Health Inequities in
Spokane County
June 28, 2012
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
Medical Model
Genetics
Individual
Health
Knowledge
Socio-Ecological
Upstream
Downstream
Institutional
Power
Social
Inequities
•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
Factors
Risk Factors &
Behaviors
Disease & Injury
Mortality
•Smoking
•Nutrition
•Physical
activity
•Violence
•Chronic
stress
•Infectious
disease
•Chronic
disease
•Injury
(intentional /
unintentional)
•Infant
mortality
•Life
expectancy
Health
Status
Healthcare
Access
Discriminatory
Beliefs (ISMS)
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
Income/
Poverty
Level
Race/
Ethnicity
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
Between (rich) societies
Within societies
age-adjusted mortality per
10,000
100
90
80
70
60
50
40
30
20
10
0
<10,000 12,000- 16,000- 20,000- 24,000- 28,000- 32,00013,999 17,999 21,999 25,999 29,999 33,999
Davey Smith et$US
al.,1980
AJPH 1996
Source: Wilkinson & Pickett, The Spirit Level (2009)
www.equalitytrust.org.uk
Leading Causes of Death (Biomedical
Model)
Other
28%
Diabetes
mellitus
3%
Unintentional
injuries
4%
Chronic
respiratory
disesaes
5%
Cerebrovascular
disease
7%
Heart Disease
30%
Malignant
neoplasm
23%
Source: Based on Mokdad, Marks, Stroup and Gerberding,
JAMA, 291:10, 2004.
Estimated actual causes of death in the US,
2004
Toxic agents
Microbial agents
5%
7%
Motor vehicle
crashes
4%
Alcohol
8%
Tobacco
42%
Diet/ physical
inactivity
34%
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
Income
inequality
14%
Individual level
poverty
15%
Area level
poverty
4%
Low education
28%
(245,000)
Low social
support
19%
(133,000)
Source: Based on Galea, Tracy , Hoggart, DiMaggio and Karpati,
AJPH, 11:8, August 2011.
Racial
segregation
20%
(176,000)
Leading Causes of Death by Model
Biomedical model
Preventable Causes of
Death
Social Causes
Heart Disease-710,760
Tobacco-435,000
Low Education-245,000
Malignant neoplasm553,091
Poor Diet/Physical
Inactivity- 400,000
Racial Segration-176,000
Cerebrovascular disease167,000
Alcohol consumption85,000
Low Social Support-133,000
Chronic lower respiratory
disease-122,009
Microbial agents-75,000
Individual level poverty119,000
Determinants of Population Health
Genes and
Biology
9%
Social / Societal
Characteristics
53%
Health
Behaviors
20%
Medical Care
18%
Death rate per 100,000 person years
Death Rate in the US by Median family
income
Source: Multiple Risk Factor Intervention Trial
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)
Social Determinants of Health
Conceptual Framework
Socioeconomic
& Political Context
Social Position
Governance
Policy
(Macroeconomic,
Social, Health)
Cultural and Societal
Norms and Values
Material Circumstances
Education
Social Cohesion
Occupation
Psychosocial Factors
Income
Behaviors
Gender
Biological Factors
Race/Ethnicity
Health Care System
Structural Determinants
of Health Inequity
Intermediate
Determinants
of Health Inequity
Distribution of Heath
and Well-being
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
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?