Health Inequities in Spokane County June 28, 2012

1. Health Inequities in Spokane County June 28, 2012

2. 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?

3. A Framework Socio-Ecological Medical Model Individual Health Knowledge Genetics UpstreamDownstream • 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 Inequities • Smoking • Nutrition • Physical activity • Violence • Chronic stress • Infectious disease • Chronic disease • Injury (intentional / unintentional) • Infant mortality • Life expectancy Institutional Power Discriminatory Beliefs (ISMS) Risk Factors & Behaviors Disease & Injury Mortality Health Status Healthcare Access Social Factors

4. 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

5. Components of Health Inequities

6. 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

7. 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.

8. 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!

9. Whitehall I Study

10. www.equalitytrust.org.uk Income per head and life-expectancy: rich & poor countries Source: Wilkinson & Pickett, The Spirit Level (2009)

11. www.equalitytrust.org.uk Health is related to income differences within rich societies but not to those between them Between (rich) societies Within societies Davey Smith et al., AJPH 1996 Source: Wilkinson & Pickett, The Spirit Level (2009)

12. Leading Causes of Death (Biomedical Model) Source: Based on Mokdad, Marks, Stroup and Gerberding, JAMA, 291:10, 2004.

13. Estimated actual causes of death in the US, 2004 Source: Based on Mokdad, Marks, Stroup and Gerberding, JAMA, 291:10, 2004.

14. 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.”

15. Estimated Deaths due to social conditions in the US, 2011 (176,000) Source: Based on Galea, Tracy , Hoggart, DiMaggio and Karpati, AJPH, 11:8, August 2011.

16. Leading Causes of Death by Model

17. Determinants of Population Health

18. Death Rate in the US by Median family income Death rate per 100,000 person years Source: Multiple Risk Factor Intervention Trial

19. 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)

20. Intermediate Determinants of Health Inequity Socioeconomic & Political Context Distribution of Heath and Well-being Structural Determinants of Health Inequity Social Position Material Circumstances Social Cohesion Education Governance Psychosocial Factors Occupation Behaviors Policy (Macroeconomic, Social, Health) Income Biological Factors Gender Race/Ethnicity Cultural and Societal Norms and Values Health Care System Social Determinants of HealthConceptual Framework

21. Purpose of Odds Against Tomorrow 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

22. 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?