Promoting Equity and Increasing Accessibility For All

The term “health equity” is broadly used, yet somewhat abstract. The World Health Organization defines it as “the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.” One angle of health equity that we don’t often think about is that of accessibility for individuals facing the barriers imposed by disability. This year at TEDMED 2017, we will hear from Speakers focused on improving equity for people with disabilities and who are working to make the world a more accessible place for all.

Automatic Alternative Text

Facebook accessibility specialist and engineer Matt King lost his vision completely in college. When he joined our accessibility team after more than 20 years in the accessibility field, one of the projects he was most excited to work on centered on using object recognition technology to automatically describe photos for people who are not able to see those photos. Today, with our launch of automatic alternative text, we're taking an important step towards achieving that goal.Automatic alternative text, or automatic alt text, is a new feature that generates a description of a photo through object recognition technology for someone who cannot see the photo. Before today, people who are visually impaired could only hear the name of the person who posted the photo as they scrolled past photos on Facebook. Now, if they're using a screen reader on iOS, they'll hear a richer description of the photo thanks to automatic alt text. For example, for a group photo on the beach, a person using a screen reader on iOS would now hear, “This image may contain: Three people, smiling, outdoors.” We are rolling this out in English over the next few weeks and will add more languages and platforms soon.Facebook's mission is to make the world more open and connected, and that means everyone, including the visually impaired community. Worldwide, more than 39 million people are blind, and over 246 million have a severe visual impairment. While this technology is still in its early stages, tapping its current capabilities to describe photos is a huge step toward providing our visually impaired community the same benefits and enjoyment that everyone else gets from photos. As Facebook becomes an increasingly visual experience, we hope our new automatic alt text technology will help the visually impaired community experience Facebook the same way others enjoy it.

Posted by Facebook Accessibility on Montag, 4. April 2016

 

Matt King is making technology and social networking more accessible and user-friendly for individuals with disabilities. As Facebook’s first blind Accessibility Engineer, Matt recognizes that as technology evolves, there is an opportunity to design it in a way that is inclusive and accessible for all users. A record-breaking tandem cyclist and three-time Paralympian, Matt is skilled at breaking through expectations and barriers. Driven by the belief that providing accessible platforms for creativity and social networking benefits everyone involved, Matt has channeled his determination toward creating equitable opportunities for people with disabilities to engage and make connections online. Matt challenges us to look at technology through a broader lens, make it more equitable, and work to redefine what is meant by “user experience” in Silicon Valley.

Amber signing with Wiz Khalifa

Much like Matt is making technology more accessible, American Sign Language (ASL) music interpreter Amber Galloway Gallego is providing the Deaf community with full access to the experience of music and live performance. Prior to launching her own production company, Amber had only witnessed lackluster ASL interpreters at concerts—performances that left her Deaf friends feeling bored and devoid of the same personal connection to music that Amber felt so strongly. After watching the expressive work of a Deaf dance company, she was inspired to bridge the access gap in the music industry. Her work is captivating, conveying emotions, tone, and guitar riffs through sign, interpreting for stage artists like the Red Hot Chili Peppers and appearing on Jimmy Kimmel Live! with Wiz Khalifa.

Amber’s work to make music more accessible to the Deaf community shines a spotlight on another area of inequality: health care. Often, health care settings fail to provide qualified interpreters for their patients or providers lack cultural competence when communicating with their Deaf patients. Because of language and cultural barriers, Deaf patients experience higher risk of morbidities such as cardiac disease and obesity, often entering the health system at a more expensive point in their care.

Another population often afflicted by a lack of access to care and feelings of isolation is the elderly. Numerous studies have shown that chronic loneliness and social isolation can have negative health consequences; in fact, loneliness exceeds obesity as a predictor for premature death. The experience of loneliness is not limited to a particular part of the world. In the United States and the United Kingdom, 30% of adults over the age of 65 and 50% of those over 85 live alone. Sophie Andrews, CEO of The Silver Line helpline, is committed to forging social connections and bridging the communication gap for older people in the United Kingdom. The Silver Line is a 24/7 hotline that fields 10,000 calls each week, providing callers with information about local services, friendship to combat loneliness, and a place to report neglect or abuse. Fifty-three percent of callers to The Silver Line say they have literally no one else to speak with. Sophie and her organization provide an accessible platform for older people to engage in confidential conversations without judgement.

These Speakers are taking steps towards connecting our world by creating platforms of inclusion. They have made music, health care resources, personal connection, and technology easier to access for so many people, improving health outcomes and personal well-being. We invite you to join us this November to hear their stories and learn more about their work.

Promoting Health Equity by Choice

This guest blog post was written by Dr. Mary Travis Bassett, the Commissioner of the New York City Department of Health and Mental Hygiene. Dr. Bassett spoke at TEDMED 2015.

mary-bassettNew York City is one of the most diverse but racially segregated cities in the United States. Neighborhood segregation and structural racism, including poor housing conditions and limited educational opportunities, have led to unacceptable health disparities in our city. In turn, these health disparities have led to many lives – mainly the lives of poor New Yorkers and people of color – being cut short.

On average, New York City residents are expected to live longer than the average person in the United States. However, within the five boroughs, health outcomes can vary substantially from one subway stop to another. Average life expectancy rates can obscure those worrying variations between neighborhoods. In places like the South Bronx and Brownsville, Brooklyn, where I first lived when I was a little girl, people can expect to live lives about 8-10 years shorter than a person living in Manhattan’s Upper East Side or Murray Hill.

The usual explanation for these unhappy odds is that people in these neighborhoods are making a whole series of bad lifestyle choices. They eat too much, don’t exercise, smoke, drink, and so on. I’d like to challenge everyone to think differently.

Instead of thinking that people in Brownsville live shorter lives because they are choosing to eat unhealthy foods and choosing not to exercise enough, let’s think of how a lack of choice can impact a person’s health. For example, people don’t choose to live in a neighborhood where it’s unsafe to walk or exercise outside at night. People don’t choose to rent an apartment in a community that does not have a grocery store nearby. No one chooses to take a job that pays a wage impossible to live on, let alone live healthy on. The problem is not lifestyle choices that are bad for one’s health, but having too few choices that negatively affect a person’s health.

When we think about health, we have to think about restoring choices. For people to live healthier, they need good housing, a more livable wage, a good education, and safe spaces to exercise. All of these help build a neighborhood where people look out for each other. To achieve health equity, we have to confront all of the factors that affect a person’s ability to live a healthy life. That’s why as health commissioner, I will use every opportunity to speak out against injustice and rally support for health equity.

Our new initiative, Take Care New York 2020, seeks to do just that. It is the City’s blueprint for giving everyone the chance to live a healthier life. Its goal is twofold — to improve every community’s health, and to make greater strides in groups with the worst health outcomes, so that our city becomes a more equitable place for everyone. TCNY 2020 looks at traditional health factors as well as social factors, like how many people in a community graduated from high school or go to jail.

Additionally, the City’s investment in Pre-K for All will go a long way toward addressing the inequalities we’ve seen emerge so early in life, which reverberate across the lifespan. Investing in early childhood development is an anti-poverty measure, an anti-crime measure, and it is good for both mental and physical health. For example, the number of words a child knows at age 3 predicts how well he will do on reading tests in third grade, predicts his likelihood of graduating from high school, and so on. Early investment is key to undoing decades of injustice.

I believe that achieving health equity is a shared responsibility, and we can only accomplish real change by working together. This is a big challenge, but I am hopeful. New Yorkers are fortunate to have a Mayor and an administration that is committed to addressing longstanding inequality. Every city needs such committed leadership if we are to see a day where someone’s ZIP code does not determine their health. I hope you will join us on this pursuit of equity.

Why do doctors practice race-based medicine?

by Dorothy Roberts, guest contributor

Biological scientists established decades ago that the human species can’t be divided into genetically discrete races. Social scientists have shown that the racial classifications we use today are invented social groupings. And historians of medicine have traced doctors’ current practice of treating patients by race to justifications for slavery. Doctors I’ve talked to readily concede that race is a “crude” proxy for patients’ individual characteristics and clinical indicators. Countless patients have been misdiagnosed and treated unjustly because of their race.

So why do doctors cling so fiercely to race-based medicine?

BWSyringe2One reason is force of habit. For generations, beginning in the slavery era, medical students have been taught to take the patient’s race into account. Race is built into the foundations of medical education, which assumes that people of different races are biologically distinct from each other and suffer from diseases in peculiar ways. What’s more, medical students aren’t given much latitude to question the lessons they are taught about race.  Without a radical disruption, these students go on to train the next generation of doctors with the same flawed racial dogmas.

Another reason is that doctors aren’t immune from commonly-held racial stereotypes and misunderstandings. Most Americans believe some version of a biological concept of race, and doctors are no exception. In fact, the entire field of biology has been plagued by controversy and confusion over the meaning of race. It is not surprising that the medical profession would be influenced by racial thinking that has been perpetuated in U.S. education, culture, and politics for centuries.

In addition, there are institutional and commercial incentives to continue practicing medicine by race. Starting in the 1980s, the federal government required the scientific use of racial categories to ensure greater participation of minorities in clinical research and to address health disparities. Unfortunately, this effort to diversify clinical studies focused on biological rather than social inequalities and has reinforced genetic definitions of race.  In 2005, the federal Food and Drug Administration approved the first race-specific drug, a therapy for African-American patients with heart failure, that was repackaged as a race-based pill to enable the cardiologist who developed it to obtain a patent. Labeling drugs by race may be financially advantageous to pharmaceutical companies by providing a marketing niche and an avenue for FDA approval. The biomedical research and pharmaceutical industries have tremendous influence over how medicine is practiced.

Doctors are quick to bristle at any suggestion that treating patients by race results from their own racial prejudice. They disavow any connection to blatantly racist medicine of the past—the horrific treatment of enslaved Africans; unethical medical experimentation on African Americans, such as the Tuskegee Syphilis Study and use of Henrietta Lacks’ cancer cells; Jim Crow segregation of medical services; and mass sterilization of black, Mexican-origin, Puerto Rican, and Native American women in the 1960s and 1970s.

Doctors argue that they are using race for benevolent reasons or, at most, as a benign way to classify their patients. But race is not a benign category. Race was invented to support racism and it is inextricably tied to racial oppression and the struggle against it. There is no biological reason to divide human beings into white, black, yellow, and red. Race seems natural only because we have been taught to see each other this way. Sometimes, when I speak to doctors about this topic, I can see their physical discomfort with giving up their reliance on race. It feels like asking deeply religious people to give up their belief in their deity. Race is more than an ordinary medical feature—it is part of people’s deeply-held identities, their sense of their place in society, and their view of how the world is ordered. This is why ending race-based medicine will require a great leap of imagination, a new vision of humanity tied to a movement for racial justice.

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Global scholar, University of Pennsylvania civil rights sociologist, and law professor Dorothy Roberts exposes the myths of race-based medicine in her TEDMED 2015 talk.