Health Inequities inHealth Inequities in Spokane County Spokane County

Income Income

Board of HealthMarch 22, 2012

The goal of this assessment is to increase and provide a perspective on different health and social inequities in Spokane County and provide information that can be used for potential changes that affect health outcomes.– Build awareness– Identify further areas for exploration– Identify community partners– 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

Data Sources

Washington State Population SurveyBehavioral Risk Factor Surveillance Survey (BRFSS)Birth CertificatesDeath CertificatesCommunity Health Assessment Tool (CHAT)Office of Financial Management, Washington StateWashington State HIV Surveillance ReportStrategic Research Associates, Omnibus Survey

Definitions

Health 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.

Definitions

Social Determinants of Health

Through research, factors (i.e., determinants) in our social and economic environment that 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.

The Ladder Position

Using ladder as 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

A Framework for Health Inequity

Upstream Downstream

•Race•Class•Gender•Immigration status•National Origin•Sexual orientation•Disability

Discriminatory Beliefs (ISMS) •Corporation

s & other businesses•Government agencies

•Schools

InstitutionalPower •Neighborhoo

d conditions

SocialPhysical

•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

Hea

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Medical Model

Risk Factors & Behaviors Disease & Injury Mortality

Socio-Ecological

Components to Health Inequities

Why Income/Poverty Level?

What We HeardFocus group participants were asked about their perceptions of stereotypes that others may have of people from their socioeconomic level: “I think the biggest stereotype is that we don’t try. I think that’s a problem. People are at this bracket for whatever reason, but I certainly don’t think it’s for lack of trying.”

Focus Group Participant (income <35k)

Scott Finyalson

Poverty• Poverty was defined as 200% FPL using the Federal Registrar’s 2008

Percent of Poverty Guidelines• For a family of 4 (2 adults and 2 children) at 200% FPL, the gross annual

household income equates to $42,0000• Household income was calculated based on total income in that

household and determined as a percent of FPL• The number of members in a household and the total income in the

household was used to determine a households poverty level• When a poverty level was determined for a household, all individuals in

that household were given the same poverty level

Increasing Income Inequality in Spokane County

Data Source: Washington State Population Survey

Looking at Growth of Income at Each Level of Wealth in Spokane County and Washington

State from 2000 to 2008

Change in Income from 2000 to 2008

5th Percentile

10th Percentile

25th Percentile

50th Percentile

75th Percentile

90th Percentile

95th Percentile

Spokane County ↓1.2K No change ↑4.3K ↑4.7K ↑8K ↑14K ↑11.5K

Washington State ↑1.1K ↑1.8K ↑5.3K ↑10.4K ↑15K ↑19.2K ↑21K

Data Source: Washington State Population Survey

Change in Median Household Income (2008 Inflation-Adjusted Dollars) from 2000 to 2008

Overall PovertyOverall Poverty by Categories, 2000 to 2008

Data Source: Washington State Population Survey

Poverty significantly increases for children whose mother is a single parent.

General Health Status by IncomeGeneral Health Status by Household Income among Adults 25 Years of Age or Older, 2000 to 2008

Data Source: Washington State Population Survey

Household Income as Percent of Federal Poverty Level

Parents’ Income and a Child’s Chance for Health

Household Income as Percent of Federal Poverty Level

Child’s Health Status by Household Income, 2000 to 2008

Data Source: Washington State Population Survey

Effects of Chronic Illness on Physical Activity by Income

Household Income as Percent of Federal Poverty Level

Physical Activity Limitations Due to Chronic Illness among Adults 25 Years of Age or Older by Household Income, 2000 to 2008

Data Source: Washington State Population Survey

Physical Inactivity Among Adults by Income

Physical Inactivity by Household Income among Adults 25 Years of Age or Older, 2005 to 2009

Household Income as Percent of Federal Poverty Level

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Smoking by Income Level Smoking by Poverty Level, 2005 to 2009

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Household Income as Percent of Federal Poverty Level

Lower income adults are more likely to smoke than adults in higher income groups.

Diabetes by Income

Household Income as Percent of Federal Poverty Level

Diabetes by Poverty Level among Adults 25 Years of Age or Older, 2005 to 2009

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Obesity by Income

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Household Income as Percent of Federal Poverty Level

Obesity by Poverty Level among Adults 25 Years of Age or Older, 2005 to 2009

Poor Mental Health by Income

Data Source: Behavioral Risk Factor Surveillance System (BRFSS)

Household Income as Percent of Federal Poverty Level

Poor Mental Health by Household Income among Adults 25 Years of Age or Older, 2005 to 2009

A Framework for Health Inequity

Upstream Downstream

•Race•Class•Gender•Immigration status•National Origin•Sexual orientation•Disability

Discriminatory Beliefs (ISMS) •Corporation

s & other businesses•Government agencies

•Schools

InstitutionalPower •Neighborhoo

d conditions

SocialPhysical

•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

Hea

lthca

re

Acce

ss

Medical Model

Risk Factors & Behaviors Disease & Injury Mortality

Socio-Ecological

All we see of someone at any moment is a snapshot of their life, there in riches or poverty, in joy or despair. Snapshots don't show the circumstances and the million decisions that led to that moment.

Richard Bach

Adrian E. Dominguez, M.S.Epidemiologist

Spokane Regional Health DistrictDisease Prevention and Response

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

509.324.1670