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Environmental Justice &

Reproductive Health:Public Health Priorities in LA County

Cynthia Harding, MPHChief Deputy Director

Los Angeles County Department of Public Health

Presentation At-a-Glance

• Social determinants and their impact on health

•Reproductive health

• Environmental justice issues

•Health equity considerations

Slide 1

Slide 2

What is a healthy community?

•A healthy community supports:

–Opportunities and resources that ensure optimal health and well-being for all

–Clean air, water and soil

–Social connections and civic engagement

Adapted from: http://www.phi.org/uploads/files/Four_Pager_Health_in_All_Policies A_Guide_for_State_and_Local_Governments.pdf

Slide 3

Factors that impact health outcomes

Health Factors

Health Outcomes

Programs and

Policies

Mortality (50%)

Morbidity (50%)

Physical environment

(10%)

Social & economic factors

(40%)

Health behaviors

(30%)

Clinical care

(20%)

Unsafe sexAlcohol use

Diet & exercise

Tobacco use

Access to care

Quality of care

Community safety

Education

Family & social support

Employment & IncomeRacism

Built environment

Environmental quality

Source: http://www.countyhealthrankings.org/our-approach

Definition of environmentThe Merriam Webster Dictionary defines environment in different ways, including:

• A) The complex of physical, chemical, and biotic factors(such as climate, soil, and living things) that act upon an organism or an ecological community and ultimately determine its form and survival

• B) The aggregate of social and cultural conditions that influence the life of an individual or community

https://www.merriam-webster.com/dictionary/environment

Social Determinants of Health: 5 Domains

Slide 5

RACISM & DISCRIMINATION

Economic

StabilityEducation

Health &

Healthcare

Neighborhood &

Built Environment

Social &

Community Context

PovertyHigh school graduation

Access tohealthcare

Access to healthy food/safe parks

Social cohesion

EmploymentLanguage & literacy

Access to primary care

Density of alcohol, tobacco, cannabis establishments

Civic participation

Food security

Early childhood education

Health literacy

Crime & violence Incarceration

Housing stability

$/per studentHealth outcomes

Environmental exposures

Networks

Adapted from: Medicaid and Social Determinants of Health: Adjusting Payment and Measuring Health Outcomeshttp://www.statenetwork.org/wp-content/uploads/2017/07/SHVS_SocialDeterminants_HMA_July2017.pdf

Slide 6

How do social determinants

affect health?

unfair or lacking policies

Unequal distribution of resources

↓power

& control

↑chronic stress &

↓ immune

response

↑disease

↓ life expectancy & quality of

life

LA County: Population Statistics

• Population size: 10.3 million

– 1 of every 4 Californians lives in LA County (26%)

– More people than in 42 other U.S. states

Slide 7

State of California, Department of Public Health, Birth Records, 2013Los Angeles Mommy and Baby Study (LAMB), 2012

Percent of Population by Race, LA County, 2015

Slide 8

Key Indicators of Health http://publichealth.lacounty.gov/ha/KeyIndicator/2017/PH-KIH_2017-sec_printing.pdf

Latino

White

African American

Asian

Native Hawaiian or Other Pacific Islander (NHOPI)

American Indian/Alaskan Native

Need for Safe

Spaces to Exercise

Slide 9

Black and Latina women fare worse among: • Percent of adults who

believe their neighborhood is safe from crime

• Percent of adults who report their neighborhoods do not have walking paths, parks, playgrounds, or sport fields

Health Indicators For Women In Los Angeles County: Highlighting Disparities by Ethnicity and Poverty Level. http://publichealth.lacounty.gov/owh/docs/HealthIndicators2.pdf

Food Desert in

Los Angeles County,

USDA 2015

Slide 10

• Green = low income and low access areas at 1 and 10 miles

• Orange = low income and low access at ½ and 10 miles

Courtesy Economic Research Service at USDA: https://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas/

Slide 11

CalEnviroScreen 3.0 Results, 2017LA County communities disproportionately burdened by multiple sources of pollution and with population characteristics that make them more sensitive to pollution

https://oehha.ca.gov/calenviroscreen/maps-data

Slide 12

Women in LA County by Age &

Race/Ethnicity, 2015

41 45 4350

25

4242

39

40

45

17 13 1810

30

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All LA CountyWomen

Asian Black Latina White

Perc

ent

of

Wo

men

65 years or older

40 to 64

18 to 39

12

Health Indicators For Women In Los Angeles County: Highlighting Disparities by Ethnicity and Poverty Level. http://publichealth.lacounty.gov/owh/docs/HealthIndicators2.pdf

Slide 13

LA County: Birth Statistics

• 2.5 million reproductive age women

• ~130,000 births per year

–1 in 30 births in the U.S.

–1 in 4 births in California

–1 in 3 births to a mother less than 24 years old

• 62 delivery hospitals Slide 13

State of California, Department of Public Health, Birth Records, 2013Los Angeles Mommy and Baby Study (LAMB), 2012

Slide 14

African American or Native American babies

are at least more likely to be born too small or too soon than white infants.

Low Birth Weight & Preterm in LAC

Native American 13.8% 16.4%

African American 12.1% 12.8%

White 6.5% 7.8%

2x

Maternal Mortality Ratio

by Race/Ethnicity LA County, 2007-2013

Slide 15

13.6

62.7

13.4 14.9

0

10

20

30

40

50

60

70

White African American Latina Asian

Slide 16

6

4

2.4

4.3

9

2.7

0

1

2

3

4

5

6

7

8

9

10

HP 2020 LA County Asian Latino Black White

Infa

nt

Dea

th R

ate

per

1,0

00

Liv

e B

irth

s

Infant Mortality by Race/Ethnicity

LA County, 2014

Table does not include data for Native Hawaiian and other Pacific Islander or American Indian/Alaskan Native.

Source: Los Angeles County Department of Public Health, Office of Health Assessment & Epidemiology, Mortality in Los Angeles County 2014

Slide 17

6.4 6.7

12.6

8.8

6.6 6.3

8.4

6.8

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

US-born Foreign-born

Perc

ent

(%)

Mother’s Nativity

White African Am Latina Asian

Percent of Low Birth Weight by Mother’s

Race/Ethnicity & Nativity: LA County, 2010-2015

Source: CDPH Birth Cohort Data, 2010-2015. Prepared by Office of Health Assessment and Epidemiology, 6/2017.

*Preterm Live Birth Rate: Live births less than 37 weeks of gestation and ≥ 17 weeks per 1,000 live births.

Percent Low Birth Weight by Stressful Life

Events African American vs. White Mothers

LA County, LAMB 2012 & 2014

Slide 18

5.7%5.0%*

9.2%

14.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

None 3 or more

White African American

*This estimate is statistically unstable due to the small sample size.

Traumatic/Toxic Stress during Pregnancy

Sources of stress during pregnancy can come from many areas in a woman’s life

• Intimate Partner Violence

• Neighborhood Conditions

• Stressful Events related to relationships, substance abuse, housing, and job security

• Experiences of Discrimination

Slide 19

Neighborhood Characteristics

Slide 20

54% of African Am. moms felt their

neighborhood was unsafe

56% of Hispanic moms felt their neighborhood

had poor police protection

38% of LA County

mothers felt their

neighborhoods were not clean

Experiences of Discrimination

• 37% of LA County mothers report experiencing at least one incident of discrimination over her lifetime.

• The most common reasons for experiencing discrimination varied by mother’s race/ethnicity.

₋ White mothers cited gender (16%) and pregnancy status (16%).

₋ African American mothers cited race (40%) and income/gender (20%).

₋ Hispanic mothers cited race (15%) and language (12%).

₋ Asian/Pacific Islander mothers cited race (17%) and language/gender (10%).

Slide 21

What are we doing to improve

reproductive health?

• Improving health conditions of women by improving the environments in which they live

• Linking women and families to enhanced systems of care

• Strengthening the support systems for women and families in communities

• Advocating for policy changes that improve lives

Slide 22

Environmental Justice Challenges

• Exide

• Aliso Canyon

• Zika and West Nile

• Climate Change

• Other

Slide 23

Slide 24

1920s

• Exide takes over plant

1980s

• Battery recycling plant permitted with ‘interim status’

• Smelter in operation at plant

2000s 2010s

• Ordered to cut production in half

• Ordered to suspend operations

• Ordered to shut down operations & clean up site

Exide Technologies Battery

Recycling Plant: A Brief History

30 years of community exposure to toxins

Slide 25

Widespread Lead Contamination in Soil

1500 ft

1.0 mi

1.5 mi2.0 mi

10,000 homes within radius

Slide 26

Let’s Talk About Exide: Survey Results

Aliso Canyon Gas Release, Porter Ranch

• Methane leak caused health symptoms and forced relocation of residents

Slide 27

Aliso Canyon Gas Leak – DPH Activities• Conducted and analyzed outdoor air

sampling data

• Conducted indoor air monitoring

• Monitored the air quality

• Educated and addressed residents’ concerns

• Logged health complaints

• Held gas company accountable to protect residents’ health

• Issued air monitoring reports and Public Health Assessment

Slide 28

Zika and West Nile Virus•Ongoing disease surveillance

•Educating clinical providers

•Collaborating with vector control agencies and local jurisdictions

• Investigating all possible cases

•Web portal

– Videos and resources for various audiences

Slide 29

publichealth.lacounty.gov/media/zika/

Slide

30

Five point plan to reduce the impacts of

climate change

Slide

31

Other Areas of Focus

•Gas leaks

•Oil wells

•Refineries

•Heavy industry

•Clean water

Slide 32

What strategies work to improve health?

Counseling & Education

Clinical Interventions

Long-Lasting Protective Interventions

Changing the context make individual’s default decisions healthy

Socioeconomic factors

33

Slide 17

Increasing Population

Impact

Increasing Individual

Effort Needed

Source: Frieden, T.R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100 (4), 590-595. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836340/pdf/590.pdf

Upstream Strategies

•Clean air

–Transportation, development, environmental hazards

• Safe housing

•Healthy schools

•Access to services

Slide 34

Slide 35

The Need for an Environmental Justice Lens

Photo sources/credits:(left to right): Larry Buhl / Free Speech Radio News; Al Seib / Los Angeles Times; KPPC

Environmental Justice

Vision

Slide 36

Results-based Accountability

Empowered communities

Strengthened regulations

Higher rates of

compliance

Fewer and less severe emergency incidents

Reduced toxic

emissions

Improved environ-mental

conditions

Slide 37

Prevention Strategies

Advocate for stricter enforcement by State regulators

Increase focus on health protection in regulatory decision-making

Promote community empowerment

Improve monitoring for early detection of health threats

Slide 38

Achieving Health Equity:

Policy, Environment and Systems Change

• Core Strategies:

– Data gathering & information sharing (communications)

– Community Investment

– Policy & Practice Change

• Guiding Principles

– Accountability to the community

– Integrity in our internal and external processes

– Collaboration and shared learning

– Commitment to racial justice and social change

Slide 38

Slide 39

Reframe Using an Equity LensConventional Question Health Equity Question

How can we promote healthy behavior?

How can we target dangerous conditions and reorganize land use and transportation policies to ensure healthy spaces and places?

How can we reduce disparities in the distribution of disease and illness?

How can we eliminate inequities in the distribution of resources and power that shape health outcomes?

What social programs and services are needed to address health disparities?

What types of institutional and social changes are necessary to tackle health inequities?

How can individuals protect themselves against health disparities?

What kinds of community organizing and alliance building are necessary to protect communities?

40

THANK YOU!