Experts identify multiple factors prevalent in less healthy areas

The Spokane Regional Health District’s report is its first attempt to measure the effects of several “social determinants of health,” and it’s meant to be the first step in a longer community conversation.

What the report does not do is identify problems that suggest easy, near-term solutions. Addressing the web of factors that influence health is not something a single agency can do; it’s not something for which any one answer will suffice. The report illustrates large problems that would take a lot of public and political will, a lot of dedication, and a lot of time to address.

“It’s what we call a wicked problem,” said Peggy Slider, a public health nurse with the district program Neighborhoods Matter.

Adrian Dominguez, an epidemiologist with the SRHD, led the effort to bring this assessment to Spokane County, using an array of state government databases – from birth and death certificates to surveys on behavioral risk factors.

Among the key messages, Dominguez says, is that health differences and social inequities are not simply a question of rich versus poor.

“The people in the middle, they’re not poor but they’re still at greater risk for negative health outcomes,” he said.

Some of the report’s findings:

The survey found strong links between education level and a range of unhealthy behaviors. Spokane County residents who had dropped out of high school were far more likely to smoke, be uninsured and drink to excess. They were also far more likely to suffer ill effects, such as chronic illness or cardiovascular disease, and the infant mortality rate among women who are high school dropouts (15 per 1,000 births) was nearly twice that of high school graduates (8.1) and far greater than that for college graduates (6.1).

Almost half of high school dropouts live in poverty, but the effects intensify for the next generation. Seventy-eight percent of children whose parents didn’t graduate from high school live in poverty. That’s almost twice the percentage as children whose parents attended community college, and more than 23 times greater than for kids of parents with advanced college degrees.

Between 2000 and 2008, the gap between the richest and poorest in Spokane County increased. The median household income for the top 5 percent of earners in the county rose $11,500 over those years; that progresses downward through the income levels. The median income for the bottom 5 percent in the county dropped by $1,200.

The lower a person’s income, the more likely the person is to suffer a range of health problems and to engage in some unhealthy behaviors.

Minority groups, which constitute 10 percent of the county population, have consistently more problems with health and poverty. The median age of death for a Native American in Spokane County is 62.1 years; for an African-American it’s 65.8; for a Hispanic it’s 68.6; and for a white resident it’s 75.6.

All these factors, and others, combine in neighborhoods. Possibly the most startling and fascinating part of the report is the neighborhood-level information it compiles. The differences in life expectancy are the most gripping of those, but the report also includes information about causes of death in particular neighborhoods, as well as the incidence of risky behaviors and poor health, neighborhood by neighborhood.

To view the entire report, visit www.spokesman.com/ documents/2012/sep/20/ health-inequities- spokane-county.

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