WEBVTT 00:00:05.980 --> 00:00:09.980 Welcome to the Roots of Health Inequity online course series, Course One. 00:00:10.837 --> 00:00:17.837 In this course, we'll introduce the concepts of health equity, health inequity and other related ideas. 00:00:18.248 --> 00:00:21.039 We'll learn about the root causes of health inequity, 00:00:21.079 --> 00:00:25.079 why they're important, and how we can strategize to act on them more directly, 00:00:26.426 --> 00:00:29.559 rather than just the resulting symptoms. 00:00:29.599 --> 00:00:33.599 We'll explore the price we all pay in economic, social, and human terms. 00:00:34.685 --> 00:00:37.502 Then we'll examine the challenges facing public health 00:00:37.542 --> 00:00:41.147 as we try to reimagine practice towards achieving equity, 00:00:41.187 --> 00:00:44.548 and discuss ideas for overcoming those challenges. 00:00:44.588 --> 00:00:47.791 First we need to understand what health equity means. 00:00:47.831 --> 00:00:51.791 Dr Camara Jones defines health equity as quote 00:00:51.831 --> 00:00:55.831 "The assurance of the conditions for optimal health for all people. 00:00:56.955 --> 00:01:01.955 Achieving health equity requires valuing all individuals and populations equally, 00:01:02.462 --> 00:01:08.462 recognizing and rectifying historical injustices, and providing resources according to need." 00:01:09.631 --> 00:01:13.513 The assurance of the conditions for optimal health for all people. 00:01:13.553 --> 00:01:17.553 In America, optimal health for all people has never been achieved. 00:01:17.790 --> 00:01:21.068 There are too many systemic forces working against it, 00:01:21.108 --> 00:01:25.108 so achieving health equity requires systemic change. 00:01:25.160 --> 00:01:28.611 Margaret Whitehead defines health inequity as quote 00:01:28.651 --> 00:01:32.651 "Differences in the distribution of disease, illness, and death 00:01:33.017 --> 00:01:39.017 that are systematic, unjust, actionable, and associated with imbalances in political power." 00:01:39.050 --> 00:01:45.250 These differences are systematic, because they are built into our social, political, and economic systems. 00:01:45.450 --> 00:01:48.454 They're unjust, which means we must rectify them. 00:01:49.126 --> 00:01:52.450 They are actionable, which means we can rectify them. 00:01:52.490 --> 00:01:56.171 And they are associated with imbalances in political power, 00:01:56.211 --> 00:02:00.211 which means we need to engage with politics and political power. 00:02:00.550 --> 00:02:04.550 But how? What can we do to end health inequity? 00:02:05.746 --> 00:02:11.746 A healthy tree needs tending to grow and thrive, but we can see that this tree is struggling. 00:02:12.021 --> 00:02:18.021 At first we might tend to the leaves, removing any of the dead ones before the other leaves are affected. 00:02:18.262 --> 00:02:22.262 But what if this isn't enough? What if the browning leaves are a symptom of a deeper issue? 00:02:23.988 --> 00:02:29.988 If we want to understand why this tree is struggling, we need to start digging deeper. 00:02:30.207 --> 00:02:34.207 If the tree doesn't have what it needs to grow and thrive, it will continue to struggle. 00:02:36.300 --> 00:02:38.565 Some parts of the tree are doing okay. 00:02:38.605 --> 00:02:42.605 But the tree will only flourish when the entire tree is healthy. 00:02:43.473 --> 00:02:46.222 We can think about health equity the same way. 00:02:46.262 --> 00:02:50.262 In public health we see health disparities across different populations. 00:02:50.854 --> 00:02:55.854 We see that there are some folks in our communities that have worse health outcomes than others. 00:02:56.157 --> 00:03:02.157 So, many of our interventions work to address these health outcomes by addressing health risk behaviors. 00:03:02.341 --> 00:03:06.341 We recognize that there are risky behaviors that can lead to health disparity. 00:03:07.580 --> 00:03:11.029 But what creates the conditions that lead to risky behaviors? 00:03:11.069 --> 00:03:15.069 More recently we've learned about the role the social determinants of health 00:03:15.300 --> 00:03:18.250 can play in shaping our living conditions. 00:03:18.300 --> 00:03:24.384 For example lack of access to quality education, health care, housing and our built environment, 00:03:24.730 --> 00:03:29.730 all can make us more likely to engage in risky health behaviors that lead to poor health outcomes. 00:03:30.647 --> 00:03:33.450 But we need to go even deeper, 00:03:33.500 --> 00:03:37.560 to ask why there are such differences in SDOH conditions across communities. 00:03:38.456 --> 00:03:42.456 We need to go beyond the surface of social determinants of health 00:03:42.765 --> 00:03:46.600 and understand the root causes of health inequity. 00:03:46.650 --> 00:03:49.383 In this course series we explore the root causes 00:03:49.423 --> 00:03:53.423 with the focus on racism, class oppression and cisheteronormativity. 00:03:54.410 --> 00:03:57.569 We need to explore what has created these root cause systems 00:03:57.609 --> 00:04:00.242 and name the conditions that cause them to develop. 00:04:00.282 --> 00:04:05.282 When a tree is planted in poor conditions from the start, it doesn't have a chance. 00:04:05.711 --> 00:04:08.403 The same is true with our society. 00:04:08.443 --> 00:04:12.443 If the conditions of our society are poor, our roots will be poor. 00:04:13.222 --> 00:04:15.164 Which limits our potential. 00:04:15.204 --> 00:04:20.204 Our work is about changing the roots, so that we can all achieve optimal health and flourish. 00:04:20.587 --> 00:04:24.440 Systemic change means working on a political and social level 00:04:24.480 --> 00:04:27.368 to produce conditions necessary for optimal health. 00:04:27.408 --> 00:04:30.357 Part of our role as public health health professionals 00:04:30.397 --> 00:04:34.397 is to understand how root causes create health inequity. 00:04:35.000 --> 00:04:40.267 We can address these root causes in our public health practice to bring about health equity for all. 00:04:41.105 --> 00:04:45.105 How you are positioned in society has a great deal to do with your overall health. 00:04:45.894 --> 00:04:49.894 Your position can affect everything. The environment you may be born into. 00:04:50.660 --> 00:04:55.660 The quality of the land and air around you. How and what food you can access. 00:04:56.000 --> 00:04:59.952 How you were treated by others around you, and those in power around you. 00:04:59.992 --> 00:05:05.002 And how you receive, or don't receive medical care that can fit your unique needs. 00:05:06.000 --> 00:05:11.000 For instance, think about one of our most common health challenges: cancer. 00:05:11.353 --> 00:05:16.353 Cancer is caused by many factors, including environmental challenges and stress. 00:05:16.759 --> 00:05:22.759 Marginalized communities often live in unsafe, unhealthy, under resourced living spaces. 00:05:23.901 --> 00:05:27.901 This can expose them to stress from many sources. 00:05:28.281 --> 00:05:31.642 We recognize that the conditions in our lived environments, 00:05:31.682 --> 00:05:34.988 in addition to the food we have access, to can cause cancer. 00:05:35.028 --> 00:05:40.028 And we do work that impacts behaviors or even helps with improving lived environments. 00:05:40.307 --> 00:05:45.307 But do we see that these unhealthy environments are the result of systemic racism, 00:05:46.163 --> 00:05:49.038 which marginalizes people and communities of color. 00:05:49.300 --> 00:05:53.078 Making it harder for them to access education, find good paying jobs, 00:05:54.274 --> 00:05:58.274 afford healthy living environments or deal with stress. 00:05:58.475 --> 00:06:02.475 We need to dig deeper and address the problem at the root level. 00:06:03.182 --> 00:06:07.182 The root causes of health inequity are deep and complex. 00:06:07.487 --> 00:06:10.414 They are the result of centuries of injustice, 00:06:10.454 --> 00:06:13.398 which requires us to build new conditions 00:06:13.438 --> 00:06:18.438 that can foster the type of growth and development we want to see in society. 00:06:18.596 --> 00:06:22.596 The symptoms of these root causes is what our profession battles daily. 00:06:22.947 --> 00:06:28.947 But we will forever battle health inequities, if we don't fix the root causes. 00:06:29.303 --> 00:06:33.303 Changing what's in the soil will repair the root causes. 00:06:33.655 --> 00:06:37.655 What is holding us back? Two things. 00:06:37.700 --> 00:06:44.799 First an overemphasis on treating the effects of health inequity, rather than addressing the root causes. 00:06:44.954 --> 00:06:49.954 We must do more than just mitigate the effects. We must attack the problem at its source. 00:06:50.531 --> 00:06:57.531 Second, political pressures hold us back. Often in our work public health must navigate competing interests. 00:06:58.215 --> 00:07:02.215 We're often funded by local governments and are subject to local laws and policy. 00:07:02.955 --> 00:07:06.287 Sometimes those policies are enacted without our input. 00:07:06.327 --> 00:07:11.327 And many times there are competing interests that are simply more powerful than ours. 00:07:11.600 --> 00:07:17.600 We need to embrace eliminating the root causes of health inequity as part of our daily practice. 00:07:18.000 --> 00:07:22.312 We need to accept the political nature of our work and engage directly with structures of power. 00:07:23.508 --> 00:07:27.508 We need to work with our communities to build collective power. 00:07:27.536 --> 00:07:32.536 We need to invest in community infrastructure, and we need to share knowledge with one another. 00:07:33.183 --> 00:07:36.836 We need to center health equity in all parts of our work. 00:07:36.876 --> 00:07:40.818 If we can diminish or eliminate the root causes of health inequity, 00:07:40.858 --> 00:07:44.006 we can make the entire community healthier. 00:07:44.046 --> 00:07:48.046 But it will take strategic thinking and focused hard work to get us there. 00:07:49.048 --> 00:07:53.048 Our profession is positioned to practice that thinking and do that hard work. 00:07:53.904 --> 00:07:57.419 We have an opportunity now, to make gains. 00:07:57.459 --> 00:08:04.459 So in this course, we're going to explore the how, the why, and the what to do to make those gains happen.