Unnatural Causes Episode Five: Place Matters 'Why are zip codes and street addressses goog predictors of population health.'

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A presentation to public health students at Benedictine University, Illinois on February 16, 2010. Slides are background to the segment of the documentary film "Unnatural Causes: Is inequality making …

A presentation to public health students at Benedictine University, Illinois on February 16, 2010. Slides are background to the segment of the documentary film "Unnatural Causes: Is inequality making us sick?" produced by California newsreel and available at http://www.unnaturalcauses.org/

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  • “ Science and me
  • “ Science and me
  • My father learned from his clients that speculators were buying properties from whites at close to market value, and then selling them to blacks “on contract” at double to quadruple market value. Just as shocking were the terms of these sales. Contract buyers made down payments and were responsible for taxes, insurance, and maintenance. But if a contract buyer missed even one payment, the seller was free to evict the buyer – and keep everything the buyer had invested to that point. The profits to the speculators were stunning. For example, one of my father’s clients bought a building for $9,950, from a speculator who had recently purchased it for $3500. His client had paid off $8,500 of that debt – plus another $2300 in improvements – when he was evicted. Approximately 85% of properties sold to black Chicagoans were sold “on contract” – and there were close to a million blacks in Chicago by the early 1960s. In 1958, my father charged that speculators were draining Chicago’s black community of $1 million dollars a day, and the evidence I’ve turned up supports his estimate. (Satter, p. 99)
  • “ The spillover effect of the subprime crisis affects whole communities negatively, in terms of abandoned houses, increased crime, devaluation of neighboring houses, and erosion of the tax base, causing revenue shortfalls that mandate service cuts. “The crisis is having a negative impact on property owners, as well as neighborhoods, and local and state governments.
  • What Do these Findings Mean? The findings suggest that beginning in the early 1980s and continuing through 1999 those who were already disadvantaged did not benefit from the gains in life expectancy experienced by the advantaged, and some became even worse off. The study emphasizes how important it is to monitor health inequalities between different groups, in order to ensure that everyone—and not just the well-off—can experience gains in life expectancy. Counties are categorized into six groups on the basis of how their life expectancy changed in relation to national sex-specific change in life expectancy (4.1 y for men and 4.8 y for women in 1961–1983; 3.1 y for men and 1.3 y for women in 1983–1999). Group 1, life expectancy increased at a level significantly higher than the national sex-specific mean; group 2, life expectancy increased at a level significantly higher than zero but not significantly distinguishable from the national sex-specific mean; group 3, life expectancy increased at a level significantly higher than zero but significantly less than the national sex-specific mean; group 4, life expectancy change was statistically indistinguishable from zero and from the national sex-specific mean; group 5, life expectancy change was statistically indistinguishable from zero and was significantly less than the national sex-specific mean; group 6, life expectancy had a statistically significant decline. All statistical significance was assessed at 90%. doi:10.1371/journal.pmed.0050066.g003 Over these four decades, the researchers found that the overall US life expectancy increased from 67 to 74 years of age for men and from 74 to 80 years for women. Between 1961 and 1983 the death rate fell in both men and women, largely due to reductions in deaths from cardiovascular disease (heart disease and stroke). During this same period, 1961–1983, the differences in death rates among/across different counties fell. However, beginning in the early 1980s the differences in death rates among/across different counties began to increase. The worst-off counties no longer experienced a fall in death rates, and in a substantial number of counties, mortality actually increased, especially for women, a shift that the researchers call ‘‘the reversal of fortunes.’’ This stagnation in the worst-off counties was primarily caused by a slowdown or halt in the reduction of deaths from cardiovascular disease coupled with a moderate rise in a number of other diseases, such as lung cancer, chronic lung disease, and diabetes, in both men and women, and a rise in HIV/ AIDS and homicide in men. The researchers’ key finding, therefore, was that the differences in life expectancy across different counties initially narrowed and then widened. What Do these Findings Mean? The findings suggest that beginning in the early 1980s and continuing through 1999 those who were already disadvantaged did not benefit from the gains in life expectancy experienced by the advantaged, and some became even worse off. The study emphasizes how important it is to monitor health inequalities between different groups, in order to ensure that everyone—and not just the well-off—can experience gains in life expectancy. Although the ‘‘ reversal of fortune’’ that the researchers found applied to only a minority of the population, the authors argue that their study results are troubling because an oft-stated aim of the US health system is the improvement of the health of ‘‘all people, and especially those at greater risk of health disparities’’

Transcript

  • 1. Unnatural Causes Episode Five: Place Matters February 16, 2010 Jim Bloyd, MPH ‘ Why are zip code and street address good predictors of population health’
  • 2. Closing the Gap in A Generation Final Report of the Commission on the Social Determinants of Health (WHO, 2008)
  • 3. Resource
    • Fairchild et al (2010): The mandate of public health-Can public health promote social, economic and political reforms?
    • The ‘New Public Health:’
    • “ The old public health was concerned with the environment; the new is concerned with the individual” Hill (1913)
  • 4. Resource Black–White Health Disparities in the United States and Chicago: A 15-Year Progress Analysis (Orsi, et al, 2010)
    • Findings: “Overall, progress toward meeting the Healthy People 2010 goal of eliminating health disparities in the United States and in Chicago remains bleak. With more than 15 years of time and effort spent at the national and local level to reduce disparities, the impact remains negligible.”
  • 5. ‘ 50’s, 60’s, Chicago and the USA
    • $1,000,000 per day was estimated paid by blacks in Chicago in 1958 under a racist contract buying system, enriching white slumlords and elite investors. (Satter, 2009)
  • 6. Disproportionate effect on communities of color
  • 7. Differences in life expectancy across different counties narrow and then widen Change in County Life Expectancy in 1961–1983 and 1983–1999 1961-1983 Female 1983-1999 Female Source: Ezatti and others, 2008, PLoS Med 5(4): e66. doi:10. 1371/journal.pmed.0050066
  • 8. Location of Grocery Stores: City of Chicago
  • 9. Grocery Stores: 6 counties
  • 10.  
  • 11. Deaths from Heart Disease percent and rate range by town 1999-2001 deaths/100,000 population
  • 12. Youth hospitalized for asthma rate per 10,000 people 2003-’05
  • 13. Thank you
    • Cook County Department of Public Health
    • www.cookcountypublichealth.org
    • Jim Bloyd, MPH 708-492-2019
    • [email_address]
    • [email_address]