Environmental Research Foundation, 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.

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[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.