Health Inequities in Spokane County

Why Neighborhoods/Place?

Education

Neighborhood

Race/Ethnicity

Income/Poverty

Level

What We Heard

“My neighborhood is better than it was when I was a kid. It’s been about six months since we’ve had a shooting within 5 blocks of my house. That’s a good distance between shootings. I remember being 2-3 years old watching out my window, watching people shoot at each other.”

Focus Group Participant (income <35k)

Teenage Pregnancy (15 to 19 Years of Age), Spokane County Neighborhoods, 2005-2009

Rank Neighborhood Percent Lower CI Upper CI

1 West Central 17.22^* 14.27 20.612 Logan 15.95^* 13.03 19.333 Chief Garry Park 15.28^* 12.25 18.824 East Central 14.90^* 12.68 17.395 Riverside 14.43^* 9.66 20.72

Spokane County 8.73* 8.39 9.07Washington State 8.19+ 8.11 8.28

36 Balboa/S. Indian Trail 4.46 1.79 9.1937 South Palouse 4.31+> 2.93 6.1238 Comstock 2.38+> 1.03 4.6939 Manito 1.33+> 0.36 3.4140 5 Mile 0.71+> 0.09 2.58

Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health, Birth Certificates^Significantly higher than Spokane County*Significantly higher than Washington State+Significantly lower than Spokane County>Significantly lower than Washington State

Maternal Smoking, Spokane County Neighborhoods, 2005-2009

Rank Neighborhood Percent Lower CI Upper CI1 West Central 41.24^* 36.59 46.322 Riverside 40.80^* 32.45 50.643 Browne’s Addition 36.36^* 27.75 46.814 Hillyard 33.39^* 28.83 38.465 Logan 32.36^* 28.14 37.04

Spokane County 18.20* 17.72 18.69Washington State 10.13+ 10.03 10.22

36 North Indian Trail 6.83+> 4.54 9.8737 Comstock 5.65+> 3.40 8.8338 Southgate 4.73+> 3.06 6.9939 5 Mile 4.66+> 2.48 7.9740 Manito 4.00+> 2.07 6.99

Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health, Birth Certificates^Significantly higher than Spokane County*Significantly higher than Washington State+Significantly lower than Spokane County>Significantly lower than Washington State

Causes of Mortality (Age Adjusted Rate per 100,000) in Spokane County with Top Five

Neighborhoods,

Cause of DeathSpokane County

Rate

Washington State Rate

Rank 1 Rank 2 Rank 3 Rank 4 Rank 5

Neighborhood Rate Neighborhood Rate Neighborhood Rate Neighborhood Rate Neighborhoo

d Rate

1. Major cardiovascular disease 255.8 249.2 Riverside^ 374.7 Hillyard^ 372.1 Nevada/

Lidgerwood^ 351.3 East Central^ 330.7 Edgecliff 323.5

2. Malignant neoplasms 188.1 183.5 Chief Garry Park^ 271.9 Whitman^ 267.9 Minnehaha^ 263.8 East Central^ 228.3 Edgecliff^ 228.1

3. Chronic lower respiratory diseases 54.6 45.6 Riverside^ 104.4 Hillyard^ 96.7 East Central^ 86.0 Bemiss^ 83.1 Emerson/

Garfield^ 79.5

4. Unintentional injury 49.1 38.1 Riverside^ 164.3 West Hills^ 110.2 East Central^ 85.5 West Central^ 84.6 Hillyard 70.6

5. Alzheimer’s disease 35.2 39.3 North Indian Trail^ 69.5 Emerson/

Garfield^ 68.3 South Palouse^ 62.2 Manito 50.1Mead/Green

Bluff/Mt. Spokane^

49.4

6. Diabetes mellitus 26.3 24.3 Emerson/Garfield^ 59.3 Whitman^ 56.7 Nevada/

Lidgerwood^ 52.4 Chattaroy/Deer Park^ 48.6 Chief Garry

Park 38.7

7. Suicide 15.7 12.8 Riverside^ 46.4 Cliff/Cannon^ 28.6 Hillyard^ 26.5 Browne’s Addition 25.5 Logan 25.5

8. Influenza and pneumonia 14.5 14.1 Emerson/

Garfield^ 34.4 West Central 24.0 Edgecliff^ 23.8 University^ 23.2 Chief Garry Park 22.0

9. Chronic liver disease and cirrhosis 10.3 9.3 Riverside^ 44.7 West Hills 27.0 East Central^ 24.6 Browne’s

Addition 21.8 Hillyard 20.7

10. Parkinson’s disease 7.9 8.1 North Indian Trail^ 17.0 Emerson/

Garfield 16.6 Cliff/Cannon 11.9 Minnehaha 10.9 South Palouse 10.7

^Significantly higher than Spokane County

Overall Age-Adjusted Mortality Rate (per 100,000), Spokane County Neighborhoods,

2005-2009

Rank Neighborhood Percent Lower CI Upper CI

1 Riverside 1,364.1^* 1,254.0 1,489.62 East Central 1,102.3^* 1,039.7 1,168.13 Emerson/Garfield 1,071.1^* 996.9 1,149.84 Hillyard 1,026.7^* 946.2 1,112.45 Nevada/Lidgerwood 1,026.1^* 985.5 1,068.1

Spokane County 790.1* 782.0 798.2Washington State 751.6 749.4 753.8

36 Manito 661.8+> 591.1 739.637 Comstock 594.0+> 544.5 648.038 5 Mile 570.0+> 465.8 695.739 Rockwood 559.3+> 494.7 631.040 Southgate 520.1+> 476.6 566.8

Data Source: Washington State Department of Health, Death Certificates^Significantly higher than Spokane County*Significantly higher than Washington State+Significantly lower than Spokane County>Significantly lower than Washington State

Life Expectancy, Spokane County Neighborhood Comparison, 1990 to 1999 vs. 2000 to 2009

Life Expectancy 1990-1999 Rank 2000-2009 Life

Expectancy77.55 State State 79.1977.35 Spokane Spokane 78.4182.39 South Palouse 1 Southgate 84.0381.29 Comstock 2 Rockwood 82.7981.19 Southgate 3 5 Mile 82.3281.11 North Indian Trail 4 Comstock 82.2080.82 Cheney/Medical Lake 5 Balboa/S. Indian Trail 81.1373.57 Hillyard 36 Emerson Garfield 74.3273.32 Browne's Addition 37 Chief Garry Park 73.7873.24 Emerson Garfield 38 Hillyard 73.6272.39 East Central 39 East Central 72.9265.38 Riverside 40 Riverside 66.17

Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health

A Framework for Health Inequity

Upstream Downstream

•Race•Class•Gender•Immigration status•National Origin•Sexual orientation•Disability

Discriminatory Beliefs (ISMS)

•Corporations & other

businesses•Government agencies•Schools

InstitutionalPower

•Neighborhood conditions Social Physical•Residential segregation•Workplace conditions

Social Inequities

•Smoking•Nutrition•Physical activity•Violence•Chronic Stress

•Infectious disease•Chronic disease•Injury (intentional / unintentional)

•Infant mortality•Life expectancy

Social Factors

Health Status

Gen

etics

Indi

vidu

al

Hea

lth

Know

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Hea

lthca

re

Acce

ss

Medical Model

Risk Factors & Behaviors Disease & Injury Mortality

Socio-Ecological

Health is more than absence of disease; it is about economics, education, environment, empowerment, and community. The health and well being of the people is critically dependent upon the system that serves them. It must provide the best possible health with the least disparities and respond equally well to everyone." Joycelyn Elders U.S. Surgeon General 1993-1994

Adrian E. Dominguez, M.S.Epidemiologist

Spokane Regional Health DistrictDisease Prevention and Response

Community Health Assessment, Planning , and Evaluationadominguez@spokanecounty.org

509.324.1670