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Health equity advocate speaks to Georgia Southern

Health equity advocate speaks to Georgia Southern

Health equity advocate speaks to Georgia Southern

After Thursday's lecture, Dr. Adewale...

Dr. Adewale Troutman, the president of the American Public Health Association, traces disparities in Americans' health to differences in income, education, race and ZIP codes. In a lecture at Georgia Southern University, he urged students to do something about it.

Troutman, 67, was the 2013 speaker in the Norman Fries Distinguished Lectureship Series. It was the Jiann-Ping Hsu College of Public Health's year to invite a speaker, and Troutman currently heads the 50,000-member American Public Health Association. His topic, "Health Equity and Social Justice, a Whole New World," follows the central current of Troutman's nearly 40-year career.

"I'm a firm believer that this discussion of public health equity and social justice has to be met by people who care in this country," Troutman said. "People who care about freedom, justice and equality can recognize that the very existence of differences in health outcome by race, ethnicity, socioeconomic status, sexual orientation and gender and age are unacceptable."

Troutman and Dr. David Satcher, the former U.S. surgeon general, in 2002 documented an excess of more than 83,000 deaths of African-Americans above what would have been predicted that year based on the general death rate. Together, Satcher and Troutman wrote the journal article, "What If We Were Equal," and Troutman appeared in the 2008 PBS television documentary series "Unnatural Causes: Is Inequality Making Us Sick?"

Troutman suggests that the number of excess deaths would have been much higher if other ethnicities, such as Latinos, Native Americans and Pacific Islanders, had been included.

"We don't even know what the number is," he said. "It could be 200,000 people who die needlessly every year because of lack of access and lack of equity in housing and education and neighborhood safety."

Speaking to public health students and others, Troutman invoked a parable of two fishermen who saw babies floating by in a river. One fisherman rushed downstream to save the babies while the other ran upstream to see who was throwing babies in the river and stop them. In this image, those who work to eliminate poverty, racism and violence and improve education are working upstream.

"We can't all go upstream," he said, observing that many are also needed "downstream" to help those already in trouble.

Troutman worked downstream early in his career. After serving briefly in community clinics, he was an emergency room physician in Newark, N.J., for 15 years. Then he turned to more upstream challenges, as the director of the Fulton County Department of Health in Atlanta and then the Louisville Metro Department of Health in Kentucky. Now he's associate dean for Health Equity and Community Engagement at the University of South Florida in Tampa.

In Louisville, Troutman received national attention for implementing publicly funded health screenings for residents of Rubbertown, an area beside the city's industrial district. In what he names as one of his proudest accomplishments, he also successfully sought a public smoking ban in the heart of a tobacco farming region.

Addressing the problem of "food deserts," without sources of fresh produce, he worked with other Louisville officials for creation of farm markets and "Healthy in a Hurry" stands stocking fruit in urban convenience stores.

‘Health in all policies'

In an interview, Troutman and his wife, Denise — managing partner of their public health consulting firm, the Troutman Group — talked about other efforts they believe are making a difference.

Among these is Kalamazoo Promise, which uses private funding to ensure that high school graduates in Kalamazoo, Mich., receive four years of college. They also praise Hope VI, a federal program to replace blighted housing projects with multi-income-level housing.

"There's a notion out there that if you tell me your ZIP code, I'll tell you how you live, and you shouldn't be able to do that," said Denise Vazquez Troutman.

More generally, Adewale Troutman observed that a "health in all policies" approach is now prompting policymakers in education, law enforcement, housing and transportation to consider how their decisions affect health.

The national public health plan, Healthy People 2020, takes a similar view, he said.

"The nation's health plan for the first time very specifically focuses on health equity, social justice and what are called the social determinants of health as a prime mover in improving the health of the entire population," Troutman said.

The income gap

Meanwhile, some measures of inequality are getting worse, he said.

"If you look at the gap in income in the United States, it's the largest of any industrialized nation on earth, and there's a direct correlation between income gap and health gap, so as the gap in income has increased, the gap in poor health has increased as well," Troutman said.

Although much of Troutman's focus is on social factors, he observes that access to health care is a major cause of disparities. He did not discuss the Affordable Care Act in his lecture, but in the interview called the law "a step in the right direction" because it is projected to extend health insurance to 30 million to 40 million more Americans and provides preventive screenings.

GSU Public Health

More than 200 people attended the lecture Thursday in the Nessmith-Lane Conference Center. The annual series was launched in 2001 with an endowment in honor of Norman Fries, the founder of Claxton Poultry, who died the following December. The university's eight colleges take turns selecting speakers.

First accredited in 2011, the College of Public Health now has about 200 students in master's and doctoral degree programs. This semester, the college launched its undergraduate program, also with about 200 students.

Dr. Gregory Evans, the dean of the college, said that equality of health care and prevention has long been a focus of public health practitioners but has received increased attention in recent years.

"It applies very much to our college because the mission of our college is to deal with rural and underserved populations," Evans said. "So often, the rural populations are the ones that just get forgotten about."

One of the Troutmans' four children, Nandi Marshall, received her doctorate in public health from the GSU College of Public Health in December. She and other family members attended the lecture.


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