The William T. Small Keynote Lecture
This presentation is the property of its rightful owner.
Sponsored Links
1 / 43

The William T. Small Keynote Lecture School of Public Health University of North Carolina-Chapel Hill March 1, 2002 PowerPoint PPT Presentation


  • 60 Views
  • Uploaded on
  • Presentation posted in: General

The William T. Small Keynote Lecture School of Public Health University of North Carolina-Chapel Hill March 1, 2002. UNC School of Public Health 1973-74. Social Determinants of Health Implications for Intervening on Racial and Ethnic Disparities Sherman A. James, Ph.D.

Download Presentation

The William T. Small Keynote Lecture School of Public Health University of North Carolina-Chapel Hill March 1, 2002

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

The William T. Small Keynote LectureSchool of Public HealthUniversity of North Carolina-Chapel HillMarch 1, 2002


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

UNC School of Public Health

1973-74


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Social Determinants of Health

Implications for Intervening on Racial

and Ethnic Disparities

Sherman A. James, Ph.D.

University of Michigan


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

SOCIALDETERMINANTS

Life enhancing resources - the food supply, economic and social relationships, educational opportunities, housing, medical care, transportation, the built environment, etc. - whose distribution across populations effectively determines inter-population differences in length and quality of life.


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Why is the elimination of racial and ethnic health disparities of such vital importance to the country?

What are some important factors that underlie persistent racial and ethnic disparities in health?

What standards are appropriate for measuring progress in eliminating racial and ethnic health disparities?

How might we organize our work so that real progress toward this goal is made during this decade?


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Source: Smith and Edmonston 1997 (National Research Council Report)


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

All Cause Age-adjusted1 Death Rates and Rate Ratios by Race/Ethnicity: United States, 1990

and 1998

Race/Ethnicity

1990

1998

Rate2

RR

Rate2

RR

White

910

855

Black

1250

1.37

1136

1.33

Hispanic

692

0.76

596

0.70

American

716

0.79

705

0.83

Indian/Native

Alaskan

Asian/Pacific

582

0.64

517

0.60

Islander

1Direct Method, 2000 US population as standard; 2deaths per 100,000

Source: Health, United States 2001


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

DIABETES MELLITUS

A complex metabolic disorder - poorly

understood and poorly managed

Source: J. McKinley, L. Marceau, Lancet 2000; 356: 757-61

Complications - eye disease, kidney disease,

heart disease, and nervous system damage

Costs US economy ~ $100 billion/year

Preventable through healthy eating, regular

exercise and weight control


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Men’s Fitness

February 2002, p. 69


Diabetes age adjusted 1 death rates and rate ratios by race ethnicity united states 1990

and 1998

1998

Rate2

RR

21.9

48.4

2.21

32.1

1.47

45.9

2.10

16.9

0.77

Diabetes Age-adjusted1 Death Ratesand Rate Ratios by Race/Ethnicity: United States, 1990

Race/Ethnicity

1990

Rate2

RR

White

18.8

Black

40.5

2.15

Hispanic

28.2

1.50

American

34.1

1.81

Indian/Native

Alaskan

Asian/Pacific

14.6

0.78

Islander

1Direct Method, 2000 US population as standard; 2deaths per 100,000

Source: Health, United States 2001


Healthy people 2010

HEALTHY PEOPLE 2010

“Our goal is to eliminate disparities in

health among all population groups by 2010…”

Hon. Tommy G. Thompson

US Secretary

Health and Human Services

Press Release: January 24, 2002


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

HEALTHY COMMUNITIES INITIATIVE

...demonstration projects in 5 communities to enhance access to services and encourage positive behavioral changes...

Source: HHS Press Release, February 6, 2002

Participating communities will match federal

resources to develop coalitions between private

and public organizations... in prevention, medical, social, educational, business, religious and civic services


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

LEVEL

Authors

Neighborhood

Individual

Outcome

Findings

Yen &

Census tract

Income

Mortality

50-60%

higher

mortality in

Kaplan

Socioenvironment

Education

Score

AJE, 1999

poorer areas

Setting

Alameda

County, CA

1983-94

follow up

Multi-level Socioeconomic Effects on Health, Health Behaviors and Health Resources


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

LEVEL

Diez Roux

Census Block

Income

2-3 fold

Authors

Neighborhood

Individual

Outcome

Findings

et al

Socioenvironment

Score, 1990

Education

Occupation

Higher

incidence

in poor

neighborhoods

NEJM, 2001

CHD

incidence

ARIC

Communities

Setting

1987-97

follow up

Multi-level Socioeconomic Effects on Health,

Health Behaviors and Health Resources


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

LEVEL

Authors

Neighborhood

Individual

Outcome

Findings

Diez Roux

Census block

Family

Income

Higher income

associated with

healthier diets

et al

median household

income, 1990

Daily

F/V/M*

consumption

JECH, 1999

ARIC

Communities

Setting

1987-97

follow up

*Fruits/Vegetables/Meat

Multi-level Socioeconomic Effects on Health,

Health Behaviors and Health Resources


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

LEVEL

Authors

Neighborhood

Individual

Outcome

Findings

Morland

et al

Census tract

Prevalence

of food

stores

More food

stores in

wealthier

areas

median home

value, 1990

NA

AJPM, 2002

Setting

216 census

tracts in ARIC

communities

Multi-level Socioeconomic Effects on Health,

Health Behaviors and Health Resources


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

LEVEL

Authors

Neighborhood

Individual

Outcome

Findings

NA

Census tract

% Black

residents, 1990

Morland

et al

Prevalence

of food

stores

Fewer food

stores in

predominately

Black areas

AJPM, 2002

Setting

216 census

tracts in ARIC

communities

Multi-level Socioeconomic Effects on Health,

Health Behaviors and Health Resources


Racial ethnic differences in access to medical care

1985

2000

CANCER

Breast

Yes

Yes

Prostate

Yes

Yes

DIABETES

?

?

HEART DISEASE

Yes

Yes

Sources: Mayberry et al, 2000; Kaiser Family Foundation Report, October 1999

Racial/Ethnic Differences in Access to Medical Care?


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Differences in Heart Surgery Rates by Race,

Disease Severity, and Survival Benefit

Percent Receiving Coronary Artery Bypass Graft Surgery

80%

61%

60%

White

Black

45%

42%

40%

35%

31%

25%

20%

0%

Severe

Disease

>1 Year Life

Extension Expected

with Surgery

Mild

Disease

SOURCE: Peterson, et al., 1997


Cdc s reach 1 2010 initiative

CDC’S REACH12010 INITIATIVE

EliminateRacial/Ethnic Disparities in Six Areas:

Infant Mortality

Cancer Screening and Management

Cardiovascular Disease

Diabetes

HIV Infection/AIDS

Child and Adult Immunizations

1Racial and Ethnic Approaches to Community Health


Oakland county

OAKLAND COUNTY

“Oakland county ranks in the top five in the country in many areas crucial to reading a County’s success. Our mix of economic activity and quality of life programs and resources make Oakland County an ideal destination for families and businesses…Oakland County ranks second in per capita income for counties with over one million people, and we have a coveted triple AAA bond rating by both Standard and Poors and Moody’s, putting the County in the top one percent of all counties…”

Source: http://www.co.oakland.mi.us/aboutcommunity/


Total number of jobs by location in metro detroit 1960 1990

Total Number of Jobs by Location in Metro Detroit, 1960 - 1990

Suburban Ring

Number of Jobs (Thousands)

City of Detroit

1960

1970

1980

1990

Source: Farley et al DetroitDivided, 2000


Majority race by census tract metro detroit 2000

Majority Race by Census TractMetro Detroit, 2000


Health status and health behaviors tri county metro detroit

Health Status and Health Behaviors, Tri-County Metro Detroit


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Health Promotion Resources Per 100,000

Residents in Metro Detroit

Oakland

Macomb

Wayne

Detroit

Primary Care

168.0

52.2

75.1

Physicians1

Fitness

Centers2

10.5

7.0

4.6

4.8

5.2

4.96

0.76

Major

Supermarkets3

(Out-Wayne)

Sources:

1

Michigan Behavioral Risk Factor Surveys, 1995-99

2

Michigan Economic Development Corporation, 1999

3

Metro Detroit yellow pages, 2002


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

All Cause Death Rates for 25-64 Yr. Old Persons

by Race and Place, Metro Detroit 1999/2000

Men

1

2

Suburbs

Rate

RR

White

392

Black

793

2.0

Detroit

White

968

2.47

Black

1124

2.87

1Oakland, Macomb, and Out-Wayne Counties

2Per100,000 Age-adjusted by Direct Method, sex-specific standard population

of 25-64 year olds in Tri-County Suburbs


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

All Cause Death Rates for 25-64 Yr. Old Persons

by Race and Place, Metro Detroit 1999/2000

Women

1

2

Suburbs

Rate

RR

White

237

Black

472

1.99

Detroit

White

522

2.20

Black

564

2.38

1Oakland, Macomb, and Out-Wayne Counties

2Per100,000 Age-adjusted by Direct Method, sex-specific standard population

of 25-64 year olds in Tri-County Suburbs


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Source: The New Yorker Magazine


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

PARTNERS WHO CAN

treat health problems effectively

promote healthy behaviors among

individuals and families

Source: J. McKinlay and L. Marceau, Lancet, 2000; 356: 757-61

COALITIONS WITH MULTI-LEVEL

PROBLEM SOLVING SKILLS

increase goods and services in poor

communities

advocate for healthy public policies

design/evaluate interventions


Reach detroit

REACH DETROIT*

Towards a Social Ecology of Health

*Funded by CDC grant number CCU517264


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

Communities

Health Care

Systems

20 MD’s

Families

150 Black

150 Hispanics

FHA’s

5 Black

5 Hispanics

CHA’s

4 Black

4 Hispanics

Detroit Hlth Dept.

EducationPrograms

UMSPH

Evaluation


The william t small keynote lecture school of public health university of north carolina chapel hill march 1 2002

CONCLUSIONS

US racial/ethnic disparities in health remain

unacceptably large

These disparities are largely socially determined,

reflecting structural inequalities in neighborhood

resources and access to quality medical care

Elimination of racial/ethnic health disparities

requires broad-based coalitions - including

strong governmental leadership - capable of

solving problems at multiple levels


Acknowledgements

ACKNOWLEDGEMENTS

Debbie Barrington

Miwon Choe

Lynda Fuerstnau

Arline Geronimus

Trevillore Raghunathan

Anita Vashi

Amanda Wobbema

Institute for Social Research

John VanHoewyk

Hatcher Graduate Library

JoAnn Dionne

UNIVERSITY OF MICHIGAN

School of Public Health


  • Login