FALLING BEHINDUSA Playing the Game of Health

Without a ScoreboardStephen Bezruchka MD, MPH

Departments of Global Health & Health ServicesSchool of Public Health

University of Washington

AgendaPopulation Health Quiz

Health Olympics

Determinants of health

–Economic Inequality & First 1000 days

What needs to be done

Health QUIZTrue False

A 15 year old girl in the US has a smaller chance of dying before reaching age 60 than a similarly aged girl in Sri Lanka.

During the period of 1987 to 2007 life expectancy for women declined in about 30% of US counties (which was not so for the previous 20 years).

Maternal mortality in the US has increased 50% over the last 15 years.

Sri Lanka US Adult Female Mortality 1970-2010

Health QUIZTrue False

A 15 year old girl in the US a smaller chance of dying before reaching age 60 than a similarly aged girl in Sri Lanka.

During the period of 1987 to 2007 life expectancy for women declined in almost 30% of US counties (which was not so for the previous 20 years).

Maternal mortality in the US has increased 50% over the last 15 years.

Ezzati et. al 2008

Female Male

US County Life Expectancy Trends 1987-2007

Health QUIZTrue False

A 15 year old girl in the US a smaller chance of dying before reaching age 60 than a similarly aged girl in Sri Lanka.

During the period of 1987 to 2007 life expectancy for women declined in about 30% of US counties (which was not so for the previous 20 years).

Maternal mortality in the US has increased 50% over the last 15 years.

Australia, Canada, Japan, Sweden US Maternal Mortality 1970-2010

Time magazine July 30, 2012 + web update

2406 702.5

667790.5

How healthy is the US?Health Olympics

Number one Gold 1-5 _______6-10 _______11-15 _______

16-20 _______21-25 _______26-30 _______31+ _______

HEALTH OLYMPICS 2011

Life

ex

pect

ancy

5

15

10

25

20

30

United Nations Human Development Report 2011

Economist April 25, 2012

African AmericanHarlem Mortality

cf.Bangladesh

Male Life Expectancies early 2000s

United States (white) 74.6

Sri Lanka 71.5

Ecuador 71.4

Malaysia 70.9

Occupied Palestinian territories 70.9

Iran 69.0

Colombia 69.3

United States (black) 68.8

Viet Nam 68.6

El Salvador 67.8

Iraq* 67.5

Nicaragua 67.3

Journal of the National Medical Association 98(4): 488-491

Maternal Mortality Rates by Race/Ethnicity, California Residents; 1999-2008

California Pregnancy-Associated Mortality Review (2011

Country withoutBlack – White

health inequities?

Life Expectancy Race, Cuba, Brazil US

Country Whites Blacks W-B

Cuba (1981) 71.2 70.2 1.0

Brazil (1980) 66.1 59.4 6.7

USA (1980) 74.4 68.1 6.3

de la Fuente(1995): Race and Inequality in Cuba, 1899-1981

WHERE IS PACIFIC NW HEALTH?

Cascadia2002NW Env Wa

Life Expectancy

CLOSER TO HOME

Killer Facts

How healthy is the US?Health Olympics

Number one Gold 1-5 _______6-10 _______11-15 _______

16-20 _______21-25 _______26-30 _______31+ _______

1st & 4th yr US medical student knowledge of Population Health

(2002)Question INCORRECT

US has higher life expectancy than any other nation?

32%

US has lower infant mortality than 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.

Playing Game of Healthwithout a scoreboard

POPULATION HEALTH

Health Inequalities (poorer people have poorer health)

Early Life: critical for adult health

Harvey 2005

Wilkinson & Pickett 2009 Spirit Level

US MORTALITY RATES BY ZIP CODE INCOME

Index of: • Life expectancy• Math & Literacy • Infant mortality• Homicides• Imprisonment• Teenage births • Trust• Obesity• Mental illness – incl.

drug & alcohol addiction

• Social mobility

Health and Social Problems are Worse in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

People who createINEQUALITY

KILL

Kondo et al. 2009

Deaths attributable to excess income inequality

1 / 3

Early life lasts a lifetime

Womb to TombFirst 1000 days

9 months–maternal grandmother

First two years outside

HALF of adult health programmed

SONGI want to be a BILLIONAIRE

When YOUR BELIEFS were

SHATTERED

NYT 050515

"This is our generation's Sputnik moment,"

State of the UnionJan 25, 2011

Stephen Bezruchkasabez@uw.edu

Resources: readings, talks other material

http://depts.washington.edu/eqhlth/pages/resources.html