Mission

The Health Equity Blog’s mission is to contribute to the discussion of health policy using evidence and research, to explore the opportunities for health equity through policy change, to raise awareness about health disparities, and to increase public advocacy for health equality.

According to the CDC, “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”

Achievement of full health potential is necessary in all aspects of life – from running errands to relationships with loved ones. Some people are born into environments that limit their ability to achieve their full health potential. We believe that because society created many health inequalities, society can also fix them.

Monday, April 14, 2014

Tobacco Use Today

Earlier this year, the United States Surgeon General released a report that marked the 50th anniversary of the first Surgeon General Report that highlighted the consequences of smoking. The 2014 report, available here, acknowledged the successful decline of adult smoking rates. In 1965 nearly 43% of adults smoked compared to 18% of adults in 2014. However, there is still work to be done.  


The risks of tobacco are clear. Smoking increases the risk for coronary heart disease, stroke, many types of cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, stroke, heart attacks, bronchitis, and low birth weight in newborns. Despite all we know, smoking is still the leading cause of preventable death in the United States and is responsible for one out of five deaths. New trends in types of tobacco products (for example e-cigarettes) and tobacco use along demographic indicators such as socioeconomic levels need to be addressed. A recent report from the Population Health Metrics found that while smoking rates are decreasing quickly in more affluent communities, the rates are staying the same among the poor.


Tobacco use in 1965
Tobacco is used differently now than it was in 1965 when the Surgeon General released the first report that warned American of the harmful effects of tobacco. In 1965, 43% of adults smoked. Smoking cigarettes was seen as something of status - rich people smoked cigarettes because they could afford to do so. Smoking was common in the workplace, in restaurants, and in schools. Kids didn’t learn about the harm of tobacco in health class. Advertisements like the ones below were everywhere. You can see many more advertisements like these here.everywhere.  





Tobacco use today
Tobacco use and smoking is no longer something for the wealthy. Instead smoking rates are higher in poor communities. Below is a map of federal smoking data by county. There is a correlation between smoking prevalence and county wealth. For example, Clay County in Eastern Kentucky is one of the country’s most impoverished counties and has the highest smoking rates





Graph: Statistics taken from the 2010 National Health Interview Survey showing the percentage of adults who smoke by poverty level


Now smoking is more common among adults who do not graduate high school - one-in-four adults without a high school level education smoke compared to one-in-ten adults with postgraduate degrees.






Another change from 1960 is tobacco advertising. The Family Smoking Prevention and Tobacco Control Act was passed in 2009 that gave the FDA authority to regulate the manufacture, distribution, and marketing of tobacco products to protect public health. Jurisdictions have also banned smoking in public places such as restaurants. Cigarettes are now heavily taxed making them more expensive to purchase. Despite the federal, state, and local regulations smoking rates remain high, especially among low socioeconomic groups.


Why rates of tobacco use are higher in poor communities
There are several possible factors and reasons why poor communities have higher rates of tobacco use.
  1. Stress. For many people tobacco use is a coping mechanism. For low socioeconomic people, stress is chronic and often caused by community violence and joblessness.
  2. Targeted marketing. Researchers have found that there are fewer tobacco advertisements in the higher socioeconomic communities compared to the lower socioeconomic communities. Point of Sale tobacco marketing (including advertisements, price promotions, and product displays in stores) disproportionately affects youth, racial minorities and people of low income/education. For example, retailers located in minority and low-income neighborhoods are more likely to advertise tobacco products in store windows.
  3. Less access to cessation programs. Compared to white collar workers, blue collar workers have less access to to cessation programs to help them quit. Blue collar workers are more likely to start smoking and less likely to quit.


Hope for the future
Anti-tobacco advocate groups as well as the federal government are working to raise awareness about the higher rates of tobacco use among poorer Americans. Awareness and data are a key part of solving a problem.


In addition to awareness, the Affordable Care Act changed Medicaid to support cessation. Medicaid enrollees smoke at a rate that is 50 percent higher than the general public so the cessation through Medicaid could help many Americans. In 2010, the ACA required all Medicaid programs to cover comprehensive tobacco cessation for pregnant woman. In 2014 the ACA required coverage of tobacco cessation medications in all states in 2014. Recently companies have been vocal about selling tobacco products. A few months ago, CVS, a major drug store, announced it would no longer sell tobacco products.

Great strides have been made in the fight against tobacco. However, an alarming number of families are impacted negatively by tobacco products so there is still work to do. As the fight against tobacco continues, it is important to not blame the individual who uses tobacco but instead to support those trying to quit.

Wednesday, April 9, 2014

The Prison Problem

Currently, there are more than 2.4 million people in prison in the United States - that means one out of every 100 people is imprisoned.  Although the US has 5% of the world population, we have 25% of the world’s prisoners.  It costs $21,000 a year to house one prisoner in a minimum security prison and $33,000 per year in a maximum security prison.  All in all, the US spends about $74 billion a year on prisons.  Whether you think that amount of money is appropriate to spend on imprisoning people or not, the reality is that what we spend on prisons, limits what we can spend on other things like job creation and education. With 68% of prisoners not finishing high school, we might connect lack of education with an increased likelihood to commit crime.  Below is a chart comparing how much it costs to educate a student or imprison someone in 40 states.  It is clear which one is more cost effective.050713-education-vs-prison-costs.png

The cost of keeping someone in jail is not the only issue when it comes to how often the US imprisons people.  We have a serious issue with racial disparities in prison populations with African Americans being imprisoned 6 times as often as white Americans.  African Americans and Hispanics are 25% of the US population but 58% of the prison population.  Part of this disparity is due to the effect of race on sentencing.  Studies have shown that black and hispanic men tend to receive harsher penalties for the same crime than other populations, among other disparities (for more more info click here).
We also have high rates of recidivism (67.5% are rearrested within 3 years of release) in this country which is not surprising when a person’s ability to find a job, get housing or qualify for a loan are all negatively affected by having a criminal record.  It is no wonder that the highest recidivism rates are for those who committed property crimes like car theft, larceny, selling/possession of stolen property and burglary.

So to sum up, we are spending a great deal of money, to the detriment of other causes like education and job creation, to imprison people, but it isn’t stopping those people from committing future crimes and it disproportionately harms minorities.  Maybe it is time for us to re-think the way we address this issue.  New York, Washington and Texas have done just that by doing things like


My own home state of Massachusetts currently has a campaign called Jobs Not Jails to reform our own criminal justice system which is currently on par with French Guiana and Kazakhstan.

What Can You Do

If you live in Massachusetts, check out Jobs Not Jails.  If you live in another state, find out if there is an equivalent campaign or start your own!