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UNIT II ■ Community Health Across Populations: Public Health Issues
Public Health Organization Responses to Health Disparities and Inequity Universal Declaration of Human Rights The Universal Declaration of Human Rights , adopted by the General Assembly of the United Nations in 1948, continues to provide the underlying framework for equity in health at the WHO and down through national- and state-level approaches to improving health equity. 54 The Declaration consists of 30 articles that serve as a standard of achievement for all nations to measure compliance with human rights and funda- mental freedoms. Article 25 states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, medical care and necessary social services, and the right to security in the event of un- employment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control.” 54 Articles 22 to 27 are most specific to equity in health care, examining economic, social, and cul- tural rights (Box 7–1). In 1978, at the International Conference on Primary Care, the Alma-Ata Declaration affirmed these human rights (see Chapter 16). 55 The goal was to see the pro- vision of primary health care to every individual by the year 2000, thus achieving the goal of health care for all. The second section of the Alma-Ata Declaration stated, “The existing gross inequality in the health status of the people particularly between developed and develop- ing countries as well as within countries is politically, socially, and economically unacceptable and is, there- fore, of common concern to all countries.” 55 In the 21st century, the WHO continues to advocate for reducing health inequity based on the concept that health is a fun- damental human right. 5 United States Healthy People 2020 stated that the impact of social and physical determinants of health “affect a wide range of health, functioning, and quality of life outcomes” 56 and provided several examples (Box 7–2). 56 As noted earlier, HP 2030 ’s foundational principles note that “[a]chiev- ing health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy,” and that “[h]ealthy physical, social, and eco- nomic environments strengthen the potential to achieve health and well-being.” 57 Along with Healthy People, several U.S. national-level organizations have placed health equity as a priority. The
a community issue and not just a school issue. Emily valued the time of all these stakeholders and tried to be organized to help them arrive at some clear out- comes by the end of each meeting. The group had three meetings. Participants offered suggestions and concrete plans to be implemented, with some to be done at the school and others in the community. The suggested collaborative actions included the following: • Improve access to care. • With the partnership of the local public health department, provide an immunization clinic and school physicals one evening a month (or on Saturday) at the school. • Negotiate with one of the primary care clinics outside the community and the board of education to provide a satellite comprehensive clinic at the school, developing underutilized school space. • Provide information at the school about the insurance and other health program eligibilities for children of low-income working parents. • Bridge cultural and literacy gaps. • Develop evening English as a second language (ESL) classes for the parents, coordinated by one teacher at the school, a local social service agency, and volunteers from the local community college. • Start monthly cultural programs organized by the school parent–teacher association to showcase all of the cultures at the school and facilitate more com- munication among the parents. • Create information tools that can be used by people with low health literacy to gain information on common childhood illnesses; health promotion and disease prevention actions; and new skills the fami- lies can use, even with limited resources, to navigate the U.S. health-care system. Offer to share these information tools with the local primary care clinics. • Communicate with the clinics about the need to provide required translation services, either with trained, certified volunteers, including college students, or with a telephone translation service. With the assistance and support of the community, Emily and the planning group were ready to design actions to implement some of these changes. Emily received two neighborhood development grants to help cover program implementation. The next steps in the process included looking for sustainable funding for an ongoing school health program aimed at reduc- ing the gap in access to care.
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