Hiding in Plain Sight: What's Missing in Health Equity | Keri Norris | TEDxEmory

Summary

Dr. Kerry Norris, Chief of Health Policy and Administration at the Fulton DeKalb Hospital Authority, addresses health disparities affecting African Americans and Hispanic women, emphasizing that equity, not equality, is key to solving these issues. She discusses how chronic stress, trauma, and environmental factors from early life, including prenatal experiences, contribute to higher rates of disease and early death in minority communities. Dr. Norris proposes early mental health interventions and integrated care as critical solutions for addressing these disparities and advocates for an equity-focused approach to public health, calling it the MR Model.

Takeaways

• ⚕️ African Americans are twice as likely to die from diabetes compared to white Americans, and have higher mortality rates from breast cancer and other diseases.
• 📉 Hispanic women are 60% more likely to be diagnosed with advanced stage cervical cancer compared to white women in the U.S.
• 🏡 Your zip code, or where you live, has a greater impact on your health and life expectancy than your genetic history.
• 🤔 Access to healthcare is more than just providing insurance or transportation; it must consider socioeconomic factors and community resources.
• 💊 Competing priorities, such as choosing between purchasing medication or paying for basic needs like food, hinder healthcare adherence for many vulnerable populations.
• 🌧️ Chronic stress, particularly in communities of color, significantly impacts health outcomes, beginning as early as in utero and leading to early death and disease.
• 🏚️ The 'weathering hypothesis' describes how constant exposure to stress erodes both mental and physical health over time, akin to a tattered house exposed to storms.
• 🧠 Mental health disparities, especially in children of color, are not adequately addressed, leading to higher rates of depression and anxiety that often go untreated.
• 🚸 Early childhood trauma, such as poverty or abuse, can lead to lifelong physical and mental health issues, with minority children having less access to mental health care.
• 🔑 Equity in healthcare should focus not just on providing resources but on addressing mental health and coping skills early on to mitigate the effects of trauma and stress.

Q & A

Why are African Americans more likely to die from diabetes than White Americans?

African Americans are twice as likely to die from diabetes due to a combination of factors including lack of access to proper healthcare, prevention, and treatment. Social determinants such as economic barriers and environmental factors also contribute to these higher mortality rates.

What is the significance of the 40% higher mortality rate in African American women with breast cancer?

Although African American women are diagnosed with breast cancer at the same rate as White women, they are 40% more likely to die from it. This disparity highlights the impact of unequal access to treatment, socioeconomic differences, and possibly delayed diagnosis.

Why are Hispanic women 60% more likely to be diagnosed with advanced-stage cervical cancer?

Hispanic women are more likely to be diagnosed with advanced-stage cervical cancer due to limited access to preventive healthcare services, such as screenings and early detection, combined with socioeconomic factors that delay diagnosis.

What role does environment play in determining health outcomes?

Environment, including where people live, affects their access to healthcare, nutrition, safe spaces for physical activity, and other factors essential for well-being. In fact, a person's zip code can have a greater impact on their health than their genetic makeup.

What are the competing interests that individuals face when managing chronic diseases like diabetes?

Competing interests refer to the difficult decisions individuals face, such as choosing between buying insulin or paying bills and feeding their children. These financial burdens complicate their ability to adhere to prescribed treatments and manage their health effectively.

Why is equality not enough to address health disparities?

Equality means giving everyone the same resources, but it doesn’t account for individual needs or challenges. Health disparities require equity, which ensures that resources and care are distributed based on specific needs, allowing everyone an equal chance at achieving good health.

How does chronic stress affect health outcomes for people of color?

Chronic stress, often due to economic hardship, systemic racism, and repeated life challenges, causes long-term damage to the body, leading to early onset of diseases and higher mortality rates in communities of color.

What is the 'weathering hypothesis' and how does it relate to health disparities?

The weathering hypothesis suggests that chronic exposure to stressors throughout life 'weathers' or deteriorates the body, similar to how a house is damaged by constant storms. This concept is used to explain why people of color often experience earlier onset of disease and premature death.

How does childhood trauma affect long-term health?

Children exposed to trauma, such as abuse or poverty, are at higher risk of developing mental health issues, like depression and anxiety, which can lead to physical health problems, including hypertension and heart disease, later in life.

What is the proposed MR model for improving health equity?

The MR model emphasizes early intervention in mental health for children, teaching coping mechanisms to prevent long-term physical and mental health issues. It promotes integrated care and addressing social determinants such as housing and transportation to move health equity forward.