J. Michael Oakes, PhD McKnight Presidential Fellow Associate Professor

1. Health Disparities J. Michael Oakes, PhD McKnight Presidential Fellow Associate Professor Division of Epidemiology & Community Health Minnesota Population Center University of Minnesota oakes007@umn.edu

2. As a biological process, we should expect differences (ie, variation) in health across individuals and groups. Pick (most) any health outcome and you’ll find differences in incidence and impact by race and class.

3. The rub is in “why” the differences exist? What’s the difference b/w a “difference” and a “disparity”? Should we be concerned with outcomes or processes? Is strict equality Good? To what extent should research offer/propose remedies?

5. Provocative, motivating documentary that should get our public health activist and research juices flowing!

6. Major Themes • Poor are less healthy • Society is making us sick • Chronic stress without control is mechanism if illnesses • We must reduce economic inequality to mitigate if not eliminate health disparities • Immigrants suffer by coming here

7. This stuff is too important to be sloppy in our thinking… What are facts?

8. Source: Coleman, W. (1982). Death is a Social Disease: Public Health and Political Economy in Early Industrial France. Madison, WI, University of Wisconsin Press.

9. Percentage of Poor Families over Time

10. Health Disparities?

11. Rich White Socioeconomic status Black Health Disparity = 3 Poor

12. Rich Excellent Health Disparity = 7 Socioeconomic status Poor Poor

13. Rich Excellent Health Disparity = 2 Poor2 Poor1 Poor

14. Rich Excellent Health Disparity = 2 Poor Poor

15. Rich Health Loss = 5 Socioeconomic status Health Disparity = 3 Poor Poor

16. Rich Excellent Poor Health Loss = 7 Health Disparity = 2 Health Loss = 1

17. Excel1 Health Loss = 2 Excel2 Rich Health Disparity = 6 Poor2 Poor Health Gain = 2 Poor1

18. Rich Excel2 Health Gain = 5 Health Disparity = 11 Excel1 Poor2 Health Gain = 4 Poor1 Poor

19. Income Inequality?

20. Lynch, J., et al. 2004. "Is income inequality a determinant of population health? Part 1. A systematic review." Milbank Q 82:5-99.

22. Lynch, J., et al. 2004. "Is income inequality a determinant of population health? Part 2. U.S. National and regional trends in income inequality and age- and cause-specific mortality." Milbank Q 82:355-400.

24. Culter, David, Angus Deaton, and Adriana Lleras-Muney. 2006. "The determinants of Mortality." Journal of Economic Perspectives 20:97-120.

25. Lee, Roland. 2003. "The demographic transition" Journal of Economic Perspectives 17

26. Non-White White InfantMortality Rates by Race, US 1900 - 1998

27. Culter, David, Angus Deaton, and Adriana Lleras-Muney. 2005. "The determinants of Mortality." White paper

28. Risk of Death by Race/Ethnicity White is reference NDI-linked NHIS data, persons 18+ in 1986-1995 samples Rogers RG, RA Hummer, CB Nam. 2000. Living and Dying in the USA: Behavioral, Health, and Social Differentials of Adult Mortality. New York: Academic Press. Figure 4.1, page 64

29. What is the effect of neighborhood poverty on American Indian infant death in Minnesota? Johnson, Pamela Jo. 2004. "The Effect of Neighborhood Environments on American Indian Mortality in Minnesota." Unpublished PhD Dissertation. Division of Epidemiology, University of Minnesota.

30. Lower Life Expectancy?

31. But Cuba!!! It’s a dictatorship island that you cannot escape. IRM rates are probably fraudulent, if not surely don’t include efforts to save preemies or other sick kids. Maternal mortality is sky high, 4-5 times higher than US. Sure, you’ll be employed but you have little to no choice in your career or life plans. 10,000 – 50,000 died trying to get to Miami.

32. How much more should the rich have to do?