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Promoting Health in the Centinela Valley byEliminating the Root Cause of Disease
Jan B. King MD MPHArea Health Office West and South Los AngelesApril 13, 2017
1
African American and Latino, South LA
21. http://dornsife.usc.edu/assets/sites/731/docs/RootsRaices_Full_Report_CSII_USC_Final2016_Web_Small.pdf
1970
2010
• Green = African Americans • Brown = Latinos
Gentrification Impacts the Westside of South LA
3
1.http://www.latimes.com/local/lanow/la-me-leimert-park-20170208-story.html
Health StatusCentinela Valley (SPA 6)
4
Health Care Access – Health Insurance
96.6 97
0
20
40
60
80
100
Percent of insured children
% children ages 0-17 years who are insured
LA County SPA 6
5
88.3 82.2
0
20
40
60
80
100
Percent of insured adults
% adults ages 18-64 years who are insured
LA County SPA 6
Self Reported Health Status
21.5
30.6
0
5
10
15
20
25
30
35
40
45
50
Health Status Fair or Poor
% of adults reporting their health to be fair or poor
LA County SPA 6
6
50% more SPA 6 residents report fair or poor health
Premature Death - Males
7
1.http://www.publichealth.lacounty.gov/dca/data/documents/mortalityrpt13.pdf
Premature Death – Homicide
8
10.8
29.7
0
5
10
15
20
25
30
35
Homicide rate among adolescent and young adults 15-34 years (per 100,000 population)
LAC SPA 6
Nearly 300 (275)% higher for SPA 6
9
116.7
147.5
0
20
40
60
80
100
120
140
160
Coronary heart disease death rate (age-adjusted per 100,000 population)
LA County SPA 6
Chronic Disease – Coronary Heart Disease
26% higher for SPA 6
10
7.1
8.5
0
1
2
3
4
5
6
7
8
9
10
Death rate due to motor vehicle crashes (age-adjusted per 100,000 population)
LAC SPA 6
Premature Death – Motor Vehicle Crashes
20% higher in SPA 6
9.812.3
0
5
10
15
20
25
30
% adults ever diagnosed with diabetes
LA County SPA 6
11
21.9
37.6
0
10
20
30
40
Diabetes death rate (age-adjusted per 100,00 population)
LA County SPA 6
Chronic Disease - Diabetes 25% Higher in SPA 6
70% Higher in SPA 6
Trend in Life ExpectancyLos Angeles County, 1991-2013
74
76
78
80
82
84
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13
Life
Exp
ecta
ncy
in Y
ears
75.8
82.1
Age-Adjusted Mortality Rate by Race/Ethnicity in Los Angeles County 1999-2015
13
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999
2015 on CDC WONDER Online Database, released December, 2016
0
2
4
6
8
10
12
14
16
SPA 1* SPA 2* SPA 3* SPA 4* SPA 5+ SPA 6 SPA 7+ SPA 8*
Infant Death Rate (per 1,000 live births) and African American Infant Death Rate (per 1,000 African American live births) by SPA
Infant death rate AA infant death rate
14
* Data are unstable- Data are suppressed
LA County average – 4.4
* Infant death is death of a child less than one year of age
Infant Death
15
1.http://www.publichealth.lacounty.gov/mch/LACALC/LACALC_InfantStats.htm
Association of Life Expectancy & Economic Hardship in Los Angeles County Cities/Communities, 2006
70
75
80
85
90
0 10 20 30 40 50 60 70 80 90 100
Life
Exp
ecta
ncy
at B
irth
(Yea
rs)
Economic Hardship Index
Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. Life Expectancy in Los Angeles County: How long do we live and why? A Cities and Communities Report. July 2010.
Healthy Community
• Education• Job opportunities• Living wage
• Clean air, soil & water
• Parks & green spaces• to recreate/exercise
• Affordable, safe housing
• Safe water• Healthful food• Transportation• Health care
18
Basic Needs Environment
Economic & Social Development
Social Relationships
• Social & civic engagement
• Supportive relationships
Social Determinants of Health
19
Lack of Educational Attainment
22.4
41.6
0
10
20
30
40
50
LA County SPA 6
% of adults with less than high school education
LA County SPA 6
20
10.2
13.6
0
5
10
15
LA County SPA 6
% of adults who are unemployed (and looking for work)
LA County SPA 6
Unemployment
86% higher, nearly double
33% Higher in SPA 6
18.433.6
0
20
40
60
80
100
LA County SPA 6
% of population with household incomes less than 100% of FPL
LA County SPA 6
21
Household Poverty
Housing Affordability
• 60% of LA renters are housing burdened paying 30% or more on housing
• 33% of renters spend more than half of their income on housing
34% Higher in SPA 6
22
Race the Power of an Illusion - The House You Live In
https://www.google.com/search?q=redline+map+of+los+angeles&espv=2&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjeoZb98JzTAhVpiFQKHTpmBS4Q_AUICCgD&biw=1920&bih=1014#imgrc=0
VSrjpbA56sKsM:
23
What You Can Do to Address Health Inequities in SPA 6
24
Infant Mortality
• Preventing unplanned pregnancy• Home visitation (Nurse Family Partnership)• Maternal access to care • Navigation healthcare system• Ensuring transportation to pre and post natal visits• Emotional support during pregnancy
25
Workforce Development: Providing Culturally Responsive Care
– Undoing Racism and Implicit Bias training (from frontline to leadership)
• People’s Institute for Survival and Beyond• Race Forward
– Providing Culturally Competent Care• Special populations
26
Patient Experience
Violence Prevention
• Universal School Based Violence Prevention Programs• Early Childhood Home Visitation Programs • Parenting support• Hospital Based Community Violence (Gang) Prevention
27
Health Equity
Education• Work to increase high school graduation rates• Safe routes to school• After school academic support (not just extracurricular) • Trauma informed care
28
Health Equity
Health Equity Lens
THANK YOU 29
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