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Retail Food and Health: An Equity Framework

Retail Food and Health: An Equity Framework



A presentation by Jim Bloyd, MPH, Cook County Place Matters Steering Committee, Cook County Dept. of Public Health, March 16, 2012, Good Food Festival and Conference, Chicago, University of Illinois ...

A presentation by Jim Bloyd, MPH, Cook County Place Matters Steering Committee, Cook County Dept. of Public Health, March 16, 2012, Good Food Festival and Conference, Chicago, University of Illinois Forum. Topics: evidence of health inequities; mixed evidence of neighborhood food environment and nutrition and health; Health Equity Framework of Anthony Iton; Power as a concept that must be considered to achievve health equity; Racial segregation in metro Chicago and resources.



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  • Health inequities exist, but the Evidence is mixed on presence of retail food outlets affecting behavior and health outcomes; Health equity framework taking into account the social determinants of health includes more of the resources people need to be healthy in neighborhoods Power is a key concept that must be considered to achieve health equity.
  • In order to examine the relationship between food access and health measures within Cook County, we grouped Chicago census tracts and suburban Cook municipalities into quintiles based on both their access to chain supermarkets only and access to chain supermarkets plus large independent groceries. Figures 7 and 8 display the life expectancy within these quintiles. The lowest quintile (census tracts and municipalities with the least access to these food providers) has an average life expectancy that is more than 12 years shorter than the quintile with the highest access. Furthermore, the risk of premature mortality is more than twice as high in the lowest quintile compared to the highest quintile. When large independent groceries are included, the difference in average life expectancy from the highest to the lowest quintile is almost 11 years. (Source: unpublished preliminary analysis of Community Health Equity Report, Cook County Place Matters, Joint Center for Political and Economic Studies DRAFT 2012)
  • Relationship between energy density of selected foods (kcal/g) and energy costs (US$/ 1,000 kcal). Food prices from Seattle supermarkets, 2006. Note that the energy cost differential between added sugars and fats and fresh vegetables and fruit can be several thousand percent, as indicated by the logarithmic scale.
  • We selected census variables that are thought to contribute to an area’s overall or total variance of deprivation based on six domains e income, poverty, housing, education, employment and occupation. Based on our previous work of contextual indicators associated with adverse birth outcomes (Elo et al., 2009; Holzman et al., 2009; O’Campo et al., 2008), we used 8 census-derived variables to measure the six domains: percentage of households below the 2000 income to poverty ratio, percentage of households on public assistance, percentage of female-headed households with dependent children, percentage of households with annual income 1 person/room), percentage of unemployed adults, and percentage of males in management or professional occupations.
  • Figure 2: Variables in the analysis Fiscal · Combined property and sales tax capacity per household 2001 · Change in tax capacity 1993-2001 · Percentage of population school age · Percentage of population over 65 · Day care slots · Median year built - housing units Transportation/Jobs · Mean travel time to work · Proportion of population near transit · Transportation efficiency index · Jobs within 10 miles · Change in Jobs within 10 miles, 1995-2000 · Jobs within Municipality/household Quality of Life · Low birth rate percentage · Cases of asthma/hypertension per capita · Voter participation rate · Polluted sites/capita · Park land/capita · Housing value change, 1990-2000 · Violent crimes/capita 2002 · Non-violent crimes/capita 2002 Schools · Average ACT score · Graduation rate · Limited English Proficiency (LEP) rate · Mobility rate · Truancy rate
  • Overall Grade for Metro Chicago: F | 99th Residential Segregation: F | 75.2 Neigh. Income Gap: F | 38.0% School Test Score Gap: F | 68.6% Employment Gap: F | 25.0% Homeownership Gap: C | 47.1% Accessed at http://datatools.metrotrends.org/charts/metrodata/rankMap_files/EquityMap_files/RankMapBlack.cfm Data Definitions Residential Segregation: Dissimilarity index, reported by Brown University’s US2010 project , using 2010 Census data. The dissimilarity index ranges from 0 to 100, where 100 reflects complete separation between two groups. Neighborhood Income Gap: Percent difference between the median income of the average non-Hispanic white’s neighborhood and that of the average black or Latino. Reported by Brown University’s US2010 project, using 2009 ACS data. School Test Score Gap: Percent difference between the state test score ranking of the school attended by the average non-Hispanic white student and that of the school attended by the average black or Latino student. Reported by Brown University’s US2010 project, using 2004 data from SchoolMatters . Employment Gap: Percent difference between the share of working-age non-Hispanic whites who are employed and the corresponding share of blacks or Latinos, based on 2010 Census data . Homeownership Gap: Percent difference between the share of non-Hispanic white households that are homeowners and the corresponding share of black or Latino households, based on 2010 Census data. Grading Scale: Each statistic is scaled by its average and given an equal weight, and then all statistics are summed into a final measure. Each metro is assigned a rank based on this measure and then fit into the following grading scale: A=Best 20, B=21-40, C=41-60, D=61-80, F=Worst 20. Scope: The top 100 metropolitan statistical areas, by population. Codes and names use the U.S. Office of Management and Budget’s 2008 Core Based Statistical Area definitions. Click here for additional information and data sources.
  • The Commission calls for: health equity to become a marker of government performance; national capacity for progressive taxation to be built; existing commitments to be honoured by increasing global aid to 0.7% of GDP; health equity impact assessments of major global, regional and bilateral economic agreements; strengthening of public sector leadership in the provision of essential health-related goods/services and control of health damaging commodities; gender equity to be promoted through enforced legislation; a gender equity unit to be created and financed; the economic contribution of housework, care work, and voluntary work to be included in national accounts; all groups in society to be empowered through fair representation in decision-making; civil society to be enabled to organize and act in a manner that promotes and realizes the political and social rights affecting health equity; the UN to adopt health equity as a core global development goal and use a social determinants of health framework to monitor progress.

Retail Food and Health: An Equity Framework Retail Food and Health: An Equity Framework Presentation Transcript

  • Jim Bloyd, MPH Cook County Department of Public Health March 16, 2012Good Food Festival and Conference , Chicago UIC Forum
  • Cook County Place Matters:Working Together for HealthEquity1. Education & Awareness2. Building Alliances with Residents to Increase Power3. Advocating for Policy Change What you can do: •Sign up so you can become involved •Like us on Facebook www.facebook.com/ccplacematters •Attend our meetings—next is Wednesday, March 21st •Support our upcoming health equity report—July 2012
  • Evidence of health inequity The death rate from diabetes in southern suburban Cook County is about 70% higher than in northern Cook. (Source: CCDPH) Access to chain supermarkets in metro-Chicago is associated with life expectancy --Areas with the least access were found to have a life expectancy 12 years shorter than the areas with the highest access. (Note: association does NOT mean ‘cause.’) ( Source: unpublished preliminary Cook County Place Matters Community Health Equity Report, in press)
  • Retail Food Presence and Health Evidence is mixed  Ruopong & Sturm (2012) “No robust relationship between food environment and consumption is found.”  Lee (2012) “differential exposure to food outlets does not independently explain weight gain over time in this sample of elementary school-aged children.”
  • 351,024 peoplelive in low foodaccess areas insuburban CookCounty,accounting forabout 14.5% ofthe populationBlock, et.al(2011)
  • Percent ofPopulationwith “LowFoodAccess” inSuburbanCookCounty,Spring 2011Source: Block, etal (2011)
  • Low Food Accessby Census BlockGroup, Spring2011Block, et.al.(2011)
  • Poverty and Obesity are LinkedSource: Drewnowski (2009) “Obesity and type 2 diabetes follow a socioeconomic gradient.” “Obesity is the toxic consequence of economic insecurity and a failing economic environment.”
  • Energy Density & Energy CostsSource: Drewnowski (2009) Note: cost differentials can be several thousand percent!
  • Does place matter? Yes.“The opportunity to move from a neighborhood with a high level of poverty to one with a low level of poverty was associated…with reductions in …extreme obesity and diabetes.”New England Journal of Medicine, 2011
  • Place matters: Neighborhood deprivation andcardiometabolic risk factorsin the Diabetes Study of Northern California(DISTANCE) (Laraia et. al (2012) Soc Sci & Med) “…higher levels of neighborhood deprivation were positively associated with indicators of cardiometabolic risk among adults with diabetes, suggesting that neighborhood level deprivation may influence individual outcomes.” Deprivation: an area’s income, poverty, housing, education, employment and occupation.
  • Opportunity-based Housing andConstellation of OpportunityStructures Source: Luce et al (2005) reproduced from Powell (2001)
  • Segregation in Metro Chicago Source: Luce et al (2005)94% of Blackresidents and83% of Latinoresidents live in‘lowopportunity’communities.[4]
  • Opportunity and Health The distribution of opportunity across neighborhoods can have a profound effect on socio-economic advancement and health outcomes.National Academy of Sciences, 2008
  • Racial Equity for African Americans:100 US Metro Areas Source: Urban Institute, 2011 Metro Area Overall Grade Chicago (2nd Worst) F Milwaukee (Worst) F St. Louis D Little Rock C Baton Rouge Chattanooga, B Richmond (VA) Atlanta Albuquerque (best) A Greenville (SC)
  • World Health Organization Closing the gap in a generation - how? Tackle the inequitable distribution of power, money, and resources Inequity in the conditions of daily living is shaped by deeper social structures and processes. The inequity is systematic, produced by social norms, policies and practices, and practices that tolerate or actually promote unfair distribution of and access to power, wealth and other necessary social resources. Source: http://www.who.int/social_determinants/thecommission/finalreport/closethegap_how/en/ index2.html
  • Family & CultureNarrative Policy Place power
  • Cook County Place MattersThank you Jim Bloyd, MPHCook County Dept. Public healthjbloyd@cookcountyhhs.org 708-863- 8314 awareness/understanding, Power, Policy advocacy ‘Fair Health Movement’ Gail Christopher Kellogg Addressing ‘root causes’ of health inequities Health equity Report rollout late July Action Lab in Chicago, late July!! Build an Alliance: See Sign In Sheet placematterscookcounty@gmail.com; facebook.com/ccplacematters 708-633-8314