Health Inequalities and Inequities in the United States
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1 Health Inequalities and Inequities in the United States Michal Engelman Teaching Poverty 101 Institute for Research on Poverty June 13, 2018 Teaching Poverty (IRP) Health Disparities June 13, / 22
2 Population Health Population health is a field of study: Documents patterns and trends in health within specific places and periods in history Explains those patterns and trends Translates research into policies and interventions to improve population health Population health statistics are measures of societal wellbeing reflect how well society is taking care of its people. Health disparities reveal social inequality, and potentially, inequity. Teaching Poverty (IRP) Health Disparities June 13, / 22
3 US life expectancy in comparative perspective: Males Teaching Poverty (IRP) Health Disparities June 13, / 22
4 US life expectancy in comparative perspective: Females Teaching Poverty (IRP) Health Disparities June 13, / 22
5 Healthcare spending as percent of GDP Teaching Poverty (IRP) Health Disparities June 13, / 22
6 America s health-wealth paradox Source: Organization for Economic Cooperation and Development (OECD) Teaching Poverty (IRP) Health Disparities June 13, / 22
7 Ranking of U.S. mortality among 17 peer countries, 2008 Source: Teaching National Poverty Research(IRP) Council 2013 Health Disparities June 13, / 22
8 U.S. Life Expectancy has declined for the past 2 years Teaching Poverty (IRP) Health Disparities June 13, / 22
9 Life Expectancy at birth by county, 2014 Source: Dwyer-Lindgren et al. (2017) JAMA internal Medicine Teaching Poverty (IRP) Health Disparities June 13, / 22
10 Rising mortality among middle-aged White Americans Source: Case & Deaton (2015). PNAS All-cause mortality, ages for US White non-hispanics (USW), US Hispanics (USH), and six comparison countries: France (FRA), Germany (GER), the United Kingdom (UK), Canada (CAN), Australia (AUS), and Sweden (SWE). The increase in white deaths is concentrated among people with a high school degree or less. Teaching Poverty (IRP) Health Disparities June 13, / 22
11 Life Expectancy at age 25 by years of schooling, 2010 Source: Sasson 2016 Demography. Image: Hummer & Hamilton Teaching Poverty (IRP) Health Disparities June 13, / 22
12 Life Expectancy at age 25 by years of schooling, United States Source: Sasson 2016 Demography. Data sources: U.S. Multiple Causes of Death public use files (CDC 2013), 5% IPUMS (Ruggles 2010), U.S. Census, and American Community Survey. Teaching Poverty (IRP) Health Disparities June 13, / 22
13 Dying of Despair? Teaching Poverty (IRP) Health Disparities June 13, / 22
14 Are White Americans really worst off? Source: Anne Case and Angus Deaton (2017). Mortality and morbidity in the 21st century. Brookings Papers on Economic Activity. Teaching Poverty (IRP) Health Disparities June 13, / 22
15 Are White Americans really worst off? Life expectancy Teaching Poverty at birth for (IRP) whites and blacks, and the Health white-black Disparities gap in life expectancy at birth, fromjune , to Image 15 / 22
16 Infant Mortality by Race Source: Hummer, R Talk at UW-Madison. Data come from linked birth/infant death files. Includes 16,127,486 births and over 100,000 infant deaths Teaching Poverty (IRP) Health Disparities June 13, / 22
17 Infant Mortality by Mother s Race and Education Source: Hummer, R Data come from linked birth/infant death files. Teaching Poverty (IRP) Health Disparities June 13, / 22
18 Racial disparities over the full life course Teaching Poverty (IRP) Health Disparities June 13, / 22
19 Black mortality disadvantage at (almost!) all ages Teaching Poverty (IRP) Health Disparities June 13, / 22
20 How should we understand racial disparities in health? Race/ethnicity is a remarkably strong predictor of health status. Does that mean that race is a CAUSE of health disparities? 3 common but wrong explanations: Racial/genetic determinism Cultural/behavioral Socioeconomic Racism, more than race, is what matters for health. Racial disparities reflect the biological impact of present and past histories of racial discrimination and economic deprivation. Teaching Poverty (IRP) Health Disparities June 13, / 22
21 AAA Statement on Race Evidence from the analysis of genetics (e.g., DNA) indicates that most physical variation, about 94%, lies within so-called racial groups. Conventional geographic racial groupings differ from one another only in about 6% of their genes. Historical research has shown that the idea of race has always carried more meanings than mere physical differences; indeed, physical variations in the human species have no meaning except the social ones that humans put on them. Teaching Poverty (IRP) Health Disparities June 13, / 22
22 Conclusion Population health trends reveal tremendous long-term success. Still, longevity and health in the United States is unequally distributed by: Geography Gender Race/ethnicity Socioeconomic status (esp. education) Why do these patterns emerge? Individual characteristics, personal choices and behaviors? Access to healthcare? Individual and population health is profoundly influenced and constrained by social forces. What can we do? Teaching Poverty (IRP) Health Disparities June 13, / 22
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