Post on 27-Jan-2015
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UNIVERSITY OF WASHINGTON
Latest life expectancy estimates by county reveal big differences nationwide
April 19, 2012
Ali H. Mokdad, PhD
Professor, Global Health
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
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How does US health compare globally?
1. US spends the most on health and medical care in the world: 16.2% of GDP
2. The vigorous debate on health reform follows three themes:
• Lack of insurance
• Rising costs
• Poor outcomes
3. But how are we actually doing?
Adult mortality trends: US, Australia, Japan
Females Males
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
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IHME’s county life expectancy estimates take CDC mortality data and use small area measurement to find:
• County trends by sex
• County trends by race (black and white)
Life expectancy by county
Life expectancy for men nationwide
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1999
1989
2009
Life expectancy for women nationwide
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1989
1999
2009
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Women in Fairfax, Virginia, have some of the best life expectancies in the US.
Women in Greensville and Sussex have among the worst.
Within states, there are wide gaps
Urban progressRates of change in life expectancy (in years), 1989-2009
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State County Men Women
Black White Black White
NY NEW YORK 17.1 12 9 6.1
CA SAN FRANCISCO 15.5 10.9 6.6 4.4
DCDISTRICT OF COLUMBIA 10.4 7.9 6.1 4.2
GA FULTON 10.4 7.7 5.7 3.7
FL MIAMI-DADE 9 6.7 6.5 4.6
CA LOS ANGELES 8.3 6.2 6.1 4.3
IL COOK 7.7 5.8 5.5 3.7
TX HARRIS 7 5.5 3.9 2.6
UNITED STATES 7.4 4.2 4.7 2.2
Counties vs. nations: men, 2009
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90% of counties
(66.3-77.1)
87% of counties
(66.3-76.9)
22% of counties
(66.3-72.5)
6% of counties
(66.3-70.4)
Greece (77.3)
Cuba (76.9)
Syria (72.5)
Iran (70.3)
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
Women losing ground with each decade
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Life expectancy for women in 661 counties either stopped dead or went backward from 1999 to 2009.For men, that happened in 166 counties.
Widening disparitiesGap between best- and worst-performing counties
Year Men Women
1989 14.7 years 8.7 years
1999 15.4 years 9.3 years
2009 15.5 years 11.7 years
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Best- and worst-performing counties, women
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Black Americans have improved rapidly
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Between 1989 and 2009, life expectancy for black American men improved by 7.4 years, compared to 4.2 years for white men
Gap between black men and white men shrinking
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
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What are the drivers of these trends?
Socio-economic inequalities
Lack of financial access to health care
Poor quality of care
Preventable causes of death
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Socio-economic status and health
• Compelling evidence that individual and community socio-economic status is a powerful determinant of health mediated through multiple mechanisms
• Progress on increasing educational attainment, reducing poverty, decreasing discrimination, reducing inequality will have health benefits
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Lack of financial access
• Central topic in US health care reform
• Lack of insurance clearly creates barriers for primary care, acute care, and long-term management of chronic diseases
• Lack of insurance not distributed uniformly in the US
Quality of care• Large variations in quality of care across race/ethnicity,
socio-economic status, and communities
• Time from onset to intervention
• Effective coverage
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Preventable causes of death
• Evidence for at least 12 risk factors is strong enough that the burden of disease for each can be assessed for US
• Cohort studies and intervention trials provide strong evidence on the relative risks of death associated with these risk factors
• Community surveys provide information on exposures
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Danaei et al., 2009 PLOS Medicine
US deaths attributable to major risk factors, 2005
Hypertension prevalence Adults 30+, 2009
SBP ≥140 mm hg and/or self-reported antihypertensive medication use
High cholesterol prevalenceAdults 30+, 2009
Total serum cholesterol ≥240 mg/dL and/or prior diagnosis
Declining improvements in women
Change in life expectancy, 1989-2009
Men Women
4.6 years 2.7 years
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Lung cancer mortality rates in the US (per 100,000)
1980 1985 1990 1995 2000 2005 20100
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20
30
40
50
60
70
80
Males
Females
Year
Lu
ng
Can
cer
Mo
rtal
ity
Rat
e p
er 1
00,0
00
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Diabetes: prevalence, diagnosis, and treatment, ages 35-64
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
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What does this all add up to?
1. Regardless of the metric of population health, the US performs poorly relative to other high-income countries.
2. The US and most of its communities are steadily falling behind each year compared to high-income nations.
3. Females are falling behind faster than males in most parts of the country.
4. Large disparities exist across the US.
5. Disparities are worsening.
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What should be done?
• Provide local data and burden of disease
• Focus on preventable risk factors
• Engage medical providers in accountable care
• Fund local strategies to cut risk factors
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
A tornado hits Oklahoma and makes headlines
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Photo by Niccolò Ubalducci
Health disparities should be news, too
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Percentage of counties that are above the US national average for male life expectancy
Why should Iowans live longer than Oklahomans?
Lifespans: King County vs. Fulton County
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Media’s role
1. Keep all of us honest
2. Focus the debate on what really matters
3. Ask the hard questions:
• Why do we have such disparities?
• What are you doing about it?
• Where are the success stories?
4. Focus on science and ignore politics
5. Get the word out
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Outline
How does US health compare globally?
How do local health outcomes compare to each other and compare to global outcomes?
Are disparities getting better or worse?
What is driving these disparities?
Summary and road map
What can be the media’s role?
Tools demonstration
Data visualizationsHighest and lowest life expectancy by county and sex (US), 1989-2009
http://www.healthmetricsandevaluation.org/tools/data-visualization/highest-and-lowest-life-expectancy-county-and-sex-us-1989-2009
Life expectancy by county and sex (US) with country comparison (Global), 1989, 1999, 2009
http://www.healthmetricsandevaluation.org/tools/data-visualization/life-expectancy-county-and-sex-us-country-comparison-global-1989-1999-2009
Life expectancy by county and sex (US), 1989-2009
http://www.healthmetricsandevaluation.org/tools/data-visualization/life-expectancy-county-and-sex-us-1989-2009
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Thank You
For more information:
www.healthmetricsandevaluation.org
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