Transcript Spokane Counts

Health Inequities in
Spokane County
Board of Health
April 26, 2012
Why Race/Ethnicity?
What We Heard
Education
Income/
Poverty
Level
Neighborhood
Race/
Ethnicity
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)
The Gardner Family
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
Population of Ethnic Minorities
in Spokane County - 2009
API NH
29.1%
AIAN NH
15.0%
Hispanic
34.5%
Black NH
21.4%
Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting
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
Overall Percent Growth of Racial/Ethnic
Groups in Spokane County 2000 to 2008
Racial/Ethnic Group Population 2000
Population 2008
Percent of Growth
Whites NH
383,128
414,717
8.2%
Blacks NH
8,015
9,481
18.3%
AIAN NH
5,699
6,659
16.8%
API NH
9,536
12,863
34.9%
Hispanic
11,561
15,289
32.2%
Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting
Unemployment by Race/Ethnicity
Washington State
Unemployment by Race among Adults 18 to 65 Years of Age, Washington State, 2000 to 2008
20.0
Percent of Unemployment
Higher proportions of American Indians/Alaska Natives, Blacks, and Hispanics are unemployed.
15.0
11.6
11.0
9.5
10.0
5.1
5.1
5.0
0.0
Hispanic
AIAN NH
Black NH
Data Source: Washington State Population Survey
NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander
API NH
White NH
Poverty by Race/Ethnicity
Racial/Ethnic Differences in Overall Poverty, 2000 to 2008
Percent of Persons in Poverty
75
52.1
Higher proportions of American Indians/Alaska Natives, Blacks, and Hispanics live in poverty.
58.5
41.5
50
44.5
39.9
38.1
26.3
20.5
20.1
25
20.8
0
Spokane County
AIAN NH
Black NH
Washington State
Hispanic
Data Source: Washington State Population Survey
NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander
White NH
API NH
Children Living in Poverty by Race/Ethnicity
Racial/Ethnic Differences in Poverty among Children Less Than 18 Years of Age, 2000 to 2008
Percent of Children <18 Years of Age in Poverty
100
Higher proportions of American Indians/Alaska Natives, Blacks, and Hispanics children live in poverty.
73.9
80
62.3
65.5
53.4
60
54.0
42.9
20.8
40
31.9
25.1
27.9
20
0
Spokane County
AIAN NH
Black NH
Washington State
Hispanic
Data Source: Washington State Population Survey
NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander
White NH
API NH
General Health Status by Race/Ethnicity
General Health Status by Race/Ethnicity among Adults 25 Years of Age or Older, 2000 to 2008
75
Percent of Adults >= 25 Years of Age
with Fair/Poor Health
Poor or fair health is much more common among American Indians/Alaska Natives, Blacks, and Hispanics.
36.4
34.3
50
25.6
30.7
14.0
25
28.8
23.0
16.8
15.8
10.3
0
Spokane County
AIAN NH
Black NH
Washington State
Hispanic
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander
White NH
API NH
Incidence of HIV by Race/Ethnicity
New HIV Diagnosis Rates (Incidence) by Race/Ethnicity, 2002 to 2008
60
The rate of HIV infection occurs more frequently among Black, American Indians/Alaska Natives, and Hispanics.
43.8
29.3
Rate per 100,000
45
16.1
30
10.5
13.3
15
10.9
3.9
5.9
6.8
0
Spokane
Black NH
Washington State
AIAN NH
Hispanic
Data Source: Washington State HIV Surveillance Report
NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander
White NH
API NH
5.6
Leading Causes of Mortality per 100,000 (Age
Adjusted) by Race/Ethnicity Spokane County
Whites NH
Blacks NH
AIAN NH
API NH
Hispanics
Rate
Rank
Cause of Death
Rate
Rank
Cause of
Death
Rate
257.2
1
Malignant
neoplasms
108.6
1
Malignant
neoplasms
132.7
2
Diseases of the
137.2
heart
2
Diseases of the
heart
102.2
2
Diseases of
the heart
87.6
93.3
3
Unintentional
injury^
97.7
3
Cerebrovascular
diseases^
63.2
3
Diabetes
mellitus^
49.2
Cerebrovascular
diseases^
63.8
4
Chronic lower
respiratory
diseases*^
75.7
4
Diabetes
mellitus^
40.1
4
Alzheimer’s
40.9
disease^
Unintentional
injury
33.8
5
Alzheimer’s
disease^
64.8
5
Unintentional
injury
32.6
5
Unintention
al injury
Rank
Cause of Death
Rate
Rank
Cause of Death
Rate
Rank Cause of Death
1
Malignant
neoplasms
184.4
1
Diseases of the
heart^
185.5
1
2
Diseases of the
heart
156.5
2
Malignant
neoplasms
154.4
3
Chronic lower
respiratory
diseases*
53.9
3
Diabetes
mellitus^
4
Unintentional
injury
53.1
4
5
Cerebrovascular
diseases
45.8
5
Malignant
neoplasms^
^Significantly higher than Spokane County
* Includes bronchitis , emphysema, asthma
Data Source: Death Certificates, Washington State Department of Health, Center for Health Statistics
31.6
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
Upstream
Downstream
Institutional
Power
Social
Inequities
•Race
•Class
•Gender
•Immigration
status
•National
Origin
•Sexual
orientation
•Disability
•Corporations
& other
businesses
•Government
agencies
•Schools
•Neighborhood
conditions
Social
Physical
•Residential
segregation
•Workplace
conditions
Risk Factors &
Behaviors
Disease & Injury
Mortality
•Smoking
•Nutrition
•Physical
activity
•Violence
•Chronic
Stress
•Infectious
disease
•Chronic
disease
•Injury
(intentional /
unintentional)
•Infant
mortality
•Life
expectancy
Health
Status
Healthcare
Access
Discriminatory
Beliefs (ISMS)
Social
Factors
Medical Model
Genetics
Individual
Health
Knowledge
Socio-Ecological
A Framework for Health Inequity
“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
Adrian E. Dominguez, M.S.
Epidemiologist
Spokane Regional Health District
Disease Prevention and Response
Community Health Assessment, Planning , and Evaluation
[email protected]
509.324.1670