Spreading the Health: Government’s Role in Addressing Health Disparities

Investigating Health Disparities: New Agendas for National Health Research Institutes

Making Disparities Count: From Government Statistics Systems to Action

These sessions have their origin in a working group initiated by the department of Society, Human Development, and Health. Nevertheless, the work and the genesis of the symposia encompasses the ideas and contributions of faculty members from across disciplines at the Harvard School of Public Health. By offering the symposia, the intent is to broaden the dialogue ever further across the University, pinpointing the ways that government can alleviate the health disparities we see today. Thanks to all who have made these symposia possible.

Purpose of the symposia - Drawing on participants from the Americas, Europe, Africa, and Asia, the three symposia will explore government responsibilities regarding: (1) policies to address social inequalities in health, based within both the health sector and also government-wide; (2) research on causes of health disparities; and (3) national data collected to monitor social inequalities in health, including in relation to class, race/ethnicity, and gender. See the symposia descriptions.

Format - Each symposium will follow a similar format. The program begins with speakers who will describe their government’s policies, followed by a discussant and then a moderated question-and-answer period by a panel of Harvard faculty, students, and journalist. They will ask the speakers candid questions about subject of the symposium. The intent is to encourage frank and enlightening discussion about agreements and disagreements on the best ways to achieve social equity in health, as well as to promote opportunities to learn from each country’s successes and difficulties in addressing health inequities.

Web cast - To enhance the global reach of the symposia, each symposium will be web-cast live, with free access, and all sessions will be archived, also with free access, on this web site hosted by the Harvard School of Public Health.

Thursday, March 3, 2005
2:00 — 5:00 pm
Harvard Conference Center Amphitheatre
77 Avenue Louis Pasteur, Boston

History books in years to come will note a disturbing development in the last decades of the twentieth century. As industrialized countries saw extraordinary growth in economic prosperity and stunning advances in medical science, the gap between rich and poor, advantaged and disadvantaged, sick and healthy yawned as never before. A rising tide did lift most boats, as it turned out, but the fleet became a shambles -- rafts on the open sea and yachts in private harbors.

The question of how much disparity societies are willing to tolerate simmers beneath the surface of virtually every major political debate. From taxation policy to public schools and welfare reform to defense budgets, social policy decisions have implications for distributive justice. Policymakers often shy away from tackling the problem of social inequality head-on, though few would dispute its importance as one of the pivotal moral and political issues of our time.

A growing body of research in the health and social sciences adds fuel to the fire. Researchers continue to uncover new connections between "healthy bodies and thick wallets." And there is little doubt today that policy decisions related to environment, transportation, labor, housing, and the organization of medical services can have profound effects on health and well-being.

For governments, this new knowledge ups the ante. Policymakers outside the health sphere cannot ignore the health implications of seemingly unrelated economic and social policy decisions. Health policymakers have new and compelling reasons to take seriously the interconnectedness of illness and health risk with a broad range of social policies. The challenges to traditional divisions in government are significant. How can governments respond? How should they?

Participants in the symposium include:

Moderator:
David Studdert, LLB, ScD, HSPH Associate Professor of Law and Public Health

Speakers:
Carolyn Clancy, MD, Director, Agency for Healthcare Research and Quality, United States Department of Health and Human Services;

Fiona Adshead, MD, Deputy Chief Medical Officer, Department of Health, England, United Kingdom;

Asa Cristina Laurell, MD, Minister of Health, Mexico City;

Irene Nilsson Carlsson, Director, Division for Public Health, Sweden.

Discussant:
Senator Dianne Wilkerson, Massachusetts State Senate

Q & A Panel:
Deborah Prothrow Stith, MD, HSPH Professor of Public Health Practice, Facilitator

Kalahn Taylor-Clark, MPH, W.K. Kellogg Doctoral Fellow in Health Policy Research, Harvard University ;

Sofia Gruskin, JD, MIA, HSPH Associate Professor of Health and Human Rights;

Ashish Jha, MD, MPH, HSPH Assistant Professor of Health Management and HMS Research Fellow in Medicine.

Thursday, April 14, 2005
2:00 — 5:00 pm
Harvard Conference Center, Avenue Louis Pasteur, Boston

Social disparities in health have been observed for centuries but, until quite recently, they have rarely been the focus of rigorous research attention nor a priority for funding among institutes of health in many countries. Over the past decade, however, with increasing scientific interest in disparities, many national institutes of health have taken note and developed priorities in this area.

If we are to develop effective preventive and medical interventions to improve the health of disadvantaged populations, we must have solid data on the magnitude of the problem and the causes of health disparities. Understanding the etiologic questions means identifying those conditions in the social and physical environment as well as variations in behaviors, medical care and biological vulnerabilities. Understanding the complex interactions among these etiologic conditions across the lifecourse has risen to a high priority in many planning efforts across institutes of health.

In this symposium, speakers describe their institutes’ approaches and plans for further understanding the causes of health disparities and identifying the magnitude of the problem associated with such disparities. The speakers will talk about how their respective institutes have created new opportunities for research and what kinds of impediments and barriers they have experienced. Countries vary significantly in how they have approached research issues related to health disparities and population health, their priority within the overall research agenda, and the disciplines and methods critical to achieving a deep understanding of the issues related to social disparities in health.

Through our symposium discussions, we hope to learn from the wide range of strategies undertaken across countries pertaining to research in health disparities, so that effective interventions across the fields of public health, medicine and public policy can be developed to improve the health of most disadvantaged populations.

Participants in the symposium include:

Moderator:
Lisa Berkman, HSPH Professor of Public Policy, Departments of Society, Human Development, and Health and Epidemiology, Harvard School of Public Health

Speakers:
Elias Zerhouni, MD, Director, U.S. National Institutes of Health;

John Frank, PhD, Scientific Director, Institute of Population and Public Health, Canada;

Mirta Roses Periago, MD, Director, Pan American Health Organization;

Sujatha Rao, MD, Member Secretary of the National Commission on Macroeconomics and Health, India.

Discussant:
Harvey Fineberg, MD, PhD, President, Institute of Medicine

Q & A Panel:
Howard Koh, MD, HSPH Professor of Health Policy, Facilitator

JudyAnn Bigby, MD, Director of Community Health Programs and HMS Center of Excellence in Women’s Health, Brigham and Women’s Hospital;

Christopher Murray, MD, PhD, HSPH Professor of Population Policy, Director of the Harvard Global Health Initiative;

Atul Gawande, MD, Assistant Professor of Surgery, Brigham and Women’s Hospital;

Maria Glymour, SD, Research Associate, HSPH Department of Society, Human Development, and Health.

Thursday, May 5, 2005
2:00 — 5:00 pm
Harvard Conference Center, 77 Avenue Louis Pasteur, Boston.

No data, no problem. Fundamental to knowledge about health disparities is the availability of population data to monitor social inequalities in health.

Yet data defining social groups at risk of health inequities are a two-edged sword, given past and present discrimination against individuals and groups based on the ascribed social categories that lie at the heart of health disparities, such as socioeconomic position, race/ethnicity, nationality, gender, and sexuality. How best should population health systems collect data on these dimensions of social inequality, so as to advance — rather than harm -- efforts to attain social equity in health?

Because data on the extent of health disparities is key for galvanizing action to address them, this symposium will present different government’s diverse approaches to monitoring social disparities in health. Some of the health statistics systems that will be described collect socioeconomic data but scant or no racial/ethnic data; others collect complex and often inconsistent data on race/ethnicity, but sparse or absent socioeconomic data. The politics of public health data, both its presence and its absence, and the impact on affecting how health statistics systems shape knowledge and ignorance relevant to addressing health disparities will be the focus of discussion.

Participants in the symposium include:

Moderator:
Nancy Krieger, PhD, HSPH Associate Professor of Society, Human Development, and Health, Harvard School of Public Health

Speakers:
John Fox, PhD, Director of Statistics, Department of Health, United Kingdom

François Héran, PhD, Director, Institut national d’études démographiques, Paris, France

Vickie Mays, PhD, Professor of Clinical Psychology, University of California-Los Angeles and Director, UCLA Center on Research, Education, Training, and Strategic Communications on Minority Health Disparities;

Eduardo Mota, SD, Chief of Health Statistics, Instituto de Saude Coletiva, Brazil;

Discussant:
Godfrey Woelk, PhD, Associate Professor, Department of Communitiy Medicine, College of Health Sciences, University of Zimbabwe;

Q & A Panel:
Robert Blendon, ScD, HSPH Professor of Health Policy and Management, Facilitator

Howard Koh, MD, HSPH Professor of Health Policy;

Mary Waters, PhD, Professor of Sociology, Harvard;

Evelynn Hammonds, PhD, SM, Professor of the History of Science and African and African American Studies, Harvard;

David Rehkopf, MPH, doctoral candidate, Harvard School of Public Health.