A Health Equity Approach to Obesity Efforts Proceedings of a Workshop (2019) / Chapter Skim
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4 Social Determinants of Health Inequities in Obesity Prevention and Control
4 Social Determinants of Health Inequities in Obesity Prevention and Control
Pages 25-40
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From page 25... ...
• Structural and institutional racism are important social deter minants of health inequities for Hispanic/Latino populations. Focusing not on culture but on such social determinants as inequalities in access to health care resources, material condi tions, and neighborhood effects and then translating what is 25
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Beyond Solutions, LLC, and co-founder of the Health Equity Cypher Group. CIVIL RIGHTS LAWS AND POLICIES Angela McGowan, project director in the Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary of Health, U.S.
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From page 27... ...
McGowan then quoted the definition of civil rights in Black's Law Dictionary: They "belong to every citizen of the state or country or, in a wider sense, to all of its inhabitants, and are not connected with the organization or administration of government. They include the rights of property, marriage, protection by laws, freedom of contract, trial by jury, etc." (Garner and Black, 2004)
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From page 28... ...
Cone Memorial Hospital. The 1960s brought many civil rights laws, she continued, pointing to the Civil Rights Act; Social Security Act amendments; and the Voting Rights Act, which she said was notable for addressing literacy and limited English proficiency as barriers to access to the right to vote.
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From page 29... ...
In closing, McGowan observed that though federal and in some cases state or local agencies are responsible for implementing, monitoring, and enforcing civil rights laws, civil rights approaches can be used broadly and applied on a community level. She acknowledged that civil rights laws can help achieve equality as they prohibit discrimination and help direct federal funding, but they do not necessarily get to equity.
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Chattel slavery provides a historical context for the social determinants of health, she elaborated, asserting that the remnants of this practice still infiltrate the United States today. She compared slavery's stripping of African Americans'
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Arline-Bradley highlighted that racism operates independently of class, which she suggested helps explain why racial health inequities persist even after controlling for socioeconomic status. Segregation and social isolation persist across income levels, she noted, and everyday discrimination impacts chronic stress (Smedley et al., 2008)
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From page 32... ...
She urged those discussing obesity in low-income populations to acknowledge an unregulated food industry in the United States whereby the options for low-income families and children often include easily available, inexpensive foods that are nutrient poor and highly caloric. Zambrana outlined four points that she would discuss in her presentation: the impact of social determinants and risk factors on everyday life for Latinos; equity discourse as action rather than research; an equity focus on structural racism and the policies that perpetuate it; and her belief that structural racism, not culture, is a predictor of inequality.
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From page 33... ...
citizens. SOURCES: Presented by Ruth Enid Zambrana, April 1, 2019 (data from Motel and Patten, 2012; Pew Research Center, 2012)
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Low education, she explained, in turn decreases opportunities for employment that provides access to quality health care benefits and other critical economic resources. As an example, she pointed out that many Mexican Americans and Central Americans tend to work for low pay with no health benefits as seasonal or migrant workers, unskilled workers, and day laborers.
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In short, Zambrana asserted, the assessment of Latino obesity and its impact on other health conditions requires a social determinants framework that accounts for the intersecting linkages among class or socioeconomic status, racialization, health insurance, place/ community resources, economic and discriminatory stressors, and lack of time and recreational spaces, observing that lower socioeconomic status is correlated with higher levels of overweight and obesity. Thus, she stressed that the major factors driving obesity are structural, not individual.
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From page 36... ...
federal government recognizes native people as citizens of sovereign tribal nations, and this government-to-government relationship affords tribes the ability to deal directly with the federal government. Jernigan explained that the health disparities experienced by native people arise from general socioeconomic factors in combination with specific cultural and historical factors that are related to their past experiences.
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From page 37... ...
. She characterized as "shocking" how difficult it is to find healthy foods in native communities, adding that healthy foods are more expensive in native communities than in neighboring non-native communities, and that many native people rely on convenience stores that sell foods high in fat, sugar, and sodium (Jernigan et al., 2012, 2017b)
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From page 38... ...
She also reiterated the importance of examining the lived experiences of people, as well as a group's historical experiences, to address its social determinants of health effectively. Following Gamble's remarks, the session speakers responded to questions from participants about pursuing health equity through structural changes and reparations, community-engaged research, and the Fair Housing Act.
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From page 39... ...
Arline-Bradley confirmed that reparations are one part of the solution, but asserted that they will not come close to fully remediating the effect of the African American experience in the United States. Reparations have fiscal as well as political implications, she suggested, clarifying that she is a proponent of reparations as a partial measure, but not as the answer to comprehensive changes in equity.
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From page 40... ...
She replied that civil rights laws apply to intentional discrimination, but an emerging trend is to apply them to disparate impact and discriminatory effect as well. She described the Fair Housing Act as an example of where a historical analysis would show the disparate racial impact of redlining and mortgage and financing practices, noting that, according to a 2015 Supreme Court opinion, the act provided an opportunity to examine disparate impact.
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