Perspectives on
HEALTH
EQUITY
& Social Determinants of Health
Kimber Bogard, Velma McBride Murry,
Charlee Alexander, Editors
NATIONAL ACADEMY OF MEDICINE • 500 FIFTH STREET, NW • WASHINGTON, DC 20001
NOTICE: This publication has been reviewed according to procedures approved by a National Academy of Medicine (NAM) report review process. Publication signifies that it is judged a competent and useful contribution worthy of public consideration, but does not imply endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual authors and do not represent formal consensus positions of the NAM; the National Academies of Sciences, Engineering, and Medicine; or the authors’ organizations.
Support for this activity was provided by the NAM’s Kellogg Health of the Public Fund.
Digital Object Identifier: https://doi.org/10.17226/27117
Library of Congress Cataloging-in-Publication Data
Names: Bogard, Kimber, editor. | Murry, Velma McBride, editor. | Alexander, Charlee M., editor. | National Academy of Medicine (U.S.), issuing body
Title: Perspectives on health equity and social determinants of health / Kimber Bogard, Velma McBride Murry, and Charlee Alexander, editors.
Description: Washington, DC : National Academy of Medicine, [2017]
Identifiers: LCCN 2017036543 (print) | LCCN 2017036909 (ebook) | ISBN 9781947103030 (Ebook) | ISBN 9781947103023 (pbk.)
Subjects: | MESH: Social Determinants of Health | Health Equity | United States
Classification: LCC RA445 (ebook) | LCC RA445 (print) | NLM WA 30 | DDC 362.10973--dc23
LC record available at https://lccn.loc.gov/2017036543
Copyright 2017 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
Suggested citation: Bogard, K., V. Murry, and C. Alexander, eds. 2017. Perspectives on health equity and social determinants of health. Washington, DC: National Academy of Medicine.
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AUTHORS
CARL C. BELL, MD, Jackson Park Hospital and Windsor University
PATRICK H. DELEON, PHD, MPH, JD, Uniformed Services University of the Health Sciences
ANGELA DIAZ, MD, PhD, MPH, Icahn School of Medicine, Mount Sinai
KAREN E. DILL-SHACKLEFORD, PhD, Fielding Graduate University
LAWRENCE M. DRAKE II, PhD, MA, MBA, LEAD Program
VIVIAN L. GADSDEN, EdD, University of Pennsylvania
HELENE GAYLE, MD, MPH, Chicago Community Trust
WALTER S. GILLIAM, PhD, Yale School of Medicine
COTI-LYNNE PUAMANA HAIA, JD, Office of Hawaiian Affairs
JEFF HUTCHINSON, MD, FAAP, Uniformed Services University of the Health Sciences
JOSEPH KEAWE’AIMOKU KAHOLOKULA, PhD, University of Hawai’i
TRACEY PÉREZ KOEHLMOOS, PhD, MHA, Marine Corps
RICHARD M. LERNER, PhD, Tufts University
NANCY LÓPEZ, PhD, University of New Mexico
RAQUEL MACK, MS, Uniformed Services University of the Health Sciences
JIM MARKS, MD, MPH, Robert Wood Johnson Foundation
SHANTEL E. MEEK, PhD, Administration for Children and Families
NOREEN MOKUAU, DSW, University of Hawai’i
VELMA MCBRIDE MURRY, PhD, Vanderbilt University
KEN PEAKE, DSW, Mount Sinai Adolescent Health Center and Icahn School of Medicine at Mount Sinai
DWAYNE PROCTOR, PhD, Robert Wood Johnson Foundation
SRIVIDYA RAMASUBRAMANIAN, PhD, MA, Texas A&M University
ROBERT SEIDEL, MLA, McDaniel College
SADÉ SOARES, Uniformed Services University of the Health Sciences
PATRICK H. TOLAN, PhD, University of Virginia
SHARON TOOMER, BlackandBrownNews.com
___________________
*Affiliations current as of December 2017
JOANN U. TSARK, MPH, University of Hawai’i, Native Hawaiian Board of Health, and Native Hawaiian Cancer Network
ALFORD A. YOUNG JR., PhD, University of Michigan
NAM Staff
KIMBER BOGARD, PhD, Senior Officer
CHARLEE ALEXANDER, Program Officer
LAURA DESTEFANO, Director of Communications
KYRA E. CAPPELUCCI, Communications Specialist
MOLLY DOYLE, Communications Specialist
REVIEWERS
The papers in this volume were reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures approved by the National Academy of Medicine. We wish to thank the following individuals for their review of the papers in this volume:
CLARA L. ADAMS-ENDER, United States Army Nurse Corps (retired)
DAVID A. BRENT, MD, University of Pittsburgh
DAVID V. B. BRITT, MPA, Sesame Workshop (retired)
HERNAN CARVENTE, BS, Youth First
MARK E. COURTNEY, PhD, University of Chicago
ELENA FUENTES-AFFLICK, MD, MPH, University of California, San Francisco
AMY LEFFLER, PhD, MSW, U.S. Department of Justice
HARRY J. HOLZER, PhD, Georgetown University
LARKE N. HUANG, PhD, Substance Abuse and Mental Health Services Administration
JEFF HUTCHINSON, MD, Uniformed Services University of the Health Sciences
ANN S. MASTEN, PhD, University of Minnesota
CHRISTINE RAMEY, MBA, BSN, RN, Health Resources and Services Administration
MARTÍN J. SEPÚLVADA, MD, MPH, Fellow, IBM
MELISSA A. SIMON, MD, Northwestern University Feinberg School of Medicine
BELINDA E. SIMS, PhD, National Institute on Drug Abuse
MILDRED THOMPSON, MSW, PolicyLink Center for Health Equity and Place (retired)
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the papers, nor did they see the final drafts before publication. Review of these papers was overseen
by Kimber Bogard, PhD, Senior Officer for Planning and Advancement and Managing Officer, Culture of Health Program, NAM. Responsibility for the final content of these papers rests entirely with the authors and the NAM.
PREFACE
On May 11, 2015, the Board on Children, Youth, and Families of the National Academies of Sciences, Engineering, and Medicine (the National Academies), held a public meeting to discuss the social determinants of health inequities and social injustice using a social justice lens. The meeting, “Armchair Discussions of Social Justice and Equity across the Life Course,” engaged academicians, policy makers, policy implementers, community service providers, and community representatives who work with vulnerable populations to achieve four objectives: (1) address the laws, policies, and leadership needed to ensure social justice and health equity for children, youth, and families; (2) highlight “institutions” such as parenting, the juvenile justice system, the foster care system, the school system, and the ways these institutions protect the development of children and youth in the context of social justice and health equity; (3) focus on health disparities resulting from discriminatory practices and policies, and missed opportunities for investing in human capital; and (4) discuss topics and priority areas for the National Academies. In the same year, the National Academy of Medicine (NAM) launched its Culture of Health Program to focus on the cultural factors that give rise to health inequities.
The NAM’s Culture of Health Program is a multiyear collaborative effort, supported by the Robert Wood Johnson Foundation, to identify strategies to create and sustain conditions that support equitable good health for all Americans. On January 25, 2017, the NAM hosted its first stakeholder meeting of the program, “Engaging Allies in the Culture of Health Movement.” The meeting brought together participants from major stakeholder groups, including philanthropy, membership associations, advocacy groups, community organizations, federal and state government, business leaders, and others not traditionally engaged with health equity issues. Presentations and discussions included health inequity across boundaries; early life inequities; and findings and recommendations from the first study of the program, Communities in Action: Pathways to Health Equity. The meeting concluded with a call to action to build a culture of health movement by empowering communities and working across sectors and disciplines.
An outcome of these two meetings is an edited volume of papers, Perspectives on Health Equity and Social Determinants of Health. This collection represents a variety of disciplines and varied schools of thought, and each paper includes a set of the authors’ recommendations to advance the agenda to promote health equity for all.
The series is organized by research approaches and policy implications, systems that perpetuate or ameliorate health disparities, and specific examples of the ways disparities manifest in communities of color. Marks and colleagues lead off with an overview of the Social and Structural Determinants of Health and Health Equity, followed by a section on health equity research and policy. The section leads with a discussion of the relevance of Health Inequities, Social Determinants, and Intersectionality in promoting health equity and social justice (López and Gadsden). An underlying theme is underscored by Tolan et al. in holding that “health equity should be as central if not more so than any other concern, principle, criterion, or value in any national prioritizing of scientific agenda, health status and care goals, knowledge organization and evaluation, practice advisories, and/or policy formulations.” They maintain that health equity is as essential a form of justice as equity in criminal and civil legal protections. Young follows this by drawing a connection between poverty and how The Character Assassination of Black Males can lead to detrimental consequences for public health research. This section continues by providing examples and guidance on how to promote health equity through research and policy, including by dismantling genetic determinism (Lerner). Seidel and colleagues emphasize the need to clearly delineate, conceptually and operationally, the meaning of equity, through an examination of ways inequities are perpetuated in Philosophical Perspectives on Social Justice.
Systems play a critical role in decreasing health disparities and increasing equity. The second section begins with a discussion by Meek and Gilliam on how school disciplinary strategies lead to later life problems, including health-compromising behaviors among children of color. Hutchinson and colleagues draw upon the important lessons we can learn from military medicine in Lessons for Health Equity: Military Medicine as a Window to Universal Health Insurance, and Principles of Adolescent- and Young-Adult-Friendly Care imparts equally important lessons that can be translated to medical settings serving marginalized youth (Diaz and Peake).
The series concludes with a section on the implications of health inequities in different populations and communities of color. Dill-Shackleford and colleagues emphasize the media’s role in the portrayal of black men and how this can lead to harmful health consequences. Mokuau and colleagues give a powerful voice to an often-overlooked community in exploring the Challenges and Promise of
Health Equity for Native Hawaiians and Bell highlights the increased prevalence of fetal alcohol spectrum disorders in low-income African American communities. Finally, Urgent Dispatch: Calling on Leadership to Respond to Violence in Black Neighborhoods is a poignant examination of how we should engage leaders as central influential voices for change (Toomer and Mack).
The rich discussions found throughout make way for the translation of policies and actions to improve health and health equity for all citizens of our society. The major health problems of our time cannot be solved alone. Collective action is needed and it is needed now. It is the responsibility and duty of everyone to build a culture of health where all people have a chance at the healthiest life possible.
—Kimber Bogard, Velma McBride Murry,
and Charlee Alexander, Editors
March 2018
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ACKNOWLEDGMENTS
We are humbled by the unwavering commitment of our authors and reviewers to raising visibility around barriers to achieving health equity, and promoting solutions for building a more equitable society. Thank you to all of you for your hard work and collaboration. We also thank Kaitlyn Friedman, Vanderbilt University, and Rajadhar Reddy, The University of Texas at Dallas, two former fellows of the Innovation to Incubation Program at the National Academy of Medicine, who helped shepherd this collection of perspectives to completion. A special thank you to the members and staff of the National Academies’ Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities for their guidance and leadership on this critical issue.
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CONTENTS
Introduction: Social and Structural Determinants of Health and Health Equity
James Marks, MD, MPH, Helene Gayle, MD, MPH, and Dwayne Proctor, PhD
SECTION I: HEALTH EQUITY RESEARCH AND POLICY
1 Health Inequities, Social Determinants, and Intersectionality
Nancy López, PhD, and Vivian L. Gadsden, EdD
Patrick H. Tolan, PhD, Velma McBride Murry, PhD, Angela Diaz, MD, PhD, MPH, and Robert Seidel, MLA
3 The Character Assassination of Black Males: Some Consequences for Research in Public Health
4 Promoting Positive Development, Health, and Social Justice Through Dismantling Genetic Determinism
Robert Seidel, MLA, Patrick H. Tolan, PhD, Angela Diaz, MD, PhD, MPH, and Velma McBride Murry, PhD
SECTION II: A SYSTEMS APPROACH TO HEALTH EQUITY
6 Expulsion and Suspension in Early Education as Matters of Social Justice and Health Equity
7 Lessons for Health Equity: Military Medicine as a Window to Universal Health Insurance
Angela Diaz, MD, PhD, MPH, and Ken Peake, DSW
SECTION III: ADVANCING HEALTH EQUITY IN COMMUNITIES OF COLOR
9 Stories About Black Men in the Media and their Consequences for Health
Karen E. Dill-Shackleford, PhD, Srividya Ramasubramanian, PhD, MA, and Lawrence M. Drake II, PhD
10 Challenges and Promise of Health Equity for Native Hawaiians
Sharon Toomer and Raquel Mack, MS
B Agenda: Armchair Discussions of Social Justice and Equity Across the Life Course
