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 [email protected]
509.324.1670