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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!
