1. Place Matters for Health: Geographic Health Patterns in Genesee County
Daniel J. Kruger, PhD
University of Michigan
School of Public Health
Genesee County Public Health Week Conference
May 7, 2013

2. John Snow England, 1813 - 1858 Voted “the greatest doctor of all time”
Hospital Doctor magazine-March 2003 survey

3. John Snow’s map of water pumps and cholera cases

4. John Snow’s map of water pumps and cholera cases
Broad Street
Pump
Cholera case
Water pump

5. John Snow Memorial

6. John Snow Memorial

7. Genesee County, Michigan

8. SPEAK TO YOUR HEALTH! Community Survey
Comparing health indicators
across geographical areas

9. Survey Methodology
Random sample of households in Genesee County
20 residents per Census Tract in Flint
10 residents per Census Tract outside of Flint
Telephone interviews conducted by the Michigan Public Health Institute
Adults ages 18 years and older
Final sample size = 1700 residents
900 in Flint and 800 Out-County
Data analyses can be weighted to take into account sampling strategy and demographic distribution

10. Survey Methodology 2011 Random sample of households in Genesee County
Adults ages 18 years and older
Telephone interviews conducted by the Michigan Public Health Institute
Mailed hard copy surveys compiled by MPHI
On-line survey linked to GCHD homepage
Results weighted to take into account sampling strategy and demographic distribution

11. Survey Topics
Physical Health and chronic health conditions Mental Health Health Care Access, Coverage, Satisfaction, Trust Physical and Mental Health Screening Health Promoting Behaviors (nutrition, exercise, etc.) Health Adverse Behaviors (tobacco use, etc.) Sleep Quality Spirituality, Religion, and Health Experiences of discrimination Financial health Violence, crime, relations with police, and incarceration Neighborhood Conditions

12. Disease Burden Heart disease Stroke Cancer Depression Anxiety Diabetes
Asthma
Sleep disorder
Sarcoidosis
Sickle cell anemia
Lupus

13. Proportion who eat at least 5 fruits and vegetables per day

14. Those who lived near more fast food outlets:
Proportion of respondents who eat at least
5 fruits and vegetables per day
Those who lived near more fast food outlets:
Were more likely to be overweight and obese
Ate fewer fruits and vegetables
Kruger, D.J., Greenberg, E., Murphy, J.B, DiFazio, D.A., & Youra, K.R. (in press). Local concentration of fast food outlets is associated with poor nutrition and obesity. American Journal of Health Promotion.

15. Minutes of exercise per week

16. Proportion who have a park in their neighborhood that they feel safe using for physical activity

17. Fear of crime

18. Proportion who sleep less than 7 hours a night

19. Diabetes Risk by EXPORT ZIP Code in Percent of Respondents Classified as High Risk In Targeted Diabetes Intervention Areas
48458
48506
48505
48504
35.0 – 36.8%
48509
30.0 – 34.9%
48532
48503
24.1 – 29.9%
48507

20. Diabetes Screening by EXPORT ZIP Code Percent of Respondents Who Say They Were Screened for Diabetes in the Past Year
48458
48506
48505
48504
76 – 82%
48509
71 – 72%
48532
48503
60 – 70%
48507

21. Project EXPORT Activities by ZIP Code Map Indicates Percent of Respondents Classified as High Risk in 2003 1
48458
48506
48505 1
48504 2 1
35.0 – 36.8%
48509 4
30.0 – 34.9%
48532
48503
24.1 – 29.9%
48507

22. 2005 Community Survey Results

23. Diabetes Risk Percent of Respondents 45+ Classified as High Risk for Diabetes by ZIP Code Genesee County, 2005
2005 Data
61 – 80%
51 – 60%
30 – 50%
Insufficient Data
Kruger, D.J., Brady, J.S., & Shirey, L.A. (2008). Using GIS to facilitate community-based public health planning of diabetes intervention efforts. Health Promotion Practice, 9,

24. Diabetes Diagnoses Percent of respondents who have been diagnosed with diabetes Genesee County, 2005
2005 Data
26 – 35%
16 – 25%
1 – 15%
Insufficient Data
Kruger, D.J., Brady, J.S., & Shirey, L.A. (2008). Using GIS to facilitate community-based public health planning of diabetes intervention efforts. Health Promotion Practice, 9,

25. Diabetes Screening Percent of respondents high risk for diabetes and have not been screened, Genesee County, 2005
2005 Data
31 – 50%
21 – 30%
1 – 20%
Insufficient Data
Kruger, D.J., Brady, J.S., & Shirey, L.A. (2008). Using GIS to facilitate community-based public health planning of diabetes intervention efforts. Health Promotion Practice, 9,

26. Diabetes Screening Percent of respondents high risk for diabetes and have not been screened, Genesee County, 2005 1
2005 Data 2 1 1 1 4
31 – 50%
21 – 30%
1 – 20%
Insufficient Data
2 Indicates EXPORT
Activities
Kruger, D.J., Brady, J.S., & Shirey, L.A. (2008). Using GIS to facilitate community-based public health planning of diabetes intervention efforts. Health Promotion Practice, 9,

27. Importance of the built environment

28. Elevated blood lead levels in older housing stock
Percentage of Housing Units Constructed Pre-1940 % % %
0 - 10%
Elevated Blood Lead Levels
No Exposure
Some Exposure
Lead Poisoned (10-19)
Lead Poisoned (20+)
Kruger, D.J., Shirey, L.A., Taylor, S. (in press). GIS facilitates community-based child lead screening efforts. Michigan Journal of Public Health.

29. Flint Environmental Block Assessment
Vacant
Residential structures

30. Flint Environmental Block Assessment
Residential structures in
disrepair or not salvageable

31. Flint Environmental Block Assessment
Vacant
Commercial structures

32. Flint Environmental Block Assessment
Commercial structures in
disrepair or not salvageable

33. The built environment affects social conditions and mental health
EBA Data
Community Survey Data
Kruger, D.J., Reischl, T.M., & Gee, G.C. (2007). Neighborhood social conditions mediate the association between physical deterioration and mental health. American Journal of Community Psychology, 40,

35. Density of deteriorated structures

36. Density of pre-mature births

37. Density of low birth weight births

38. The built environment and birth outcomes
Correlations with density of structural deterioration
Race
Pre-maturity
Low birth weight
All
.441***
.500***
Black
.354***
.336***
White
.228**
.026
N = 169; ** indicates p < .01, *** indicates p < Controlling for
maternal education, paternal education, and private insurance status.
Kruger, D.J., Munsell, M.A., & French-Turner, T. M. (2011). Using a life history framework to understand the relationship between neighborhood structural deterioration and adverse birth outcomes. Journal of Social, Evolutionary, and Cultural Psychology, 5,

39. The built environment and birth outcomes
Black births were overrepresented in areas with high structural deterioration
Proportion of births by area level of deterioration
Race
Top 25%
Top 5%
Black
49%
20%
White
22% 6%
Kruger, D.J., Munsell, M.A., & French-Turner, T. M. (2011). Using a life history framework to understand the relationship between neighborhood structural deterioration and adverse birth outcomes. Journal of Social, Evolutionary, and Cultural Psychology, 5,

40. University of Michigan
Thank you!
Daniel J. Kruger, PhD
University of Michigan
School of Public Health