1. Health Inequities in Spokane County

2. Why Neighborhoods/Place? What We Heard “My neighborhood is better than it was when I was a kid. It’s been about six months since we’ve had a shooting within 5 blocks of my house. That’s a good distance between shootings. I remember being 2-3 years old watching out my window, watching people shoot at each other.” Focus Group Participant (income <35k)

3. Teenage Pregnancy (15 to 19 Years of Age), Spokane County Neighborhoods, 2005-2009 RankNeighborhoodPercentLower CIUpper CI 1West Central17.22^*14.2720.61 2Logan15.95^*13.0319.33 3Chief Garry Park15.28^*12.2518.82 4East Central14.90^*12.6817.39 5Riverside14.43^*9.6620.72 Spokane County8.73*8.399.07 Washington State8.19+8.118.28 36Balboa/S. Indian Trail4.461.799.19 37South Palouse4.31+>2.936.12 38Comstock2.38+>1.034.69 39Manito1.33+>0.363.41 405 Mile0.71+>0.092.58 Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health, Birth Certificates ^Significantly higher than Spokane County *Significantly higher than Washington State +Significantly lower than Spokane County >Significantly lower than Washington State

4. Maternal Smoking, Spokane County Neighborhoods, 2005-2009 RankNeighborhoodPercentLower CIUpper CI 1West Central41.24^*36.5946.32 2Riverside40.80^*32.4550.64 3Browne’s Addition36.36^*27.7546.81 4Hillyard33.39^*28.8338.46 5Logan32.36^*28.1437.04 Spokane County18.20*17.7218.69 Washington State10.13+10.0310.22 36North Indian Trail6.83+>4.549.87 37Comstock5.65+>3.408.83 38Southgate4.73+>3.066.99 395 Mile4.66+>2.487.97 40Manito4.00+>2.076.99 Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health, Birth Certificates ^Significantly higher than Spokane County *Significantly higher than Washington State +Significantly lower than Spokane County >Significantly lower than Washington State

5. Causes of Mortality (Age Adjusted Rate per 100,000) in Spokane County with Top Five Neighborhoods, Cause of Death Spokane County Rate Washington State Rate Rank 1Rank 2Rank 3Rank 4Rank 5 NeighborhoodRateNeighborhoodRateNeighborhoodRateNeighborhoodRateNeighborhoodRate 1. Major cardiovascular disease 255.8249.2Riverside^374.7Hillyard^372.1 Nevada/ Lidgerwood^ 351.3East Central^330.7Edgecliff323.5 2. Malignant neoplasms188.1183.5 Chief Garry Park^ 271.9Whitman^267.9Minnehaha^263.8East Central^228.3Edgecliff^228.1 3. Chronic lower respiratory diseases 54.645.6Riverside^104.4Hillyard^96.7East Central^86.0Bemiss^83.1 Emerson/ Garfield^ 79.5 4. Unintentional injury49.138.1Riverside^164.3West Hills^110.2East Central^85.5West Central^84.6Hillyard70.6 5. Alzheimer’s disease35.239.3 North Indian Trail^ 69.5 Emerson/ Garfield^ 68.3South Palouse^62.2Manito50.1 Mead/Green Bluff/Mt. Spokane^ 49.4 6. Diabetes mellitus26.324.3 Emerson/ Garfield^ 59.3Whitman^56.7 Nevada/ Lidgerwood^ 52.4 Chattaroy/ Deer Park^ 48.6 Chief Garry Park 38.7 7. Suicide15.712.8Riverside^46.4Cliff/Cannon^28.6Hillyard^26.5 Browne’s Addition 25.5Logan25.5 8. Influenza and pneumonia 14.514.1 Emerson/ Garfield^ 34.4West Central24.0Edgecliff^23.8University^23.2 Chief Garry Park 22.0 9. Chronic liver disease and cirrhosis 10.39.3Riverside^44.7West Hills27.0East Central^24.6 Browne’s Addition 21.8Hillyard20.7 10. Parkinson’s disease7.98.1 North Indian Trail^ 17.0 Emerson/ Garfield 16.6Cliff/Cannon11.9Minnehaha10.9South Palouse10.7 ^Significantly higher than Spokane County

6. Overall Age-Adjusted Mortality Rate (per 100,000), Spokane County Neighborhoods, 2005-2009 RankNeighborhoodPercentLower CIUpper CI 1Riverside1,364.1^*1,254.01,489.6 2East Central1,102.3^*1,039.71,168.1 3Emerson/Garfield1,071.1^*996.91,149.8 4Hillyard1,026.7^*946.21,112.4 5Nevada/Lidgerwood1,026.1^*985.51,068.1 Spokane County790.1*782.0798.2 Washington State751.6749.4753.8 36Manito661.8+>591.1739.6 37Comstock594.0+>544.5648.0 385 Mile570.0+>465.8695.7 39Rockwood559.3+>494.7631.0 40Southgate520.1+>476.6566.8 Data Source: Washington State Department of Health, Death Certificates ^Significantly higher than Spokane County *Significantly higher than Washington State +Significantly lower than Spokane County >Significantly lower than Washington State

7. Life Expectancy, Spokane County Neighborhood Comparison, 1990 to 1999 vs. 2000 to 2009 Life Expectancy 1990-1999Rank2000-2009 Life Expectancy 77.55State 79.19 77.35Spokane 78.41 82.39South Palouse1Southgate 84.03 81.29Comstock2Rockwood 82.79 81.19Southgate35 Mile 82.32 81.11North Indian Trail4Comstock 82.20 80.82Cheney/Medical Lake5Balboa/S. Indian Trail 81.13 73.57Hillyard36Emerson Garfield 74.32 73.32Browne's Addition37Chief Garry Park 73.78 73.24Emerson Garfield38Hillyard 73.62 72.39East Central39East Central 72.92 65.38Riverside40Riverside66.17 Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health

8. 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

9. Health is more than absence of disease; it is about economics, education, environment, empowerment, and community. The health and well being of the people is critically dependent upon the system that serves them. It must provide the best possible health with the least disparities and respond equally well to everyone." Joycelyn Elders U.S. Surgeon General 1993-1994

10. 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