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Welcome to

Health,Race,andSocialDeterminants


Today’s Team…

AndyKingTrainingSpecialistAmeriCorpsVISTA

RobynStegmanProjectSpecialist

CampaignConsultation,Inc.

SuzanneKniznerProjectSpecialist

CampaignConsultation,Inc.


Today’s Agenda

• CaseStudy:LeeCounty• HealthDisparities• SocialDeterminantsofHealth• HowCanWeDoBetter?


Today’s Presenter

DanielS.Blumenthal,MD,MPHProfessorofCommunityHealth&PreventiveMedicine

AssociateDeanforCommunityHealthMorehouseSchoolofMedicineVISTAHealthAdvocates1969‐70


Presenter Content


Lee County, 1969

• 7th‐poorestcountyinUS• Population~18,000• 60%black• Povertyrate=50%


Lee County Cooperative Clinic

• StartedwithOEOgrant

• Organizedasacooperative:all‐consumer(patient)BoardofDirectors

• 2directorselectedfromeachof4NeighborhoodActionCouncils


Lee County, 1971‐72

• ConcernedCitizensofLeeCounty– firstblackcandidatessinceReconstruction

• Schoolboycott

• Downtownbusinessboycott

• Shotsfired,buildingsburned


Lee County ‐ Progress

• 1990BillLewellen– firstblackstatesenator

• 1994RobertTaylor– firstblackmayorofMarianna


Lee County facts

• 2009population10,000• Povertyrate:

• 197050%• 198036%• 200025%• 201038%


Health Disparities


Poll

Whichracial/ethnicgrouphasthehighestmortalityrate?Thelowest?(groupslistedinalphabeticorder)• Asian• Black(African‐American)• Hispanic• NativeAmerican• White


Mortality Rates, All Causes

Deaths/100,000population– age‐adjustedSource:Health,UnitedStates,2009

• Asian436.7• Hispanic579.5• NativeAmerican652.9• White777.8• Black1,006.2


Mortality Rates


Heart Disease Mortality Rates

• Asian134.6

• NativeAmerican157.4

• Hispanic180.5

• White239.2

• Black308.4


Heart Disease Mortality


Cancer Mortality Rates

• Asian113.6


• Hispanic128.4

• White195.6

• Black238.8


Cancer Mortality


Stroke Mortality Rates

• Hispanic41.3


• Asian47.7

• White54.6

• Black76.3


Stroke Mortality


Diabetes Mortality Rates

• Asian17.4

• White22.2

• Hispanic35.6


• Black49.5


Diabetes Mortality


Homicide Mortality Rates

• White2.8

• Asian2.9

• Hispanic7.3


• Black21.0


Homocide Mortality


AIDS Mortality Rates

• Asian0.8

• White2.1


• Hispanic5.8

• Black22.5


Homicide Mortality


Infant MortalityInfantDeaths/1000livebirths

• Asian4.8• Hispanic5.6• White5.8• NativeAmerican8.6• Black13.8


Infant Mortality


Are We Making Progress?

• 1985:ReportoftheSecretary’sTaskForceonBlackandMinorityHealth.• MargaretHeckler,SecretaryofUSDHHS

58,942excessAfrican‐Americandeathsin1979‐81


Poll

20yearslater,thenumberofexcessdeathswas:• Higher• Lower• Aboutthesame


Are We Making Progress?

• 2005:Satcher,Fryer,McCann,Troutman,Woolf,andRust:WhatIfWeWereEqual?HealthAffairs(Millwood)24:2005459‐464

83,570excessAfrican‐Americandeathsin2002


How can we do better?


Social Determinants of Health

“Thesocialdeterminantsofhealtharethecircumstancesinwhichpeopleareborn,growup,live,workandage,andthesystemsputinplacetodealwithillness.Thesecircumstancesareinturnshapedbyawidersetofforces:economics,socialpolicies,andpolitics.”

‐‐ WorldHealthOrganization


Some Social Determinants of Health

• Poverty• Education• Housing• Occupation• Transportation• Socialstatus• Racism


Poverty by Race/Ethnicity

White Black Hispanic Other Total

United States 13% 35% 33% 23% 20%

Georgia 16% 34% 42% 18% 23%


Income Distribution: Children with Asthma vs. All Children


Education and Health


HS Graduate or MoreYear White Black Hispanic

1960 43.2% 20.1% NA

1970 54.5 31.4 32.1

1980 68.8 51.2 44.0

1990 79.1 66.2 50.8

2000 84.9 78.5 57.0

2010 87.6 84.2 62.9


College Graduate or MoreYear White Black Hispanic

1960 8.1% 3.1% NA

1970 11.3 4.4 4.5

1980 17.1 8.4 7.6

1990 22.0 11.3 9.2

2000 26.1 16.5 10.6

2010 30.3 19.8 13.9


Unemployment Rates by Education


Health Insurance


Fighting the War on Cancer


Cancer Mortality Rates, Age‐Adjusted, All Sites, US

Deaths/100,000DataSource:USDHHS:HealthUnitedStates,2002;SEERupdate2006


Poll

Thedecreaseincancermortalityrateisprimarilydueto:• Newdiscoveriesincancergenetics• Improvedcancertreatment• Morecancerprevention• Youngerpopulation


Lung Cancer Mortality Rates, Age‐Adjusted, U.S.Deaths/100,000

DataSource:USDHHS:HealthUnitedStates,2002;SEERupdate2009


Smoking Prevalence, US,Males > 18 Years Old, 1965‐2000


Smoking Prevalence, US,Females > 18 Years Old, 1965‐2000


Education and Smoking%ofSmokers

Education Cigarette Smokers

GED 49%HSdropout 34%Somecollege(nodegree) 23%Associatedegree 20%Undergraduate degree 11%Graduatedegree 6%


%ofSmokersEducation and Smoking


Poverty and Smoking

• Atorabovepovertylevel:19%smokers• Belowpovertylevel:31%smokers


Summary

• Healthinequitiesaretiedtosocialdeterminants:• Raceandracism• Poverty• Education• Occupation• Etc.

• Addressinganyofthesewillhelpreduceinequities


Addressing Social Determinants

• Poverty• Collectingusedclothing

forthepoor• Establishingajob

trainingprogram





trainingprogram

• Education• Tutoringkidsafter

school• Organizingtoadvocate

forincreasedpublicschoolfunding





trainingprogram




• Racism• Identifyandreport

violationsofequalhousinglaws.





trainingprogram




• Racism• Identifyandreport

violationsofequalhousinglaws.

• HealthInsurance• Workwithorganizations

advocatingforMedicaidexpansionundertheAffordableCareAct(“Obamacare”)


That’s All Folks


Questions?


Evaluation

Pleasetakeafewmomentstoshareyourfeedback.Howcanweimprovethesesessions?Whattopicsshouldweincludeinfuturewebinars?

Thankyouverymuchforyourtimeandparticipation!


THANK YOUfor your participation!

Ifyouhavefurtherquestionsorformoreinformation,contactus:[email protected]

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health, race, and social determinants final.ppt · pdf fileto join the audio portion, please...

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