Fadzai Manungo, a master in public health student at the University of Minnesota, remembers disparities in Zimbabwe, the country where she was raised. Some of them fell along socio-economic lines.
Manungo’s middle class neighborhood, for instance, was humble, the streets full of potholes. But when she started commuting to a school one hour away, she saw different ways of life.
First she’d pass through a poor, black neighborhood; then a less poor, Indian neighborhood; then an even less poor, white neighborhood. Then she’d reach a wealthy neighborhood where her school was located.
Manungo’s classmates vacationed in Europe or the Americas. Her father’s aging, modest car looked out-of-place in the school parking lot.
When Manungo moved to the United States in 2012, she was shocked to see poor neighborhoods here, too. “I always had this romanticization of America,” she said. She was also shocked to learn that neighborhoods, income, education, employment and other “social determinants of health” affect people's health.
Determined to learn more and to help, Manungo began a master in public health.
Fadzai Manungo was shocked to see poor neighborhoods in the United States, too. And to learn that neighborhoods, income, education, employment and other “social determinants of health” affect people's health.
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While good medical and preventive care are important for healthy populations, studies show that medical care only accounts for 10 to 15 percent of population health. The social determinants of health and discrimination have the greatest impact on health. Predictably, most of Minnesota’s health disparities fall along these lines.
For instance, residents in the Twin Cities’ highest income neighborhoods live eight years longer, on average, than residents in the lowest income neighborhoods. And life expectancy varies dramatically by race, with Asians living an average of 83 years and American Indians 62.
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"When a lot of people hear the word 'health,' they think about 'medical care,'” says Susan Palchick, Hennepin County Public Health director. “We're trying to get the message across that there are a lot of things other than medical care that help determine whether you're healthy. Like whether you have a stable place to live and a social network. Not everyone has equal access to these things. And that's where health equity comes in.”
Health equity is when every person has the opportunity to realize their highest level of physical, mental, and social well-being — without limits imposed by race, ethnicity, gender, income, sexual orientation, neighborhood, or other social conditions. Check out this 3 1/2 minute video, "What is health equity?," from the Health Equity Research Institute for Research, Practice, and Policy to learn more.
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This summer Fadzai Manungo completed a health equity internship with Hennepin County Public Health. The department is trying to increase health equity and reduce health disparities.
To do this, they’ve championed Health in All Policies (HiAP), an approach that integrates health considerations into decision making. Public Health has also launched several health equity pilot projects, and is working to advance health equity through trainings and communication.
During her internship, Manungo gave classes about health disparities. One of her classes used the film When the Bough Breaks from the UnNatural Causes series to show how the social determinants of health and discrimination affect infant mortality.
Studies show that the children of women with the lowest incomes and least education are at highest risk of infant mortality, in every racial group. But babies of African American mothers are at especially high risk. In fact, African American mothers with a college degree have worse birth outcomes than white mothers without a college degree!
Research suggests that this is because it’s not just the mother’s stress during pregnancy that determines the health of her baby, but the cumulative experiences of the mother over her lifetime. The corollary is that African American women have greater disparities in birth outcomes because of differential experiences across their lives.
After the class, a middle-class, college-educated African American participant came up to Manungo and said, “From the moment I sat down, that film told my life story.”
“That hit me because it was the realization that in public health we focus a lot on the population,” Manungo says. “But we always need to remember that the population is made up of individuals with real lived experiences.”
In addition to keeping an individual perspective, Manungo is adamant that statistics and classes are useless unless it yields a change in policy, planning, or program development. “You can know about everything … but at the end of the day you’re no better than someone with no knowledge if you don’t do anything about the problem,” she says.
Manungo hopes to bring her newfound knowledge back to Zimbabwe, and help reduce the health disparities that are prevalent there – as they are in America and across the world.
Written by: Lori Imsdahl