A New Paradigm Shift: Health Equity in Tobacco Control Rod Lew, MPH Asian Pacific Partners for Empowerment, Advocacy and Leadership San Diego Tobacco Control Coalition April 8, 2020
Other Equity Collaborations California • ADEPT Equity Collaborative (commercial tobacco) • CA4LessSoda Coalition (sugar‐sweetened beverages) National • CDC National Networks on Tobacco Control • Phoenix Equity Group • APHA PHEHP Health Equity Subcommittee
Objectives 1. Provide background history to the first paradigm shift in tobacco control 2. Discuss why tobacco control needs a second paradigm shift on equity 3. Describe pathway to advancing health equity in tobacco control 4. Connection between tobacco, COVID-19 and health equity
Historical View of Tobacco Control Policy Change
Successes of Policy Change • What is a Paradigm Shift? • Paradigm Shift from Individual Behavior Change to Environmental Change • The California Model- “quarter that changed the world” • Comprehensive Smoke-free Air Policies • Tobacco Taxes • Media Campaign • Unintended Consequences of Policy Change
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Tobacco Disparities Still Exist American Indian/Alaskan Native/ Native Hawaiian Pacific Islanders/LGBT higher prevalence African Americans face greatest burden of death and disability due to tobacco consumption Fastest growing populations: Asian Americans and Latinos, impacted by second hand smoke Underlying socioeconomic and political inequities including structural racism, homophobia and transphobia
Where the Story of Tobacco Begins
Slavery and the Commercialization of Tobacco
Industry Targeting of Communities of Color and LGBT Communities • History of Tobacco ʼ s Commercialization • Heavy Targeting by the Tobacco Industry • Cultural Appropriation and Exploitation • The Menthol Failure
History of Equity in Commercial Tobacco Control • Health equity “relatively new” term in tobacco control • California tobacco control– a pioneer in recognizing value of communities of color and statewide ethnic networks (and nationally) • Defunding of ethnic networks in CA • Necessary rebuilding of community-led tobacco control from ground zero and continuing systemic barriers (e.g. funding mechanisms)
HP2020 Definition of Health Disparities Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.”
Definitions of Health Equity “the attainment of the highest level of health for all people” Healthy People 2020 “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” Paula Braveman et al (Health Affairs June 2017)
Equality vs. Equity
Another View…..
Key Questions? Where do I get the boxes? Are disparities widening? Who built the fence? What game are we watching? Can we play in the game? What is “liberation”? Freedom of choice?
Health Equity is about… 1) building community power 2) systems change within tobacco control, public health and other institutions and systems that impact inequities
Health Equity is not about… • Designing only culturally tailored programs • Outside entities developing strategies for marginalized communities • Funding communities with only short term goals in mind • Placing solely accountability for change on marginalized communities
Health Equity Principles • Health equity as defined by systems change or building community power • Address tobacco industry targeting • Address institutional racism, homophobia and transphobia (including implicit bias, institutional and explicit) • Engage and empower communities of color and LGBTQs all along the spectrum of tobacco control • Nurture development of the next generation of community leaders • Move tobacco control toward a Second Paradigm Shift focused on “Health Equity as a Policy Goal” ADEPT 2019
Health Equity as a Policy Goal? ‐ the Ultimate Systems Change • Build on First Paradigm Shift in Tobacco Control • Incorporates social determinants of health and impact on tobacco • Builds capacity of communities to be set up for success in “policy change” long term • Addresses systemic change on multiple levels of “policy”
Redlining: San Diego in 1936 CREDIT: T‐RACES https://www.kpbs.org/news/2018/apr/05/Redlinings‐Mark‐ On‐San‐Diego‐Persists/
What is an Equity Pathway that for Communities Can Choose? It’s not only “What” you do but “How” you do it?
Strategic Framework for Tobacco Control among Priority Populations Inputs Guiding Strategic Community Short Term and Long Term Principles Planning Capacity Intermediate Outcomes Building Outcomes Community Leadership 4-Prong Policy Advocates Readiness Development Change Model Community Community Communities Participation Policy Mainstream Coalitions Institution Environment Community Policy Community Assessment Mobilization Legislative Leaders and Data and Organizing Competence Policy Corporate Partnerships Policy Resources Community Prioritization Infrastructure Empowerment and Goal- Development Time Programs Setting Cessation Prevention Reduced Tobacco Use Health Parity and Health Justice
APPEAL 2016
Building Community Power through Leadership “ APPEAL trainings are intense, in-depth, refreshing, and understands and embraces the diversity and cultural perspectives of the participants. And most of all you feel good… because for the first time my history, cultural, and experiences -- were allowed at the table. ” - Brandie Flood, Center for Multicultural Health
LAAMPP Fellows Help Influence Passage of Minnesota Tobacco Tax
African/African American LAAMPP Fellows Helps Pass Smoke‐free Foster Care Policy in Ramsay County
Mainstream Institution Policy: Health Equity 1. Mandate funding of community engagement efforts among COCs and LGBTQs to be key players in commercial tobacco control in the future (e.g through leadership programs) (state and local health depts) 2. Mandate “community‐friendly” funding and grant mechanism system to ensure that those most marginalized and unreached of COCs and LGBTQs are prioritized 3. Mandate development of a Strategic and Implementation Health Equity Plan for CTCP with health equity policy goals aligned with ADEPT’s health equity principles 4 . Work with Offices of Health Equity to ensure implementation of health equity action steps including: a. Institutionalize committees on best practices b. Reinforce implementation of CLAS Standards c. Institutionalize health equity agenda 5. Mandate the creation of an internal system that adequately ensures accountability in the development and implementation of health equity goals with related benchmarks
Tobacco and COVID‐19 (Each and Together) Create Widening Disparities • Smokers and vapers at greater risk • Racist attacks against Asian Americans • African Americans more likely to die from COVID‐19 • Impact on uninsured and underinsured • Representation in health care industry and service industry • “Work at home” and technology divide
Be a part of the New Paradigm Shift towards Equity in Tobacco Control Thank You !!! www.appealforhealth.org rodlew@appealforhealth.org
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