working toward equity is to critically examine the pervasive ways inequities have been perpetuated. This section looks at how systemic racism is impacting the health of people living in the communities we are charged with serving and challenges us to stand ready to address it as a root cause of health inequities, health disparities, and poor health outcomes for racialized populations. If we come to a place of acknowledgment about the role racism has played in the systems where we live, work, and play, we will be better equipped to find the solutions needed to eliminate its adverse impact on people, families, and communities.
Watch: TIME 100 Talks Health Summit: CDC Director Dr. Rochelle Walensky on Health Equity (https://www.facebook.com/time/videos/cdc-director-dr-rochelle-p-walensky-on-health-equity/494864391826911/), (3:05 minutes)
Read: Director’s Commentary (https://www.cdc.gov/healthequity/racism-disparities/director-commentary.html), by Dr. Rochelle Walensky, MD, MPH, Director of CDC (5 minutes)
Read: Racism and Health: Racism is a Serious Threat to the Public’s Health (https://www.cdc.gov/healthequity/racism-disparities/index.html) (5 minutes)
Reflect:
- How can your organization align with the CDC’s identified role of addressing the impact of racism on the public’s health?
- Across the country, local and state leaders are declaring racism a public health emergency. These declarations are an important first step in the movement to advance health equity, racial equity, and social justice.
- Do you believe that racism is a public health emergency? What evidence supports your position?
- What effects do these declarations have on public health practice in general?
- Think about what these declarations mean for you. What are the implications for your work? How might your work need to change to address racism more explicitly?
- Identify who, within your organization needs to support and have buy-in to advance racial equity strategies?
- List your current network of partner organizations (or possibly individual champions) that address health inequities, advance racial equity, or support priority populations.
- Which partner organizations are missing that could strengthen your network, improve your work, and increase your reach?
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper: To learn more about race and health, explore the following resources. Suggested time allocation: Up to 3 hours
- Impact of Racism on our Nation’s Health — CDC (https://www.cdc.gov/healthequity/racism-disparities/impact-of-racism.html)
- Social Vulnerability Index — CDC (https://bit.ly/3hvLmiu)
- Race Equity and Public Health — American Public Health Association (https://bit.ly/3mgAWVF)
- Racism: The Ultimate Underlying Condition — American Public Health Association (https://www.apha.org/events-and-meetings/apha-calendar/webinar-events/2020/racial-equity-part-1)
Time Needed: 45 minutes
We have learned that racism is a public health issue, and we explored the ways in which CDC is addressing systemic racism within public health. Now, we will explore more deeply the concepts of race and racism as barriers to achieving health equity for racialized populations. We acknowledge that racism hurts the health of our nation by preventing some people the opportunity to attain their highest social, economic, educational, and political potential. As public health professionals, historically, we have focused heavily on downstream strategies that focus on individuals. However, more recently we have begun to understand the importance of moving toward upstream strategies—policy and systems change—in our efforts to improve the public’s health. The Race Toward Health podcast series examines a broad range of topics on achieving health equity, including discussions on the impact of racism on our nation’s health.
Reflect:
- LaVeist defines racism as the ways in which systems within society have been established to produce racially differential outcomes. Therefore, he ascertains that racism is not solely about individual thoughts, behaviors, and attitudes toward different racial groups, but about the systems that inherently produce different experiential realities for different racial groups.
- How is the definition of racism explained by Dr. LaVeist different than or the same as your understanding of racism?
- If racism is a root cause of health disparities and inequities, what is the role of public health in mitigating the impact of racism?
- What public health policies, practices, or programs can you think of that have contributed to health inequities?
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper: To hear more about systems leading to racial inequalities, visit the following links. Suggested time allocation: Up to 3 hours
- ‘What is a Racial Equity Culture?’ (https://chronicdisease.org/race-toward-health-what-is-a-race-equity-culture/), with Dr. Kristine Andrews (13:37 minutes)
- The Political Determinants of Health (https://chronicdisease.org/race-toward-health-political-determinants-of-health-how-to-address-equity-through-a-political-lens/), with Daniel Dawes (50:58 minutes)
- Impact of Unresolved Trauma on American Indian Health Equity (https://www.youtube.com/watch?v=CBKiKuVtrtg), by Donald Warne, MD, MPH (1 hour, 27 minutes)
Time Needed: 45 minutes
Now we will explore the levels of racism and their intersection with and impact on our work in public health through a theoretical framework developed by Dr. Camara Phyllis Jones. Dr. Jones, a former CDC Medical Officer and Research Director on Social Determinants of Health and Equity, is a family physician and epidemiologist whose work focuses on naming, measuring, and addressing the impacts of racism on the health and well-being of the nation. To broaden the national health debate beyond just universal access to high-quality healthcare, Dr. Jones challenges public health professionals to meaningfully address the social determinants of health (including poverty) and the social determinants of equity (including racism) in our work.
The framework developed by Dr. Jones helps us understand racism on three levels: institutionalized, personally mediated, and internalized. Her framework raises more comprehensive and thoughtful questions about the origin of race-based differences in health outcomes.
Read: Levels of Racism: A Theoretic Framework and a Gardener’s Tale (https://www.health.state.mn.us/communities/practice/resources/equitylibrary/docs/jones-allegories.pdf), by Dr. Camara Phyllis Jones (15 minutes)
Reflect:
- Jones states in her article, “What we really have to do to set things right in this garden is address institutionalized racism.” Reflect on what that statement means to you both personally and professionally. Write down your thoughts.
- Jones mentions “the gardener” and defines it as the person with the power to decide, the power to act, and the power to have control over the resources. Think about the power that you have as a public health professional. How can you use your power to help create and maintain “rich soil” in this country?
- How can the Levels of Racism framework influence strategies to promote racial and health equity within your service delivery area?
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper: To hear more on racism and public health, watch the following videos. Suggested time allocation: Up to 3 hours
- How Racism Makes Us Sick (https://www.ted.com/talks/david_r_williams_how_racism_makes_us_sick) by David R. Williams (17:19 minutes)
- Asian Americans and Health Equity: Dismantling Stereotypes (https://www.youtube.com/watch?v=vbjMv7wAtnY) by Simona C. Kwon (45 minutes)
- If Racism is a Public Health Crisis, What Does that Mean for My Work? (https://www.youtube.com/watch?v=y0hhtIrul5U&t=3354s) by Dr. Camara Phyllis Jones (1 hour, 48:31 minutes)
- Download the editable version of Part 1 of the Health Equity Journal.
Part 2: Unpacking:
Examining Biases and Challenging Self
Examining Biases and Challenging Self
Watch a video message about Part 2 of the Health Equity Journal.
To work toward health equity, we need to understand the systemic drivers that are either facilitating or impeding health. Part 1 of this journal was designed to help us understand race as a social construct, the implication of racism on poor health outcomes, and the responsibility of public health to address systemic barriers to health.
Part 2 of this journal will focus on us as individuals. It provides an opportunity to look within to examine and challenge the thoughts, ideas, beliefs, and behaviors that drive our work. This is where the hard work begins. In 1963, Martin Luther King Jr. challenged the citizens of this country to take “vigorous and positive action” toward change. He stated, “This is no time for apathy or complacency.” Consider the next section of this journal the impetus for action that will move us closer to a more equitable and just society in which every person can achieve and maintain their optimal health potential. Racism is embedded in the systems and structures around us. The revelation is that those systems and structures are run by people just like us—each with their own biases, backgrounds, beliefs, and behaviors. To be agents of change within the communities we are charged with serving, we must examine ourselves and be challenged to lead, govern, allocate resources, and develop programs with equity and justice as the solid foundation.
In this section of the journal, we will discuss bias, privilege and power, and intersectionality. There are many more concepts to understand while we are on this journey, but these were selected because of the importance of social identities and their implications on our ability to advance health equity.
Time Needed: 45 minutes
Implicit biases are defined as the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. Everyone has biases. Our biases determine our actions, but because they live in our subconscious, we are not always aware of them and may not have a full understanding of how they impact our work. A part of unpacking is doing the challenging work of uncovering these biases, acknowledging their existence, and overcoming them so we can ensure that our thoughts, beliefs, and attitudes about another person or groups of people are unbiased, fair, and not unintentionally causing harm.
Watch: How Do We Overcome Our Biases—Walk Boldly Towards Them (https://www.youtube.com/watch?v=uYyvbgINZkQ), by Verna Myers (Time: 17:40 minutes)
Reflect:
- Myers gives three ways to overcome our biases: (1) Look for evidence that the stereotype you have is untrue, (2) Walk in the direction of your discomfort and fear, and (3) When you see something, say something. Which have you already done? Which appear to be the most challenging?
- Name one thing you plan to do to uncover any subconscious biases that you have.
- Were you and your staff already aware of these types of biases?
- Are there policies within your organization that enable these biases as the norm or culture?
- What information or resources do you need to work on this area?
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper:
Suggested time allocation: Dependent upon the number of tests that you choose to take
To explore more about implicit biases, take the Harvard Implicit Association Test (https://implicit.harvard.edu/implicit/takeatest.html). Please note: There are 14 separate association tests, each with several questions. No one at CDC, NACDD, or your organization has access to your test results should you choose to complete any of the Harvard Implicit Association Tests.
Time Needed: 45 minutes
Power means having influence, authority, or control over people and resources and the ability to freely take action over or against them based upon your beliefs. Racism, and other root causes of health inequities, cannot be understood without acknowledging that power is experienced individually and culturally. This means that people can have power over other people, and certain cultures and groups can have power over other cultures and groups.
Privilege refers to certain social advantages, benefits, and degrees of prestige and respect that an individual has by virtue of belonging to certain social identity groups. Within American and other Western societies, these privileged social identities include whites, males, cis-gendered males and females, Christians, the able-bodied, young people, and the wealthy. Some are rooted in historically occupied positions of dominance.
Oppression is the systematic marginalization of one group by a group with more power for societal, economic, and political benefit or gain. Oppression is intricately connected to health and is embedded into systems. Because experiencing oppression significantly influences a person’s or a group’s well-being, it is important to address, analyze, and uproot systemic forces that uphold the oppressive practices if we want to improve poor health outcomes.
Having power and privilege is not a bad thing. If you have privilege or are in a position of power, the questions you should begin to ask yourself are, “What am I doing with the power and privilege I possess?” and “How am I using my power and privilege to help advance health equity and create opportunities for those without power and privilege to be heard, seen, and served?”
When considering privilege, think about accessibility to resources. Many people with privilege and in positions of power generally have unearned access to things that those without power—typically members of groups that have been historically traumatized and marginalized—do not have. How easy is it for you to access resources? How easy is it for those in the communities you serve to access resources? If there is a difference in your ability to access resources compared to those living in the communities you are serving, what is the cause of that difference?
Unfolding Power and Privilege
- Privilege is contextual; identities held can provide an advantage or a disadvantage based on how people are perceived by others.
- Privilege does not mean that people in privileged categories have not experienced struggles.
- Privilege does not mean that a person in a privileged category did not work hard for the things they have.
- Privilege does mean that access is granted based on an identity or position of power. This unearned access is where the inequities lie.
- Privilege has historically been a taboo subject, not acknowledged as existing, therefore not acknowledged as a potential problem.
- Privilege can enable oppression.
- Privilege is fluid; it can change throughout life.
Read: Unpacking the Invisible Knapsack of Privilege (https://psychology.umbc.edu/files/2016/10/White-Privilege_McIntosh-1989.pdf) by Peggy McIntosh Suggested time allocation: 30 minutes
Reflect:
- We have all experienced privilege. In what ways have you experienced and benefitted from privilege?
- Brainstorm three ways you can use the privilege you have to improve the lives of others and advance health equity in your work.
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper: To explore privilege and power further, visit the following. Suggested time allocation: 50 minutes
Time Needed: 45 minutes
Intersectionality is the acknowledgment that everyone has multiple social identities which overlap and create different combinations of privilege and oppression. These combinations can lead to heightened advantages or disadvantages.
As public health professionals, it is important that we consider intersectionality when planning, implementing, and evaluating programs. We serve people with complex lived experiences that belong to multiple social identity groups. Therefore, we must be thoughtful as we do our work, so we do not cause unintended harm, especially to those most in need of our services. When developing public health programs, services, and interventions, we should consider the intersection of oppressions that certain social identity groups experience. It is also important to note that for some the social identity groups to which they belong may not be visibly evident but belonging to those groups still has a profound impact on how they engage with the world around them and how they should be engaged.
Watch:
- Kimberlé Crenshaw: What is Intersectionality? (https://www.youtube.com/watch?v=ViDtnfQ9FHc) (Time: 2 minutes)
- Kimberlé Crenshaw at Ted + Animation (https://www.youtube.com/watch?v=JRci2V8PxW4) (Time: 6 minutes)
- Intersectionality and health explained (https://www.youtube.com/watch?v=rwqnC1fy_zc) (Time: 4 minutes)
Reflect:
- Think about the social identities of the people most impacted by breast and cervical cancer. Note all the social identities to which you think they could belong.
- How might the intersection of the social identities you just identified impact a person’s ability to achieve or maintain health, comply with medical directives from a healthcare professional, or get screened for breast and/or cervical cancer?
- What are the conditions that contribute to making screening inequitable for groups that you serve that have been historically burdened with poor health outcomes? They can be social, political, economic, or environmental.
- As a public health professional, what is your role in ensuring that screening is available for people with intersecting social identities? How can you make it likely that care is culturally relevant and addresses multiple relevant aspects of their lived experiences?
- What information, tools, and resources do you and your team need to help you develop strategies to promote screening for people with intersecting social identities?
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper: To explore the concept of intersectionality further, visit the following. Suggested time allocation: 60 minutes
- Missing and Murdered Indigenous Womxn, Girls, and Two Spirit (https://www.csvanw.org/mmiw) by the Coalition to Stop Violence Against Native Women
- The Urgency of Intersectionality (https://www.youtube.com/watch?v=akOe5-UsQ2o), by Kimbrelé Crenshaw (Time: 18:49 minutes)
- Download the editable version of Part 2 of the Health Equity Journal.
Part 3:
The Social Intersections of Health
The Social Intersections of Health
Watch a video message about Part 3 of the Health Equity Journal.
Now that we have laid the foundation for this work and you have spent time unpacking, discovering, and challenging yourself, we will dig deeper into the social factors that intersect with and have the capacity to impede health. Social factors that will be discussed in this section are housing, the built environment, and the resulting impact on transportation access and other factors that influence health. We will begin to explore social contexts and their intersection with the health of communities.
Time Needed: 45 minutes
The health of a person is intrinsically linked to their housing status. When families have access to stable, affordable housing in safe communities with access to public transportation, grocery stores, and other amenities, they have greater potential for better health outcomes. However, many of the people we aim to serve do not live in these conditions. Why is that? Have you ever wondered how communities got to be the way that they are? What causes some communities to thrive and other communities to struggle? And what does that have to do with a person’s health?
This week, we will explore the intersection of health and housing. Recall that one step toward equity is acknowledgment of and reckoning with the past. That sometimes requires that we unlearn what we have been taught so that we can make room for empathy and a better understanding of communities’ unique experiences, challenges, and assets. This empathy and understanding encourages engagement with those communities to affect change and health improvement.
Watch:
Does My Neighborhood Determine My Future? (https://www.youtube.com/watch?v=pu2sKNJMH-k) (Time: 30 minutes)
Watch:
Where You Live Has a Huge Impact On Your Health (https://www.youtube.com/watch?v=zNzFnHL-8Zk) (Time: 9 minutes)
Reflect:
- Look at the community where you live or work. What services are available to you? What services are missing? Is there evidence of detrimental impacts of long-standing housing policies and practices?
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper: To explore the intersection of health and housing further, watch Segregated by Design (https://www.segregatedbydesign.com/) (17:40 minutes).
Time Needed: 45 minutes
The built environment is another major influencer of health. Communities with access to various modes of transportation, such as walking, running, biking, and public transit, are healthier. However, Black, Hispanic, other racialized communities, LGBTQ communities, and people with disabilities in both rural and urban settings tend to have restricted access to safe transportation as well as limited access to economic opportunities. The needs for these populations are different from those of other groups that we serve, so how we address them requires new approaches, new partners, and concerted efforts.
Listen: Health to be Determined: Using Built Environment to Relieve Communities from Arrested Mobility by Charles T. Brown, MBA (https://chronicdisease.org/health-to-be-determined-using-built-environment-to-relieve-communities-from-arrested-mobility/) (Time: 32:48 minutes)
Reflect:
- How might the concept of Arrested Mobility impact the health of people living in the communities you serve?
- Many health challenges are directly related to transportation, land use patterns, infrastructure, and accessibility. How can public health professionals influence the design of communities to promote optimal health for all? For example, can you use your power or connections to influence bus routes to increase access to healthcare?
Resonance:
An Instance of Challenge:
An “Aha!” Moment:
An Inspiration:
Going Deeper: To explore the intersection of health and the built environment further, review Why the Built Environment? (https://www.youtube.com/watch?v=vL4VPMYmTUw) Suggested time allocation: 15 minutes
Download an editable version of Part 3 of the Journal.
You have done a lot of work! In Part 1, we laid the groundwork to give us a laser focus on the social determinants of health and to provide support for intentionally addressing racism along with other upstream root causes of inequity. In Part 2, we challenged you to unpack your own biases by examining your thoughts, beliefs, and attitudes about social identity groups and to consider how they may impact your work. In Part 3, we explored the intersection of health and the social determinants of health such as housing and transportation. We hope that you found this work enlightening and rewarding!
So, we ask that you complete the statement below again.
Health equity is important to me because:
How has your statement changed since the beginning of the journey?
Whether this journal has been a refresher for you or your starting point, get ready to go further. The work is not done yet! Your next step is to join our Health Equity Council to explore strategies to address some of the inequities that we have learned so much about.
Learn more about the Health Equity Council.
Resources
Ableism
Ableism is a set of beliefs or practices that devalue and discriminate against people with physical, intellectual, or psychiatric disabilities and often rests on the assumption that disabled people need to be ‘fixed’ in one form or the other.
Bias
Bias is an inclination of temperament or outlook. Bias is also a personal and sometimes unreasoned judgment.
Classism
Classism is differential treatment based on social class or perceived social class. Classism is the systematic oppression of subordinated class groups to advantage and strengthen the dominant class groups. It’s the systematic assignment of characteristics of worth and ability based on social class.
Downstream Strategies
Downstream strategies are interventions which often involve individual-level behavioral approaches for prevention or disease management.
Elitism
Elitism is when a group of individuals who may be of higher intellect, wealth, power, and/or special skills and experiences higher influence in society.
Ethnicity
Ethnicity is a state of belonging to a social group that has a common national or cultural tradition.
Fair
Fair is marked by impartiality and honesty: free from self-interest, prejudice or favoritism.
Genderism
Genderism is the systematic belief that people need to conform to their gender assigned at birth in a gender-binary system that includes only female and male.
Health Disparity
Health disparities are differences in health among groups of people that are linked to social, economic, geographic, and/or environmental disadvantage.
Health Equity
Health equity is when everyone has the opportunity to be as healthy as possible.
Health Inequity
Health inequities are systematic differences to opportunities leading to unfair and avoidable differences in health outcomes.
Heterosexism
Heterosexism is prejudice against any non-heterosexual form of behavior, relationship, or community, particularly the denigration of lesbians, gay men, and those who are bisexual or transgender. Whereas homophobia generally refers to an individual’s fear or dread of gay men or lesbians, heterosexism denotes a wider system of beliefs, attitudes, and institutional structures that attach value to heterosexuality and disparage alternative sexual behavior and orientation.
Implicit Bias
Implicit bias is unconscious, automatic, and relies on associations that we form over time. We can form bias toward groups of people based on what we see in the media, our background, and experiences. Our biases reflect how we internalize messages about our society rather than our intent.
Intersectionality
Intersectionality is the interconnected nature of social categorizations such as race, class, and gender, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.
Just
It is acting or being in conformity with what is morally upright or good.
Oppression
Oppression is the systematic subjugation of one social group by a more powerful social group for the social, economic, and political benefit of the more powerful social group.
Oppression = Power + Prejudice
Power
Power is a special right, advantage, or immunity granted or available only to a particular person or group.
Privilege
Privilege refers to certain social advantages, benefits, or degrees of prestige and respect that an individual has by virtue of belonging to certain social identity groups.
Race
In practice, the designation of race is based on socially defined visual traits as seen through the filter of individual and social perspective, while ethnicity is a category determined by genes, culture, and social class, a product of social evolution.
Racism
Racism is a system consisting of structures, policies, practices, and norms that assigns value and determines opportunity based on the way people look or the color of their skin. This results in conditions that unfairly advantage some and disadvantage others throughout society.
Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they gather in community.
Sizeism
Sizeism is prejudice or discrimination on the grounds of a person’s size or weight.
Social Construct
A social construct is an idea that has been created and accepted by the people in a society.
Social Determinants of Equity
The social determinants of equity are quality experiences in the early years, education and building personal and community resilience, good quality employment and working conditions, having sufficient income to lead a healthy life, healthy environments, and priority public health conditions.
Social Determinants of Health
The social determinants of health are the non-medical factors that influence health outcomes. Social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. The state social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.
Social Identity
Social identity is a person’s sense of who they are based on their group membership. The groups that people belong to can be a source of pride and self-esteem.
Systemic Racism
Systemic racism is what happens when cultural institutions and systems reflect that individual racism.
Unearned Access
Unearned access is access based on an identity someone holds traditionally associated with privilege.
Upstream Strategies
Upstream interventions involve policy approaches that can affect large populations through regulation, increased access, or economic incentives. For example, increasing tobacco taxes is an effective method for controlling tobacco-related diseases (7). Midstream interventions occur within organizations. Downstream interventions would be the rate of self-reported exposure to secondhand smoke (downstream).
Xenophobia
Xenophobia is fear of people from another country or group.