Tackling Health Inequities Through Public Health Practice: A Handbook for Action THE NATIONAL ASSOCIATION OF COUNTY & CITY HEALTH OFFICIALS Washington, DC THE INGHAM COUNTY HEALTH DEPARTMENT Lansing, Michigan Edited by Richard Hofrichter This publication was supported by a grant from the W.K. Kellogg Foundation Copyright ©2006 Sources iii Sources Chapter 4 Alonzo Plough, “Promoting Social Justice through Public Health Policies, Pro- grams, and Services,” in Barry S. Levy and Victor Sidel, eds., Social Injustice and Public Health (New York: Oxford University Press, 2006). Reprinted by permission. Chapter 10 Kathryn Horsley and Sandra J. Ciske, “From Neurons to King County Neighbor- hoods: Partnering to Promote Policies Based on the Science of Early Childhood Development,” American Journal of Public Health 95 (April 2005): 562-567. Reprinted by permission. Appendix C1 Lawrence Wallack and Regina Lawrence, “Talking about Public Health: Devel- oping America’s ‘Second Language,’” American Journal of Public Health 95(4) (April, 2005): 567-570. Reprinted by permission. Appendix C2 Makani Themba-Nixon, “Helping Public Health Matter: Strategies for Building Public Awareness” NACCHO Exchange 4(2) (Spring, 2005): 10-12. Published by the National Association of County & City Health Officials, Washington, D.C. Appendix D1 An excerpt from Rodrick Wallace, Deborah Wallace, and Robert Wallace, “Cor- onary Heart Disease, Chronic Inflammation, and Pathogenic Social Hierarchy: Biological Limit to Possible Mortality Reductions in Morbidity and Mortality,” Journal of the National Medical Association 96(5) (2004): 609-619. Reprinted by permission. Appendix D2 David Williams and Pamela Braboy Jackson, “Social Sources of Racial Dispari- ties in Health,” Health Affairs 24(2) (March-April, 2005): 325-334. Reprinted by permission. Acknowledgements v Acknowledgements any people provided ideas, insight, and support in the production and review of this handbook, including both substantive and edi- Mtorial suggestions. First and foremost, we would like to thank our colleagues at the Ingham County Health Department, Bruce Bragg and Doak Bloss. At NACCHO they include Kathi Schaff, and members of the Social Justice Team. Members of NACCHO’s Health and Social Justice Advisory Committee offered significant guidance including Rajiv Bhatia, Epi Bodhi, Stephanie Brundage, Tony Iton, Nancy Jorn, Adam Karpati, Elaine O’ Keefe, Ngozi Oleru, and Adewale Troutman. Special thanks to Makani Themba-Nixon for her insights and to Bob Prentice and Baker Salsbury for many helpful conversations. In addition, we wish to express our gratitude to the W.K. Kellogg Foun- dation for their continuing support of our work. Special thanks to Barbara Sabol for her insights and efforts on our behalf. We very much appreciate the work of Kimberly Singletary and the staff of Conceptual Geniuses, including Jane Hahn and Kung Pik Liu, in the design and production of this document. Finally, we would like to thank Peter Frykholm for his excellent editorial work. -Richard Hofrichter, Editor Preface vii Preface ealth practitioners in local health departments (LHDs) face many dilemmas and struggles in seeking to protect and improve the pub- Hlic’s health. As the front line of the public health response in local communities, they often must cope with immediate crises and chronic issues with limited resources, restrictive statutory mandates, categorical funding, and political pressures from state and local officials. Address- ing the root causes of inequities in the distribution of disease and illness might seem like a luxury. But it is not. Persistent, severe health inequities are increasing significantly, with serious implications for the nation’s well- being. While Hurricane Katrina made these health inequities and their underlying injustices salient to a wide population, the day-to-day conse- quences are a major threat to public health. They must be challenged. The good news is that success will mean fewer resources need to be spent on coping with the consequences. With leadership, strategic alliances, com- mitment, and public support, LHDs can meet the challenge. At the same time, addressing health inequities will demand a supportive environment for and collaboration with staff as well as community-based organizations. Social justice has always been a major philosophical underpinning of public health because much of the etiology of disease is rooted in social conditions. Social justice has also often been a motivating force in draw- ing many people to the field. Elizabeth Fee notes in her introduction to George Rosen’s A History of Public Health, “When the history of public health is seen as a history of how populations experience health and ill- ness, how social, economic, and political systems structure the possibili- ties for healthy or unhealthy lives, how societies create the preconditions for the production and transmission of disease, and how people, both as individuals and social groups, attempt to promote their own health or avoid illness, we find that public health history is not limited to the study of bureaucratic structures and institutions but pervades every aspect of social viii Preface and cultural life.” Progress toward the elimination of health inequities will therefore require an expanded and expansive view of the scope of public health practice. Tackling Health Inequities raises questions and provides a starting point to assist health practitioners in considering the potential for reorienting public health practice to address the root causes of health inequities, par- ticularly with respect to restructuring the organization, culture and daily work of public health. It is meant to inspire readers to imagine or envision public health practice and their roles in a way that challenges contempo- rary thinking, as emerging trends, social conditions, and policies generate increasing inequities in health. No protocols or tools can eliminate health inequity. It will require taking risks and questioning assumptions. Recent experience in many jurisdictions suggests that many health practitioners are willing to meet the challenge. NACCHO expects to provide guidance and assistance in that endeavor and this book represents one step in a long journey. Contents ix Table of Contents PART ONE Chapter 1 .......................................................................................................................................................11 Introduction Chapter 2 ....................................................................................................................................................33 Initiating Social Justice Action through Dialogue in a Local Health Department: The Ingham County Experience Doak Bloss Chapter 3 ....................................................................................................................................................59 Transforming Elements of Public Health Practice: Preliminary Considerations Richard Hofrichter Chapter 4 ....................................................................................................................................................77 Promoting Social Justice through Public Health Policies, Programs and Services Alonzo Plough PART TWO: THE PUBLIC HEALTH COMMUNITY IN ACTION: CASE STUDIES AND STORIES Introduction ............................................................................................................................................. 89 Chapter 5 .....................................................................................................................................................91 Health Impact Assessment in Land Use Development: A Case Study in Health Equity Practice Rajiv Bhatia Chapter 6 .................................................................................................................................................. 103 The Community Action Model in a Public Health Department Setting Case Study: Tobacco Divestment on College Campuses Alma Avila, Alyonik Hrushow, Susana Hennessey Lavery, Mele Lau Smith, Diane Reed, and Melinda Moore Chapter 7 ................................................................................................................................................... 115 Tackling the Root Causes of Health Disparities through Community Capacity Building Anthony Iton Chapter 8 ...................................................................................................................................................137 Lessons from the Turning Point Initiative: Implications for Public Health Practice and Social Justice Vincent Lafronza Chapter 9 .................................................................................................................................................. 155 Using Living Wage Campaigns to Benefit Public Health David Reynolds x Contents Chapter 10 ................................................................................................................................................ 167 From Neurons to King County Neighborhoods: Partnering to Promote Policies Based on the Science of Early Childhood Development Kathryn Horsley and Sandra Ciske Chapter 11 ................................................................................................................................................. 177 The Evolution of the Health Determinants, Planning and Evaluation Division: The Region of Waterloo Public Health Department Theresa Schumilas Chapter 12 ................................................................................................................................................185