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This module introduces various frameworks for understanding contributing factors to health disparities and introduces the concept of health equity.

Introduction | 6 minutes

Activities
Videos
Podcasts
Readings
Additional Resources

Activites

Learning Objectives

Learners will understand how social determinants of health shape health disparities.
Learners will differentiate 'equality' versus 'equity'.
Learners will reflect on personal opportunities to advance health equity.

Part 1

Using the Adverse Childhood Experience (ACE) Questionnaire please answer the following:

Calculate your own ACE score (for your own reflection purposes only). How does your ACE score impact your sense of self, agency and opportunity in the world?
Can you think of a person with a high ACE score? How do you think their score impacts their sense of self, agency and opportunity in the world? How might it influence their ability to seek out health care or to follow treatment recommendations?

Part 2

Read The Health Stigma and Discrimination Framework (2019) and answer the following:

Think of someone you know with 'intersecting stigmas' or intersectional stigmatized identities (i.e. a transgender person of color). What are some potential barriers to that person in accessing health care? As a clinician, what can you do to be aware of and to try to mitigate stigma for our patients?

Part 3

Choose 1 video or podcast from the collection provided and answer the following:

Which video or podcast did you select?
After reviewing, what struck you about what you viewed and how will this impact your future practice as a physician?

Part 4

Participate in small group discussion.

Videos

How Childhood Trauma Affects Health Across a Lifetime | 16 minutes
Dr. Nadine Burke Harris | TEDMED Talk

Jamaican-American pediatrician Nadine Burke Harris is founder and CEO of Center for Youth Wellness, an initiative seeking to create a clinical model that recognizes and effectively treats toxic stress in children, and practices at the California Pacific Medical Center Bayview Child Health Center, where she was the founding physician. Her work pushes the health establishment to reexamine its relationship to social risk factors, and advocates for active medical interventions to counteract the damaging physiologic impact of stress.

The Cliff of Good Health | 5 minutes
Dr. Camara Jones

Dr. Camara Jones, the past president of the American Public Health Association, believes that everyone should have the opportunity to achieve good health. But, as she explains through her cliff analogy, that’s often not the case.

I believe in health care as a human right | 3 minutes
Dr. Paul Farmer

Dr. Paul Farmer, a revolutionary in global human rights and social activism and the founder on the non-profit Partners in Health (PIH) describes his views on access to healthcare in a world fraught with inequality.

What makes us sick? Look upstream | 18 minutes
Dr. Rishi Manchanda | TED Talk

Dr. Rishi Manchanda has worked in South Central Los Angeles for a decade where he’s come to realize his job isn’t just about treating a patient’s symptoms, but about getting to the root cause of what is making them ill- the upstream factors like a poor diet, a stressful job, a lack of fresh air. It’s a powerful call for doctors to pay attention to life outside the exam room.

Minority Health Disparities | 5 minutes
Johns Hopkins Medicine

Michelle’s story highlights minority health disparities. Dr. Lisa Cooper, a professor of Medicine at Johns Hopkins University, discusses community programming.

Podcasts

1619 Episode 4. How the Bad Blood Started | 39 minutes
1619 Podcast | New York Times

New York Times Podcast on how slavery has transformed America. This episode focuses on health care. Black Americans were denied access to doctors and hospitals for decades. From the shadows of this exclusion, they pushed to create the nation's first federal healthcare programs.

The Adverse Childhood Experiences Study | 60 minutes
Safe Space Radio | NPR

Learn about the Adverse Childhood Experiences Study and how adverse experiences in childhood affect mental and physical health later in life.

Child Abuse and Physical health 25 Years Later with Vincent Felitti | 30 minutes
Safe Space Radio | NPR

Dr. Vincent Felitti talks about his groundbreaking research to show that Adverse Childhood Experiences are correlated not only with mental illness and addition, but also with physical illnesses like heart disease, lunch disease and even auto-immune diseases.

Readings

A Conceptual Framework for Action on the Social Determinants of Health (2010)

Landmark 2010 WHO paper by Orielle Solar and Alec Wilson, providing a forum for sharing knowledge, guiding empirical study and informing policy on how to tackle the social determinants of health to improve health equity.

A New Way to Talk About the Social Determinants of Health (2010)

A Robert Wood Johnson Foundation publication offering best practices in language and framing of social determinants of health for clinical and policy work aimed at reducing disparities.

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care (2012)

Chin et al. article in Journal of General Internal Medicine (JGIM) shifting the focus from documenting health disparities to organizational strategies to combat racial and ethnic health disparities.

Adverse Childhood Experiences and their Relationship to Adult Well-being and Disease (2012)

National Council Webinar PowerPoint slides from a 2012 presentation by Robert Anda, MD and Vincent Felitti, MD reviewing the ACE Study findings. The slides highlight how a combination of adverse childhood experiences represent the prime determinant of the health, social and economic well-being of our nation.

Stigma as a Fundamental Cause of Population Health Inequalities (2013)

Hatzenbuehler et al. article from the Journal of Public Health discussing stigma and offering a conceptual framework describing the psychological and structural pathways through which stigma influences health.

The Health Stigma and Discrimination Framework (2019)

Stangl et al. BMC Medicine article proposing a global, crosscutting framework based on theory, research, and practice, and demonstrating its application to a range of health conditions. The authors also discuss how stigma relates to race, gender, sexual orientation, class, and occupation.

Additional Resources

Medical Ethics and Health Equity: The Henrietta Lacks Story (2015)

In this MedEd Portal publication, Barkley and Alford discuss a team based learning module around health equity for medical students. See related learning materials below.

Adverse Childhood Experience (ACE) Questionnaire

Ten question validated screening questionnaire for adverse childhood experiences.

Community Commons Website

Welcome to Community Commons, a community of change-makers working to create healthy, equitable, sustainable communities. Find curated tools, resources, and inspirational stories to drive your work forward. Community Commons is dedicated to lifting up community voices. We believe in the power of storytelling to learn from each other and inspire change for the greater good.