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Race, Poverty, and Health Tim Monroe, MD, MPH Forsyth County Health Director Race, Ethnicity & the US Census Race categories White Black American Indian and Alaska Native Asian and Pacific Islander Ethnicity categories Hispanic Non-Hispanic

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Race, Poverty, and Health

Tim Monroe, MD, MPH

Forsyth County Health Director


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Race, Ethnicity & the US Census

  • Race categories

    • White

    • Black

    • American Indian and Alaska Native

    • Asian and Pacific Islander

  • Ethnicity categories

    • Hispanic

    • Non-Hispanic


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Race, Ethnicity, and the NC State Center for Health Statistics

  • Minority “Non-white”

    (>80% African American in N.C.)

    • African- , Asian- , or Native- American

    • Hispanic and non-Hispanic

  • White

    • Hispanic and non-Hispanic


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Racial Inequities in Health StatisticsDisease-Specific Death Rates, 1999-2000

Source: NC SCHS


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Concentrated Poverty and Health Statistics

  • “the fundamental causes of disease…[are]…those that involve access to the resources necessary to maintain health and avoid disease.”

  • “race-based residential segregation is a fundamental cause of racial disparities in health, isolating many African-Americans in spatially distinct neighborhoods where their access to the resources necessary to maintain health is limited.”

    Schultz


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Racial Disparities in Health Outcomes: StatisticsConsequences of Public Policy

  • Effects of race-based concentrated poverty on human health and welfare

    • Deprivation of beneficial and healthful resources

      • education, health care, recreation, constructive finance and commerce

    • Concentration of exposure to negative and harmful influences

      • harmful illegal marketing; harmful legal marketing; industrial sites and brown fields; freeways


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Racial Disparities in Health Outcomes: StatisticsConsequences of Unjust Public Policy

  • Effects of concentrated poverty on human health and welfare (cont.)

    • Stresses of living in poverty

    • Stresses of living with racism

    • Racial barriers to accessing beneficial resources

    • Constant pressure of harmful marketeering

  • Result: excess preventable disease and premature death


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Race, Poverty, and Health Statistics

  • African Americans are nearly five time more likely to live in poverty than whites

  • Averaging the annual risk of death over a lifetime, an African-American from Forsyth County is 30% more likely to die in any given year of his/her life that a white person from Forsyth County


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Health and Diet Statistics

  • African-Americans have higher rates of type II diabetes and cardiovascular disease than the white population

  • Higher proportionate consumption of healthy fruits and vegetables can prevent morbidity and mortality from heart disease and type II diabetes


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Diet and Community Resources Statistics

  • Consumption of healthy fruits and vegetables increases substantially with increased residential proximity to full service grocery stores

  • Full service grocery stores are relatively sparse in racially segregated minority neighborhoods


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Market Resources and Health Statistics

  • Limited access to full service grocery stores or food markets can be understood as a significant contributor to preventable morbidity and mortality from type II diabetes and cardiovascular disease

  • Food retail marketing is unlikely to meet the needs of racially segregated minority neighborhoods as a consequence of market forces


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Planning, Health, and Justice Statistics

  • Need public policy-based mechanisms to assure that a resource (grocery stores) important to the welfare (health) of all residents is provided equitably

  • The American Planning Association’s Policy Guide on Public Redevelopment identifies “social equity and environmental justice” as critical guiding principles


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Planning and Justice Statistics

  • Social equity: “the expansion of opportunities for betterment that are available to those communities most in need, creating more choices for those who have few”

  • A legitimate application of the community planning process is to redress the consequences of injustice that have and continue to adversely impact minority neighborhoods and the welfare of their residents.


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Race, Poverty, and Health Statistics

  • The 1938 Fair Labor Practices Act established a minimum wage as one component of an effort designed to promote the “maintenance of the minimum standard of living necessary for health, efficiency, and general well-being of workers”

  • The Federal Poverty Guideline was established in 1965 as a budget necessary to prevent starvation in an emergency or temporary situation


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Race, Poverty, and Health Statistics

  • The Federal Poverty Guideline (FPG) if $9.30/hour (with health benefits, or $12.00 without health benefits) or $19,350/year for a full-time, year round worker supporting a family of four

  • The FPG for one adult and one child is $6.26/hour or $13,020/year


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Race, Poverty, and Health Statistics

  • The Federal Minimum Wage is $5.15/hour or $10,712/year

  • The N.C. Minimum Wage is $6.15/hour or $12,792/year

  • The Federal Minimum Wage of $1.60 in 1968 would be worth $8.30 in todays dollars


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Race, Poverty, and Health Statistics

  • The North Carolina Justice Center (NCJC) established a Living Income Standard which is the income level that would provide for the essential needs to live (housing, food, clothing, child care, transportation, education, health care, and taxes)

  • At a national level this standard is $18.60/hour or $38,688/year for a family of four

  • It is estimated that 49% of N.C. Families live below this standard


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Race, Poverty, and Health Statistics

  • Public Policy and Values:

    • The American work ethic dictates that individuals sustain their families and themselves with gainful employment; i.e., a personal responsibility

    • Yet we expect individuals to work for half the income necessary on which to do.

    • Those living in poverty do not have the same opportunity to be healthy as those with means.


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Poverty and Access to Health Care Statistics

  • Majority in US believe access to health care to be a right: however, not assured by government

  • In US, private sector is given first dibs on all profitable aspects of the health care market

  • Public sector and/or charity are expected to fulfill moral obligation to assure care for all

  • Public sector will never be given adequate resources to meet the need until we recognize that it is a responsibility of government


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