5
Discussion and Moving Forward

BREAKOUT SESSIONS

The workshop attendees were split into five different groups to discuss the following general topics for discussion and questions:

  • Briefly talk about the demographic transitions that have occurred over the past 10 to 15 years in your community. Are there “old” versus “new” ethnic groups in your community? What, if any, has been the impact of immigration on your community?

  • What assets have your community’s newer ethnic groups brought to the community?

  • Have attitudes about race and expressions of racism changed with the arrival of new community members?

  • Describe the major health and health disparity concerns in your community.

  • How has the community worked to address these health and health disparity concerns? Specifically, how has your framing of these issues affected your progress?

  • Have the different racial and ethnic groups worked together? What have been your successes in addressing these concerns? What have been your challenges in addressing these concerns?

  • What suggestions on how to frame health disparity issues do you have for other communities?



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 59
5 Discussion and Moving Forward bREAKOUT SESSIONS The workshop attendees were split into five different groups to discuss the following general topics for discussion and questions: • riefly talk about the demographic transitions that have occurred B over the past 10 to 15 years in your community. Are there “old” versus “new” ethnic groups in your community? What, if any, has been the impact of immigration on your community? • hat assets have your community’s newer ethnic groups brought W to the community? • ave attitudes about race and expressions of racism changed with H the arrival of new community members? • escribe the major health and health disparity concerns in your D community. • ow has the community worked to address these health and health H disparity concerns? Specifically, how has your framing of these issues affected your progress? • ave the different racial and ethnic groups worked together? What H have been your successes in addressing these concerns? What have been your challenges in addressing these concerns? • hat suggestions on how to frame health disparity issues do you W have for other communities? 9

OCR for page 59
0 DEMOGRAPHIC CHANGES, A VIEW FROM CALIFORNIA After the small-group discussions, each group reported back to the larger group. Will Crimi summarized the themes outlined by the small groups, as described below. Working Across Racial and Ethnic groups Several participants noted the difficulties in bringing together groups that have their own interests to work together. One person suggested find- ing a common goal to bring groups together, for example, focusing on reducing poverty or supporting immigrant rights. Certainly, one area of common ground is the issue of health equity. Another approach to encourage working across groups is to highlight the idea that health disparities are a shared problem and a multicultural issue. Therefore, finding the solution requires all groups to take responsi- bility together so that no one suffers. Health disparities, one participant said, need to be framed as a community problem rather than an individual problem. In this way, more people within a community will have ownership of the problem. One participant suggested that it is easier to effect change by using the infrastructure already present in the community rather than starting from scratch. For example, working with the media and working with local fast- food outlets within the community can create an environment conducive to behavior change. The Importance of Framing A second theme that emerged from the small-group discussions was the importance of reframing the issue of health disparities so that the message appeals to a broader constituency. Several groups discussed the role of the media in framing issues; and the topic of how to take advantage of new forms of media, such as blogging, was raised. One participant, echoing Lori Dorfman’s comments, suggested that it is essential to encourage the media to pay attention to the context as well as the individual. Roundtable member Sam So, in describing his work in the Asian Amer- ican community in Northern California, noted the importance of framing hepatitis B and liver cancer as community problems rather than as health disparities. Dr. So also worked with the media to promote health messages to the community. Systemic Issues A third theme that emerged from the discussions is that health dispari- ties will never be reduced until broad systemic issues are addressed. One

OCR for page 59
 DISCUSSION AND MOVING FORWARD group raised the importance of working across domains by engaging, for example, the housing policy community and the transportation policy community. Similarly, another group noted that investment is needed in a wide array of sectors within communities, from investing in health care systems to investing in education and economic development. In short, it is essential to build a range of diverse partnerships to successfully address health disparities. The role of policy decisions in producing and reinforcing health inequi- ties was another aspect of systemic issues that was discussed. One speaker noted that “health inequities were created and reproduced by a set of policy issues.” It is only by identifying those policies and changing them that health disparities will be addressed. Tony Iton noted that to address disparities, it is critical to build a move- ment to encourage policy makers to focus on public health. The idea of creating a movement was raised throughout the day, with one participant noting that such a movement needs a shared vision of striving for health equity. This shared vision, in turn, should provide a road map for entering into political dialogue at the local, state, and federal levels. Another key issue to promoting health equity involves thinking about and understanding the need to work with governments at various levels, particularly the federal government, because the federal government is able to offer so many more potential funding opportunities than other levels of government are. One participant noted that the federal government also has power as well as funds. A number of the small groups discussed the conditions that facilitate disparities, in particular, classism, racism, oppression, and poverty. William Crimi noted that attention needs to be paid to both urban oppression (a lack of transportation, a lack of jobs that pay a living wage) and rural oppression (the conditions facing agricultural workers). Poverty not only leads to fewer available resources but also leads to less access to health care services. America Bracho stated that the issues surrounding racism should be used as a device to frame any discussion of health disparities. She noted that immigrants in particular are victims of racism, classism, and discrimination. Another participant talked about the importance of language in dealing with health disparities: if people do not have access to providers who can communicate with them, they cannot be properly treated and diagnosed. Among the other comments from participants reporting back included a need to focus on social determinants and their role in health inequity. In particular, the development of a simpler language that may be used to talk about social determinants is important to get communities to focus on health inequity. Many of the small groups discussed immigration. Immigrants, for

OCR for page 59
2 DEMOGRAPHIC CHANGES, A VIEW FROM CALIFORNIA example, are more likely to be poor and therefore to have less access to health care. Another workshop participant, promoting the need for immi- gration reform, noted that the link between immigration and foreign policy needs to be made. Workshop presenter Genoveva Islas-Hooker echoed the need for immi- gration reform, adding that until immigration reform happens, immigrants will be vulnerable to exploitation. Workshop presenter Ruben Abrica added that because immigrants typically make very little money, they often operate in an underground economy. The communities in which these immigrants live and work need to facilitate their economic integration into the commu- nity to help revitalize the community’s economy. In fact, another attendee noted the importance of immigrant integration initiatives to encourage immigrants to become a part of the broader community. One workshop participant discussed the importance of monitoring demographic changes so that the changes occurring in individual commu- nities are known. In particular, better data on racial and ethnic subgroups need to be collected, and the collection of these data needs to be ensured. Roundtable member Sam So added that it is also essential to collect data on U.S.-born versus foreign-born members within the same ethnic group to get a truly accurate picture of health disparities. Apartheid? During the reporting back from the small groups, keynote speaker Mindy Fullilove described what she called “the American apartheid system” and stated that “we need to talk about apartheid in America,” which is a system that disconnects and divides different ethnic and racial groups. In particular, she said, the destabilization of minorities has been especially devastating to those groups who have been in the United States for a long time, namely, Native Americans and African Americans. Another partici- pant added that the United States has the same problems with apartheid that were previously seen in South Africa. However, another workshop attendee, Vickie Katz, raised objections to the use of the word “apartheid” to describe the situation in the United States. As a native South African, she grew up under the apartheid system and believes that the word “apartheid” refers only to “a very specific regime that involved the systematic movement and destruction of 95 percent of the population by less than 5 percent.” Additionally, the oppressing minority had a sense of manifest destiny and the belief that “God had given them this right.” Katz found the use of the term “apartheid” to describe the situation in Los Angeles to be dangerous and divisive and cautioned the group to be careful about how the word is used.

OCR for page 59
 DISCUSSION AND MOVING FORWARD Disparities That Need to be Addressed One group outlined the disparities that it believed are present in the California communities profiled at this workshop. Mental health, poverty, violence, obesity, and a lack of spirituality were all mentioned as disparities that need to be solved. Tony Iton further suggested that if the true desire is to reduce or eliminate health disparities, the Healthy People 200 report should be used as the road map. MOVINg FORWARD Nicole Lurie, chair of the roundtable, again outlined the goal of the workshop: to talk about framing and how framing is used to talk about race and racial and ethnic health disparities. Frames, she summarized, are mental structures that are used as cues to “fill in the blanks” in our think- ing. The conversation about health disparities should be reframed so that it is a discussion about health equity, Lurie said. Disparities do not come out of thin air but arise from all of the social determinants discussed during the day, Lurie said. Each of us is born into a community, and every community has its own history. All too often, this history has been destructive to health. These social determinants are a part of the landscape and history of the communities in which people live. It is this landscape of the community whose modification must be thought about as health disparities are addressed. Lurie continued that another way to focus on reframing is through reframing interactions with the government. Rather than thinking of gov- ernment as the enemy, it also needs to be acknowledged that the govern- ment uses its influence to act on people’s behalf as well. We also need to think about our own roles as individuals in our communities. Lurie noted that individuals and communities have opportunities to influence the way the government acts on our behalf. The final comment of the day, from keynote speaker Mindy Fullilove, reminded the participants that things are getting worse for many people. This should, she said, be a reminder to keep working toward the goal of eliminating health disparities.

OCR for page 59