Health Equity: Exploring the root causes of health disparities at the local level

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Health Equity Exploring the root causes of
health disparities at the local level
Terry Lenahan, Policy and Planning Associate,
Community Solutions Charles Modlin, MD,
Director, Minority Men's Health Center
Associate Professor of Surgery, Glickman
Urological  Kidney Institute, Cleveland Clinic
Najeebah Shine, Director of Community Health
Services, Cuyahoga County Board of Health
Moderator Peter Whitt, Associate Director,
Center for Health Equity, Maxine Goodman Levin
College of Urban Affairs, Cleveland State
University
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• Health is more than health care
• Its about human rights
• A lack of health care is not the cause of illness
  and disease
• Its about health equity and social justice

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• We carry our history in our bodies
• Place matters!
• Chronic stress the stress caused by living day
  in and day out with racial discrimination
• Health is embedded in the larger conditions in
  which we live and work

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Understanding the root causes of health
disparities

• BEFORE

healthcare access
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Special Thanks to our Committee

• Karen Butler, Commissioner of Health, Department
  of Public Health
• Freddy Collier, City Planning Commission, City of
  Cleveland
• Kendra Daniel, Maxine Goodman Levin College of
  Urban Affairs, Cleveland State University
• Lena Grafton, Department of Community Outreach,
  Saint Vincent Charity Hospital
• Martha Halko, Cuyahoga County Board of Health
• Yvonka Hall, Local Office of Minority Affairs,
  Department Public Health
• Terry Lenahan, Center for Community Solutions
• Kara Patterson, Diversity Center
• Najeebah Shine, Community Health Services,
  Cuyahoga County Board of Health
• Ken Slenkovich, Center for Community Solutions
• Tameka Taylor
• Teleange Thomas, Sisters of Charity Foundation
• Peter Whitt, Maxine Goodman Levin College of
  Urban Affairs, Cleveland State University

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Health Equity / Health Disparities
Human Services Institute ? March 13, 2009
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Health Equity / Health Disparities

• Social factors (income, housing, race, education)
  affect our health at birth, throughout our lives,
  and may influence how long we live.

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POVERTYandRACE
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Northeast Ohio poverty level was 13 in 2000
Lake
Ashtabula
Cuyahoga
Geauga
Lorain
Portage
Summit
Note Poverty threshold in 2000 for a family of 4
was 17,029. In 2009, 22,050.
Medina
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Northeast Ohio poverty level for single mothers
was 35 in 2000
Ashtabula
Lake
Cuyahoga
Geauga
Lorain
Summit
Portage
Note Poverty threshold in 2000 for a family of 3
was 13,290. In 2009, 18,310.
Medina
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Percent Population Below Poverty Cuyahoga County,
2000
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. with Minority Populations Cuyahoga County, 2000
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Minorities account for about two-thirds of
Clevelands population . . .
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Most African-Americans live in Cleveland and its
eastern suburbs . . .
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EDUCATIONaffects knowledge, attitudes, and
lifestyles, which are related to health.
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Percent of all births that occurred to girls and
women with no high school diploma
Location of Independence home for unwed teen
mothers
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Housing Conditions
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Number of housing units in below average
condition
fair to unsound in 2001
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Poor housing conditions may lead to elevated
blood lead levels in children
Elevated blood lead level rates among tested
children under age six, 1997 to 2000
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Prenatal Care,Premature andLow-Weight Births
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Perhaps no factor is more critical to the
physical and social health of a community than
the health of its children.
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Contributing factors to less-than-optimal birth
outcomes

• low socioeconomic status / education
• maternal health problems / behaviors gestational
  diabetes, hypertension, smoking
• health care access late / no prenatal care
• chronic stress

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Premature Birth Rate in Northeast Ohio
Ashtabula
Lake
Cuyahoga
Geauga
Averages by Race U.S. White 10.6, Black 17.5
Ohio White 10.4, Black 16.8 Cuyahoga
County White 10.1, Black 17.4 Summit
County White 11.1, Black 17.4
Portage
Lorain
Summit
Medina
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Low-Weight Birth Rate in Northeast Ohio
Ashtabula
Lake
Cuyahoga
Geauga
Averages by Race U.S. White 6.6, Black 13.0
Ohio White 6.8, Black 13.3 Cuyahoga County
White 6.6, Black 13.6 Summit County White
7.1, Black 13.9
Lorain
Summit
Portage
Medina
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Percent Population Below Poverty and Low-Weight
Births
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Infant health summary . . .

• Despite positive changes in maternal behaviors,
  premature and low-weight births are higher among
  African Americans and in urban areas.

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Infant Deaths
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Contributing factors to infant deaths

• congenital abnormalities
• premature / low weight births
• SIDS (Sudden Infant Death Syndrome)
• poverty
• maternal health behaviors smoking and drinking
• teen births

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Percent Population Below Poverty and Infant Deaths
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Health Care Use and Access
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Heart Disease is leading cause of death in the
U.S.
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Population Density with hospitals and outpatient
facilities
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www.CommunitySolutions.com
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Understanding the root causes of health
disparities

• BEFORE

healthcare access
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• A lack of health care is not the cause of illness
  and disease
• Its about health equity and social justice

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Resource Promoting Health Equity A resource to
help communities address social determinants of
health CDC
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Discussion

• How should we define health?
• What is the definition of health equity?
• How does your work or the work of your
  organization contribute to the advancement of
  health equity?

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Upcoming Events April 2, 23, 30 Minority
Health Month Unnatural Causes Viewing/Discussion
Location 6 West Auditorium - St. Vincent Charity
Hospital (2351 E. 22nd Street), noon 100 p.m.
(lunch provided) RSVP to Lena Grafton,
216-363-3310 June 20 Universal Health Care
Action Network of Ohio brings T.R. Reid to town
Trinity Cathedral 2230 Euclid Avenue 700
p.m. Contact Gary Benjamin for more information
216-241-8422, ext. 21 (gbenjamin_at_uhcanohio.org) S
ummer 09 Rebroadcast of Unnatural Causes
Documentary Series on WVIZ/PBS Ideastream Fall
09 Larger community meeting to launch a new
initiative (details soon)