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Place Matters for Health: Geographic Health Patterns in Genesee County Daniel J. Kruger, PhD University of Michigan School of Public Health Genesee County.

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Presentation on theme: "Place Matters for Health: Geographic Health Patterns in Genesee County Daniel J. Kruger, PhD University of Michigan School of Public Health Genesee County."— Presentation transcript:

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, Voted the greatest doctor of all time Hospital Doctor magazine-March 2003 survey

3 John Snows map of water pumps and cholera cases Cholera case Water pump

4 John Snows map of water pumps and cholera cases Cholera case Water pump Broad Street Pump

5 John Snow Memorial

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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 Random sample of households in Genesee County 20 residents per Census Tract in Flint20 residents per Census Tract in Flint 10 residents per Census Tract outside of Flint10 residents per Census Tract outside of Flint Telephone interviews conducted by the Michigan Public Health Institute Telephone interviews conducted by the Michigan Public Health Institute Adults ages 18 years and older Adults ages 18 years and older Final sample size = 1700 residents Final sample size = 1700 residents 900 in Flint and 800 Out-County900 in Flint and 800 Out-County Data analyses can be weighted to take into account sampling strategy and demographic distribution Data analyses can be weighted to take into account sampling strategy and demographic distribution

10 Survey Methodology 2011 Random sample of households in Genesee CountyRandom sample of households in Genesee County Adults ages 18 years and olderAdults ages 18 years and older Telephone interviews conducted by the Michigan Public Health InstituteTelephone interviews conducted by the Michigan Public Health Institute Mailed hard copy surveys compiled by MPHIMailed hard copy surveys compiled by MPHI On-line survey linked to GCHD homepageOn-line survey linked to GCHD homepage Results weighted to take into account sampling strategy and demographic distributionResults 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 Proportion of respondents who eat at least 5 fruits and vegetables per day 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. Those who lived near more fast food outlets: Were more likely to be overweight and obese Ate fewer fruits and vegetables

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 2003 Percent of Respondents Classified as High Risk In Targeted Diabetes Intervention Areas – 29.9% 30.0 – 34.9% 35.0 – 36.8%

20 by EXPORT ZIP Diabetes Screening by EXPORT ZIP Code Percent of Respondents Who Say They Were Screened for Diabetes in the Past Year 76 – 82% 71 – 72% 60 – 70% 48458

21 Project EXPORT Activities by ZIP Code Map Indicates Percent of Respondents Classified as High Risk in – 29.9% 30.0 – 34.9% 35.0 – 36.8%

22 2005 Community Survey Results

23 Diabetes Risk Percent of Respondents 45+ Classified as High Risk for Diabetes by ZIP Code Genesee County, – 80% 51 – 60% 30 – 50% Insufficient Data 2005 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 45+ who have been diagnosed with diabetes Genesee County, – 35% 16 – 25% 1 – 15% Insufficient Data 2005 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 45+ high risk for diabetes and have not been screened, Genesee County, – 50% 21 – 30% 1 – 20% Insufficient Data 2005 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 45+ high risk for diabetes and have not been screened, Genesee County, – 50% 21 – 30% 1 – 20% Insufficient Data 2005 Data 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 % % % % % No Exposure Some Exposure Lead Poisoned (10-19) Lead Poisoned (20+) Elevated Blood Lead Levels 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 Residential structures in disrepair or not salvageable Flint Environmental Block Assessment

31 Vacant Commercial structures Flint Environmental Block Assessment

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

33 The built environment affects social conditions and mental health EBA DataCommunity 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,

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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 RacePre-maturityLow birth weight All.441***.500*** Black.354***.336*** White.228**.026 N = 169; ** indicates p <.01, *** indicates p <.001. 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 RaceTop 25%Top 5% Black49%20% White22%6% Proportion of births by area level of deterioration 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 Thank you! Daniel J. Kruger, PhD University of Michigan School of Public Health


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