“Any responsible attempt to define disease must account for the phenomenon's complexity. Disease is a deeply social process. Its distribution lays bare society's structures of wealth and power, and the responses it elicits illuminate strongly held values.”
New England Journal of Medicine - December 2012 The Burden of Disease and the Changing Task of Medicine
Ingham County Health Department seeks to improve the health of our entire community by working toward fair and just access to opportunities and conditions needed to achieve health and well-being. Through intensive internal work and collaborations with community partners, we strive to remove unfair and unjust differences in healthcare and public health services, employment, education, housing, transportation and criminal justice systems. We also work to promote a culture of inclusion that recognizes and embraces the validity of people's experiences, cultures and orientations.
In 2018, ICHD Health Officer Linda Vail signed into effect the department's first-ever Health Equity Policy (PDF) to formalize practices and procedures of the department related to health equity and social justice. The policy was drafted and vetted through the ICHD Health Equity Resource Team
Health Officer Linda Vail has also been involved in efforts to assess and expand the department's capacity to advance health equity and social justice through resources provided by the Kresge Foundation Emerging Leaders in Public Health (ELPH
) program. Learn more about ICHD ELPH efforts here (PDF)
, including an upcoming Health Equity Report of Ingham County and a departmental health equity self-assessment.
With the knowledge that inequities stem from historical factors and explicit and implicit biases, ICHD uses dialogue-based approaches to bridge the divide between lived experiences, perceptions, data, and common practices and ideas in our community about different groups. The department also promotes and supports community development and community organizing approaches to creating health equity.
The following definitions inform the basis of this work:
- Health Equity: a fair, just distribution of the resources and opportunities need to achieve well-being
- Social Justice: the absence of unfair, unjust advantage or privilege based on race, class, gender or other forms of difference, and a world which affords individuals and groups fair treatment and an equitable share of the benefits of society
- Implicit Bias: attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner
Image source: https://www.mobilizegreen.org/blog/2018/9/30/environmental-equity-vs-environmental-justice-whats-the-difference
The following resources were developed and/or assembled by ICHD in 2018 to assist department staff and county residents in developing a common language and understanding of health equity principles and practices.
- LGBTQIA Health Equity Resources:
- ICHD Health Equity & Social Justice Workshop (PDF). With more than 1,000 people participating since it was first offered in 2005, this local workshop provides facilitated discussions, exercises and frameworks for helping participants understand forms of oppression and change, and learn ways to challenge and replace behaviors and practices that contribute to health disparities at personal, interpersonal, institutional and cultural levels.
What workshop participants say: the single most valuable experience I have had as an ICHD employee” - “gave me the tools and words to address problematic and discriminatory behavior happening around me” - “helped me see how institutional practices contribute to health disparities, and gave me the courage to engage institutional partners in trying new practices.”
Local and Statewide Organizations Creating Health Equity and Social Justice:
- Lansing Invest Health Team:
- Project 60/50: project 60/50 is an ongoing series of community events and conversations being held in the Lansing area about race and justice. Initially created in 2014 to honor the 1954 Supreme Court decision to integrate schools and the passage 1964 federal Civil Rights Act, the series has continued due to its widespread popularity and participation. Those hosting social justice events can also submit a proposal to 60/50 for inclusion in the events calendar and promotional tools of the 60/50 umbrella.
- Bias Busters: Guides to Cultural Competence: Journalism students from Michigan State University have create a series of guides that provide 100 Questions and Answers about simple, everyday questions that people have about each other but might be afraid to ask. New guides are continually being added to the series.
- Environmental Justice: addresses the disproportionate environmental risks borne by low-income communities and communities of color resulting from poor housing stock, poor nutrition, lack of access to healthcare, unemployment, underemployment, and employment in the most hazardous jobs. Lead poisoning, asthma and poor housing conditions are of particular concern in Ingham County.
Other Online Tools and Resources:
- Implicit Bias Self- Assessment Tool: Project Implicit ® from Harvard University offers a series of confidential Implicit Association Tests (IAT) which measure “attitudes and beliefs that people may be unwilling or unable to report”. IATs use exercises based in scientific knowledge of social cognition to help people identify and learn about how they sort and categorize different groups. You can take the various tests over time, as you are able.
Public health organizations were originally founded in the late-1800’s as people began to recognize the important role of overall social and environmental conditions in determining the spread of disease, as opposed to illness being solely the result of individual and moral failings.
It was with this recognition that public health departments were founded in many communities, serving to promote public sanitation (management of wastewater and solid waste) and later providing individual child and maternal health services and tracking disease and death data.
In the late-1990s, health departments began to analyze differences in health and healthcare between different groups by factors such as race, income and sexual orientation. The federal Healthcare and Research Quality Act of 1999 mandated the Agency for Healthcare Research and Quality (AHRQ) produce annual reports on health disparities and healthcare quality in the United States. These reports have been published each year since 2003, and are available online.
Michigan Public Act 653 of 2006, known as the Minority Health Bill, requires research and public education of health disparities.
· MDHHS Health Equity Report
· CDC Health Disparities & Inequalities Report
A series of studies in 2009 reveal the connections between inequality and poorer health for all members of a society:
“inequalities among and within societies have been shown to be strong determinants of health and many other measures of societal function, such as rates of teen pregnancies, incarcerations, crime, educational outcomes, trust, innovation, and mental illness (Wilkinson and Pickett 2009)… perhaps a quarter of all deaths in the US may be attributed to the large income gap there (Kondo et al. 2009)”
Health Equity in the USA, Stephen Bezruchka, Social Alternatives Vol. 29 No. 2, 2010