Lynn Todman, PhD. Executive Director of Population Health Lakeland Health

Lynn Todman, PhD Executive Director of Population Health Lakeland Health

David Ansell, MD, MPH How Inequality Kills: Health Systems and Health Equity Michael E. Kelley Professor of Internal Medicine SVP and Associate Provost for Community Health Equity Rush University Medical Center

A Talk in Three Parts Death Gaps Naming Racism: social determinants of health and social determinants of inequity Health Systems and Health Equity

Part 1: Death Gaps In America, where you live dictates when you die

Growing US Income Inequality

Widening US Gap in Life Expectancy Between High and Low Earners Remaining Life Expectancy for Men Turning 60 Source: Waldron. ORES, Social Security Admin, #108, 2007

Neighborhood Income Change, Chicago 1970-2010 Income distribution in Chicago, Then and Now 2003 RUSH University Medical Center

Chicago Death Gaps

Percent low birth weight by Chicago community

Chicago

Los Angeles

Virginia

Michigan

Berrien County Life Expectancy

19 Year Life Expectancy Gap in Nine Miles

The Social Determinants of Health and Inequity 2003 RUSH University Medical Center

How Health Care Inequities Arise Differences in quality of care Differences in access Life opportunity gaps that lead to health status differences

Racism is a Determinant of Health Inequities

Segregation and Mortality African Americans in Berrien County are seven times more likely to live in a high-mortality neighborhood than a low-mortality neighborhood Whites in Berrien County are two times more likely to live in a low-mortality neighborhood than a high-mortality neighborhood

Median Household Income by Race % as percentage of median household income of the entire population 1 Including Hispanic whites 2 American Indians and Alaska Native 3 Entire population 4 and other Pacific Islander

Household Income Distribution by Race Independent household income distribution of the given ethno-racial groups, normalized so that the sum of each interval is 100% Scope: households in Berrien County Count number of people in interval 1 non-hispanic whites 2 White Hispanic 3 Including Hispanic

Part 2: Naming Racism Differential access to the goods, services and opportunities of society by race Racism is a system of structuring opportunity and assigning value based on how someone looks Difficult to recognize a system of inequity that privileges us

Six Ways Racism Causes Inequity 1. Unfair concentration of Black disadvantage (White Advantage)- zip code effect 2. Institutional racism: police, incarceration, schools, hospitals, housing, jobs, food 3. Embodiment of racism (Embodiment of Privilege) 4. Bias (Implicit and Explicit) 5. Inequality in quality of health care delivery 6. Inequity in health outcomes

Institute of Medicine Report on Healthcare Disparity

2003 RUSH University Medical Center

Deaths per 100,000 women Chicago Black Women are 62% More Likely To Die Of Breast Cancer 50 40 30 39 35 38 Age-Adjusted Female Breast Cancer Mortality for Chicago, Per 100,000 Population. Prepared by The Sinai Urban Health Institute 20 10 0 1981-1983 Black White 1984-1986 1987-1989 1990-1992 38 per 100,000 is 62% more deaths than 24 per 100,000 1993-1995 1996-1998 1999-2001 2002-2004 24 2005-2007

Geography Of the Death Gap Chicago Community Areas with the Highest Annual Breast Cancer Mortality Rates 2000-2005 Predominately African American Communities Non- African American Communities Hospitals with American College of Surgeons Approved Cancer Programs

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How Does Structural Racism Work Here?

Part 3: Health Systems and Health Equity

Health Systems and Health Equity Hospitals often the largest employer Provide access to care through insurance and clinical locations to underserved Large purchaser of supplies Have large reserves in major banks Have many employees from afflicted communities Have responsibility for community health

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 42

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 43

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 44

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 45

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 46

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 47

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 48

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 49

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 50

Equity is an Inside-Out and Outside-In Strategy Equity strategy must be endorsed by Board and led by senior leaders Accelerate diversity and inclusion in leadership aim to achieve demographic parity in leadership We will screen our patients and partner to treat the social and structural determinants of health We name the root causes of health inequity including structural racism, economic and educational deprivation We have identified opportunities to build wealth among our low wage employees through pension reform, educational and career pathways We have adopted an anchor mission to buy, hire, invest and volunteer locally We work to identify and eliminate health care outcome gaps We partner with community groups, hospitals and community providers to address place-based root-causes of these gaps We communicate widely in many forums about what equity means 51

Title Slide? Should we introduce West Side United?

West Side United Goal: Decrease life expectancy gap by 50% by 2030 53

The West Side United Mission, Vision and Aim MISSION To build community health and economic wellness on Chicago s West Side and build healthy, vibrant neighborhoods. 54

The West Side United Mission, Vision and Aim VISION To improve neighborhood health by addressing inequities in healthcare, education, economic vitality and the physical environment using a cross-sector, place-based strategy. Partners will include other healthcare providers, education providers, the faith community, business, government and residents that work together to coordinate investments and share outcomes. 55

The West Side United Mission, Vision and Aim AIM To reduce the life expectancy gap between the Loop and Westside neighborhoods by 50% by 2030. 56

West Side United: a place-based, equity-framed approach to well being and neighborhood vitality Health and Healthcare Economic Vitality Neighborhood and Physical Environment Education Holistically address the social and structural determinants of health Have a unified West Side Voice to outside audiences Create opportunities to scale programs that work on the community level Identify and create new high-value connections between organizations Create common measures of success Increase the visibility of existing efforts Community led Aim: Reduce the Life Expectancy Gap between Loop and West Side by 50% by 2030

West Side United Work Streams West Side United Community Partnerships & Projects West Side Anchor Committee Projects Population Health Projects Individual Institutions Projects CHNA/CHIP, Internal Anchor Mission Governance Decision Rights Staffing Funding - Communications

Listening Tours Recommended Focus Areas from What We Heard Report

Hire locally and develop talent Buy and source locally Invest locally Volunteer and support community building Employment preference initiative Career ladder development Skills training Mentoring and coaching Local purchasing program Local labor for capital projects Apprenticeship Diversity hiring and contracts Impact investing in local communities Local business incubation to fulfill sourcing needs Employee engagement in local communities Leveraging employee expertise (e.g., teaching skills class)

West Side United Envisions Vital, Healthy Communities for All Residents and Stakeholders Equal access to behavioral and physical health services Healthy, affordable food in each neighborhood Residents employed in high-quality jobs Summer jobs & apprenticeships opportunities for all students Goal: Decrease the life expectancy gap between each neighborhood and the Loop by 50% by 2030 62

Health Equity Achieved.Nothing About Us Without US 63

Thank You