While the United States has made strides in ensuring that people have access to health care, pervasive health inequities continue to affect millions of Americans, especially those from socioeconomically disadvantaged backgrounds and across several racial and ethnic groups. The discussion focused on what can be done to reduce health disparities and improve health outcomes, and how to better engage communities in these efforts.

Speakers were:

Dr. Thomas LaVeist, William C. and Nancy F. Richardson Professor in Health Policy at the Johns Hopkins Bloomberg School of Public Health and founding director of the Hopkins Center for Health Disparities Solutions.

Dr. Garth Graham, president of the Aetna Foundation and a national authority on health disparities.

Dr. LaVeist opened the discussion with a short clip of a documentary film he is working on that examines the disparities between black and white health in the United State, why it exists, and what can be done about it. Common misconceptions about health disparities among different racial and ethnic groups are part of the problem, including that some races are predisposed for certain diseases or that equal access to health care by itself will eliminate these inequities. “Race as biology or genetics is an absolute fiction,” said LaVeist. In actuality, a complex interplay of social determinants are the real drivers of health inequities. A person’s zip code will impact health more than one’s genetic makeup. Access to healthy food, opportunities for physical activity in safe places, and the economic vitality of a community are some of forces that can have a positive or negative impact on health and contribute to inequities.

LaVeist shared data on the relationship between income, race, and health inequities. He focused on two low-income, black communities—Brownsville, NY, and Baltimore, MD—to give an in-depth look at how disparities are localized and how environments like these drive illness. He also highlighted the positive changes that are happening in these low-income areas and efforts by community members to make meaningful changes. Finally, he spoke about the potential for philanthropy to support social entrepreneurs in their attempts to reclaim a culture of health for communities, as well as the media’s role in altering negative health messaging.

Dr. Graham discussed how clinical medicine and public health often operate in separate, disconnected spheres, and how breaking down these silos can lead to better interventions and delivery of care to reduce health disparities. Despite gains in health care and opportunities afforded by health reform, many Americans across the country continue live in different worlds when it comes to health outcomes and quality of life. Life expectancy in some American zip codes is on par with war-torn Iraq and Afghanistan and other developing nations in the bottom rankings, such as Gambia and Angola. “We don’t understand the true gravity of that and what this means,” said Graham. While improving clinical interventions and developing technology to help providers look at all the elements affecting patient health is a positive step toward reducing disparities and saving lives, shifting interventions beyond health care is imperative. Practical, evidence-based strategies are needed to support healthy behaviors in communities and make it easier for individuals to make healthy choices. Philanthropy can play a role by supporting innovations that break down barriers to health and programs that use integrated data on health care and social determinants of health to reduce disparities and improve health outcomes for all Americans.

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