1. Health Inequities in Spokane County Health Inequities in Spokane County Board of Health April 26, 2012

2. Why Race/Ethnicity? What We Heard Though race and ethnicity wasn’t specifically discussed, several focus group participants reflected on the impact of their race on their quality of life. One participant describes his socioeconomic status as follows: “I’m always the first to say that I was born a white, American male. I am at the top of the food chain as far as economic opportunities. I don’t think it gets any easier.” Focus Group Participant (income >75k)

3. The Gardner Family

4. Population by Race/Ethnicity in Spokane County - 2009 Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting

5. Population of Ethnic Minorities in Spokane County - 2009 Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting

6. Percent Growth of Racial/Ethnic Groups in Spokane County 2000 to 2008 Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting

7. Overall Percent Growth of Racial/Ethnic Groups in Spokane County 2000 to 2008 Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting Racial/Ethnic GroupPopulation 2000Population 2008Percent of Growth Whites NH383,128414,7178.2% Blacks NH8,0159,48118.3% AIAN NH5,6996,65916.8% API NH9,53612,86334.9% Hispanic11,56115,28932.2%

8. Unemployment by Race/Ethnicity Washington State Unemployment by Race among Adults 18 to 65 Years of Age, Washington State, 2000 to 2008 Data Source: Washington State Population Survey NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

9. Poverty by Race/Ethnicity Racial/Ethnic Differences in Overall Poverty, 2000 to 2008 Data Source: Washington State Population Survey NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

10. Children Living in Poverty by Race/Ethnicity Racial/Ethnic Differences in Poverty among Children Less Than 18 Years of Age, 2000 to 2008 Data Source: Washington State Population Survey NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

11. General Health Status by Race/Ethnicity General Health Status by Race/Ethnicity among Adults 25 Years of Age or Older, 2000 to 2008 Data Source: Behavioral Risk Factor Surveillance System (BRFSS) NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

12. Incidence of HIV by Race/Ethnicity New HIV Diagnosis Rates (Incidence) by Race/Ethnicity, 2002 to 2008 Data Source: Washington State HIV Surveillance Report NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

13. Leading Causes of Mortality per 100,000 (Age Adjusted) by Race/Ethnicity Spokane County Whites NHBlacks NHAIAN NHAPI NHHispanics RankCause of DeathRateRankCause of DeathRateRankCause of DeathRateRankCause of DeathRateRank Cause of Death Rate 1 Malignant neoplasms 184.41 Diseases of the heart^ 185.51 Malignant neoplasms^ 257.21 Malignant neoplasms 108.61 Malignant neoplasms 132.7 2 Diseases of the heart 156.52 Malignant neoplasms 154.42 Diseases of the heart 137.22 Diseases of the heart 102.22 Diseases of the heart 87.6 3 Chronic lower respiratory diseases* 53.93 Diabetes mellitus^ 93.33 Unintentional injury^ 97.73 Cerebrovascular diseases^ 63.23 Diabetes mellitus^ 49.2 4 Unintentional injury 53.14 Cerebrovascular diseases^ 63.84 Chronic lower respiratory diseases*^ 75.74 Diabetes mellitus^ 40.14 Alzheimer’s disease^ 40.9 5 Cerebrovascular diseases 45.85 Unintentional injury 33.85 Alzheimer’s disease^ 64.85 Unintentional injury 32.65 Unintention al injury 31.6 ^Significantly higher than Spokane County * Includes bronchitis, emphysema, asthma Data Source: Death Certificates, Washington State Department of Health, Center for Health Statistics

14. Mean age of Death by Race/Ethnicity Mean Age of Death by Race/Ethnicity Adults 25 Years of Age or Older, 2008 to 2009 Data Source: Death Certificates, Washington State Department of Health, Center for Health Statistics

15. A Framework for Health Inequity Upstream Downstream Race Class Gender Immigration status National Origin Sexual orientation Disability Race Class Gender Immigration status National Origin Sexual orientation Disability Discriminatory Beliefs (ISMS) Corporations & other businesses Government agencies Schools Corporations & other businesses Government agencies Schools Institutional Power Neighborhood conditions  Social  Physical Residential segregation Workplace conditions Neighborhood conditions  Social  Physical Residential segregation Workplace conditions Social Inequities Smoking Nutrition Physical activity Violence Chronic Stress Smoking Nutrition Physical activity Violence Chronic Stress Infectious disease Chronic disease Injury (intentional / unintentional) Infectious disease Chronic disease Injury (intentional / unintentional) Infant mortality Life expectancy Infant mortality Life expectancy Social Factors Health Status Genetics Individual Health Knowledge Healthcare Access Medical Model Risk Factors & Behaviors Disease & InjuryMortality Socio-Ecological

16. “In order to get beyond racism, we must first take account of race. There is no other way. And in order to treat people equally, we must treat them differently.” Harry A. Blackmun American Supreme Court justice

17. Adrian E. Dominguez, M.S. Epidemiologist Spokane Regional Health District Disease Prevention and Response Community Health Assessment, Planning, and Evaluation adominguez@spokanecounty.org 509.324.1670 adominguez@spokanecounty.org Adrian E. Dominguez, M.S. Epidemiologist Spokane Regional Health District Disease Prevention and Response Community Health Assessment, Planning, and Evaluation adominguez@spokanecounty.org 509.324.1670 adominguez@spokanecounty.org