Transcript Health Inequity - Spokane Regional Health District

Health Inequities in
Spokane County
Income
Board of Health
March 22, 2012
Purpose of Health Inequity Report
 The goal of this assessment is to increase and provide a
perspective on different health and social inequities in
Spokane County and provide information that can be
used for potential changes that affect health outcomes.
– Build awareness
– Identify further areas for exploration
– Identify community partners
– Intended for health professionals, legislators (policy
makers), administrators, community members, and
anyone interested in addressing health concerns in
Spokane County
Data Sources
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
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
Through research, factors (i.e., determinants) in our
social and economic environment that 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.
The Ladder Position
 Using ladder as 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
Upstream
Downstream
Institutional
Power
•Race
•Class
•Gender
•Immigration
status
•National
Origin
•Sexual
orientation
•Disability
•Corporations
& other
businesses
•Government
agencies
•Schools
Social
Inequities
•Neighborhood
conditions
Social
Physical
•Residential
segregation
•Workplace
conditions
•Education
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
Components to Health Inequities
Why Income/Poverty Level?
What We Heard
Focus group participants were
asked about their perceptions
of stereotypes that others may
have of people from their
socioeconomic level:
“I think the biggest stereotype is
that we don’t try. I think that’s a
problem. People are at this
bracket for whatever reason,
but I certainly don’t think it’s for
lack of trying.”
Focus Group Participant (income <35k)
Scott Finyalson
Poverty
• Poverty was defined as 200% FPL using the Federal Registrar’s 2008
Percent of Poverty Guidelines
• For a family of 4 (2 adults and 2 children) at 200% FPL, the gross annual
household income equates to $42,0000
• Household income was calculated based on total income in that
household and determined as a percent of FPL
• The number of members in a household and the total income in the
household was used to determine a households poverty level
• When a poverty level was determined for a household, all individuals in
that household were given the same poverty level
Increasing Income Inequality in Spokane County
Data Source: Washington State Population Survey
Looking at Growth of Income at Each Level of
Wealth in Spokane County and Washington
State from 2000 to 2008
Change in Median Household Income (2008 Inflation-Adjusted Dollars) from 2000 to 2008
Change in Income from
2000 to 2008
5th
Percentile
10th
Percentile
25th
Percentile
50th
Percentile
75th
Percentile
90th
Percentile
95th
Percentile
Spokane County
↓1.2K
No change
↑4.3K
↑4.7K
↑8K
↑14K
↑11.5K
Washington State
↑1.1K
↑1.8K
↑5.3K
↑10.4K
↑15K
↑19.2K
↑21K
Data Source: Washington State Population Survey
Overall Poverty
Overall Poverty by Categories, 2000 to 2008
Poverty significantly increases for children whose mother is a single parent.
Data Source: Washington State Population Survey
General Health Status by Income
General Health Status by Household Income among Adults 25 Years of Age or Older, 2000 to 2008
Household Income as Percent of Federal Poverty Level
Data Source: Washington State Population Survey
Parents’ Income and a Child’s Chance for Health
Child’s Health Status by Household Income, 2000 to 2008
Household Income as Percent of Federal Poverty Level
Data Source: Washington State Population Survey
Effects of Chronic Illness on Physical Activity by Income
Physical Activity Limitations Due to Chronic Illness among Adults 25 Years of Age or Older by Household
Income, 2000 to 2008
Household Income as Percent of Federal Poverty Level
Data Source: Washington State Population Survey
Physical Inactivity Among Adults by Income
Physical Inactivity by Household Income among Adults 25 Years of Age or Older, 2005 to 2009
Household Income as Percent of Federal Poverty Level
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Smoking by Income Level
Smoking by Poverty Level, 2005 to 2009
Lower income adults are more likely to smoke than adults in higher income groups.
Household Income as Percent of Federal Poverty Level
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Diabetes by Income
Diabetes by Poverty Level among Adults 25 Years of Age or Older, 2005 to 2009
Household Income as Percent of Federal Poverty Level
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Obesity by Income
Obesity by Poverty Level among Adults 25 Years of Age or Older, 2005 to 2009
Household Income as Percent of Federal Poverty Level
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Poor Mental Health by Income
Poor Mental Health by Household Income among Adults 25 Years of Age or Older, 2005 to 2009
Household Income as Percent of Federal Poverty Level
Data Source: Behavioral Risk Factor Surveillance System (BRFSS)
Upstream
Downstream
Institutional
Power
•Race
•Class
•Gender
•Immigration
status
•National
Origin
•Sexual
orientation
•Disability
•Corporations
& other
businesses
•Government
agencies
•Schools
Social
Inequities
•Neighborhood
conditions
Social
Physical
•Residential
segregation
•Workplace
conditions
•Education
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
All we see of someone at any
moment is a snapshot of their life,
there in riches or poverty, in joy or
despair. Snapshots don't show the
circumstances and the million
decisions that led to that moment.
Richard Bach
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