Why Are We Unhealthy?

Adrian DominguezBob Lutz

All of us should have the opportunity to make the choices allowing us to live a healthy life,

regardless of income, education, ethnic background

or where we live.

Health is a resource for everyday life, not the objective of living. Health is a positive concept

emphasizing social and personal resources, as well as physical capacities.

The Ladder Position A metaphor to explain

health inequities Societies are

structured like ladders

The rungs of the ladder represent the resources that determine whether people can live a good life or a life plagued by difficulties

Dynamic Relationship Between Health and Ladder Position

Retirement/Income

Health

Birth/Childhood

ParentalSocioeconomic

Resources

Health

Adolescence/Young Adult

Educational Attainment

Health

Work/Career

Occupation and

Income

HealthHealth

Elderly

Health

Retirement Income

A Framework

Upstream Downstream

•Race•Class•Gender•Immigration status•National origin•Sexual orientation•Disability

Discriminatory Beliefs (ISMS)

•Corporations & other

businesses•Government agencies•Schools

InstitutionalPower

•Neighborhood conditions Social Physical•Residential segregation•Workplace conditions•Education

Social Inequities

•Smoking•Nutrition•Physical activity•Violence•Chronic stress

•Infectious disease•Chronic disease•Injury (intentional / unintentional)

•Infant mortality•Life expectancy

Social Factors

Health Status

Gen

etics

Indi

vidu

al

Hea

lth

Know

ledg

eH

ealth

care

Ac

cess

Medical Model

Risk Factors & Behaviors Disease & Injury Mortality

Socio-Ecological

IndividualEnhancing skills, knowledge,

attitudes and motivation

InterpersonalIncreasing support from friends, family and peers

OrganizationalChanging policies and

practices of organizations

CommunityCollaborating and creating

partnerships to effect change in the community

Public PolicyDeveloping, influencing, and

enforcing local, state and national laws

Socio-ecological Model

That which does not kill us makes us stronger. Friedrich Nietzche

Health Inequities in Spokane County

Data Sources

> Washington State Population Survey> Behavioral Risk Factor Surveillance Survey

(BRFSS)> Birth Certificates> Death Certificates> Community Health Assessment Tool (CHAT)> Office of Financial Management, Washington

State> Washington State HIV Surveillance Report> Strategic Research Associates, Omnibus Survey

The goal of this assessment is to increase awareness about different health and social factors in Spokane County and provide information that can be used for potential changes that affect health outcomes.• Build awareness• Identify further areas for exploration• Intended for health professionals, legislators (policy

makers), administrators, community members, and anyone interested in addressing health concerns in Spokane County

Purpose of Health Inequity Report

DefinitionsHealth DisparityDifferences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups.

Health InequityConcerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable; thus being inherently unjust and unfair.

DefinitionsSocial Determinants of Health Factors (i.e., determinants) in our social and economic environment that researchers have been found to negatively (or positively) affect health.

Social Gradient An individual's or population group's position in society and different access to and security of resources such as education, employment and housing, as well as different levels of participation in civic society and control over life.

Components of Health Inequities

Education

Neighborhood Race/Ethnicity

Income/Poverty

Level

Why Education?

What We HeardWhen invited to discuss what could be done to improve quality of life, many focus group participants discussed the importance of jobs and education:

“You said jobs, I say schooling to get a job. Jobs are good, but I think to get a solid job is to get an education.”

Focus Group Participant (income <35k)

Education

Neighborhood Race/Ethnicity

Income/Poverty

Level

The Faces of Inequities in Spokane

Effects of Education on Poverty

Spokane County Washington State0

20

40

60

80

31.1

26.125.3

20.921.8

15.612.0

9.08.2

5.3

<HS HS grad./GED Some college (no degree) Associate's degree Bachelor's degree Advanced degree

Perc

ent o

f Adu

lts

>=25

Yea

rs o

f Age

in P

over

ty

Educational differences in poverty. As the level of education increases for adults, the likelihood of living in poverty significantly decreases.

Adults 25 Years of Age or Older Living in Poverty by Education, 2000 to 2008

Data Source: Washington State Population Survey

General Health Status by Education

General Health Status by Education among Adults 25 Years of Age or Older, 2000 to 2008

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Spokane County Washington State0

10

20

30

40

50

20.118.3

15.4 15.3

7.77.4

7.66.7

Less than high school Highschool/GED graduate Some college (no degree) Bachelor's Advanced degree

Perc

ent o

f Adu

lts

>=25

Yea

rs o

f Age

wit

h Fa

ir/P

oor H

ealt

h

Adults with less education are more likely to rate their health as poor or fair.

Smoking by Education Smoking by Education among Adults 25 Years of Age or Older, 2005 to 2009

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Spokane County Washington State0

15

30

45

22.9

20.918.517.3

8.97.4

Less than high school High school/GED graduate Some college (no degree) >=College graduate

Per

cent

of A

dult

s >=

25 Y

ears

of A

ge w

ho a

re

Curr

ent S

mok

ers

More adults with less education smoke compared to adults with a higher education.

Effects of Education on Cardiovascular Disease

Spokane County Washington State0

6

12

18

24

30

13.8

12.510.3 10.7

7.57.3

Less than high school High school/GED graduate Some college >=College graduate

Per

cent

of A

dults

>=2

5 Ye

ars o

f Age

who

with

Car

diov

ascu

lar D

iseas

e

Cardiovascular disease (CVD) and the likelihood of CVD significantly decreases as the level of education increases.

Cardiovascular Disease by Education among Adults 25 Years of Age or Older, 2005 to 2009

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Diabetes by EducationDiabetes by Education among Adults 25 Years of Age or Older, 2005 to 2009

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Spokane County Washington State0

7

14

21

12.111.910.9

11.1

7.8

7.3

Less than high school High school/GED graduate Some college >=College graduate

Per

cent

of A

dult

s >=

25 Y

ears

of A

ge

wit

h D

iabe

tes

Diabetes significantly decreases as the level of education increases.

Children in Poverty by Parent’s Education

Children Living in Poverty by Parent’s Highest Level of Education, 2000 to 2008

Data Source: Washington State Population Survey

Spokane County Washington State0

20

40

60

80

100

64.2

59.5

39.9 48.339.9

37.2

21.9 27.413.2

23.8

<HS HS grad./GED Some college (no degree) Associate's degree Bachelor's degree Advanced degree

Perc

ent o

f Chi

ldre

n <1

8 Ye

ars o

f Age

in P

over

ty

As the parent's level of education increases the likelihood of their children living in poverty signifi-cantly decreases.

Infant Mortality by Mother’s Education Infant Mortality by Mother’s Education of Women 25 Years or Older, 2003 to 2009

Data Source: Birth and Death Certificates

Spokane County Washington State0

5

10

15

20

25

8.1 8.56.5

6.26.1

4.1

Less than high school High school/GED graduate Some College >=College graduate

Infa

nt M

orta

lity

Rate

(per

1,0

00 li

ve b

irth

s) Babies born to mothers who did not finish high school are more likely to die before their first birthday as ba-bies born to college graduate.

Health Starts in Our Homes, Schools and

Communities

A Framework

Upstream Downstream

•Race•Class•Gender•Immigration status•National origin•Sexual orientation•Disability

Discriminatory Beliefs (ISMS)

•Corporations & other

businesses•Government agencies•Schools

InstitutionalPower

•Neighborhood conditions Social Physical•Residential segregation•Workplace conditions•Education

Social Inequities

•Smoking•Nutrition•Physical activity•Violence•Chronic stress

•Infectious disease•Chronic disease•Injury (intentional / unintentional)

•Infant mortality•Life expectancy

Social Factors

Health Status

Gen

etics

Indi

vidu

al

Hea

lth

Know

ledg

eH

ealth

care

Ac

cess

Medical Model

Risk Factors & Behaviors Disease & Injury Mortality

Socio-Ecological

Adrian E. Dominguez, M.S.Epidemiologist

Spokane Regional Health DistrictDisease Prevention and Response

Community Health Assessmentadominguez@spokanecounty.org

509.324.1670