Transcript Spokane Counts

Why Are We
Unhealthy?
Adrian Dominguez
Bob Lutz
All of us should have the
opportunity to make the choices
allowing us to live a healthy life,
regardless of income,
education, ethnic background
or where we live.
Health is a resource for everyday life,
not the objective of living.
Health is a positive concept
emphasizing social and personal
resources, as well as physical capacities.
The Ladder Position
 A metaphor to explain
health inequities
 Societies are
structured like
ladders
 The rungs of the
ladder represent the
resources that
determine whether
people can live a good
life or a life plagued
by difficulties
Dynamic Relationship Between
Health and Ladder Position
Birth/
Childhood
Parental
Socioeconomic
Resources
Health
Adolescence/
Young Adult
Educational
Attainment
Health
Work/
Career
Elderly
Occupation
and
Income
Retirement
Retirement/
Income
Income
Health
Health
Health
Health
A Framework
Medical Model
Genetics
Individual
Health
Knowledge
Socio-Ecological
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
•Education
Social
Factors
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)
Socio-ecological
Model
Individual
Enhancing skills, knowledge,
attitudes and motivation
Interpersonal
Increasing support from
friends, family and peers
Organizational
Changing policies and
practices of organizations
Community
Collaborating and creating
partnerships to effect change
in the community
Public Policy
Developing, influencing, and
enforcing local, state and
national laws
That which does not kill
us makes us stronger.
Friedrich Nietzche
Health
Inequities in
Spokane County
Data Sources
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Washington State Population Survey
Behavioral Risk Factor Surveillance Survey (BRFSS)
Birth Certificates
Death Certificates
Community Health Assessment Tool (CHAT)
Office of Financial Management, Washington State
Washington State HIV Surveillance Report
Strategic Research Associates, Omnibus Survey
Purpose of Health Inequity Report
The goal of this assessment is to increase
awareness about different health and social
factors in Spokane County and provide
information that can be used for potential
changes that affect health outcomes.
• Build awareness
• Identify further areas for exploration
• Intended for health professionals, legislators (policy
makers), administrators, community members, and
anyone interested in addressing health concerns in
Spokane County
Definitions
Health Disparity
Differences in the incidence, prevalence,
mortality, and burden of diseases and other
adverse health conditions that exist among
specific population groups.
Health Inequity
Concerns those differences in population
health that can be traced to unequal economic
and social conditions and are systemic and
avoidable; thus being inherently unjust and
unfair.
Definitions
Social Determinants of Health
Factors (i.e., determinants) in our social and
economic environment that researchers have
been found to negatively (or positively) affect
health.
Social Gradient
An individual's or population group's position in
society and different access to and security of
resources such as education, employment and
housing, as well as different levels of
participation in civic society and control over life.
Components of Health Inequities
Education
Neighborhood
Income/
Poverty
Level
Race/
Ethnicity
Why Education?
What We Heard
Education
Income/
Poverty
Level
Neighborhood
Race/
Ethnicity
When invited to discuss what
could be done to improve quality
of life, many focus group
participants discussed the
importance of jobs and education:
“You said jobs, I say schooling to
get a job. Jobs are good, but I
think to get a solid job is to get an
education.”
Focus Group Participant (income <35k)
The Faces of Inequities in Spokane
Effects of Education on Poverty
Percent of Adults >=25 Years of Age in Poverty
Adults 25 Years of Age or Older Living in Poverty by Education, 2000 to 2008
80
Educational differences in poverty. As the level of education increases
for adults, the likelihood of living in poverty significantly decreases.
60
53.4
46.0
40
31.1
25.3
26.1
21.8
20
20.9
12.0
15.6
8.2
9.0
5.3
0
Spokane County
<HS
HS grad./GED
Some college (no degree)
Data Source: Washington State Population Survey
Washington State
Associate's degree
Bachelor's degree
Advanced degree
General Health Status by Education
General Health Status by Education among Adults 25 Years of Age or Older, 2000 to 2008
50
Percent of Adults >=25 Years of Age with
Fair/Poor Health
Adults with less education are more likely to rate their health as poor or fair.
40
34.0
34.8
30
20.1
18.3
20
15.4
15.3
7.7
10
7.6
7.4
6.7
0
Spokane County
Less than high school
Highschool/GED graduate
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Washington State
Some college (no degree)
Bachelor's
Advanced degree
Smoking by Education
Smoking by Education among Adults 25 Years of Age or Older, 2005 to 2009
Percent of Adults >=25 Years of Age who are
Current Smokers
45
36.1
More adults with less education smoke compared to adults with a higher education.
30
25.4
22.9
20.9
18.5
17.3
15
8.9
7.4
0
Spokane County
Less than high school
High school/GED graduate
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Washington State
Some college (no degree)
>=College graduate
Effects of Education on Cardiovascular Disease
Cardiovascular Disease by Education among Adults 25 Years of Age or Older, 2005 to 2009
Percent of Adults >=25 Years of Age who
with Cardiovascular Disease
30
Cardiovascular disease (CVD) and the likelihood of CVD
significantly decreases as the level of education increases.
24
16.3
16.9
18
13.8
12.5
10.3
12
10.7
7.5
7.3
6
0
Spokane County
Less than high school
High school/GED graduate
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Washington State
Some college
>=College graduate
Diabetes by Education
Percent of Adults >=25 Years of Age
with Diabetes
Diabetes by Education among Adults 25 Years of Age or Older, 2005 to 2009
21
15.6
Diabetes significantly decreases as the level of education increases.
15.0
12.1
14
10.9
11.9
11.1
7.8
7.3
7
0
Spokane County
Less than high school
High school/GED graduate
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Washington State
Some college
>=College graduate
Children in Poverty by Parent’s Education
Children Living in Poverty by Parent’s Highest Level of Education, 2000 to 2008
As the parent's level of education increases the likelihood of their children living in poverty
significantly decreases.
Percent of Children <18 Years of Age in Poverty
100
90.8
78.1
80
64.2
59.5
60
39.9
48.3
39.9
37.2
40
27.4
21.9
13.2
20
23.8
0
Spokane County
<HS
HS grad./GED
Some college (no degree)
Data Source: Washington State Population Survey
Washington State
Associate's degree
Bachelor's degree
Advanced degree
Infant Mortality by Mother’s Education
Infant Mortality by Mother’s Education of Women 25 Years or Older, 2003 to 2009
Infant Mortality Rate (per 1,000 live births)
25
Babies born to mothers who did not finish high school are more likely to die before their first birthday as babies
born to college graduate.
20
15.0
15
10.2
8.1
10
8.5
6.5
6.1
6.2
4.1
5
0
Spokane County
Less than high school
Data Source: Birth and Death Certificates
High school/GED graduate
Washington State
Some College
>=College graduate
Health Starts in Our
Homes, Schools and
Communities
A Framework
Medical Model
Genetics
Individual
Health
Knowledge
Socio-Ecological
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
•Education
Social
Factors
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)
Adrian E. Dominguez, M.S.
Epidemiologist
Spokane Regional Health District
Disease Prevention and Response
Community Health Assessment
[email protected]
509.324.1670