Welcome to the Roots of Health Inequity online course series, Course One.
In this course, we'll introduce the concepts of health equity, health inequity and other related ideas.
We'll learn about the root causes of health inequity,
why they're important, and how we can strategize to act on them more directly,
rather than just the resulting symptoms.
We'll explore the price we all pay in economic, social, and human terms.
Then we'll examine the challenges facing public health
as we try to reimagine practice towards achieving equity,
and discuss ideas for overcoming those challenges.
First we need to understand what health equity means.
Dr Camara Jones defines health equity as quote
"The assurance of the conditions for optimal health for all people.
Achieving health equity requires valuing all individuals and populations equally,
recognizing and rectifying historical injustices, and providing resources according to need."
The assurance of the conditions for optimal health for all people.
In America, optimal health for all people has never been achieved.
There are too many systemic forces working against it,
so achieving health equity requires systemic change.
Margaret Whitehead defines health inequity as quote
"Differences in the distribution of disease, illness, and death
that are systematic, unjust, actionable, and associated with imbalances in political power."
These differences are systematic, because they are built into our social, political, and economic systems.
They're unjust, which means we must rectify them.
They are actionable, which means we can rectify them.
And they are associated with imbalances in political power,
which means we need to engage with politics and political power.
But how? What can we do to end health inequity?
A healthy tree needs tending to grow and thrive, but we can see that this tree is struggling.
At first we might tend to the leaves, removing any of the dead ones before the other leaves are affected.
But what if this isn't enough? What if the browning leaves are a symptom of a deeper issue?
If we want to understand why this tree is struggling, we need to start digging deeper.
If the tree doesn't have what it needs to grow and thrive, it will continue to struggle.
Some parts of the tree are doing okay.
But the tree will only flourish when the entire tree is healthy.
We can think about health equity the same way.
In public health we see health disparities across different populations.
We see that there are some folks in our communities that have worse health outcomes than others.
So, many of our interventions work to address these health outcomes by addressing health risk behaviors.
We recognize that there are risky behaviors that can lead to health disparity.
But what creates the conditions that lead to risky behaviors?
More recently we've learned about the role the social determinants of health
can play in shaping our living conditions.
For example lack of access to quality education, health care, housing and our built environment,
all can make us more likely to engage in risky health behaviors that lead to poor health outcomes.
But we need to go even deeper,
to ask why there are such differences in SDOH conditions across communities.
We need to go beyond the surface of social determinants of health
and understand the root causes of health inequity.
In this course series we explore the root causes
with the focus on racism, class oppression and cisheteronormativity.
We need to explore what has created these root cause systems
and name the conditions that cause them to develop.
When a tree is planted in poor conditions from the start, it doesn't have a chance.
The same is true with our society.
If the conditions of our society are poor, our roots will be poor.
Which limits our potential.
Our work is about changing the roots, so that we can all achieve optimal health and flourish.
Systemic change means working on a political and social level
to produce conditions necessary for optimal health.
Part of our role as public health health professionals
is to understand how root causes create health inequity.
We can address these root causes in our public health practice to bring about health equity for all.
How you are positioned in society has a great deal to do with your overall health.
Your position can affect everything. The environment you may be born into.
The quality of the land and air around you. How and what food you can access.
How you were treated by others around you, and those in power around you.
And how you receive, or don't receive medical care that can fit your unique needs.
For instance, think about one of our most common health challenges: cancer.
Cancer is caused by many factors, including environmental challenges and stress.
Marginalized communities often live in unsafe, unhealthy, under resourced living spaces.
This can expose them to stress from many sources.
We recognize that the conditions in our lived environments,
in addition to the food we have access, to can cause cancer.
And we do work that impacts behaviors or even helps with improving lived environments.
But do we see that these unhealthy environments are the result of systemic racism,
which marginalizes people and communities of color.
Making it harder for them to access education, find good paying jobs,
afford healthy living environments or deal with stress.
We need to dig deeper and address the problem at the root level.
The root causes of health inequity are deep and complex.
They are the result of centuries of injustice,
which requires us to build new conditions
that can foster the type of growth and development we want to see in society.
The symptoms of these root causes is what our profession battles daily.
But we will forever battle health inequities, if we don't fix the root causes.
Changing what's in the soil will repair the root causes.
What is holding us back? Two things.
First an overemphasis on treating the effects of health inequity, rather than addressing the root causes.
We must do more than just mitigate the effects. We must attack the problem at its source.
Second, political pressures hold us back. Often in our work public health must navigate competing interests.
We're often funded by local governments and are subject to local laws and policy.
Sometimes those policies are enacted without our input.
And many times there are competing interests that are simply more powerful than ours.
We need to embrace eliminating the root causes of health inequity as part of our daily practice.
We need to accept the political nature of our work and engage directly with structures of power.
We need to work with our communities to build collective power.
We need to invest in community infrastructure, and we need to share knowledge with one another.
We need to center health equity in all parts of our work.
If we can diminish or eliminate the root causes of health inequity,
we can make the entire community healthier.
But it will take strategic thinking and focused hard work to get us there.
Our profession is positioned to practice that thinking and do that hard work.
We have an opportunity now, to make gains.
So in this course, we're going to explore the how, the why, and the what to do to make those gains happen.