health inequities in spokane county june 28, 2012
TRANSCRIPT
Questions• What does this information mean to
you as a Board of Health member?• How can you use this information
professionally? Personally?• How do these social determinants
(and others) affect and impact members of your community?
• Are some more relevant to your community than others?
• What should/can we do as a Board of Health to address health inequities?
A Framework
Upstream Downstream
•Race•Class•Gender•Immigration status
•National origin•Sexual orientation•Disability
Discriminatory Beliefs (ISMS)
•Corporations & other
businesses•Government agencies
•Schools
InstitutionalPower
•Neighborhood conditions Social Physical•Residential segregation•Workplace conditions•Education
Social Inequities
•Smoking•Nutrition•Physical activity•Violence•Chronic stress
•Infectious disease•Chronic disease•Injury (intentional / unintentional)
•Infant mortality•Life expectancy
Social Factors
Health Status
Gen
etics
Indi
vidu
al
Hea
lth
Know
ledg
eH
ealth
care
Ac
cess
Medical Model
Risk Factors & Behaviors Disease & Injury Mortality
Socio-Ecological
Recap Important Points• Previous presentations analyzed data
thru lens of 4 Social Determinants of Health
• Inequitable distribution of health in Spokane County
• Social gradient• Composite, not individual
characteristics• Not only health, but also well being
Components of Health Inequities
Education
Neighborhood Race/Ethnicity
Income/Poverty
Level
Social Determinants of Health• Income and income distribution• Early childhood development• Employment and working conditions• Food insecurity• Housing• Social Inclusion• Social safety net• Access to health services• Gender• Race and Ethnicity• Disability
Social Determinants of Health• Social determinants of health are the
economic and social conditions under which people live which determine their health.
• They are "societal risk conditions", rather than individual risk factors that either increase or decrease the risk for a disease.
Whitehall Studies
• Studies of British civil servants• Purpose: study mortality rates• Socioeconomic factors were not initially on the
agenda• Finding: Inverse social gradient in mortality
• Whitehall made it clear that inequalities in health were not limited to the health consequences of being poor!
Whitehall I Study
Income per head and life-expectancy: rich & poor countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Health is related to income differences within rich societies but not to those between them
Within societiesBetween (rich) societies
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
0
10
20
30
40
50
60
70
80
90
100
age-a
djuste
d mort
ality
per
10,00
0
<10,000 12,000-13,999
16,000-17,999
20,000-21,999
24,000-25,999
28,000-29,999
32,000-33,999
$US 1980Davey Smith et al., AJPH 1996
Leading Causes of Death (Biomedical Model)
Heart Disease30%
Malignant neoplasm
23%
Cerebrovas-cular disease
7%
Chronic respiratory
disesaes5%
Uninten-tional in-
juries4%
Diabetes mellitus
3%
Other28%
Source: Based on Mokdad, Marks, Stroup and Gerberding, JAMA, 291:10, 2004.
Estimated actual causes of death in the US, 2004
Tobacco42%
Diet/ physical inactivity
34%
Alcohol8%
Microbial agents
7%
Toxic agents
5%
Motor vehicle crashes4%
Source: Based on Mokdad, Marks, Stroup and Gerberding, JAMA, 291:10, 2004.
McGinnis and Foege editorial
• “it is also important to better capture and apply evidence about the centrality of social circumstances to health status and outcomes…the data are still not crisp enough to quantify the contributions [of social circumstances] in the same fashion as many other factors.”
Estimated Deaths due to social conditions in the US, 2011
Low education28%
Racial seg-regation
20%
Low social support
19%
Individual level poverty
15%
Income inequality
14%
Area level poverty4%
(245,000)
(133,000)
Source: Based on Galea, Tracy , Hoggart, DiMaggio and Karpati, AJPH, 11:8, August 2011.
(176,000)
Leading Causes of Death by ModelBiomedical model Preventable Causes of
DeathSocial Causes
Heart Disease-710,760 Tobacco-435,000 Low Education-245,000
Malignant neoplasm- 553,091
Poor Diet/Physical Inactivity- 400,000
Racial Segration-176,000
Cerebrovascular disease-167,000
Alcohol consumption-85,000
Low Social Support-133,000
Chronic lower respiratory disease-122,009
Microbial agents-75,000 Individual level poverty-119,000
Determinants of Population Health
Health Behaviors
20%
Medical Care18%
Social / Societal Characteristics
53%
Genes and Biology9%
Death Rate in the US by Median family income
Source: Multiple Risk Factor Intervention Trial
Dea
th ra
te p
er 1
00,0
00 p
erso
n ye
ars
What SRHD is Doing About Health Inequities
• Health inequity report - Odds Against Tomorrow
• Creating awareness of health inequities in Spokane County – Presentations (40) with partners and community
• Strategic Goal #4 – Education of SRHD staff
• Organizing a community forum• Neighborhoods Matter• Health Promotion – Community
Transformation Grant (CTG)
Education
Occupation
Income
Gender
Race/Ethnicity
Social Position
Socioeconomic& Political Context
Governance
Policy(Macroeconomic, Social, Health)
Cultural and Societal Norms and Values
Material Circumstances
Social Cohesion
Psychosocial Factors
Behaviors
Biological Factors
Health Care System
Structural Determinants of Health Inequity
Intermediate Determinantsof Health Inequity
Social Determinants of HealthConceptual Framework
Distribution of Heathand Well-being
Goals – • Increase awareness about different health and
social factors in Spokane County• Provide information that could be used for
potential changes affecting health outcomes• Identify further areas for exploration
Audience – • Health professionals• Policy makers• Community members• Those interested in addressing health concerns
in Spokane County
Purpose of Odds Against Tomorrow
Questions• What does this information mean to
you as a Board of Health member?• How can you use this information
professionally? Personally?• How do these social determinants
(and others) affect and impact members of your community?
• Are some more relevant to your community than others?
• What should/can we do as a Board of Health to address health inequities?