Health Inequities in Spokane County

Board of HealthApril 26, 2012

Why Race/Ethnicity?

Education

Neighbor-hood

Race/Ethnic-

ity

Income/Poverty

Level

What We Heard

Though race and ethnicity wasn’t specifically discussed, several focus group participants reflected on the impact of their race on their quality of life. One participant describes his socioeconomic status as follows:

“I’m always the first to say that I was born a white, American male. I am at the top of the food chain as far as economic opportunities. I don’t think it gets any easier.”

Focus Group Participant (income >75k)

The Gardner Family

Population by Race/Ethnicity in Spokane County - 2009

Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting

Population of Ethnic Minorities in Spokane County - 2009

Black NH21.4%

AIAN NH15.0%

API NH29.1% Hispanic

34.5%

Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting

Percent Growth of Racial/Ethnic Groups in Spokane County 2000 to

2008

Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting

Overall Percent Growth of Racial/Ethnic Groups in Spokane

County 2000 to 2008

Data Source: CHAT Population Estimates for Public Health Assessment, Washington State Department of Health and Krupski Consulting

Racial/Ethnic Group Population 2000 Population 2008 Percent of Growth

Whites NH 383,128 414,717 8.2%

Blacks NH 8,015 9,481 18.3%

AIAN NH 5,699 6,659 16.8%

API NH 9,536 12,863 34.9%

Hispanic 11,561 15,289 32.2%

Unemployment by Race/EthnicityWashington State

Unemployment by Race among Adults 18 to 65 Years of Age, Washington State, 2000 to 2008

Data Source: Washington State Population SurveyNH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

Series10.0

5.0

10.0

15.0

20.0

11.6 11.0

9.5

5.15.1

Hispanic AIAN NH Black NH API NH White NH

Perc

ent o

f Une

mpl

oym

ent

Higher proportions of American Indians/Alaska Natives, Blacks, and Hispanics are unemployed.

Poverty by Race/Ethnicity

Racial/Ethnic Differences in Overall Poverty, 2000 to 2008

Data Source: Washington State Population SurveyNH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

Spokane County Washington State0

25

50

75

41.5

38.139.9

58.5

26.3

20.1

20.5

20.8

AIAN NH Black NH Hispanic White NH API NH

Perc

ent o

f Per

sons

in P

over

ty

Higher proportions of American Indians/Alaska Natives, Blacks, and Hispanics live in poverty.

Children Living in Poverty by Race/Ethnicity

Racial/Ethnic Differences in Poverty among Children Less Than 18 Years of Age, 2000 to 2008

Spokane County Washington State0

20

40

60

80

100

62.3

53.4

42.9

65.5

31.925.1

20.8

27.9

AIAN NH Black NH Hispanic White NH API NH

Perc

ent

of C

hild

ren

<18

Year

s o

f Age

in P

over

ty Higher proportions of American Indians/Alaska Natives, Blacks, and Hispanics children live in poverty.

Data Source: Washington State Population SurveyNH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

General Health Status by Race/Ethnicity

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

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)NH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

Spokane County Washington State0

25

50

75

34.3

23.0

25.628.8

16.815.8

14.0

10.3

AIAN NH Black NH Hispanic White NH API NH

Perc

ent o

f Adu

lts >

= 25

Yea

rs o

f Age

w

ith F

air/

Poor

Hea

lth

Poor or fair health is much more common among American Indians/Alaska Natives, Blacks, and Hispanics.

Incidence of HIV by Race/Ethnicity

Spokane Washington State0

15

30

45

60

29.3 43.8

16.1

13.3

10.5

10.9

5.9 6.8

3.9

5.6

Black NH AIAN NH Hispanic White NH API NH

Rate

per

100

,000

The rate of HIV infection occurs more frequently among Black, American Indians/Alaska Natives, and Hispanics.

New HIV Diagnosis Rates (Incidence) by Race/Ethnicity, 2002 to 2008

Data Source: Washington State HIV Surveillance ReportNH=Non-Hispanic, AIAN=American Indian/Alaska Native, API=Asian Pacific Islander

Leading Causes of Mortality per 100,000 (Age Adjusted) by Race/Ethnicity Spokane County

Whites NH Blacks NH AIAN NH API NH Hispanics

Rank Cause of Death Rate Rank Cause of Death Rate Rank Cause of Death Rate Rank Cause of Death Rate Rank Cause of Death Rate

1 Malignant neoplasms 184.4 1 Diseases of the

heart^ 185.5 1 Malignant neoplasms^ 257.2 1 Malignant

neoplasms

108.6 1 Malignant neoplasms 132.7

2 Diseases of the heart 156.5 2 Malignant

neoplasms 154.4 2 Diseases of the heart 137.2 2 Diseases of the

heart 102.2 2 Diseases of the heart 87.6

3Chronic lower

respiratory diseases*

53.9 3 Diabetes mellitus^ 93.3 3 Unintentional

injury^ 97.7 3 Cerebrovascular diseases^ 63.2 3 Diabetes

mellitus^ 49.2

4 Unintentional injury 53.1 4 Cerebrovascular

diseases^ 63.8 4Chronic lower

respiratory diseases*^

75.7 4 Diabetes mellitus^ 40.1 4 Alzheimer’s

disease^ 40.9

5 Cerebrovascular diseases 45.8 5 Unintentional

injury 33.8 5 Alzheimer’s disease^ 64.8 5 Unintentional

injury 32.6 5 Unintentional injury 31.6

^Significantly higher than Spokane County* Includes bronchitis , emphysema, asthmaData Source: Death Certificates, Washington State Department of Health, Center for Health Statistics

Mean age of Death by Race/Ethnicity

Mean Age of Death by Race/Ethnicity Adults 25 Years of Age or Older, 2008 to 2009

Data Source: Death Certificates, Washington State Department of Health, Center for Health Statistics

A Framework for Health Inequity

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

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

e

Hea

lthca

re

Acce

ss

Medical Model

Risk Factors & Behaviors Disease & Injury Mortality

Socio-Ecological

“In order to get beyond racism, we must first take account of race. There is no other way. And in order to treat people equally, we must treat them differently.”

Harry A. BlackmunAmerican Supreme Court justice

Adrian E. Dominguez, M.S.Epidemiologist

Spokane Regional Health DistrictDisease Prevention and Response

Community Health Assessment, Planning , and Evaluationadominguez@spokanecounty.org

509.324.1670