building health equitypublichealth.lacounty.gov/owh/docs/keynotespeakerbferrer.pdf ·...

Building Health EquityJanuary 31, 2018

Barbara Ferrer, PhD, MPH, MEd Director, Los Angeles County Department of Public Health

Presentation At-a-Glance• Population health snapshot • Inequities in health outcomes• Opportunities for

collaboration

Slide 1

Population Health Snapshot—Los Angeles County

Women in LA County Slide 3

25%Percent of adult women who have less than a high school graduationLatina 45% | Black 10% | Asian 10% | White 5%

27%Percent of adult women with household incomes <100% of the FPLLatina 38% | Black 35% | Asian 22% | White 10%

Percent of adult women in LA County by Age

10%Percent of adult women ages 18-64 who are uninsuredLatina 14% | Black 3% | Asian 8% | White 5%

41%

42%

17%

65 years or older

40-64 years

18-39 years

Trend in Life Expectancy, LA County, 1991-2013

Slide 4

75.8

82.1

74

76

78

80

82

84

'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13

Years

Life Expectancy at Birth by Gender and Race/Ethnicity, LA County, 2013

Slide 5

79.5 79.080.5

72.4

85.584.5

83.5

86.1

79.1

89.1

65

70

75

80

85

90

95

All White Latino African American Asian

Male Female

Source: Mortality In Los Angeles County 2013 Leading Causes of Death and Premature Death with Trends for 2004-2013 http://publichealth.lacounty.gov/dca/data/documents/mortalityrpt13.pdf

http://publichealth.lacounty.gov/dca/data/documents/mortalityrpt13.pdf

Ten Leading Causes of Death & Premature Death For Women, LA County, 2013

Slide 6

Leading causes of death Leading causes of premature death1. Coronary heart disease 1. Coronary heart disease2. Stroke 2. Breast cancer3. Alzheimer’s disease 3. Lung cancer4. COPD 4. Drug overdose5. Lung cancer 5. Stroke6. Pneumonia/influenza 6. Diabetes7. Breast cancer 7. Motor vehicle crash8. Diabetes 8. Liver disease/cirrhosis9. Hypertension 9. Colorectal cancer10. Colorectal cancer 10. Suicide

Source: Mortality In Los Angeles County 2013 Leading Causes of Death and Premature Death with Trends for 2004-2013 http://publichealth.lacounty.gov/dca/data/documents/mortalityrpt13.pdf


Coronary Heart Disease Death Rate for WomenLA County, 2013 (age adjusted per 100,000 population)

Slide 7

88.698.3

70.3

141.4

58.8

0

20

40

60

80

100

120

140

160

All White Latina Black AsianSource: Health Indicators For Women In Los Angeles County. Highlighting Disparities by Ethnicity and Poverty Level. http://publichealth.lacounty.gov/owh/docs/DataReport/2017-HealthIndicatorsforWomeninLACounty.pdf

http://publichealth.lacounty.gov/owh/docs/DataReport/2017-HealthIndicatorsforWomeninLACounty.pdf

Stroke Death Rate for Women, LA County, 2013 (age adjusted per 100,000 population)

Slide 8

31 30.626.9

48.2

26.8

0

10

20

30

40

50

60



Breast Cancer Death Rate, LA County, 2013(age adjusted per 100,000 female population)

Slide 9

20.5

24.6

15.9

29.8

14.9

0

5

10

15

20

25

30

35



Lung Cancer Death Rate for Women, LA County, 2013 (age adjusted per 100,000 population)

Slide 10

23.2

30.4

12.3

33.5

18.8

0

5

10

15

20

25

30

35

40



Cervical Cancer Death Rate, LA County, 2013(age adjusted per 100,000 female population)

Slide 11

3

2.6

3.1

4.1

2.3

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5



Drug Overdose Death Rate in Women, LA County, 2013 (age adjusted per 100,000 population)

Slide 12

4.3

8.1

2.1

7.6

0.9

0

1

2

3

4

5

6

7

8

9

All White Latina Black AsianSource: Mortality In Los Angeles County 2013 Leading Causes of Death and Premature Death with Trends for 2004-2013 http://publichealth.lacounty.gov/dca/data/documents/mortalityrpt13.pdf


to your neighbor

Pair ShareWhat factors do you believe contribute to inequities in health outcomes?

Percent of Adult Women who are Obese (BMI ≥ 30.0), LA County, 2013

Slide 14

24.4%

16.8%

32.3%

36.3%

8.2%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%



Percent of Adult Women Ever Diagnosed with Diabetes, LA County, 2013

Slide 15

10.0%

7.1%

11.5%

15.1%

7.1%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%



Percent of Adults Ever Diagnosed with Diabetes by Service Planning Area, LA County, 2013

Slide 16

9.8%

13.9%

8.2% 9.1%

11.6%

4.5%

12.3%11.2%

24.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

All SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8Source: Key Indicators of Health by Service Planning Area, 2016 . http://publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH-KIH_2017-sec%20UPDATED.pdf

http://publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH-KIH_2017-sec%20UPDATED.pdf

Need for Safe Spaces to Exercise

Slide 17

Black and Latina women fare worse among: • Percent of adults who

believe their neighborhood is safe from crime

• Percent of adults who report their neighborhoods have walking paths, parks, playgrounds, or sport fields

Health Indicators For Women In Los Angeles County: Highlighting Disparities by Ethnicity and Poverty Level. http://publichealth.lacounty.gov/owh/docs/HealthIndicators2.pdf

http://publichealth.lacounty.gov/owh/docs/HealthIndicators2.pdf

Food Desert in LA County, USDA 2015

Slide 18

• Green = low income and low access areas at 1 and 10 miles

• Orange = low income and low access at ½ and 10 miles

Courtesy Economic Research Service at USDA: https://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas/

https://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas/

Inequities in Health Outcomes

6

4

2.4

4.3

9

2.7

0

1

2

3

4

5

6

7

8

9

10

HP 2020 LA County Asian Latino Black White

Infa

nt D

eath

Rat

e pe

r 1,0

00 L

ive

Birt

hs

Infant Mortality by Race/Ethnicity LA County, 2014

Table does not include data for Native Hawaiian and other Pacific Islander or American Indian/Alaskan Native.Source: Los Angeles County Department of Public Health, Office of Health Assessment & Epidemiology, Mortality in Los Angeles County 2014

Annual Infant Mortality Rate* by Race/Ethnicity, LA County 2004-2014

Slide 21

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

White African Am

Latina Asian

Rate

(per

1,0

00 li

ve b

irths

)

*Rate (per 1,000 live births) applies to Infant Mortality and Percent applies to Birth weight and Preterm. ** Total excludes any suppressed values. -- Cell size <5 therefore suppressed. Source: CADPH Birth Cohort Data and Birth Linked Data. 2004-2014. Prepared by OHAE, 6/2017.

Percent Low Birth Weight* Rate, by Race/Ethnicity, LA County, 2007-2015

Slide 22

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

2007 2008 2009 2010 2012 2013 2014 2015

White African Am Latina Asian

*Low Birth Weight Rate: Live births weighing less than 2,500 grams at birth per 1,000 live births. Source: Linked Birth File, 2007-2015. Prepared by Office of Health Assessment and Epidemiology, 6/2017.

Perc

ent(

%)

6.4 6.7

12.6

8.8

6.6 6.3

8.4

6.8

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

US-born Foreign-born

Perc

ent (

%)

Mother’s Nativity

White African Am Latina Asian

Percent of Low Birth Weight by Mother’s Race/Ethnicity & Nativity: LA County, 2010-2015

Source: CDPH Birth Cohort Data, 2010-2015. Prepared by Office of Health Assessment and Epidemiology, 6/2017.*Preterm Live Birth Rate: Live births less than 37 weeks of gestation and ≥ 17 weeks per 1,000 live births.

Percent Low Birth Weight*, by Education Among African Americans and Whites: LA County, 2015

Slide 24

8.47.1 7.0 6.3

15.4

12.611.6

10.0

0.0

5.0

10.0

15.0

20.0

Less than High School High School Diploma Some College Bachelor's Degree +

White African American

*Education attainment at time of deliverySource: Linked Birth Data -2015. Prepared by Office of Health Assessment and Epidemiology, 6/2017.

Low Birth Weight by Insurance and Race/Ethnicity, LA County, 2015

Slide 25

8.0

13.9

6.87.5

6.5

10.0

6.98.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

White Black Latina Asian

Perc

ent (

%)

Mother’s Race/Ethnicity

Public Private

Insurance: based on expected source of payment for deliverySource: Birth Linked Data, 2015. Prepared by Office of Health Assessment and Epidemiology, 6/2017.

Percent Low Birth Weight Among African Americans With Early Entry Into Prenatal Care vs Percent Low Birth Weight Among Whites With Late Entry/No Prenatal Care

Slide 26

*Early Entry into prenatal care defined as prenatal care at 1st trimester; Late Entry into prenatal care defined as no prenatal care or after 1st trimester

9.9%

17.3%

5.9% 5.3%*

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

Early Late

African American White

Percent Low Birth Weight by Smoking During Pregnancy African American vs White Mothers LA County, LAMB 2012 & 2014

Slide 27

16.9%

11.1%

3.9%*

5.8%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Smoked Did Not Smoke

African American White

Percent Low Birth Weight by Stressful Life Events African American vs. White MothersLA County, LAMB 2012 & 2014

Slide 28

5.7%5.0%*

9.2%

14.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

None 3 or more

White African American

*This estimate is statistically unstable due to the small sample size.

Maternal Mortality Ratio by Race/Ethnicity LA County, 2007-2013

Slide 29

13.6

62.7

13.4 14.9

0

10

20

30

40

50

60

70

White African American Latina Asian

Factors to Consider• Impact of structural racism• Lack of social support• Exposure to environmental hazards• Residential segregation• Differences in access to medical

services/treatment• Chronic stress

Slide 30

Opportunities for Collaboration

What strategies work to improve health?

Counseling & Education

Clinical Interventions

Long-Lasting Protective Interventions

Changing the context make individual’s default decisions healthy

Socioeconomic factors

32

Slide 17

Increasing Population

Impact

Increasing Individual

Effort Needed

Source: Frieden, T.R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100 (4), 590-595. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836340/pdf/590.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836340/pdf/590.pdf

Framework for Promoting Health Equity

1) Develop institutional competency to engage in sustained efforts to eliminate inequities

2) Support/build community capacity to lead and engage in efforts to eliminate inequities

3) Identify partnership opportunities to enhance and promote efforts that result in equitable health outcomes

4) Align resources to the work

Slide 33

Achieving Health Equity: Policy, Environment and Systems Change• Core Strategies:

– Data gathering & information sharing (communications)

– Community Investment– Policy & Practice Change

• Guiding Principles– Accountability to the

community– Integrity in our internal

and external processes– Collaboration and shared

learning– Commitment to racial

justice and social changeSlide 34

The Center for Health Equity (CHE)• DPH launched CHE this fall:

– Community Launch Event– Listening Sessions

• CHE efforts will span across the Health Agency of Los Angeles (HALA) and will:– Leverage existing resources and efforts;– Ensure a racial and social justice lens; – Serve as a critical touchpoint for partners and

community

Closing the Gap: Key Focus Areas

Slide 36

Infant Mortality

Sexually Transmitted Infections (STIs)

Environmental Justice

Health Neighborhoods

Cultural & Linguistic Competency

Partnership Opportunities• Ensure access for women

and families to enhanced systems of care– Reproductive health– Culturally responsive healthcare

services– Coordinated/integrated care

• Improve environments in which women and families live– Environmental justice – Built environment

Slide 37

• Strengthen support systems for women and families in communities– Parenting support– Trauma support/recovery services– Supports for other social/economic

needs (e.g. transportation, housing)

• Advocate for policy changes that improve lives– Educational investments– Economic opportunities (paid leave)– Reproductive rights

Reframe Using an Equity LensConventional Question Health Equity Question

How can we promote healthy behavior?

How can we target dangerous conditions and reorganize land use and transportation policies to ensure healthy spaces and places?

How can we reduce disparities in the distribution of disease and illness?

How can we eliminate inequities in the distribution of resources and power that shape health outcomes?

What social programs and services are needed to address health disparities?

What types of institutional and social changes are necessary to tackle health inequities?

How can individuals protect themselves against health disparities?

What kinds of community organizing and alliance building are necessary to protect communities?

THANK YOU!Dr. Barbara Ferrer

Director, Los Angeles County Department of Public Health313 North Figueroa Street, Suite 806

Los Angeles, California 90012Office: (213) 240-8117

Email: [email protected]

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