Presentation on theme: "Health Inequities in Spokane County June 28, 2012"— Presentation transcript:
1 Health Inequities in Spokane County June 28, 2012
2 QuestionsWhat does this information mean to you as a Board of Health member?How can you use this information professionally? Personally?How do these social determinants (and others) affect and impact members of your community?Are some more relevant to your community than others?What should/can we do as a Board of Health to address health inequities?
3 Discriminatory Beliefs (ISMS) A FrameworkSocio-EcologicalMedical ModelIndividual Health KnowledgeGeneticsUpstream DownstreamRaceClassGenderImmigration statusNational originSexualorientationDisabilityDiscriminatory Beliefs (ISMS)Corporations & other businessesGovernment agenciesSchoolsInstitutionalPowerNeighborhood conditionsSocialPhysicalResidential segregationWorkplace conditionsEducationSocial InequitiesSmokingNutritionPhysical activityViolenceChronic stressInfectious diseaseChronic diseaseInjury (intentional / unintentional)Infant mortalityLife expectancyRisk Factors & BehaviorsDisease & InjuryMortalityFramework for Health EquityUsed to understand and address the multiple pathways that lead to stark differences in health outcomesTraditionally , Public Health Departments work on the right side of the chartProviding immunizations, diabetes education, smoking cessation, and other services to individuals in needHowever, health education and access to healthcare can only influence outcomes, but only partially explain different health outcomesHealth StatusHealthcare AccessSocial Factors
4 Recap Important Points Previous presentations analyzed data thru lens of 4 Social Determinants of HealthInequitable distribution of health in Spokane CountySocial gradientComposite, not individual characteristicsNot only health, but also well being
6 Social Determinants of Health Income and income distributionEarly childhood developmentEmployment and working conditionsFood insecurityHousingSocial InclusionSocial safety netAccess to health servicesGenderRace and EthnicityDisability
7 Social Determinants of Health Social determinants of health are the economic and social conditions under which people live which determine their health.They are "societal risk conditions", rather than individual risk factors that either increase or decrease the risk for a disease.A key component of this definition is that our health is shaped by our surroundings.
8 Whitehall Studies Studies of British civil servants Purpose: study mortality ratesSocioeconomic factors were not initially on the agendaFinding: Inverse social gradient in mortalityWhitehall made it clear that inequalities in health were not limited to the health consequences of being poor!The first Whitehall study was first set up in the 1960s, as a kind of a British Framingham Study (tell them about Framingham), in that it was a longitudinal study of cardiorespiratory disease and diabetes, looking at individual risk factors. The purpose was to study mortality rates among British civil servants, agedSocioeconomic factors were not initially on the agenda.The general view at the time was that poor people got diseases because of material deprivation and rich people got heart disease and ulcers because of stress.In this population middle-aged British men, all employed in stable jobs in the British Civil Service, there was an inverse social gradient in mortality: lower the grade, the higher the risk of death.In other words, it showed that the more senior you are in the employment hierarchy, the longer you might expect to live, compared to people in lower employment grades. This is particularly interesting when we reflect that the civil services excludes the richest and the poorest members of society.Low status was also associated with obesity, smoking, less physical activity, and higher blood pressure.RR for death from heart disease was 2.2 for clerical compared to senior administrative staffRR for death from heart disease was 1.6 for those in intermediate professional and professional grades
9 Whitehall I StudyThis is one of the important pieces of data from Whitehall I. It’s showing us all-cause mortality in the cohort British civil servants by grade or rank within their system. For orientation, it’s better to have a lower mortality rate, so lower the better. Also in their system, administration (pinkish purple) is the highest ranking and other (in green) is the lowest ranking.This data clearly shows a gradient in mortality rates with the lowest mortality in the high ranking administration workers and the highest in other (messengers, doorkeepers, etc.)
10 Income per head and life-expectancy: rich & poor countries Source: Wilkinson & Pickett, The Spirit Level (2009)
11 Health is related to income differences within rich societies but not to those between them Within societiesBetween (rich) societiesSource: Wilkinson & Pickett, The Spirit Level (2009)Davey Smith et al., AJPH 1996
12 Leading Causes of Death (Biomedical Model) Source: Based on Mokdad, Marks, Stroup and Gerberding,JAMA, 291:10, 2004.
13 Estimated actual causes of death in the US, 2004 Source: Based on Mokdad, Marks, Stroup and Gerberding,JAMA, 291:10, 2004.
14 McGinnis and Foege editorial “it is also important to better capture and apply evidence about the centrality of social circumstances to health status and outcomes…the data are still not crisp enough to quantify the contributions [of social circumstances] in the same fashion as many other factors.”
15 Estimated Deaths due to social conditions in the US, 2011 (176,000)Source: Based on Galea, Tracy , Hoggart, DiMaggio and Karpati,AJPH, 11:8, August 2011.
16 Leading Causes of Death by Model Biomedical modelPreventable Causes of DeathSocial CausesHeart Disease-710,760Tobacco-435,000Low Education-245,000Malignant neoplasm- 553,091Poor Diet/Physical Inactivity- 400,000Racial Segration-176,000Cerebrovascular disease-167,000Alcohol consumption-85,000Low Social Support-133,000Chronic lower respiratory disease-122,009Microbial agents-75,000Individual level poverty-119,000
17 Determinants of Population Health Scientists generally recognize five determinants of health of a populationFigure 1 represents rough estimates of how much each of the five determinants contributes to the health of a population. Scientists do not know the precise contributions of each determinant at this time.
18 Death Rate in the US by Median family income Death rate per 100,000 person yearsSource: Multiple Risk Factor Intervention Trial
19 What SRHD is Doing About Health Inequities Health inequity report - Odds Against TomorrowCreating awareness of health inequities in Spokane County – Presentations (40) with partners and communityStrategic Goal #4 – Education of SRHD staffOrganizing a community forumNeighborhoods MatterHealth Promotion – Community Transformation Grant (CTG)
20 Social Determinants of Health Conceptual Framework Socioeconomic& Political ContextGovernancePolicy(Macroeconomic,Social, Health)Cultural and Societal Norms and ValuesEducationOccupationIncomeGenderRace/EthnicitySocial PositionMaterial CircumstancesSocial CohesionPsychosocial FactorsBehaviorsBiological FactorsHealth Care SystemDistribution of Heathand Well-beingStructural Determinantsof Health InequityIntermediate Determinantsof Health Inequity
21 Purpose of Odds Against Tomorrow Goals –Increase awareness about different health and social factors in Spokane CountyProvide information that could be used for potential changes affecting health outcomesIdentify further areas for explorationAudience –Health professionalsPolicy makersCommunity membersThose interested in addressing health concerns in Spokane CountyProject has taken 1 year to complete.You will find yourself somewhere on the ladder regardless of what component we are looking at i.e. education, income, race/ethnicity, neighborhoodPassion and interest in this area of workData alarmingWe want to look at health in Spokane County and Washington State through an inequity lens for various social determinants of health i.e. education, poverty, race/ethnicity, neighborhood and we want to provide information that can be used for potential changes in policies that affect human life and health outcomes.Before we get started, I want to go over a few definitions that are used when discussing health inequities.Quantitative PartQualitative Part
22 QuestionsWhat does this information mean to you as a Board of Health member?How can you use this information professionally? Personally?How do these social determinants (and others) affect and impact members of your community?Are some more relevant to your community than others?What should/can we do as a Board of Health to address health inequities?