SUPPORTING A MOVEMENT
for HEALTH
and HEALTH EQUITY

Lessons from Social Movements

WORKSHOP SUMMARY

Alison Mack, Alina Baciu, and Nirupa Goel, Rapporteurs

Roundtable on Population Health Improvement

Roundtable on the Promotion of Health Equity and the
Elimination of Health Disparities

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

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Alison Mack, Alina Baciu, and Nirupa Goel, Rapporteurs Roundtable on Population Health Improvement Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities Board on Population Health and Public Health Practice

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THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and The California Endowment (20112338), the California HealthCare Foundation (17102), Health Partners, Health Resources and Services Administra- tion (HHSH25034015T), Kaiser East Bay Community Foundation (20131471), The Kresge Foundation (101288), the Mayo Clinic, Missouri Foundation for Health (12-0879-SOF-12), the National Association of County and City Health Officials (2013-010204), Nemours, New York State Health Foundation (12-01708), Novo Nordisk, and the Robert Wood Johnson Foundation (70555). The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13:  978-0-309-30331-6 International Standard Book Number-10:  0-309-30331-1 Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover image credits: Photo of protest from the Library of Congress, Prints & Photo- graphs Division, U.S. News & World Report Magazine Collection [LC-U9-10364- 37]. Photo of pins from the Smithsonian National Museum of American History’s Division of the History of Medicine and Science. Used with permission. Suggested citation: IOM (Institute of Medicine). 2014. Supporting a movement for health and health equity: Workshop summary. Washington, DC: The National Acad- emies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal govern- ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its mem- bers, sharing with the National Academy of Sciences the responsibility for advis- ing the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in pro- viding services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON ACCELERATING IMPROVEMENT IN THE PUBLIC’S HEALTH1 DAVID KINDIG (Co-Chair), Professor Emeritus, University of Wisconsin School of Medicine and Public Health MILDRED THOMPSON (Co-Chair), Director, PolicyLink Center for Health Equity and Place TERRY ALLAN, Health Commissioner, Cuyahoga County Board of Health MARTHE R. GOLD, Professor, City College of New York GEORGE ISHAM, Senior Advisor, HealthPartners, Inc. SANNE MAGNAN, President and CEO, Institute for Clinical Systems Improvement MARY PITTMAN, President and Chief Executive Officer, Public Health Institute IOM Staff KAREN M. ANDERSON, Study Director ALINA B. BACIU, Study Director COLIN F. FINK, Senior Program Assistant AMY GELLER, Senior Program Officer LYLA HERNANDEZ, Senior Program Officer ANDREW LEMERISE, Research Associate CAROL MASON SPICER, Associate Program Officer ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice Consultant ALISON MACK, Writer 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1 GEORGE ISHAM (Co-Chair), Senior Advisor, HealthPartners, Inc., and Senior Fellow, HealthPartners Institute for Education and Research DAVID A. KINDIG (Co-Chair), Professor Emeritus, University of Wisconsin School of Medicine and Public Health TERRY ALLAN, President, National Association of County and City Health Officials, and Health Commissioner, Cuyahoga County Board of Health CATHERINE BAASE, Chief Health Officer, The Dow Chemical Company GILLIAN BARCLAY, Vice President, Aetna Foundation RAYMOND J. BAXTER, Senior Vice President, Community Benefit, Research and Health Policy, and President, Kaiser Foundation International, Kaiser Foundation Health Plan, Inc. DEBBIE I. CHANG, Vice President, Policy and Prevention, Nemours GEORGE R. FLORES, Program Manager, The California Endowment MARY LOU GOEKE, Executive Director, United Way of Santa Cruz County MARTHE R. GOLD, Visiting Scholar, New York Academy of Medicine, and Professor, City College of New York GARTH GRAHAM, President, Aetna Foundation PEGGY A. HONORÉ, Director, Public Health System, Finance and Quality Program, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services ROBERT HUGHES, President and Chief Executive Officer, Missouri Foundation for Health ROBERT M. KAPLAN, Director, Office of Behavioral and Social Sciences Research, National Institutes of Health JAMES KNICKMAN, President and Chief Executive Officer, New York State Health Foundation PAULA LANTZ, Professor and Chair, Department of Health Policy, George Washington University School of Public Health and Health Services MICHELLE LARKIN, Assistant Vice President, Health Group, Robert Wood Johnson Foundation THOMAS A. LaVEIST, Professor and Director, Hopkins for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health 1Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the work- shop rapporteurs and the institution. vii

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JEFFREY LEVI, Executive Director, Trust for America’s Health SARAH R. LINDE, Rear Admiral, U.S. Public Health Service, Chief Public Health Officer, Health Resources and Services Administration SANNE MAGNAN, President and Chief Executive Officer, Institute for Clinical Systems Improvement PHYLLIS D. MEADOWS, Associate Dean for Practice, Office of Public Health Practice, School of Public Health, University of Michigan, and Senior Fellow, Health Program, The Kresge Foundation JUDITH A. MONROE, Director, Office for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention JOSÉ MONTERO, President, Association of State and Territorial Health Officials, and Director, New Hampshire Division of Public Health Services MARY PITTMAN, President and Chief Executive Officer, Public Health Institute PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation LILA J. FINNEY RUTTEN, Associate Scientific Director, Population Health Science Program, Department of Health Sciences Research, Mayo Clinic BRIAN SAKURADA, Senior Director, Managed Markets and Integrated Health Systems MARTIN JOSÉ SEPÚLVEDA, Fellow and Vice President, Health Research, International Business Machines Corporation ANDREW WEBBER, Chief Executive Officer, Maine Health Management Coalition IOM Staff ALINA B. BACIU, Study Director COLIN F. FINK, Senior Program Assistant AMY GELLER, Senior Program Officer LYLA HERNANDEZ, Senior Program Officer ANDREW LEMERISE, Research Associate CAROL MASON SPICER, Associate Program Officer ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice viii

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ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY AND THE ELIMINATION OF HEALTH DISPARITIES1 ANTONIA VILLARRUEL (Chair), Associate Dean for Research and Global Affairs, University of Michigan School of Nursing MILDRED THOMPSON (Co-Chair), Director, PolicyLink Center for Health Equity and Place PATRICIA BAKER, President and CEO, The Connecticut Health Foundation GILLIAN BARCLAY, Vice President, Aetna Foundation ANNE C. BEAL, Senior Vice President and Chief Patient Officer, Sanofi-Aventis REBECCA BRUNE, Vice President, Strategic Planning, Methodist Healthcare Ministries of South Texas, Inc. NED CALONGE, President and Chief Executive Officer, The Colorado Trust IRENE DANKWA-MULLAN, Acting Director, Division of Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health GERIMALD P. DAUS, Public Health Analyst, Office of Health Equity, Health Resources and Services Administration JAMILA DAVISON, Pinellas County Health Department FRANCISCO GARCIA, Director, Pima County Department of Health ALLAN GOLDBERG, Leader, U.S. Advocacy and Professional Affairs, Merck & Co., Inc. J. NADINE GRACIA, Director, Officer of Minority Health, U.S. Department of Health and Human Services JEFFREY A. HENDERSON, President and Chief Executive Officer, Black Hills Center for American Indian Health EVE J. HIGGINBOTHAM, Vice Dean, Perelman School of Medicine, University of Pennsylvania CARA V. JAMES, Director, Office of Minority Health, Centers for Medicare & Medicaid Services OCTAVIO MARTINEZ, JR., Executive Director and Clinical Professor, Hogg Foundation for Mental Health, University of Texas at Austin NEWELL McELWEE, Executive Director, U.S. Outcomes Research, Merck & Co., Inc. 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the work- shop rapporteurs and the institution. ix

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PHYLLIS D. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation AMELIE G. RAMIREZ, Director and Professor, Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio MELISSA A. SIMON, George H. Gardner Professor of Clinical Gynecology, Northwestern University Feinberg School of Medicine PATTIE TUCKER, Associate Director for Health Equity, Centers for Disease Control and Prevention ROHIT VARMA, Grace and Emory Beardsley Professor and Chair, University of Southern California WINSTON F. WONG, Medical Director, Community Benefit, Kaiser Permanente TERRI D. WRIGHT, Director, Center for School, Health and Education, American Public Health Association IOM Staff KAREN M. ANDERSON, Study Director ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice x

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Reviewers T his workshop summary has been reviewed in draft form by individ- uals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the insti- tution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Dawn Alley, Office of the Surgeon General, U.S. Department of Health and Human Services Jacqueline Martinez Garcel, New York State Health Foundation Frances Lu, University of California, Davis Connie Mitchell, California Department of Public Health Although the reviewers listed above have provided many construc- tive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop sum- mary was overseen by Susan J. Curry, University of Iowa. Appointed by the Institute of Medicine, she was responsible for making certain xi

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xii REVIEWERS that an independent examination of this workshop summary was car- ried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.

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Contents ACRONYMS xv 1 INTRODUCTION 1 2 LESSONS FROM SOCIAL MOVEMENTS 5 Insights from the Sociology of Social Movements, 5 Practical Lessons in Movement Building, 9 Discussion, 14 3 LESSONS FROM HEALTH-RELATED MOVEMENTS 21 Supporting Health Equity, 21 The Role of Philanthropies in Social Movements, 23 Lessons from the Healthy Cities and Communities Movement, 26 Building Public Will to Achieve Health Equity, 28 Lessons from the Walking Movement, 31 Panel Discussion, 34 4 INVESTING IN HEALTHY COMMUNITIES: ONE FOUNDATION’S APPROACH 39 Political Exclusion and Health Inequity, 40 Toward a Narrative of Inclusion, 41 Discussion, 42 xiii

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xiv CONTENTS 5 LESSONS FROM SOCIAL MOVEMENTS BEYOND HEALTH 45 Community Economic Development and Education, 45 Tackling Health Inequity by Building Democracy, 49 Building Social Movements from the Bottom Up, 51 A Perspective at the Intersection of Movement and Politics, 53 Panel Discussion, 55 6 REACTION AND RESPONSE 57 Initial Reactions to the Day, 57 Roundtable and Audience Responses, 60 Closing Remarks, 63 APPENDIXES A REFERENCES 65 B WORKSHOP AGENDA 67 C CONSIDERATIONS FOR BUILDING A POPULATION HEALTH MOVEMENT: FIVE KEY DEBATES 71 D GLOSSARY OF MOVEMENT TERMINOLOGY 83 E SPEAKER AND MODERATOR BIOGRAPHIES 85

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Acronyms ACA Patient Protection and Affordable Care Act ACT UP AIDS Coalition to Unleash Power EPA U.S. Environmental Protection Agency EU European Union IOM Institute of Medicine MEDA Mission Economic Development Association MPN Mission Promise Neighborhood NAACP National Association for the Advancement of Colored People NRC National Research Council OSHA Occupational Safety and Health Administration PICO People Improving Communities through Organizing PSR–LA Physicians for Social Responsibility–Los Angeles RWJF Robert Wood Johnson Foundation xv

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