Based Prevention: Place Matters Assembly Health Committee 1/10/2013 - - PowerPoint PPT Presentation

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Based Prevention: Place Matters Assembly Health Committee 1/10/2013 - - PowerPoint PPT Presentation

Sep 06, 2022 313 likes •779 views

Reimagining Community Based Prevention: Place Matters Assembly Health Committee 1/10/2013 Tony Iton, M.D., J.D., MPH Senior Vice President The California Endowment Health Health care Where You Live Matters It Matters A LOT! Does Your Zip

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Reimagining Community Based Prevention: Place Matters

Assembly Health Committee 1/10/2013

Tony Iton, M.D., J.D., MPH Senior Vice President The California Endowment

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Health ≠ Health care Where You Live Matters

It Matters A LOT!

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Does Your Zip Code Matter More Than Your Genetic Code ?

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There are no silver bullets!

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… is the average lifespan a newborn can expect

Gapminder.org

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Race ce and d Racism cism Matters: tters:

He Health h Inequitie uities s by Ra Race/Ethn e/Ethnicity city

2.3 years 4.9 years 7.8 years

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60 65 70 75 80 85 1960 1962 1964 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001

Years

Overall White Overall Black without Homicides White without Homicides Black without AIDS White without AIDS Black without Both White without Both Black

Race ce and d Racism cism Matters: tters:

He Health h Inequitie uities s by Ra Race/Ethn e/Ethnicity city

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Life Expectancy by Poverty Group 2000-2003

Alameda County

50 55 60 65 70 75 80 85 90 95 100 0% 10% 20% 30% 40% 50% 60% Poverty Rate Life Expectancy (Years)

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SLIDE 14 Alameda County 50 55 60 65 70 75 80 85 90 95 100 0% 10% 20% 30% 40% 50% 60% Poverty Rate Life Expectancy (Years) San Francisco County 50 55 60 65 70 75 80 85 90 95 100 0% 10% 20% 30% 40% 50% 60% Poverty Rate Life Expectancy (Years) Contra Costa County 50 55 60 65 70 75 80 85 90 95 100 0% 10% 20% 30% 40% 50% 60% Poverty Rate Life Expectancy (Years)

Tract Poverty vs. Life Expectancy

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BARHII Life Expectancy and Poverty by Tract

50 55 60 65 70 75 80 85 90 95 100 0% 10% 20% 30% 40% 50% 60% Poverty Rate Life Expectancy (Years)

Bay Area Poverty vs. Life Expectancy

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Life Expectancy v. Percentage Poverty

y = -13.539x + 81.084 R2 = 0.1183 60 65 70 75 80 85 90 95 100 0% 10% 20% 30% 40% 50% 60% 70% 80% Percentage Poverty Life Expectancy

California Poverty vs. Life Expectancy

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Cost of Poverty in San Francisco Bay Area

  • Every additional $12,500 in

household income buys one year

  • f life expectancy
  • (Benefit appears to plateau at household

incomes above $150,000)

  • Similar gradients in Baltimore, NYC,

Philadelphia, Hennepin County (Minneapolis-

  • St. Paul), Colorado, California, AND

Cuyahoga County ($6304/year of life)

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A 30 year longitudinal study of nearly 7000 Alameda County residents from 1965 forward. Those residents with household income 1 SD above mean were 25% less likely to die prematurely, 1 SD below mean were 35% more likely to die early.

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SPECIAL REPORT Volume 352:1138-1145 March 17, 2005 Number 11 A Potential Decline in Life Expectancy in the United States in the 21st Century

  • S. Jay Olshansky, Ph.D., Douglas J. Passaro, M.D., Ronald C. Hershow, M.D., Jennifer

Layden, M.P.H., Bruce A. Carnes, Ph.D., Jacob Brody, M.D., Leonard Hayflick, Ph.D., Robert N. Butler, M.D., David B. Allison, Ph.D., and David S. Ludwig, M.D., Ph.D.

ABSTRACT Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as Social Security and

  • Medicare. Although the Social Security Administration recently raised its

estimates of how long Americans are going to live in the 21st century, current trends in obesity in the United States suggest that these estimates may not be

  • accurate. From our analysis of the effect of obesity on longevity, we conclude

that the steady rise in life expectancy during the past two centuries may soon come to an end.

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US Male Life Expectancy 1987-2007

Between 2000 and 2007, more than 80% of US counties fell in standing against the average of the 10 nations with the best life expectancies in the world, known as the international frontier.-IHME

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“Geographic and racial disparities,” said first author Mark Cullen, MD, “are best understood as related to disparities in education, occupations and the like, which are strongly associated with outcomes in every county we studied, whether it was large, small, urban, rural, Southern or not.”

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Social Gradients Various Jurisdictions

500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 <10% 10%-19.9% 20%-29.9% 30+% Neighborhood Poverty Group Age-Adjusted Mortality Rate Philadelphia Cuyahoga County Hennepin County Bay Area Colorado Alameda County California Los Angeles County

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California Social Gradient

200 400 600 800 1,000 1,200 1,400 <10% 10%-19.9% 20%-29.9% 30+% Neighborhood Poverty Group Age-Adjusted Mortality Rate

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California Social Gradient by Race/Ethnicity

California

200 400 600 800 1,000 1,200 1,400 1,600 <10% 10%-19.9% 20%-29.9% 30+% Neighborhood Poverty Group Age-Adjusted Mortality Rate African American White All Hispanic/Latino Asian

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Insured vs. Whole Population

200 400 600 800 1,000 1,200 1,400 <10% 10-19.9% 20-29.9% 30+% Neighborhood Poverty Group Age-Adjusted Mortality Rate Alameda County - Whole Population Kaiser Permanente Enrollees in Alameda County

% of AC pop’n 32.3% 29.9% 26.0% 22.0%

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Wh When en th the e ex exte tern rnal al bec ecom

  • mes

es in inter ternal: nal: How

  • w we in

e inter ternalize nalize ou

  • ur en

envir vironmen

  • nment

Allostatic Load

Inadequate Transportation Long Commutes Housing Lack of social capital High Demand- Low Control Jobs Lack of access to stores, jobs, services Crime Stress Stress Stress Stress Stress Stress

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CRH

AFFECTS MULTIPLE ORGANS & SYSTEMS

STRESSOR

CORTISOL Hypothalamus Pituitary Gland Adrenal Glands ACTH

Stress pathway from brain to body

Center on Social Disparities in Health, University of CA, San Francisco

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Disparities are the tip of the iceberg…

Disparities

Policy Racism Stress Low Educational Attainment Poverty Access to Health Care Poor Housing Unemployment Hopelessness Tobacco Use Neighborhood Quality Social Support Access to Nutritious Food

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The Health of White Americans

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Life Expectancy

US White 78 years

Chile 78 years Costa Rica 78 years Cuba 78 years Slovenia 78 years Kuwait 78 years

US Whites

WHO Statistical Information System

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US Whites Living Shorter Lives Than:

WHO Statistical Information System

  • 79 years: Belgium, Denmark, Finland, Malta,

Portugal, Spain, Sweden, U.K., Korea

  • 80 years: Austria, Cyprus, Germany, Greece,

Ireland, Netherlands, Norway, New Zealand, Singapore

  • 81 years: Canada, France, Iceland, Israel, Italy
  • 82 years: Switzerland, Australia
  • 83 years: Japan
  • 26 countries
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Understanding Health at the Macro Level

  • Despite our wealth, the U.S. is unhealthier

across the board than our peers.

  • There is evidence that flattening the social

gradient improves the health of all. (Not a zero sum proposition).

  • Focused upstream interventions (policy

and place) may offer promise.

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Family & Culture

Inequities Disparities Health Health

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Family & Culture

Inequities Disparities

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Family & Culture

Conditions

Consequences

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School Absence /Truancy Grade Failure Drop- Out

Family & Culture

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Family & Culture

Place Policy Narrative

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Family & Culture

Place Policy Narrative

$$$ COSTS $$$

New Payment Incentives

HEALTH

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The Interface Between The Clinic & The Community

  • Health homes
  • Promotoras
  • In home interventions (asthma, nurse

home visitation)

  • Telehealth
  • Cooking, shopping and gardening

programs

  • SBHCs
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Contact Information

Tony Iton, MD, JD, MPH Senior Vice President The California Endowment aiton@calendow.org 510 271-4310

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The California FreshWorks Fund

The California FreshWorks Fund is a public-private partnership loan fund intended to finance grocery stores and other forms of fresh food retail and distribution in underserved communities throughout CA. It is modeled after the PA Fresh Food Financing Initiative and it has been developed to align with the National Healthy Food Financing Initiative.

Fund Size: $264 million Uses of Capital: Loans & Grants to Grocery Stores & Other Fresh Food Retailers & Distributors Capitalization: Debt & Grants Program Eligibility: Program Guidelines to be released shortly Launch: July 2011