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!"# %& '()*)+,( -./0)12#31 2"# '45(.6)*.7
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Stephen Bezruchka MD, MPHDepartments of Global Health & Health Services
School of Public HealthUniversity of Washington
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Agenda
My background
Population Health Quiz
Health Olympics
Determinants of health
Economic Inequality & First 1000 days
Education Olympics
Determinants of educational outcomes
Next steps:
INTERRUPTASK QUESTIONS
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Problem to address
Why has US world
leadership ineducational outcomes
in schools declined?
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Main IdeaUS educational outcomes are not great
despite spending $$$, NCLB, Race to Top
Student capabilities to learn arecompromised by early life circumstances
Economic inequality creates this situation
We must consider structures in US societyafter WWII when there was more equity.
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Health QUIZTrue
False
A 15 year old girl in the US has a smallerchance of dying before reaching age 60than a similarly aged girl in Sri Lanka.
During the period of 1987 to 2007 lifeexpectancy for women declined in about30% of US counties (which was not so forthe previous 20 years).
Maternal mortality in the US has increased50% over the last 15 years.
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Sri Lanka US #Adult Female Mortality 1970-2010#
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Ezzati et. al 2008#
Female# Male#
US County Mortality Trends 1992-6-2002-6#Age-Adjusted mortality rates ($75 yrs)/100000 #
Kindig & Cheng 2013#
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Ezzati et. al 2008#
Female#
US County Mortality Trends 1992-6 / 2002-6#Age-Adjusted mortality rates ($75 yrs)/100000 #
Kindig & Cheng 2013#
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Australia, Canada, Japan, Sweden #US Maternal Mortality 1970-2010#
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Economist April 25, 2012#
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0 2 4 6 8 10 12
Japan
France
Germany
Spain
Greece
UK
Czech Republic
Portugal
Belgium
Hungary
ItalyDenmark
Netherlans
Australia
Poland
Canada
Korea
New Zealand
USA
*Austria, Finland, Ireland, Norway, Sweden and Switzerland had fewer than 20 deaths reported and therefore
rates were not calculated.
Youth violence OlympicsHomicide rates among youth aged 10-29 (most
recent year available) from the World Health Organizations World Report on
Violence and Health, 2002*
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Age distribution and overall rates of homicide:England and Wales compared with Chicago.
(age and sex of perpetrator)
Source: Cronin H.
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Age distribution and overall rates of homicide:England and Wales compared with Chicago.
(age and sex of perpetrator)
Source: Cronin H.
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INFANT
MORTALITY
OLYMPICS
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How healthy is the US?Health Olympics
Number one Gold1-5 _______
6-10 _______
11-15 _______
16-20 _______21-25 _______
26-30 _______
31+ _______
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How healthy is the US?Health Olympics
Number one Gold1-5 _______
6-10 _______
11-15 _______
16-20 _______21-25 _______
26-30 _______
31+ _______
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1st & 4th yr US medical studentknowledge of Population Health
(2002)Question INCORRECT
US has higher life expectancythan any other nation?
32%
US has lower infant mortalitythan 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.
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POPULATION HEALTH
Health Inequalities (poorer
people have poorer health)
Early Life: critical for adult health
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Harvey 2005
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Wilkinson & Pickett 2009 Spirit Level#
US MORTALITY RATES BY ZIP CODE INCOME#
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Index of:
Life expectancy
Math & Literacy
Infant mortality
Homicides
Imprisonment Teenage births
Trust
Obesity
Mental illness incl.drug & alcoholaddiction
Social mobility
Health and Social Problems are Worse in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
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TEEN BIRTHOLYMPICS
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IOM Shorter Lives, Poorer Health2013#
Teen (15-9) Birth Rates 2010#
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Wilkinson & Pickett 2009 Spirit Level#
Homicides
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Wilkinson & Pickett 2009 Spirit Level#
Homicides
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Wilkinson & Pickett 2009 Spirit Level#
Teen Births
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Wilkinson & Pickett 2009 Spirit Level#
US Teen Births
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Pickett AJPH 2005
Violence and Teen Birth Rates related
Higher TEEN BIRTHS
HigherHOMIC
DERates
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PRETERM
BIRTH
OLYMPICS
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MacDorman & Mathews 2009
PTD % Excluding
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Born Too Soon. 2012#
PRETERM BIRTHS/100#
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Muglia et al. 2010#
PRETERM BIRTHS
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LOW BIRTH
WEIGHT
OLYMPICS
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LOW BIRTH WEIGHTIOM Shorter Lives, Poorer Health2013#
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e g
H
I
E
R
A
RC
H
I
C
A
L
l i t a r i a n
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ve
r
t
i
c
a
l
DO
M
I
N
A
N
C
E
PO
W
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R
CO
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R
C
I
O
N
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People who createINEQUALITY
KILL
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Kondo et al. 2009#
Deaths attributable toexcess income inequality
1 / 3
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Early life lasts a lifetime
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Poor first 1000 days
Increased Risk of
Pre-term Delivery
Stillbirth
Low Birth Weight
Caesarian Section
Infant MortalityBehavioral Problems
Poor School Performance
Earlier reproduction
Cardiovascular DiseaseObesity
Metabolic syndrome
DiabetesHypertension
Common Cancers
Early death
EARLY LATER LIFE
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Related to (caused by) entire life history ofwoman before she become pregnant
Impacted by parents
Impacted by grandparents
Impacted by previous generations
Poor pregnancy conditions
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Hart & Risley 1995#
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LOW BIRTHWEIGHT
Educational impact
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1000 days#
6708$ 9:7;$8 :) 8:
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1000 days#
6708$ 9:7;$8 :) 8:
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How educated is the US?EDUCATION Olympics
Number one Gold1-5 _______
6-10 _______
11-15 _______
16-20 _______21-25 _______
26-30 _______
31+ _______
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OECD 2006
OECD 2006
US Test Scores #
Adjusted for Poverty#
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OECD 2006
OECD 2006
2012 PISA R l
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OECD 2006
OECD 2006
2012 PISA Results#
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OECD 2006
OECD 2006
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Wilkinson et. al.
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OECD 2006
OECD 2006
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EDUCATION
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EDUCATION
INEQUALITY
SAT Scores Income Inequality
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OECD 2006
OECD 2006
SAT Scores Income Inequality
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OECD 2006
OECD 2006
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Enrollment: 2,900 + Students
Gender: 51.8% Male/ 48.2% Female
Race/Ethnicity:
American Indian/Native 0.7%Asian/Pacific Islander 28.3%
Black/African American 19.5%
Hispanic 26.4%
White 15.4%
Mixed/Multi Race 6.1%Poverty/F &R: 77.6%
Special ed: 9.2%
Tran. Bilingual: 38.6%
Washington State Report Card 2012-2013
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Ed ti l Di d t
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Educational Disadvantage
relative poverty
in early life
CHILD POVERTY OLYMPICS
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CHILD POVERTY OLYMPICS
Wilkinson & Pickett 2009 Spirit Level#
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Math Literacy Scores 15 yr olds
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OECD 2006
OECD 2006
Ed ti l Di d t
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Educational Disadvantage
Wrong focus
in US society
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Heckman. 2008#
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NYT 050515
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r > g#Rate of return on capital#
Greater thanRate of return on growth#
Income Inequality Anglo-saxon countries 1910-2010
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Piketty 2014#
Income Inequality Anglo saxon countries 1910 2010
Income Inequality Europe, Japan 1910-2010
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Piketty 2014#
q y p , p
Income Inequality Northern, Southern Europe, 1910-2010
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Piketty 2014#
q y , p ,
Minimum Wage France US 1950-2013
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Piketty 2014#
g
Top Income Tax Rates 1900-2013
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Piketty 2014#
p
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EquityEquality
distinction
Eq it
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http://sherinefahmy92.wordpress.com#
Equity
orEquality?
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http://sherinefahmy92.wordpress.com#
Equity
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http://sherinefahmy92.wordpress.com#
Equity
orEquality?
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Harvey 2005
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NYT 050515
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NYT 050515
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FAMILY BENEFIT
SPENDING
OECD
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6.87.0
2001-2
OECD 2009
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6.87.0
2001-2
OECD 2009
1,168,354homeless #t d t ll d
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students enrolled #
US preschools, #+ K-12 in 2011-2#
NYT 131026#
1.46 millionhouseholds living on$2 or less in incomeper person per dayin given monthRECORD
Educational Advantage
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Educational Advantage
What to do?
Regaining Olympic Gold
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Regaining Olympic Gold
Create awareness of societal determinants
Community/National focus NOT individual
Decrease economic inequality
Support early life
Learn from others (Canada, Finland)
Educational system reform
State or national funding parity
Recruit best students to be teachers