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.