Think Locally, Act Globally

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Think Locally, Act Globally

• Data Implications for Addressing Health
  Disparities in Chicago
• Sandra Thomas, MD, MS
• Assistant Commissioner for Epidemiology
• Chicago Department of Public Health

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Variations in Health Status
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What Are Your Assumptions?

• Disparity A great difference (dictionary
  definition)
• Disparity Public Health definition
• Injustice
• Implies referent group
• Minority is always defined relatively
• Category does not equal identity

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Non-Categorical Differences in Chicagos Ethnic
Populations

• Non-African Americans are 2.5 to 8.5 times more
  likely to be recent immigrants than African
  Americans
• Between 17-74 percent of Non-African American
  ethnic group members were born outside of the US,
  compared to 2 of African Americans
• Less than 1 of African American adults have
  limited English fluency, compared to 5 -8 of
  Whites, 17-47 percent of Asians, and 32-47
  percent of Hispanic adults

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Non-Categorical Differences in Chicagos Ethnic
Populations
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Is Poverty the Primary Explanatory Factor?

• Solve for ? 0.5 , this results in a ratio of
  y8.5x
• So, for a condition that occurs at a rate of 10
  in the non-poor, it would have to occur at a rate
  of 85 in the poor to be able to bring the overall
  Black/White disparity ratio to 2

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Recent Trends Type A Disparity
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Recent TrendsType B Disparity
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Recent Trends Type C Disparity
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Recent Trends Type D Disparity
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Act Globally

• There are substantial demographic differences
  between Chicagos ethnic groups that are relevant
  to expected health outcomes
• Large health outcome differences require
  ethnicity specific poverty effects and/or
  differences in the in the non-poor as well as the
  poor
• Populations across class are mobile within small
  areas (40-60 had changed address within 5 years)
• Larger scale changes needed to improve population
  outcomes
• Examine before explaining ?