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FALLING BEHIND USA Playing the Game of Health Without a Scoreboard Stephen Bezruchka MD, MPH Departments of Global Health & Health Services School of Public Health University of Washington
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FALLING BEHINDUSA Playing the Game of Health
Without a ScoreboardStephen Bezruchka MD, MPH
Departments of Global Health & Health ServicesSchool of Public Health
University of Washington
AgendaPopulation Health Quiz
Health Olympics
Determinants of health
–Economic Inequality & First 1000 days
What needs to be done
Health QUIZTrue False
A 15 year old girl in the US has a smaller chance of dying before reaching age 60 than a similarly aged girl in Sri Lanka.
During the period of 1987 to 2007 life expectancy for women declined in about 30% of US counties (which was not so for the previous 20 years).
Maternal mortality in the US has increased 50% over the last 15 years.
Sri Lanka US Adult Female Mortality 1970-2010
Health QUIZTrue False
A 15 year old girl in the US a smaller chance of dying before reaching age 60 than a similarly aged girl in Sri Lanka.
During the period of 1987 to 2007 life expectancy for women declined in almost 30% of US counties (which was not so for the previous 20 years).
Maternal mortality in the US has increased 50% over the last 15 years.
Ezzati et. al 2008
Female Male
US County Life Expectancy Trends 1987-2007
Health QUIZTrue False
A 15 year old girl in the US a smaller chance of dying before reaching age 60 than a similarly aged girl in Sri Lanka.
During the period of 1987 to 2007 life expectancy for women declined in about 30% of US counties (which was not so for the previous 20 years).
Maternal mortality in the US has increased 50% over the last 15 years.
Australia, Canada, Japan, Sweden US Maternal Mortality 1970-2010
Time magazine July 30, 2012 + web update
2406 702.5
667790.5
How healthy is the US?Health Olympics
Number one Gold 1-5 _______6-10 _______11-15 _______
16-20 _______21-25 _______26-30 _______31+ _______
HEALTH OLYMPICS 2011
Life
ex
pect
ancy
5
15
10
25
20
30
United Nations Human Development Report 2011
Economist April 25, 2012
African AmericanHarlem Mortality
cf.Bangladesh
Male Life Expectancies early 2000s
United States (white) 74.6
Sri Lanka 71.5
Ecuador 71.4
Malaysia 70.9
Occupied Palestinian territories 70.9
Iran 69.0
Colombia 69.3
United States (black) 68.8
Viet Nam 68.6
El Salvador 67.8
Iraq* 67.5
Nicaragua 67.3
Journal of the National Medical Association 98(4): 488-491
Maternal Mortality Rates by Race/Ethnicity, California Residents; 1999-2008
California Pregnancy-Associated Mortality Review (2011
Country withoutBlack – White
health inequities?
Life Expectancy Race, Cuba, Brazil US
Country Whites Blacks W-B
Cuba (1981) 71.2 70.2 1.0
Brazil (1980) 66.1 59.4 6.7
USA (1980) 74.4 68.1 6.3
de la Fuente(1995): Race and Inequality in Cuba, 1899-1981
WHERE IS PACIFIC NW HEALTH?
Cascadia2002NW Env Wa
Life Expectancy
CLOSER TO HOME
Killer Facts
How healthy is the US?Health Olympics
Number one Gold 1-5 _______6-10 _______11-15 _______
16-20 _______21-25 _______26-30 _______31+ _______
1st & 4th yr US medical student knowledge of Population Health
(2002)Question INCORRECT
US has higher life expectancy than any other nation?
32%
US has lower infant mortality than any other nation?
34%
Agrawal, J. R., J. Huebner, et al. (2005). "Medical students' knowledge of the U.S. health care system and their preferences for curricular change: a national survey." Acad Med 80(5): 484-8.
Playing Game of Healthwithout a scoreboard
POPULATION HEALTH
Health Inequalities (poorer people have poorer health)
Early Life: critical for adult health
Harvey 2005
Wilkinson & Pickett 2009 Spirit Level
US MORTALITY RATES BY ZIP CODE INCOME
Index of: • Life expectancy• Math & Literacy • Infant mortality• Homicides• Imprisonment• Teenage births • Trust• Obesity• Mental illness – incl.
drug & alcohol addiction
• Social mobility
Health and Social Problems are Worse in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
People who createINEQUALITY
KILL
Kondo et al. 2009
Deaths attributable to excess income inequality
1 / 3
Early life lasts a lifetime
Womb to TombFirst 1000 days
9 months–maternal grandmother
First two years outside
HALF of adult health programmed
SONGI want to be a BILLIONAIRE
When YOUR BELIEFS were
SHATTERED
NYT 050515
"This is our generation's Sputnik moment,"
State of the UnionJan 25, 2011
Stephen [email protected]
Resources: readings, talks other material
http://depts.washington.edu/eqhlth/pages/resources.html
