2011 Virginia Rural Health Summit presentation

1. Slide for pictures

2. “How High is the Wall in Your Town?” The Impact of Socioeconomic Disparities on Health in Central Appalachia Virginia Rural Health Summit April 6, 2011 Randy Wykoff, MD, MPH & TM Dean, College of Public Health East Tennessee State University

3. Central Appalachia 8,941,987 People, living in . . . 238 counties in . . . Kentucky, North Carolina, Ohio, Tennessee, Virginia and West Virginia

4. Premature Mortality: United States Compared to Central Appalachia McDowell, WV Noble, Ohio Mississippi Minnesota 2011 County Health Rankings: www.countyhealthrankings.org

7. Factors Contributing to Premature Death Environmental Exposures 5% Health Care 10% Social Circumstances 15% Genetics 30% 40% Behavioral Factors We Can Do Better: Improving the Health of the American People Schroeder SA. New England Journal of Medicine 357: 1221-1228 http://content.nejm.org/cgi/content/full/357/12/1221

9. Diet/activity patterns 15.2% of all deaths

10. Alcohol 3.5% of all deaths

11. Microbial agents 3.1% of all deaths

12. Toxic agents 2.3% of all deaths

13. Motor vehicles 1.8% of all deaths

14. Firearms 1.1% of all deaths

15. Sexual behavior 0.8% of all deaths

16. Illicit Drug Use 0.7% of all deathsActual Causes of Death in the United States, 2000 Mokdad et al JAMA 291: 1238-1245 http://jama.ama-assn.org/cgi/content/abstract/291/10/1238 and erratum: http://jama.ama-assn.org/cgi/content/full/293/3/298

18. Diet/activity patterns 15.2% of all deaths

19. Alcohol 3.5% of all deaths

20. Microbial agents 3.1% of all deaths

21. Toxic agents 2.3% of all deaths

22. Motor vehicles 1.8% of all deaths

23. Firearms 1.1% of all deaths

24. Sexual behavior 0.8% of all deaths

25. Illicit Drug Use 0.7% of all deathsActual Causes of Death in the United States, 2000 Mokdad et al JAMA 291: 1238-1245 http://jama.ama-assn.org/cgi/content/abstract/291/10/1238 and erratum: http://jama.ama-assn.org/cgi/content/full/293/3/298

26. Adult Smoking United States Compared to Central Appalachia 2011 County Health Rankings: www.countyhealthrankings.org

29. Diet/activity patterns 15.2% of all deaths

30. Alcohol 3.5% of all deaths

31. Microbial agents 3.1% of all deaths

32. Toxic agents 2.3% of all deaths

33. Motor vehicles 1.8% of all deaths

34. Firearms 1.1% of all deaths

35. Sexual behavior 0.8% of all deaths

36. Illicit Drug Use 0.7% of all deathsActual Causes of Death in the United States, 2000 Mokdad et al JAMA 291: 1238-1245 http://jama.ama-assn.org/cgi/content/abstract/291/10/1238 and erratum: http://jama.ama-assn.org/cgi/content/full/293/3/298

37. Adult Obesity United States Compared to Central Appalachia 2011 County Health Rankings: www.countyhealthrankings.org

40. Diet/activity patterns 15.2% of all deaths

41. Alcohol 3.5% of all deaths

42. Microbial agents 3.1% of all deaths

43. Toxic agents 2.3% of all deaths

44. Motor vehicles 1.8% of all deaths

45. Firearms 1.1% of all deaths

46. Sexual behavior 0.8% of all deaths

47. Illicit Drug Use 0.7% of all deathsActual Causes of Death in the United States, 2000 Mokdad et al JAMA 291: 1238-1245 http://jama.ama-assn.org/cgi/content/abstract/291/10/1238 and erratum: http://jama.ama-assn.org/cgi/content/full/293/3/298

48. Obvious Question . . . WHY?

49. Factors Contributing to Premature Death Environmental Exposures 5% Health Care 10% Social Circumstances 15% Genetics 30% 40% Behavioral Factors We Can Do Better: Improving the Health of the American People Schroeder SA. New England Journal of Medicine 357: 1221-1228 http://content.nejm.org/cgi/content/full/357/12/1221

50. The Social Determinants of Health Early Life Experiences Income Economy Health Race and Ethnicity Education Community Work Housing Robert Wood Johnson: Commission to Build a Healthier America

51. The Social Determinants of Health Early Life Experiences Income Economy Health Race and Ethnicity Education Community Work Housing Robert Wood Johnson: Commission to Build a Healthier America

53. Life Expectancy at Age 45 by Income, Gender and Race (1979-1989) 6.9 yrs 7.8 yrs 3.0 yrs 3.5 yrs 1980 Dollars Ethn Dis. 2003 Spring;13(2):240-7. A further study of life expectancy by socioeconomic factors in the National Longitudinal Mortality Study. Lin, CC et al.

54. Relative Risk of Dying Before the Age of 65 By Income: United States Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the United States

55. Income and Health Income Health

56. Children Living in Poverty United States Compared to Central Appalachia 2011 County Health Rankings: www.countyhealthrankings.org

59. The Social Determinants of Health Early Life Experiences Income Economy Health Race and Ethnicity Education Community Work Housing Robert Wood Johnson: Commission to Build a Healthier America

60. The Social Determinants of Health Early Life Experiences Income Economy Health Race and Ethnicity Education Community Work Housing Robert Wood Johnson: Commission to Build a Healthier America

61. Life Expectancy at Age 25 by Educational Achievement 6.8 yrs 5.1 yrs Education Matters for Health: Robert Wood Johnson Foundation. September, 2009

62. Infant Mortality by Mother’s Educational Status 8.1/1000 4.2/1000 Education Matters for Health: Robert Wood Johnson Foundation. September, 2009

63. Education and Health Education Health

64. Adults Who Are College Graduates United States Compared to Central Appalachia 2011 County Health Rankings: www.countyhealthrankings.org

67. What Can We Do To Improve Health in Central Appalachia? What Can We Do To Improve Health in Rural Virginia? What Can We Do To Improve Health in the United States? Income Education Health

68. What Can We Do To Improve Health in the United States? We need to work together to assure access to affordable health care, including preventive services; We need to work together to enhance economic opportunity and reduce poverty; We need to work together to improve educational achievement;

69. What Can We Do To Improve Health in the United States? We need to work together to assure access to affordable health care, including preventive services; We need to work together to enhance economic opportunity and reduce poverty; We need to work together to improve educational achievement;

71. The “Virginia Health Bulletin” 1908 and 1909

72. Life Expectancy 30+ years

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74. The “Virginia Health Bulletin” 1908 and 1909

75. The “Virginia Health Bulletin” 1908 and 1909

77. Contact Information Randy Wykoff, MD, MPH & TM Dean, College of Public Health East Tennessee State University (423) 439-4243 wykoff@etsu.edu www.etsu.edu/cph