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Health Equity: The Evolution of Public Health Practice in the 21 st Century December 4, 2013 Rex Archer, MD MPH Director of Health Kansas City, Missouri.

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Presentation on theme: "Health Equity: The Evolution of Public Health Practice in the 21 st Century December 4, 2013 Rex Archer, MD MPH Director of Health Kansas City, Missouri."— Presentation transcript:

1 Health Equity: The Evolution of Public Health Practice in the 21 st Century December 4, 2013 Rex Archer, MD MPH Director of Health Kansas City, Missouri Saving Lives, Protecting People from Health Threats, Saving Money through Prevention

2 “ Public health is what we, as a society, do collectively through organized actions to assure the conditions in which all people can be healthy.” -Institute of Medicine (1988), Future of Public Health

3 “Show-Me” Health Overall National Rank 2012: 42 2011 Rank: 401990 Rank 24

4 "The reason we have government is to solve problems collectively that we can not solve individually." Dr. Thomas Farley, NYC Health Commissioner (from the HBO May, 2012 Documentary, "Weight of the Nation" Saving Lives, Protecting People from Health Threats, Saving Money through Prevention

5 Zip Code* Life expectancy (years) Zip Code* Life expectancy (Years) 64158856410876 64112836411076 64113836411176 64156836413176 64157836413376 64151826412475 64152816413475 64153816412974 64154816412373 64114796414573 64117796410671 64118796412771 64155796410970 64116786412870 64119786413270 64137786413069 6413878 Life Expectancy by Zip Code, Kansas City, MO, 2008-2009 *Zip codes with population >5,000 people. 10-16 years difference

6 Life expectancy by zip code, Kansas City, MO 2008-2009 Life expectancyNonwhite Below poverty, Median household (year)%income ($) 81-85 years14.17.376,928 73-79 years35.120.546,241 69-71 years83.539.023,363 *Too small population to calculate life expectancy

7 Longest and Shortest Life Expectancy Area by Zip Code, KCMO Longest life expectancy Shortest life expectancy 4zipcodes area has 55,846 residents 5zipcodes area has 46,162 residents Kansas city, MO has 459,787 residents

8 Leading Causes Crude Mortality Rates in Two Areas, CMO 2005-2009 4zipcodes include zip code 64109, 64128, 64130, 64132, which are the shortest life expectancy; 5zipcodes include zip code 64112, 64113, 64156, 64157, and 64158, which are the longest life expectancy.

9 1.INTERRUPT TRANSMISSION How Are Epidemics Reversed? 3. CHANGE COMMUNITY NORMS 2. BEHAVIOR CHANGE

10 The Cure Violence / Aim4Peace Model to Stop Shootings and Killings Identification and Detection Change Behaviors and Norms Interruption, Intervention and Risk Reduction Data and Monitoring

11 Image: Neil Slade Interrupt Transmission: Anger

12 Prepared by: T.Cole Exhibit A EPD Sector 330 – YellowEPD Sectors 320 & 340 - Grey

13 Prepared by: T.Cole Aim4Peace is not a silver bullet… We are focused on prevention of gun-related violence that is primarily related to arguments and retaliation in targeted areas of East Patrol, but we seek to expand to the entire Kansas and Missouri Region. A4P Current Target Zone: Kansas City Police Sector 330 (Beat 324 is of keen interest. We monitor, without proper staffing level.) 2010 (Jan-Dec) 2011 (Jan-Dec) 2012 (Jan- Dec) diff% change2013 (Jan-Dec 1, 2013) diff% change 331043-25%2 -33% 3326374133%1 -6 -86% 333052-3-60%0 -2 -100% 334834133%3 -25% 141516 17% 6 -10 -63% 324474-3-100% 1 -3 -75%

14 January – October 2013 Results Prepared by: T.Cole Conflict Mediations by KCPD Sector Sector 1101 Sector 1401 Sector 2101 Sector 3207 Sector 33031 Other6 A4P Current Target Zone: Kansas City Police Sector 330 Provide Alternatives to violence: 47 Conflicts mediated 34 Dispute intakes (calls for service)

15 Annualized infant mortality rates by zip code median family income, KCMo, 2003-2007 Saving Lives, Protecting People from Health Threats, Saving Money through Prevention

16 Kansas City’s Geography of Health Inequity 16 Source: Map produced by and data derived from the Kansas City Health Department, 2010 Community Health Assessment

17 Saving Lives, Protecting People from Health Threats, Saving Money through Prevention

18 Family &Culture

19

20 Health Inequities Health Disparities

21 Family &Culture PlacePolicyNarrative POWER

22 Health System Dynamics Presented by: Jeanne F. Ayers, Minnesota Department of Health - Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world. Atlanta, GA: Syndemics Prevention Network, Centers for Disease Control and Prevention; April 15, 2008. Available at: http://www.cdc.gov/syndemics/monograph/index.htmhttp://www.cdc.gov/syndemics/monograph/index.htm

23 Safer, Healthier Population Becoming Vulnerable Becoming no longer vulnerable Vulnerable Population Becoming Afflicted without Complications Developing Complications Afflicted with Complications Targeted protection Primary prevention Secondary prevention Dying from Complications Tertiary prevention Society's Health Response General protection Adverse Living Conditions World of Providing… Education Screening Disease management Pharmaceuticals Clinical services Physical and financial access Etc… Medical and Public Health Policy DISEASE AND RISK MANAGEMENT World of Transforming… Deprivation Dependency Violence Disconnection Environmental decay Stress Insecurity Etc… By Strengthening… Leaders and institutions Foresight and precaution The meaning of work Mutual accountability Plurality Democracy Freedom Etc… Healthy Public Policy & Public Work DEMOCRATIC SELF-GOVERNANCE Presented by: Jeanne F. Ayers, Minnesota Department of Health - Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world. Atlanta, GA: Syndemics Prevention Network, Centers for Disease Control and Prevention; April 15, 2008. Available at: http://www.cdc.gov/syndemics/monograph/index.htmhttp://www.cdc.gov/syndemics/monograph/index.htm Areas of Emphasis

24 Refocusing Upstream

25 Seeing a Wider Set of Relationships Health Living Conditions Capacity to Act Centers for Disease Control and Prevention, Bobby Milstein

26 Power Ability to act or produce an effect

27 Arena’s of Power Directly impacting decision makers Developing deeper relationships and aligning interests Consciously shifting the narrative

28 Latinos/Hispanics in Kansas City, Missouri 2001-2010

29 Hispanic Population, 2000 and 2010 Distribution of Hispanic population, by age, Kansas City, Missouri, 2000 and 2010 20002010 Age (Years)Hispanic Percent Hispanic All RacesHispanic Percent Hispanic All Races 0-43,61511.4%31,7556,00917.4%34,557 5-93,0159.5%31,8295,96919.3%30,874 10-142,4478.0%30,7704,70016.5%28,566 15-192,4658.5%29,0533,94813.6%28,931 20-243,23710.2%31,5903,55610.4%34,043 25-346,0928.4%72,3938,97511.9%75,490 35-444,2265.9%71,3096,73111.0%60,956 45-542,5494.5%56,4925,3868.3%64,947 55-641,3263.8%34,6622,3304.6%50,717 65-741,0013.7%27,1631,3645.1%26,701 75+6312.6%24,5298323.5%24,005 Total30,6046.9%441,54549,80010.8%459,787

30 Hispanic Males, 2000 and 2010 Distribution of Hispanic men, by age, Kansas City, Missouri, 2000 and 2010 20002010 Age (Years)Hispanic Percent Hispanic All RacesHispanic Percent Hispanic All Races 0-41,87611.6%16,1053,33319.0%17,570 5-91,5509.6%16,2193,10919.8%15,703 10-141,2808.1%15,8072,45416.9%14,525 15-191,3709.4%14,578238416.5%14,420 20-241,85912.2%15,2841,5499.5%16,277 25-343,4359.5%36,0794,44512.0%37,191 35-442,3586.6%35,4983,35911.0%30,564 45-541,3685.0%27,1542,9469.2%32,073 55-646524.0%16,1851,3245.5%23,997 65-744493.8%11,6718637.2%11,943 75+2573.0%8,5612803.1%8,920 Total16,4547.7%213,14126,04611.7%223,183

31 Hispanic Females, 2000 and 2010 Distribution of Hispanic women, by age, Kansas City, Missouri, 2000 and 2010 20002010 Age (Years)Hispanic Percent Hispanic All RacesHispanic Percent Hispanic All Races 0-41,73911.1%15,6502,67615.8%16,987 5-91,4659.4%15,6102,86018.9%15,171 10-141,1677.8%14,9632,24616.0%14,041 15-191,0957.6%14,475156410.8%14,511 20-241,3788.5%16,3062,00711.3%17,766 25-342,6577.3%36,314453011.8%38,299 35-441,8685.2%35,8113,37211.1%30,392 45-541,1814.0%29,3382,4407.4%32,874 55-646743.6%18,4771,0063.8%26,720 65-745523.6%15,4925013.4%14,758 75+3742.3%15,9685523.7%15,085 Total14,1506.2%228,40423,75410.0%236,604

32 Births Hispanic births, Kansas City, Missouri, 2001-2010 YearHispanicPercent HispanicAll Ethnicities 200199713.6%7,345 20021,01513.8%7,357 20031,15215.7%7,345 20041,28217.2%7,442 20051,27116.8%7,582 20061,25816.0%7,866 20071,32416.5%8,023 20081,23115.7%7,850 20091,09214.1%7,758 20101,03213.9%7,429 Total11,65415.3%75,997

33 Deaths Hispanic deaths, Kansas City, Missouri, 2001-2010 YearHispanicPercent HispanicAll Ethnicities 20011002.6%3,896 20021122.9%3,840 20031173.1%3,742 20041233.3%3,745 20051133.0%3,784 20061122.9%3,809 20071283.4%3,721 20081032.6%3,903 2009822.3%3,609 20101032.8%3,643 Total1,0932.9%37,692

34 Poverty and income Poverty and income, by race and ethnicity, 2007-2011, Kansas City, Missouri, American Community Survey Families living in poverty (n (%)) Households receiving food stamps (n(%)) Mean per capita income (in dollars) White5,6647.64%10,05935.92%$30,033 Black or African American8,54735.43%15,05153.74%$21,258 American Indian and Alaska Native 79 1890.67%$15,999 Asian34715.77%4961.77%$ 24,707 Native Hawaiian and Other Pacific Islander 66 980.35%$11,024 Hispanic or Latino origin (of any race) 2,35731.21%2,6189.35%$20,151 White alone, not Hispanic or Latino 4,5586.52%8,74531.22%$31,048

35 Language Languages spoken at home, Kansas City, Missouri, 2007- 2011, American Community Survey NumberPercent Population 5 years and over 511,60692.77 English only456,56689.24 Language other than English 55,04110.76 Speak English less than "very well" 23,83643.31 Spanish32,4796.35 Speak English less than "very well" 15,18546.75

36 Expansion of Medicaid coverage reduces mortality among adults Benjamin D. Sommers DB et al. Mortality and Access to Care among Adults after State Medicaid Expansions. N Engl J Med 2012; 367:1025-1034 176 insured to prevent one death per year For every 10M more insured, ~57,000 lives saved per year For every 300,000 additional Missourians insured by Medicaid ~ 1,700 lives saved per year ~150 KCMO lives Saved per year

37 Questions? Your Nationally Accredited Kansas City, Mo., Health Department Improving Service. Protecting People. Saving Lives.

38 POPULATION APPROACH VS. INDIVIDUAL APPROACH

39 Public Health As A Social Justice Enterprise JUSTICE = TRUTH + POWER Public Health Practice Research + Data Community Organizing =

40 Of all the forms of inequality, injustice in health is the most shocking and inhumane. -- Martin Luther King, Jr. Presentation at: The Second National Convention of the Medical Committee for Human Rights; March 25, 1966; Chicago, IL.

41 In U.S., Latinos outlive whites by 2 1/2 years CDC's report on life expectancy yields surprising results - Associated Press 10-13-10

42

43 January – October 2013 Results Prepared by: T.Cole A4P Current Target Zone: Kansas City Police Sector 330 Indicator Quarterly Data MayJuneJulyQ1 (May-July) AugustSeptemberOctoberQ2 (Aug - Oct) Aim4Peace (street conflict) mediations526132147 Number of community changes in intermediary measures to assess how Aim4Peace Program is contributing to overall change in the zone 31263217 Number of participants and pre-participants who received case management services through the Aim4Peace Program 876568220555153159 Number of contacts with participants and pre- participants (target is 4 contacts per participant) 117301332750 294 172214680 Percent of participants who are high risk100%93%87%93.3% 84% (26/31) 84% (27/32) 84% (26.7/31.7)

44 Examples Condoms, eat healthy, be physically active Rx for high blood pressure, high cholesterol Poverty, education, housing, inequality Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax Religious, moral teachings, beliefs Largest Impact Smallest Impact Contributory (Social) Justice Changing the Context to make individuals’ default decisions healthy Long-lasting Protective Interventions Clinical Interventions Counseling & Education Socioeconomic Factors Factors that Affect Health Frieden, Archer

45 Population and Employment Population and employment by race/ethnicity, Kansas City, Missouri, 2007-2011, American Community Survey Population (n (%))Adults in labor force (n (%))Unemployed (n (%)) Total population551,464 One race534,65196.95% White357,90564.90%205,82657.51%18,39910.94% Black or African American 142,61725.86%69,84048.98%19,53932.10% American Indian and Alaska Native 2,2650.41%1,26755.94%18318.90% Asian13,0052.36%7,24755.73%63910.82% Native Hawaiian and Other Pacific Islander 1,0740.19%43540.50%143.99% Hispanic or Latino origin (of any race) 48,8668.86%23,48048.05%3,97818.40% White alone, not Hispanic or Latino 331,70960.15%192,99758.18%16,70210.67%


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