1 / 20

Health Equity

Health Equity. Ron Chapman, MD, MPH Director and State Health Officer California Department of Public Health. What causes health inequities?.

amal
Télécharger la présentation

Health Equity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Equity Ron Chapman, MD, MPH Director and State Health Officer California Department of Public Health

  2. What causes health inequities? “The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries. The structural roots of health inequities lie within education, taxation, labor and housing markets, urban planning, government regulation, health care systems, all of which are powerful determinants of health, and ones over which individuals have little or no direct personal control but can only be altered through social and economic policies and political processes.” WHO Commission on the Social Determinants of Health

  3. “Social Determinants of Health” • Social-Physical-Economic-Services Determinants • Income & income inequality • Education • Race/ethnicity/gender & related discrimination • Built Environment • Stress • Social support • Early child experiences • Employment • Housing • Transportation • Food Environment • Social standing

  4. What is the role of health care? • Public Health Agency of Canada: “there is mounting evidence that the contribution of medicine and health care is quite limited, and that spending more on health care will not result in significant further improvements in population health. On the other hand, there are strong and growing indications that other factors such as living and working conditions are crucially important for a healthy population.”

  5. Estimated Deaths Attributable to Social Factors in the US - 2000 • Low education: 245,000 • Racial segregation: 176,000 • Low social support: 162,000 • Individual level poverty: 133,000 • Income inequality: 119,000 • Area level poverty: 39,000 • In comparison: • Acute MI: 192,898 • Cerebrovascular disease: 167,661 • Lung cancer: 155,521 Estimated Deaths Attributable to Social Factors in the US. Galea S et.al. AJPH:June 16,2011;eprint.

  6. Life Expectancy in the Bay Area • People who live in West Oakland can expect to live on average 10 years less than those who live in the Berkeley Hills. • People who live in Bayview/Hunters Point can expect to live on average 14 years less than their counterparts on Russian Hill • Residents of Bay Point can expect to live on average 11 years less than people in Orinda Oakland, CA

  7. Compared to a white child born in the Oakland hills, a black child born in West Oakland is: • Likely to die almost 15 years earlier • 5x more likely to be hospitalized with diabetes • 2x as likely to die of heart disease • 3x more likely to die of stroke • 2x more likely to die of cancer • 7x more likely to be born into poverty • 4x less likely to read at grade level by grade 4 • 4 x as likely to live in a neighborhood with high density of fast food and liquor outlets • 5.6x more likely to drop out of school Alameda County Department of Public Health

  8. Inequities in Contra Costa County • Hospitalization rate for asthma for African American children 5x that of White children • Latinas have a rate of births to teens more than twice that of the county overall • Most of the homicide deaths in Contra Costa occurred among African Americans • People living in San Pablo, Oakley, Richmond, Antioch, Brentwood and Pittsburg, as well as African Americans and men overall, are more likely to die from heart disease

  9. Health Equity in California • Lowest Infant Mortality • African Americans double • Lowest Teenage Pregnancy • Hispanic teens double • Lowest Tobacco Use • Low income population double

  10. Parents’ income shapes the next generation’s: Education, which shapes their Working conditions (physical & psychosocial) & Income How could income effect health? Income directly shapes: • Nutrition & physical activity options • Housing quality • Neighborhood conditions • Social networks & support • Stress due to inadequate resources to face daily challenges • Medical care Center on Social Disparities in Health, UCSF

  11. Children Raised in Poverty • Have lower levels of educational attainment • more likely to score lower on standardized tests, be held back a grade, drop out of high school, • less likely to get a college degree • attend schools with fewer resources • suffer from poor nutrition, chronic stress, and other health problems that interfere with their school work • change residences and schools frequently as their families struggle to find affordable housing • Have lower earnings and are more likely to live in poverty as adults

  12. The Social Gradient in Health * BARHII

  13. Across racial and ethnic groups, higher income*, more physically active adults * Similar by education NHIS 2001-2005 Age-adjusted

  14. 6.1 million Californians (16.3%) incomes <FPL  2.2 million Ca children (nearly ¼) in families <FPL • U.S. • California

  15. Health Impact of Resolving Racial Disparities • 1991 to 2000 • Medical advances averted 176,633 deaths • Equalizing the mortality rates of Whites and African Americans would have averted 886,202 deaths • “The prudence of investing billions in the development of new drugs and technologies while investing only a fraction of that amount in the correction of disparities deserves reconsideration. It is an imbalance that may claim more lives than it saves.” Wolff S. Satcher D., et.al. The Health Impact of Resolving Racial Disparities: An Analysis of US Mortality Data. Am J Public Health. 2004;94:2078–2081

  16. How could a neighborhood affect health? Safe places to exercise Access to healthy food Exposure to targeted advertising of harmful substances Social networks & support Norms, role models, peer pressure Fear, anxiety, stress, despair Violence and fear Quality of schools

  17. UPSTREAM DOWNSTREAM SOCIAL INEQUITIES Class Race/ethnicity Immigration status Gender Sexual orientation INSTITUTIONAL POWER Corporations & businesses Government agencies Schools Laws & regulations Not-for-profit organizations LIVING CONDITIONS Physical environment Land use Transportation Housing Residential segregation Exposure to toxins Social environment Experience of class, racism, gender, immigration Culture, incl. mediaViolence Economic & Work Environment Employment Income Retail businessesOccupational hazards Service environment Health care Education Social services RISK BEHAVIORS Risk Behaviors Smoking Poor nutrition Low physical activity Violence Alcohol & other Drugs Sexual behavior DISEASE & INJURY Communicable disease Chronic disease Injury (intentional & &unintentional) MORTALITY Infant mortality Life expectancy Individual health education Health care Strategic partnerships Advocacy Case management Community capacity building Community organizing Civic engagement POLICY Emerging Public Health Practice Current Public Health Practice A PUBLIC HEALTH FRAMEWORK FOR REDUCING HEALTH INEQUITIES BAY AREA REGIONAL HEALTH INEQUITIES INITIATIVE

  18. Go Before You ShowPrenatal Campaign • First trimester prenatal care is key to healthy birth outcomes. • In Solano County, 1st trimester prenatal care was much higher for women on commercial insurance vs. Medi-Cal. • Go Before You Show campaign created to increase 1st trimester prenatal care in Medi-Cal. • Results…

  19. Office of Health Equity • Office of Multicultural Health • Office of Multicultural Services • Office of Women’s Health • Health in All Policies • Healthy Place Team

More Related