Environmental Research Foundation  [Printer-friendly version]
February 12, 2007

GOOD HEALTH FOR ALL

[The latest draft of this proposal can be found online with live links
here: http://www.tinyurl.com/34s4b6]

A Campaign To Prevent and Eliminate Health Disparities

Environmental health cuts two ways

No matter how hard we try, we can't stay healthy if the environment is
making us sick. Likewise, if we are sick, we cannot protect the
environment around us. If we have diabetes or cancer or lupus, we
can't do our best to protect Creation -- the air, water, soil and
living things upon which all life depends.

What is "health?" What conditions are necessary for health?

The preamble to the constitution of the World Health Organization
(WHO, July 22, 1946), defines health as "a state of complete
well-being, physical, social, and mental, and not merely the absence
of disease or infirmity." The WHO's Ottawa Charter says, "The
fundamental conditions and resources for health are: peace, shelter,
education, food, income, a stable eco-system, sustainable resources,
social justice, and equity."

Health is a fundamental human right

The WHO constitution also defines health as a basic human right:
"The enjoyment of the highest standard of health is one of the
fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition." This is
consistent with Article 25 of the Universal Declaration of Human
Rights of 1948, which says,

"Everyone has the right to a standard of living adequate for the
health and well-being of himself and his/her family, including food,
clothing, housing, and medical care."

The right to health is crucial to all other human rights

Enjoyment of the human right to health is vital to all aspects of a
person's life and well-being, and is crucial to the realization of all
other fundamental human rights and freedoms.

Health disparities are a human rights violation

Health disparities are a human rights violation because they indicate
that someone has been deprived of their right to health; therefore
health disparities are unacceptable and must be eliminated and
prevented.

How do you define "health disparities"?

NACCHO (National Association of County and City Health Officials) has
defined "health disparities" as "differences in populations' health
status that are avoidable and can be changed. These differences can
result from social and/or economic conditions, as well as public
policy. Examples include situations whereby hazardous waste sites are
located in poor communities, there is a lack of affordable housing,
and there is limited or no access to transportation. These and other
factors adversely affect population health."

"Elimination of health disparities" is a widely-held goal

** The American Public Health Association has called for action to
eliminate health disparities.

** NACCHO -- The National Association of County and City Health
Officials -- has passed a strong resolution advocating for programs
and policies that minimize health inequities;

** NACCHO has published standards that every local health department
(LHD) should be able to meet: "These standards describe the
responsibilities that every person, regardless of where they live,
should reasonably expect their LHD to fulfill."

The NACCHO standards say, "...all LHDs (local health departments)
exist for the common good and are responsible for demonstrating strong
leadership in the promotion of physical, behavioral, environmental,
social, and economic conditions that improve health and well-being;
prevent illness, disease, injury, and premature death; and eliminate
health disparities."

** The federal Department of Health and Human Services has
established an Office of Minority Health with a "National action
agenda to eliminate health disparities for racial and ethnic minority
populations."

** The federal program, Healthy People 2010, has two goals: "(1)
Increase quality and years of healthy life; and (2) Eliminate health
disparities, including differences that occur by gender, race or
ethnicity, education or income, disability, geographic location, or
sexual orientation."

** In Article III of its bylaws, the New Jersey Public Health
Association identifies one of its "purposes" as "the elimination of
health disparities."

** The NJ State Department of Health and Senior Services (DHSS) has
established an Office of Minority and Multicultural Health" with the
goal of eliminating racial and ethnic disparities in minority health.

** In 2007, the New Jersey Department of Health and Senior Services
published a Strategic Plan to Eliminate Health Disparities in New
Jersey 2007. In announcing the plan on March 6, 2007 Governor Jon
Corzine wrote, "Health and Senior Services Commissioner Fred Jacobs
frequently says there is no more important mission for the Department
of Health and Senior Services than reducing health disparities."

** The national Society for Public Health Education in 2002 passed a
"Resolution for Eliminating Racial and Ethnic Health Disparities."

** The members of the New Jersey chapter of the Society for Public
Health Education chose as their top priority for 2006-2007,
"eliminating health disparities."

** The UMDNJ Institute for the Elimination of Health Disparities
says, "There is national consensus that the existing health
disparities between racial and ethnic groups must be eliminated."

Some examples of health disparities in New Jersey

Cancer

Between 1995 and 1999, the incidence rate for prostate cancer in
African-American men in New Jersey was 277.8 per 100,000 compared to
180.7 per 100,000 for white men.[1]

In 1999, the age-adjusted prostate cancer mortality rate for white men
in New Jersey was 10.4 per 100,000, and for African-American men it
was double that number at 20.6 per 100,000.[1]

The cervical cancer rate for Latino women in New Jersey is 86 percent
higher than the rate for non-Latino white women.[2]

Incidence rates for invasive cervical cancer are higher for blacks
than they are for whites (17.5 versus 9.0 per 100,000 women in 2000)
[3]

African-American women are 28 percent more likely to die from breast
cancer than white women, although the incidence is higher among white
women than Black.[2]

In 2000, the age-adjusted female breast cancer mortality rate was 38.0
for blacks vs. 30.9 for whites per 100,000 of the population.[4]

In New Jersey, only 57 percent of Black women with breast cancer are
diagnosed at the early stages in comparison to 65 percent of the new
cases in white women.[1]

Lead Poisoning and Asthma

New Jersey's urban municipalities had the greatest concentration of
minority residents in the state and at the same time had the largest
percentage of reported cases of lead poisoning in fiscal year 2002.
For example, 8.2 percent of children tested in Newark had elevated
blood lead levels (> 10 mg/dl is elevated as determined by U.S.
Centers for Disease Control). By contrast, Marlboro Township had no
reported cases.[5]

Black, non-Hispanic adults are the most likely to report having ever
been diagnosed with asthma, followed by Hispanic adults and white,
non-Hispanic adults.

Black non-Hispanics are more than 4 times more likely than white non-
Hispanics residents to be hospitalized for asthma while Hispanic
residents are more than 3 times more likely than non-Hispanic whites
to be hospitalized for asthma.[6]

Data show that between 1990 and 1999, African-Americans in New Jersey
were four times more likely than whites to die from asthma.[7]

Diabetes

Diabetes disproportionately affects ethnic and racial minorities in
New Jersey. In 2001, the age-adjusted prevalence of diabetes among all
adults aged 50 and over was 13 percent. African-Americans had the
highest age-adjusted prevalence at 23 percent, followed by Latinos at
15 percent and whites at 10 percent.[8]

African-Americans are almost twice as likely as whites to die from
diabetes and diabetes-related complications.[8]

Healthcare Quality and Access

Data from a 2002 study by the Institute of Medicine showed that New
Jersey has an uninsured population of 15.8 percent. In all likelihood,
this number is greater given the significant undocumented population.
[9]

Recent data show that 31 percent of Latinos and 22 percent of African-
Americans in New Jersey lack health insurance as compared to 15
percent of their non-Latino white counterparts.[9]

Only 74 percent of Latinos reported having a regular source of
healthcare as compared to 83 percent of the total population as found
in a 1999 study performed by the New Jersey Office of Minority Health.
[10]

Why do we need a new campaign to eliminate health disparities?

There is a great deal of worthy work going on to eliminate health
disparities. But so far there's one essential perspective missing:
environmental justice.

The environmental justice perspective reminds us that "the
environment" has three parts:

(a) The natural environment (air, water, soil, and all forms
of life)

(b) the built environment -- highways, factories, suburban sprawl,
chemicals, and so forth

c) and the all-important social environment -- friends; family;
relationships of trust and support; but also poverty, stressful jobs;
poor housing, inadequate transportation, unemployment; fast food;
hierarchies of domination; disrespect; the sense that life is out of
control; injustice; racism and white privilege, and more.

This leads us to focus attention on the social determinants of
health, which create and worsen health disparities.

What would the goals of such a campaign be?

Here are some possibilities

a. A win-win combination of citizen support for local health
departments, which need additional resources, and reciprocal help for
citizens who need assistance establishing policies aimed at
preventing and eliminating health disparities and other
environmental justice problems.

b. To develop a national culture of prevention and precaution by
engaging citizens and their local health departments in activities
aimed at preventing and eliminating health disparities.

c. To get citizens involved with their local health department (LHD),
comparing the capacity of the LHD to the NACCHO standards and then
helping the LHD acquire the resources needed to fill any gaps in
practice.

d. To create more good jobs in public health -- many of them union
jobs -- especially for people of color, recent immigrants, and women.
Unions gaining new jobs might include United Steel Workers (USW), HPAE
(Health Professionals and Allied Employees), SEIU, AFSCME, and the
Health Service Workers Industrial Union.

e. To achieve the widely-held goal of eliminating health
disparities and, in the process, to identify burdened communities and
vulnerable populations, which can then get special attention from a
human rights and environmental justice perspective.

f. To gain new allies for citizens as they work for environmental
justice, thus helping build a broad-based social movement for a
sustainable world. Increasingly, citizens should be able to involve
the public health community in "creating the conditions that allow
people to be healthy," which entails bringing a prevention and social
justice perspective into local economic development, land-use
planning, conditions in the workplace, affordable housing, public
schools, transportation, and environment-and-health and environmental
justice problems, racism, white privilege, and more.

g. To create greater awareness of (1) health disparities, (2) the
"social determinants of health," and (3) the need for a prevention
approach among local boards of health and health departments, among
municipal and county officials, among journalists, and among the
general public.

h. To integrate environmental work and public health work more
closely, as advocated by NACCHO in Resolution 99-13.

i. To raise awareness of the "environmental justice" perspective among
public health workers, physicians, the press, the public, and
government personnel.

k. To foster the creation of new multi-issue, multi-racial,
multi-cultural alliances and coalitions as work on all three aspects
of "the environment" becomes more commonplace.

==============

[1] New Jersey Cancer Facts and Figures 2002: American Cancer Society
and New Jersey Department of Health and Senior Services. Available at:
http://www.state.nj.us/health/cancer/nj2002facts.pdf

[2] New Jersey Office of Minority and Multicultural Affairs. Some
Facts About Diversity in New Jersey. Available at:
http://www.state.nj.us/health/commiss/omh/latino.shtml

[3] Monthly health data fact sheet, January 2004. Center for Health
Statistics, New Jersey Department of Health and Human Services.
Available at:
http://www.state.nj.us/health/chs/monthlyfactsheets/jan04cervical.pdf

[4] Monthly health data fact sheet, October 2003. Center for Health
Statistics, New Jersey Department of Health and Human Services.
Available at:
http://www.state.nj.us/health/chs/monthlyfactsheets/oct03breastca.pdf

[5] Childhood Lead Poisoning in NJ Annual Report: Fiscal Year 2002.New
Jersey Department of Health and Human Services.

[6] Asthma in New Jersey, Annual Update 2003. New Jersey Department of
Health and Senior Services, Division of Family Health Services.
Available at: http://www.state.nj.us/health/fhs/asthma_2003.pdf

[7] Asthma in New Jersey, New Jersey Department of Health and Senior
Services, Feb 2003. Available at:
http://www.state.nj.us/health/fhs/asthma.pdf

[8] Diabetes Fact Sheet: Center for Health Statistics; New Jersey
Department of Health and Senior Services, Nov 2003. Available at:
http://www.state.nj.us/health/chs/monthlyfactsheets/nov03diab.pdf

[9] Insuring America's Health: Principles and Recommendations.
Institute of Medicine of the National Academies of Science. Board on
Healthcare Services. Committee on the Consequences of Uninsurance
2004.

[10] New Jersey Office of Minority Health Advisory Commission Summit
Recommendations Report. May 2000.