PHE 500 BARHII Model Text Version Title of graphic: A Public Health Framework for Reducing Health Inequities Source of graphic: Bay Area Regional Health Inequities Initiative (BARHII) Conceptual Framework, 2006. The Bay Area Regional Health Inequities Initiative (BARHII) model shows how factors impacting health can be presented through an upstream/downstream model —with upstream inequities that can create unequal living conditi ons. These unequal conditions then shape how we can approach our health behaviors, which lead to disparities downstream in disease, injury, and mortality. Upstream inequities include the following : Social inequities (Class , race/ethnicity, immigration status, gender, sexual orientation ) Which are causally connected to the following : Institutional inequities (Corporations and businesses, government agencies, schools, laws and regulations, not -for -profit organization s) Which are causally connected to the following : Living conditions , including the following : Physical Environment o Land Use o Transportation o Housing Residential Segregation o Exposure to Toxins Social Environment o Experience of Class, Racism, Gender, Immigration o Culture , Ads , Media Violence Economic and Work Environment o Employment o Income o Retail Businesses o Occupational Hazards Service Environment o Health Care o Education o Social Services Living conditions are causally connected to the following : Risk behaviors (Smoking, poor nutrition, low physical activity, violence, alcohol and other drugs, sexual behavior ) Risk behaviors are causally connected to the following : Disease and injury (Communicable disease, chronic disease, injury (intentional and unintentional )) Disease and injury are connected to Mortality (Infant mortality, life expectancy ) Strategic Partnerships and Advocacy impact Institutional Inequities . Community Capacity Building , Community Organizing , Civic Engagement impact Living Conditions . Policy impacts both upstream and downstream determinants . Individual Health Education mitigates Risk Behaviors . Health Care impacts Disease and Injury . Case Management impacts Risk Behaviors and Disease and Injury . Emerging Public Health Practice focuses on upstream determinants . Current Public Health Practice focuses on downstream determinants .