Dr. Bezruchka: Tukwila School District Intercultural Speakers Series

8/9/2019 Dr. Bezruchka: Tukwila School District Intercultural Speakers Series

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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


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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Homicides


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Homicides


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Teen Births


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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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DO

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People who createINEQUALITY

KILL


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Kondo et al. 2009#

Deaths attributable toexcess income inequality

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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


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



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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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Equity


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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

Dr. Bezruchka: Tukwila School District Intercultural Speakers Series

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Transcript of Dr. Bezruchka: Tukwila School District Intercultural Speakers Series