Unnatural Causes
Poverty causes ill health
AND
Ill health causes poverty
United States
•Spends more than twice the average of other industrialized countries yet has highest:
• Infant Mortality rate• Homocide rate• Child poverty rate• Gap between high and low
mortality rates in country• Gap between rich and rest of the
population
BARHII Framework
The Bay Area Regional Health Inequities Initiative (BARHII) is a unique undertaking by local health departments in the San Francisco Bay Area to confront health inequities.
All of the following slides are adopted from a presentation to NYSACHO by Anthony Iton, Director and Health Officer, Alameda County Public Health Department. May 2008.
Infant mortality
Mortality
Life expectancy
Chronic disease
Infectious disease
Injury (intentional and unintentional)
Disease Access to and Mortality health care
Injury
10-15%
Genetics 10-15%
Smoking Medical Model
Nutrition
Physical activity
Individual health Disease Risk
knowledge and Mortality Behaviors
Injury 70% ??
Violence
Physical environment
Social environment
Neighbor- Disease Risk
hood and Mortality Behaviors
Conditions Injury
Residential segregation
Schools
Corporations and businesses
Neighbor- Disease Institutional Risk
hood and Mortality Power Behaviors
Conditions Injury
Government agencies
Race/ethnicity
Class
Gender
Neighbor- Disease Social Institutional Risk
hood and Mortality Inequalities Power Behaviors
Conditions Injury
Immigration status
Socio-Ecological (society) Medical Model (individuals)
Diseased Biased
Societal Community Behaviors Behavior Disease Death
Decision Death Processes
Comm. Policy Health Clinics Emergency Capacity Advocacy Education Rooms Building
“Services Overkill?” How Government Human Service Agencies Behave
$$ $$$$ $$$$$
Life Expectancy
High school grads: 90% Unemployment: 4%
Poverty: 7% >80 Home ownership: 64%
Non-White: 49%
High school grads: 81% Unemployment: 6%
Poverty: 10% 74.3 - 80 Home ownership: 52%
Non-White: 59%
High school grads: 65% Unemployment: 12% <74.3 Poverty: 25%
Home ownership: 38% Non-White: 89%
In Oakland, African American and Latino 7th graders read below the level of White 3rd graders
700
687
675 656
650 631
625 625
600
575
White 3rd Grade White 7th Grade Black 7th Grade Latino 7th Grade
CAT/6 2005
Source: California Department of Education, http://data1.cde.ca.gov/dataquest/
Cost of Poverty in Alameda County
‘Every additional $12,500 in household income buys one year of life expectancy
‘ (Benefit appears to plateau at household incomes above $150,000)
Results of the statistical comparison of weather and deaths over 12 years show that blacks and those with a high school education or less are most likely to die on extremely hot days. - Harvard School of Public Health study of almost 8 million deaths in 50 cities from 1989 to 2000.
Socio-Ecological Medical Model
Bay Area Regional Health Inequities Initiative
The Social Determinants of Health at the Neighborhood Level
Physical Environment Social Environment Economic Environment Services Environment
Key Strategies for Enhancing the Social Environment
‘Community capacity building - Organizing
- Increases social capital/connectedness - Increases civic engagement
‘Youth development - Risk vs. resiliency
Definitions Community Capacity Building/Empowerment
“Aims to strengthen characteristics of communities to plan, develop, implement & maintain effective community programs that positively affect broader community conditions that determine health and well being”
-adapted from the W. K. Kellogg Foundation
HP 2010
Healthy People 2010 recognizes that communities, States, and national organizations will need to take a multidisciplinary approach to achieving health equity—an approach that involves improving health, education, housing, labor, justice, transportation, agriculture, and the environment.
Unnatural Causes: Is Inequality Making Us Sick?
‘Prediction: You will ‘A very different feel overwhelmed with portrait of health than the scope, scale and we are used to seeing profundity of the issues in the media. raised AND their implications for you as a PH official and as an American.
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