INFORM ME: PRINCIPLES

Current Thinking
Disparities in health status or health risk exposure are often the result of institutionalized practices, not necessarily the result of individual behavior patterns. They result primarily from inequitable distribution of resources at the institutional level, such as cessation programs being available primarily to persons with health insurance, but not to uninsured people. Another example is the tobacco industry’s marketing practices that target and influence specific population groups disproportionately. To eliminate disparities these institutionalized practices, need to be addressed at the policy or macro level and done using comprehensive (multiple), sustained strategies. Tobacco control efforts will have greater impact if they are integrated with efforts to influence environmental conditions (e.g., poverty, low education levels) that are the result of institutionalized practices.

Components
The principle behind eliminating disparities is one of equalizing the outcomes of tobacco control work among different populations in a specific community. There are three primary components to achieving the goal of eliminating disparities.

1. Knowledge of Community - A program must be culturally competent so as to understand the community it serves. The program should take into account:

   a. History: Past events that impact various groups of people.
   b. Culture: This refers to shared values, such as religion, agrarian life style, etc.
   c. Context: Certain populations are impacted negatively by racism or homophobia, for example.
   d. Geography: The unique qualities of a geographic area (e.g., the south side of town) must be taken into account.

2. Knowledge

   a. Research that addresses specific needs compiled by researchers who represent the community or interests of the population.
   b. Programs that reflect the diversity of the community or population.
   c. Leaders representative of the community or population.
   d. Organizations that represent community, or population tobacco control interests and that provide related services.
   e. Networks representing the community or population that facilitate communication, planning, coordination, policy analysis and agenda setting.

3. Program Plans that Specifically Address Disparities - Community tobacco control and prevention strategies need to have specific goals and objectives addressing the elimination of disparities, using broad public health approaches. These plans should emphasize community development and social determinants of health at the institutional level.

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