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Left to Right: Ashley
Lewis (SPPA student), Erin Knight (CCRS), Hira Rashid (SPPA
student), Dr. Rattay (Director of Public Health), and Cassandra
Codes-Johnson (Director of Community Health for DPH)
Delaware Voice Karyl T. Rattay
10:05 a.m. EST February 2, 2016
mission at the Division of Public Health (DPH) is to protect and
promote the health of all people in Delaware. Public health work is
guided by a parable that says you can do your work downstream and pull
drowning people from the river -- meaning to focus on treating the
already sick. Or you can focus upstream and work with people to keep
them from falling into the river in the first place -- meaning prevent
an illness before it starts.
Working with our many partners,
Delaware is making progress as we can see population health measures
improving in many areas. Yet even as our overall health improves, we
have persistent health inequities in our state. In some cases, the gaps
we see in health between different population groups or communities are
getting worse, not better.
Individuals who are of low income or of
color are more likely to have diabetes, suffer certain kinds of cancers
and other serious chronic diseases, their life expectancy is often
lower, and disability rates among these population often are higher.
For instance, Delawares black infant mortality rate was as high as 2.8
times that of the white rate for the most recent data available.
Hispanic children in Delaware are four times as likely and non-Hispanic
black children are nearly twice as likely to be in less than optimal
health compared to non-Hispanic white children. The number of Delaware
children birth to age 5 living in poverty (a factor directly linked to
poorer health outcomes)climbed from 12,481 (17 percent) in 2008-2010 to
16,417 (24.7 percent) in 2012-2014, according to Kids Count.
and growing inequities are certainly not unique to Delaware, however,
it is time for a more concerted upstreaman effort focused on addressing
those inequities. Over the course of the past several years, DPH has
worked with many community leaders, non-profit organizations, other
governmental agencies and stakeholders to develop a strategy to reach
our vision of health equity for all Delawareans where everyone will
achieve their full health potential.
To help Delawareans
understand our health inequities and how to reduce them, DPH, the Center
for Community Research and Service at the University of Delaware, and
other partners created the Health Equity Guide for Public Health
Practitioners and Partners. I am pleased to present this guide as a
resource to support the efforts of DPH and our many partners, new and
old. In this guide, you will find the evidence that supports the need to
focus more of our attention and resources on underlying social
conditions in our communities. The document shares evidence-based and
promising strategies, and provides numerous references and web links for
Move this whole section up, swapping places with the section above it.
Left to Right: Rita
Landraf (Secretary of Health & Social Services), Cassandra
Codes-Johnson (Director of Community Health for DPH),
Erin Knight (CCRS), Dr. Rattay (Director of Public Health), Joseph
Hickey (Executive Director of St. Patrick's Center in Wilmington), and
Senator Margaret Rose Henry.
As you will read, many of the factors
that influence health are grounded in historical inequities, often
beyond the reach of traditional public health efforts and beyond even
the reach of state government. Health inequities result from a complex
web of factors that span multiple sectors and disciplines. We all have a
role to play in reducing such inequities, and this guide is meant to be
a resource to promote and support a sustained, coordinated approach for
moving upstream. Many individuals working outside of the health sector
may not even realize the impact their work has on health and health
equity. By raising awareness of the social determinants of health and
sharing strategies and lessons learned for promoting healthier living
and working conditions, we can mobilize our collective capacity to
foster optimal health for all Delawareans.
acknowledge that the concepts outlined in this guide represent a new
way of doing business for DPH and our partners. Change is not always
easy. But we also cannot afford to wait. According to the Centers for
Medicare and Medicaid Services, per capita health care spending in
Delaware is among highest in the country.
While there is a
practical imperative for change that is difficult to ignore, there is
also a moral imperative. It is simply not acceptable that Black infants
in Delaware die at a rate that is more than twice that of White infants.
It is unacceptable that in certain cases we may be able to predict how
long someone will live based upon their ZIP code or income level. These
are not naturally occurring or random phenomena.. Rather, they are
systemic, structural, and predictable. At the same time they are not
insurmountable. In fact, many efforts to improve social conditions are
making a difference in the health of communities across the country.
Many important initiatives are already making a difference in our state,
for which I am grateful.
Everyone regardless of race, ethnicity, ability, sexual orientation
and economic or social condition has the right to attain their optimal
health. I look forward to sharing this guide and working with you.