Closing Spokane’s health gap

There may always be “haves” and “have-nots” in society, but as far as Spokane Regional Health District staff are concerned, class distinctions should not extend to the health of Spokane citizens.

In her annual assessment of the health of the community, Spokane Health Officer Dr. Kim Thorburn calls for eliminating disparities in the well-being of residents based on socioeconomic factors.

“We cannot declare ourselves completely healthy when there are different health outcomes among populations,” Thorburn wrote in her State of Spokane’s Health 2006 report, which she will present to the health board on Jan. 26. A copy of the report was made available to The Spokesman-Review in advance.

Thorburn cites many factors contributing to health disparities. They include age, gender, race or ethnicity, education, sexual orientation, disability and income.

U.S. and world disasters during 2005 disproportionately affected the poor and people of color and opened a new national debate on poverty and race in America.

“Katrina was a very important reminder that as we focus on better response to emergencies and disasters we can’t forget fundamental work in closing the gap in health status,” Thorburn said.

While acknowledging that many social inequalities are beyond the purview of public health workers, Thorburn said her agency is dedicated to closing health disparities that result in earlier deaths, more disease and injury, and lower quality of life of Spokane citizens.

Thorburn cited examples of health disparities from the Spokane Counts project, a statistical analysis of various public health surveys compiled by the Community Health Assessment Office. Details are available online at www.srhd.org.

The surveys show economic level played a crucial role in a respondents’ sense of well-being, an important health indicator. Among participants asked to rank how safe and secure they believed they are, those living below 100 percent of the federal poverty level felt significantly less secure than those at 200 percent of the poverty level.

Housing, transportation, education, neighborhood safety and security all suffer as a result of poverty, Thorburn said.

“In order to be healthy we need access to these societal benefits,” she said.

Education levels affected certain behaviors, increasing the risk of chronic diseases such as cancer and heart disease. For example, high school dropouts were more than twice as likely to be current smokers compared with respondents who had some college. Dropouts are 10 times more likely to smoke as those with college degrees.

“Big tobacco has picked out groups to target through the years, most recently African Americans. Women were a target in the late ‘80s and early ‘90s,” Thorburn said. “Youth are more vulnerable to these messages. With less education you have fewer skills to critically evaluate messages from the tobacco industry, for example.”

Race and ethnicity also are associated with health disparities.

In Spokane, the life expectancy at birth of Asian Americans was nearly 14 years longer on average than the lifespan of a Native American. The expected lifespans of whites and African Americans also were longer than that of Native Americans.

People of color in Spokane were nearly five times more likely to die from homicide than whites.

One-third more Native American children and adolescents reported periods of depression than white youth. Data also suggest disparities in infant mortality and vaccine-preventable disease rates in Native Americans.

Access to health care also is affected by race, ethnicity and income level with a greater proportion of Native Americans, African Americans and Slavic people lacking health insurance in Spokane.

“Clearly access to health care is important,” Thorburn said. “If we were to analyze cause of death, we would see more death from treatable chronic illness” among minorities.

Thorburn said the state of Spokane’s health compares favorably to national and state health statistics. “But when we look at ourselves internally, we see we have some work to do to make ourselves a healthy community.”

The community, she said, can intervene to eliminate health disparities by making neighborhoods safer, providing health programs that specifically target at-risk groups, improving immunization rates and ensuring equal access to health care.

The health district has formed partnerships with community groups such as the low-income advocacy group VOICES, Russian educators and churches, the Regional Chamber of Commerce, and community clinics to deal with the underlying social causes of health disparities.

One such partner, the Emmanuel Center, is making a difference by providing child care and after-school programs to children in Spokane’s south-central neighborhood.

“This place is really important to the community,” said Brenda Kane, director of Richard Allen Enterprises Inc., which runs the center sponsored by the Bethel AME Church. “Children have a safe place to come.”

Besides child care, the center distributes more than 2,000 pounds of food a week from the Second Harvest Food Bank and provides hot dinners twice a week January through March. The Emmanuel Center, in cooperation with the health district, also provides culturally appropriate information to the community about preventable and treatable disease.

The key, Thorburn said, is “understanding where disparities exist and putting resources – not just ours, but our partners’ – toward those areas.”