Health Equity Summit

National leaders discuss social determinants of health at the New Haven Health Equity Summit.

Dr. David Satcher presents at the New Haven Health Equity Summit. See more photos here.

A Health Equity Summit hosted by the City of New Haven/Community Services Administration and New Haven Healthy Start and co-sponsored by Yale School of Medicine and The Community Foundation for Greater New Haven brought national experts to discuss the underlying causes of health disparities that affect racial and ethnic minorities.

Dr. David Satcher, the 16th U.S. Surgeon General, was the first keynote speaker. Widely recognized for elevating health disparities into the national conversation, he defined health equity as the equal opportunity for people to be healthy.

Satcher presented the "Prescription for Healthy Living" he issued in 1998 to the nation: 30 minutes of moderate exercise five days a week; five servings of fruits and vegetables daily; avoidance of smoking and other toxins; engaging in responsible sexual behavior; and reducing stress.

The prescription came, he said, from research that shows behavior is the single biggest factor in health outcomes. But not everybody shares in the same opportunity to follow the behavior recommendations.

"The prescription requires an environment where it can be implemented," Satcher said. "When it's not safe to sit on the front porch, you're less likely to be active. When there is no grocery story in your neighborhood with fresh fruits and vegetables, you are less likely to eat well."

Neighborhood safety, school quality, job stability and other social and environmental conditions known as "social determinants" are widely recognized by public health experts as having a major impact on health outcomes. Addressing social determinants is a primary goal of Healthy People 2020, the ten year health objectives set for the nation by the US Department of Health and Human Services (HHS).

The second keynote speaker, Dr. Camara Jones, American Public Health Association President-Elect, identified the complex system of racism in the U.S. as a highly destructive social determinant of health that underlies many inequities.

"It saps the strength of the whole society through a waste of human resources," Jones said. "We know there is genius in all of our neighborhoods."

Jones illustrated how racism operates on three levels with her frequently cited allegory, "The Gardener's Tale."

Institutional racism, the first level Jones identified, is rooted in slavery and perpetuated by historical insults such as segregation, federal rules that excluded blacks from subsidized mortgages in the middle of the 20th century, and the school funding system of today that is based on local property taxes.

"It doesn't just so happen that people of color are overrepresented in poverty and white people are overrepresented in wealth," Jones said.

Jones then moved to personally mediated racism, which she said is located in the assumptions that someone makes about the abilities and motives of another person who is a different color. Such racism takes the form of police brutality, disrespect from a doctor, teacher devaluation, waiter indifference, and other interactions where a person of color is devalued based on an interpretation of how they look, Jones said.

The third level of racism identified by Jones is internalized racism, or the acceptance of negative messages by the stigmatized race. She illustrated this form with the old saying, "the white man's ice is colder," which refers to a bias among Blacks that goods or services sold by Whites are inherently superior.

Making health equity a reality, Jones said, requires valuing all individuals and populations equally, while recognizing and rectifying historical injustices.

"Racism is most often passive," Jones said. "We have to name it, organize, and move to action to address it. Let's dismantle the system."

Connecticut Health Foundation CEO and President Pat Baker, the third speaker, highlighted the role of philanthropy plays in increasing health equity. She said that among the most effective investments were those that built up a diverse group of leaders in the field.

"Who sits around the table is important," Baker said.

Read the New Haven Independent coverage.

Watch highlights from the event below: