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Transforming Public Health Practice to Achieve Health Equity in Alameda County

Transforming Public Health Practice to Achieve Health Equity in Alameda County. Tony Iton, M.D., J.D., MPH Director Alameda County Public Health Department Place Matters Design Lab Oakland, Ca July 23, 2008. Health Inequities.

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Transforming Public Health Practice to Achieve Health Equity in Alameda County

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  1. Transforming Public Health Practice to Achieve Health Equity in Alameda County Tony Iton, M.D., J.D., MPH Director Alameda County Public Health Department Place Matters Design Lab Oakland, Ca July 23, 2008

  2. Health Inequities “Health inequities are differences in health status and mortality rates across population groups that are systemic, avoidable, unfair, and unjust.” -Margaret Whitehead

  3. BARHII Framework

  4. Infant mortality Mortality Life expectancy

  5. 67%

  6. What Do We Know? • Major improvements in health outcomes • Major health inequities persist or are growing - poorer residents and African Americans bear the greatest burden of poor health outcomes • Big gap in life expectancy • Major inequities in life expectancy and mortality driven by chronic diseases

  7. Chronic disease Infectious disease Injury (intentional and unintentional) Disease and Injury Mortality Access to health care 10 – 15% Genetics 10 – 15%

  8. Smoking Medical Model Nutrition Physical activity Risk Behaviors Disease and Injury Mortality Individual health knowledge 70% ?? Violence

  9. Is This All About Personal Responsibility? The Medical Model Assumes that “Risk Behaviors” are the Missing 70%

  10. Medical Model Interventions“SERVICES” • Tend to focus on individuals • Tend to be remedial in nature • Do not address underlying conditions • Expensive and difficult to sustain • No sustained impact on health disparities • Majority of Health, Social Services & Criminal Justice budget spent on these kind of interventions

  11. “Services Overkill?” How Government Human Service Agencies Behave

  12. Recipients as of Oct 2006.

  13. Community Trajectories HOW MUCH DOES PLACE MATTER?

  14. Physical environment Social environment ? Neighbor- hood Conditions Risk Behaviors Disease and Injury Mortality Residential segregation

  15. High school grads: 90% Unemployment: 4% Poverty: 7% Home ownership: 64% Non-White: 49%

  16. High school grads: 81% Unemployment: 6% Poverty: 10% Home ownership: 52% Non-White: 59%

  17. High school grads: 65% Unemployment: 12% Poverty: 25% Home ownership: 38% Non-White: 89%

  18. Life Expectancy by Poverty Group 2000-2003

  19. Tract Poverty vs. Life Expectancy

  20. Bay Area Poverty vs. Life Expectancy

  21. Cost of Poverty in Alameda County • Every additional $12,500 in household income buys one year of life expectancy • (Benefit appears to plateau at household incomes above $150,000)

  22. 1964 Oakland Residential Segregation Study • "Shows how lines of discrimination are drawn.” • “Shows the area pattern of social exclusion… community graded indices of wealth, status, health, education, and social behavior.” • “Grades fairly evenly from low to high, beginning with the Bay-flats region, and extending to the upper portion, the “hill area”. -Housing Discrimination in Oakland: A Study Prepared for the Oakland Mayor’s Committee on Full Opportunity and Alameda County Council of Social Planning-1964.

  23. “It is necessary that properties shall continue to be occupied by the same social and racial groups”- Federal Housing Administration Underwriting Manual 1938 in recommending racially restrictive covenants.

  24. Life Expectancy—Oakland Flats and Hills (2000-2003)

  25. The Neighborhood Context

  26. The Neighborhood Context

  27. Schools Corporations and businesses Institutional Power Neighbor- hood Conditions Risk Behaviors Disease and Injury Mortality Government agencies

  28. CST 4th Grade Reading Oakland Unified, by Ethnicity Source: California Department of Education, http://data1.cde.ca.gov/dataquest/

  29. CST 8th Grade ReadingOakland Unified, by Ethnicity Source: California Department of Education, http://data1.cde.ca.gov/dataquest/

  30. CST 11th Grade ReadingOakland Unified, by Ethnicity Source: California Department of Education, http://data1.cde.ca.gov/dataquest/

  31. In Oakland, African American and Latino 7th graders read below the level of White 3rd graders CAT/6 2005 Source: California Department of Education, http://data1.cde.ca.gov/dataquest/

  32. Equal Postsecondary Attendance Rates for Low-Income, High Achievers and High-Income Low Achievers Source: NELS: 88, Second (1992) and Third Follow up (1994); in, USDOE, NCES, NCES Condition of Education 1997 p. 64

  33. “The American high school is obsolete…. If we keep the system as it is, millions of children will never get a chance to fulfill their promise because of their zip code, their skin color, or the income of their parents. That is offensive to our values, and it’s an insult to who we are.”-Bill Gates addressing the National Governors Assoc. 2005

  34. NIH • “A review of the scientific literature shows associations between education and health across a broad range of illnesses, including coronary heart disease, many specific cancers, Alzheimer's disease, some mental illnesses, diabetes, and alcoholism.” -NIH RFA OB-03-001-PATHWAYS LINKING EDUCATION TO HEALTH

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