Health Equity Race & Place

Community Action Partnership Management & Leadership Training Conference February 5, 2021

Georges C. Benjamin, MD, MACP, FACEP(E), FNAPA EXECUTIVE DIRECTOR What Is Health?

Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June,1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The Definition has not been amended since 1948.

Zip Code Determines Access To

• High-quality schools • Toxic exposures • Job opportunities • Quality healthcare • Healthy housing • Good public transit • Nutritious food • Social cohesion • Safe communities • Social capital • Green space

5 • Life expectancy differs by two years. • 97 percent white • Healthiest Communities scores more than 20 points apart • The people in Mason County are not making more unhealthy choices • Putnam County has better schools, a stronger economy & spends more on public safety

West Virginia Delmar Blvd. Divide in St. Louis, Mo Blacks More Likely to Have Heart Disease or Cancer I 35W Minnesota Bridge Collapse, 2007

Homelessness Is A Social Determinant of Health

• Poor health is a cause of homelessness • 14% in homeless health programs are kids • Homeless 3 - 6 times more likely to be sick • 3 - 4 times more likely to die prematurely • High percent without health insurance

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SARS-CoV-2 >26.0 million cases >450,000 deaths >35 million vaccine doses to date Virus Mutations • More infectious • No vaccine escape yet • Some testing escape Significant Health Inequities

Age-adjusted COVID-19-associated hospitalization rates by race and ethnicity, COVID-NET, March – June 13, 2020 Societal Determinates Drive COVID-19 Inequities

• Exposure - Public facing occupations - Delayed sheltering in place • Susceptibility - Prevalence of chronic disease • Social determinates - Lack of paid sick leave - Poverty - Housing situation - Racism Race & Racism Defined RACISM

RACE The false belief in the superiority of one group of people over another based on race A social construct based on physical characteristics • Unfairly disadvantages some individuals and communities • Unfairly advantages other individuals We as a species share 99.9% and communities of our DNA with each other • Saps strength of the whole society by wasting human resources

31 Types of Racism Personally Internalized Structural Mediated Racism: Racism: Racism: Acceptance by the Prejudice and stigmatized “races” Differential access to discrimination based of negative goods, services and on assumptions messages about opportunities by race about capabilities, ones own abilities motives and intent and intrinsic worth

32 Structural Racism: COVID-19 Testing

ACCESS TO TESTING

Location & mode of test facility • Location not located in minority communities • Drive through vs. walk up • Long lines

Messaging on the need for a gateway provider Call your doctor or health care provider

Cost of testing (Federal coverage for now)

Cost for care (Uninsured or underinsured)

33 Tuesday, January 26, 2021 Black Americans Are Being Vaccinated At Far Lower Rates

“Some have hinted the lack of vaccine access is rooted in racism – not an unwillingness of minorities to get vaccinated. Dr. Taison Bell, of the University of Virginia, told NBC News that he was “horrified to discover that members of environmental services — the janitorial staff — did not have access to hospital email.”

Hospital staff receives its vaccination information via email, Dr. Bell stated.

“That’s what structural racism looks like,” Dr. Georges Benjamin, executive director of the American Public Health Association, told NBC.

“Those groups were seen and not heard — nobody thought “……. Address Structural Vaccine Access Vaccine Barriers

• Ensuring equity in access – Vaccination sites in community – Use all forms of registration tools – Transportation – 24 / 7 availability • Enhance vaccine seeking – Address misinformation • Targeted education with trusted messengers in their language • Use trusted messengers Personally Mediated Racism: Masking While Black

36 Internalized Racism: Behavioral Barriers to COVID-19 Testing

Lack of clear understanding of benefits of test or what results mean

Fear of stigma: Black disease

Fear of discovery

Lack of trust in “system”

37 Vaccine acceptance Enhance Vaccine Acceptance

• Address misinformation – Targeted education with trusted messengers in their language – Use trusted messengers APHA Actions • Police Violence policy • Racism as a public health concern declared • Racism book published • Racism webinar series • Walking the talk • Built health equity in our COVID response

About APHA

The American Public Health Association champions the health of all people and all communities. We are the only organization that combines a nearly 150-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health. Learn more at www.apha.org.

● Founded – April 18, 1872 ● 501C(3) & Nonpartisan ● Over 50,000 individual & affiliate members