COALITION FOR RACIAL EQUITY AND SOCIAL JUSTICE

Visit us at http//coalition4justice.com DONATE • America’s Long-standing Inequities in Health and Health Care Exposed ❖HEALTH AND HEALTH CARE EQUITY DEFINED: o The American Public Health Association – defines “Health Equity” as everyone having the opportunity to attain their highest level of WHAT IS health. o The Center for Disease Control and Prevention (CDC) – states that HEALTH AND health equity is achieved when every person has the opportunity to “attain his or her full health potential“ and no one is “disadvantaged from achieving this potential because of social position or other HEALTH socially determined circumstances.” o Robert Wood Johnson Foundation (RWF) says “Health equity means CARE that everyone has a fair and just opportunity to be healthier. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and EQUITY? lack of access to good jobs, quality education and housing, safe environments and health care.” o (Institute of Medicine (IOM) – “Providing care to everyone that does not vary in quality because of personal characteristics such as Gender, Ethnicity, Geography, and Socioeconomic status.” • Everyone having opportunity to attain What is ➢Quality health Common ➢Full health Among the ➢Highest level of health • No one is disadvantaged because of – Definitions? ➢Discrimination ➢ Poverty ➢ Powerlessness ➢Personal Characteristics HEALTH AND • Giving Every Person the Quality of Health Care HEALTH • They need, and CARE EQUITY MEANS • When they need it WHAT ARE THE UNDERLYING DETERMINANTS OF HEALTH • ??????????????????????????????????????? ????????????????????? DISPARITIES? Health and Health Care Disparities

• Viewed typically from the lens of Race and Ethnicity • Other ways to look at health and healthcare disparities:

❖Socio-economics status

❖Age

❖Location

❖Gender

❖Disability status

❖Sexual Orientation UNDERLYING • Racism and ❖Recreation Discrimination ❖Transportation DETERMINANTS ❖Poverty ❖Social Gradient ❖ OF HEALTH Lack of or unequal ❖Work Environment DISPARITIES? access ❖ ❖Social Exclusion and Education Isolation ❖Unemployment ❖Stress ❖ Income Stability ❖Stigma ❖ Housing ❖Lifestyle ❖Food Insecurity ❖Distrust of Health Care ❖Nutrition and Medical System ❖Environmental Hazards Are the underlying social determinants of health Underlying Social determinants FAIR? of Health

AVOIDABLE? • Why are People of Color Distrustful DISTRUST IN of the US Healthcare System? THE AMERICAN HEALTH CARE • ??????????????????????????????? AND MEDICAL ???????????????????????????? SYSTEM • Generational Scar from Lived Personal Experiences of People of Color Black and ➢Three Major Studies in US: 1. The Tuskegee Syphilis Study in Alabama (1912- Brown 1972)

Americans ✓6oo blacks recruited for study, Lack Trust in ✓399 had contracted Syphilis, and the Health Care System ✓201 did not have the disease. • Study Goal – To see the history and progression Tuskegee of syphilis Syphilis ❖Penicillin approved for treatment of syphilis Study, 1912- ❖Patients not treated for cure of the disease

1972 ❖Patients given placebos – aspirin and mineral supplements Tuskegee Syphilis Study Some Tuskegee Syphilis Experiment Patients Tuskegee Syphilis Patients Being Vaccinated Tuskegee Syphilis Patient Being Injected with the Disease Tuskegee Syphilis Study Tuskegee Syphilis Study Impact

• 128 Participants dead by 1972

• 40 plus study souses contracted syphilis

• 19 children of study participants born with syphilis Tuskegee Syphilis Study

• Unethical Tuskegee Syphilis Study used in – ✓Medical in United States Journals ✓To teach medical students ✓July 1972 Study leaked in national media ✓Study shut down ✓Study doctors sued for criminal misconduct not convicted • 1973 - US Government Congressional Hearing on Tuskegee Study

Tuskegee • Class Action lawsuit – Settled out of court with federal government and study patients Syphilis and deceased patient families Study • $10,000 million paid as compensation to heirs and survivors of study patients. • Born Loretta Pleasant on August 1, 1920 Roanoke, Virginia to Eliza and Johnny Pleasant • Diagnosed with aggressive cancerous cell in 1951 • Hospitalized and treated at Johns Hopkins Hospital. Baltimore, MD • Lacks died of aggressive cervical cancer at age 31 2. Lacks Cell Study years in 1951 Henrietta Lacks, 1920-1951 Aggressive Cancerous Cells Johns Hopkins Hospital, Baltimore, MD

• People of color (Black, Brown and Indigenous People) were refused treatment in most hospitals in US • Johns Hopkins Hospital in Baltimore, Maryland was one of very few hospitals that treated POC ➢Henrietta Lacks Cell Study at Johns Hopkins Hospital Baltimore, MD ➢Unauthorized and unethical use of Lack’s cancerous cells by her doctors and other Black and researchers while under treatment and after her death. Brown ✓Her Cancer cells taken and passed around in medical community for research without her Americans knowledge and consent Lack Trust in ✓Lacks’ cell shared widely by Johns Hopkins researchers with other scientists US Health ✓Her medical record released to media and her Care System cells’ gnome published online Unethical Henrietta Lacks Cell Study Henrietta Lacks Immortal (hela) Cells Henrietta Lacks Cell Study

• Henrietta Lacks immortalized cells – a fixture in US medical research community and globally for decades • Her cell line – extraordinary capacity to survive and reproduce maternally • Hela Cells – used for vaccines development: • Polio vaccine • HIV • Herpes • Parkinson’s disease • COVID-19, and • Many Others Henrietta Lacks Legacy to the World

• Scientists around the world use the immortal Hela cells for medical discoveries and treatment oof diseases.

• Hela cells used by a German virologist to prove that the human papillomavirus (HPV) causes cancer Books on Henrietta Lacks Black and • 3. Guatemala Study (1946-1948) Brown ➢700 men and women intentionally Americans injected with syphilis Lack Trust in ➢ the Health These people did not contract syphilis Care System ➢Study researchers wanted to determine whether penicillin could prevent syphilis

➢Researchers also used prostitutes also for the syphilis experiment Clinton on the Guatemala Study US Sponsored Unethical Study US Sponsored Unethical Study

• People in Guatemala lined up to be injected with syphilis vaccine • Dark Chapters in the History of US Sponsored Medicine in the US Unethical ➢Syphilis – a major health issue in the US in 1920s ➢Researchers wanted to know the natural history Studies or progression of the disease ➢Studies Methodology – Unethical ➢Study participants were - ✓ denied of treatment ✓ denied information ✓ NO Patient consent obtained for study ✓ tricked and used as guinea pigs US Sponsored Unethical Studies

• Any Wonder that People of Color are Distrustful of US Government When it Comes to Vaccines? ➢ Decades of Generational Scar of black and Brown Communities ➢ 1973: study Congressional Hearings on Study Ethics- o 37 Years after Tuskegee Study o 25 Years after Guatemala Study, and o 22 Years after Lacks Study ✓ Presidents Clinton and Obama and Hilary Clinton apologized for US involvement in unethical Studies ✓ Class action lawsuit – settled out of court with US government ✓ $10,000 paid to heirs/survivors of Study participants ✓ No conviction for doctors and researched involved in the unethical studies Hilary Clinton Apologies for US and Medical Community Mistreatment of People of Color WHY DO HEALTH AND

HEALTH CARE • ???????????????????????????????????????????????????? EQUITY ???

MATTER ? • ???????????????????????????????????????????????????? ???

• ???????????????????????????????????????????????????? ??? HEALTH AND HEALTH CARE EQUITY MATTER

• Health and wellbeing of the population is the foundation of vibrant communities and society ❖Healthy Equity matters from an equity, social justice and civil rights standpoint ❖Inequity does NOT affect only the group facing disparities ❖Health disparities have spillover effects on the rest of society ❖Reduces social cohesion and leads to stress, fear and insecurity ❖Limits overall gains in quality care and health of the broader population. ❖Results in significant unnecessary costs, not only to the individuals but also to society. ❖Improves health and the quality of care more broadly to achieve overall population health. CHALLENGES IN ADDRESSING HEALTH • WHAT ARE THE CHALLENGES? AND HEATHCARE DISPARIITIES

• HOW CAN WE REDUCE HEALTH AND HEALTHCARE DISPARITIES? • Affordable Health Care – ✓ Not Perfect ✓ Needs Improvement ❖Roll back in health insurance coverage Decline in Gains ❖Efforts to overturn ACA Made with the ❖Decreased funds for outreach and enrollment assistance Affordable Care Act ❖Adding restrictions to Medicaid such as eligibility (ACA) verification requirements to Medicaid ❖Allowing states to cap federal funding for Medicaid ❖Decreased funding for Prevention and Public Health Care Reducing or Eliminating Health and What Needs to Happen to Overcome Healthcare Challenges and Reduce or Eliminate Health Disparities and Health Care Disparities?

???????????????????????????????????????? ???????? Addressing Health and Healthcare Disparities

• Integrate Health Equity considerations into policies and programs • Policy makers Response to health and healthcare inequity issues – Critical

❖ Goal of Health and Human Services (HHS) Initiative (2016):

➢ To Advance Health and Health Care Equity ➢ Expand Access and Quality of Coverage and Care ➢ Promote and Provide Whole Person Care

➢ Strengthen Healthcare Infrastructure and Workforce • State Government Efforts: ❖Mostly on reducing factors that influence health in underserved population. ❖23 states and territories have a strategic plan Addressing for addressing minority health or health equity ❖Many states’ disparity efforts focus on specific Health and populations like

Healthcare ➢Children Disparities ➢Refugees, and/or ➢The Homeless • Diversifying Health Care Workforce • Providing Culturally and Linguistically Addressing Sensitive Care Health and • National standards for Culturally and Healthcare Linguistically Appropriate Services (CLAS) created by Health and Human Services in Disparities 2013 • Provide Universal Health Care • Make Health Care Insurance Affordable to All Americans • Policy Coverage on Expansion: Addressing ➢Affordable Care Act (ACA) aka Health and Obama Care Health ✓New Coverage Options Care ✓Medicaid Expansion Disparities ✓Health Insurance Marketplaces • Results of the Affordable Care Act (ACA) ➢Large coverage gains across racial, Addressing ethnic and low socioeconomic groups Health and ➢Helps narrow the percentage point Health Care differences in uninsured rates between Disparities people of color and white people ➢Relative health disparities by income also narrowed Health and • 2019 US Census Study (2010-2018) Reveals Huge disparities still among groups: Health Care ➢ Blacks were 1.5 times more likely than whites to be uninsured Disparities in US ➢ Maternal mortality among women of color was 3 times compared to white women ➢ Infant mortality among children of color was higher among white children than white children ➢ Hispanics were 2.5 times more likely to be uninsured than white people ➢ Income disparities between poor people and those at higher incomes were 5 times higher in 2010 ➢ In 2018 it was 4 times higher ➢ Lower income groups remain more likely to be uninsured than those at higher income level. Health and Health Care Disparities in US THANK YOU! Visit us at http//coalition4justice.com ~ Bernadine Ahonkhai MA, ED. D and

Founder, Coalition4justice DONATE

Phone: (215) 588-7509

Email: [email protected]