Tracing the roots of difference: A blog series

“We are not makers of history. We are made by history.”

Martin Luther King, Jr.

In addressing questions about equity, analysts often present results that differ significantly by race or gender or sexual orientation.  But however dramatic the differences – even for life-and-death indicators like life expectancy and infant mortality – they rarely explore the contexts in which disparities occur.

The contexts, of course, are broad; and they differ, at least somewhat, for every group.  Events that occurred decades or even centuries ago (such as the horrors of slavery – experienced by both African American and Native American populations – or the forcible removal of Indigenous children from their families for assimilation to white European culture) can be crucially relevant to health, wealth, and overall wellbeing among people today. Just as the effects of traumatic experiences can pass from generation to generation, the effects of historically racist policies (unfair lending and hiring practices, restrictive real estate covenants, unequal access to GI Bill benefits, unequal access to quality education) have impaired the ability of multiple generations to acquire wealth and build a buffer against hard times.

This is the first in a series of EQUITY BLOGS that looks at the root causes – historical and contemporary – of longstanding disparities in the health and wellbeing of King County residents. The blogs will investigate the notion, supported by many public health leaders, that “health is a function of social inequality.” They will also describe biological mechanisms that have been proposed to mediate the close relationship between social inequality and health outcomes.

Over the next few months, blogs will explore the following topics:

  • Discrimination: An equal opportunity experience? Results of the national Discrimination in America survey.
  • Historical trauma: What is it? Why is it important now? The lasting effects of major, sanctioned oppressions that deny or ignore a group’s humanity.
  • Intersectionality in action. Effects of trauma can be compounded by intersecting identities. Illustrated with recent data from King County communities.
  • Economic policy maintains the hierarchy. How policy has been shaped to preserve power, with enduring impacts.
  • Housing policies and practices in King County. How past and present housing policies influence opportunities for residents of King County.
  • Unequal education. A look at differences in educational opportunity and the differential benefits of education.
  • Unequal justice under the law. How do we explain growing disparities in our justice system? What are we doing about it?
  • Where is environmental justice? Introducing a mapping tool to see where demography intersects with pollution and how that relates to health in King County.
  • The R word: Racism. What does it mean? Why are we so hesitant to use it? A look at changing norms and attitudes.
  • The high cost of “making it.” The stresses of having to be 10 times as good to succeed, often in a hostile environment, are reflected in a host of health outcomes.
  • Birth outcome disparities, part II. Biological explanations of persistent disparities in infant and maternal mortality. “We carry our histories in our bodies. How would we not?” (Nancy Krieger)
  • Disparities tool debuts on Communities Count. Introduction to an interactive tool that highlights disparities – and patterns of disparities – across a range of indicators.
  • Equity sources. An organized, evolving list of curated sources – national and regional – related to the above blog topics will be available on the Data Resources page.

In addition to helping us understand disparities in local data, blogs in the series are meant to show how tightly our history weaves itself into our lives and our children’s futures. In looking at trauma, we acknowledge the rich variability of responses within and across groups and generations, from strength and resilience to ongoing harm embedded in policy and culture. Our goal is not to exacerbate existing divisions, but to reaffirm the shared values, identified by King County residents, that guide the work of Communities Count.  Whenever possible, the blogs focus on the lives of King County residents, calling out local heroes as well as promising regional programs and practices.

Links

Data sources about King County communities include …

  • Communities Count offers interactive charts and maps on indicators across the following topics: education, family & community support, food, health, housing & transportation, income, population, and public safety.
  • Community Health Indicators: For 168 health and determinants-of-health indicators offers interactive charts and maps showing trends and demographics; data for King County regions, cities, and some neighborhoods.
  • City Health Profiles provides demographic and health data for 26 cities / geographic areas in King County.

 

Pediatricians urged to tackle poverty head-on

For the first time ever, The American Academy of Pediatrics (AAP) has issued a policy statement on poverty.  As affirmed by AAP President Benard P. Dreyer, “research shows that living in deep and persistent poverty can have detrimental health consequences that are severe and lifelong.”  Acknowledging that “almost half of young children in the United States live in poverty or near poverty,” the AAP has emerged as a strong advocate for programs and policies that improve health and quality of life for children and families living in poverty.

Pediatricians are being asked to do more than increase their awareness of poverty.  In the context of a family-centered medical home that coordinates strategies to address social determinants of health (poverty, for example), physicians are urged to:

  • Assess family financial stability (perhaps by asking if the family has trouble making ends meet at the end of the month).
  • Screen for risks for adversity (food insecurity, maternal depression, family instability, unemployment, frequent moves).
  • Identify family strengths that protect against adversity (secure attachment to caretakers; strong family and social connections; responsive, nurturing, and consistent parenting).
  • Coordinate care with community partners (such as those providing legal aid and job training, and addressing issues like food, energy, and housing insecurity).
  • Participate in programs that integrate behavioral health into primary care (Incredible Years and Triple P) and promote literacy (Reach Out and Read and the Video Interaction Project [VIP]).
  • Link families to community resources that support and assist families in need.
  • Advocate for programs/policies that buffer children against adverse effects of poverty. Examples include:
    • Earned Income Tax Credit (EITC)
    • Temporary Assistance for Needy Families (TANF)
    • Raising the minimum wage
    • Supports for quality child care and early childhood education
    • Access to comprehensive health care
    • Nutrition support such as WIC (the Supplemental Nutrition Program for Women, Infants, and Children), SNAP (formerly “food stamps”), and the National School Lunch Program
    • Home visiting programs such as the Nurse-Family Partnership

Does this go “above and beyond” what should be expected of a pediatrician?  The AAP affirms that it’s all in the line of duty:  prevention of childhood diseases – an accepted pediatric mandate – depends in part on “early detection and management of poverty-related disorders.”

Of course pediatricians cannot tackle poverty on their own. In King County, they can expect support from a wide assortment of community-based organizations and effective programs already in place. They should also be able to tap into the expertise and community networks that continue to evolve around regional efforts such as Communities of Opportunity and Best Starts for Kids, which are already aligned with the goals of the AAP’s war against child poverty.

For data on poverty-related indicators, see Communities Count updates on food, housing, income, qualification for free/reduced-price school meals, and the relationship between adult health outcomes and adverse childhood experiences.  Communities Count has recently added several years of data on student homelessness, making it easier to look at trends (by school district) from 2007-08 through 2014-15 school years.  For data on child, maternal, and adult health, see King County’s Community Health Indicators.