1. Suburban Health Inequity: SocialDeterminants, Health Outcomes and Missing Pieces Martine HackettHofstra University

2. What is thecontribution ofsuburban spacein Nassau Countyto healthinequities? What are thechallenges tocreating healthequity in NassauCounty? 3. Source: Vital Signs, 2009 4. Source: Vital Signs, 2009 5. Massey and Denton(1993): "the keystructural factor forthe perpetuation ofBlack poverty in theU.S." and the"missing link" inefforts to understandurban poverty. 6. Condition DisparityTeen Pregnancy Rate 4X higher in Roosevelt than Nassau Countyaverage 3X higher in Westbury, Uniondale, HempsteadChlamydia Incidence 5X higher in Roosevelt than Nassau Countyaverage 4X higher in HempsteadDiabetes Hospitalization3x higher in blacks vs. whitesCancer MortalityHighest among black malesAssault Hospitalizations5x higher in Roosevelt than Nassau County averagePoisoning hospitalizations2.5X higher in Roosevelt than Nassau CountyaveragePeople living with HIV/AIDS Significantly higher in Roosevelt and Hempsteadincident ratesSource: Nassau County Department of Health, 2010 7. Segregation determines SES by affectingquality of education and employmentopportunities. Segregation can create negativeneighborhood and housing conditions. Conditions linked to segregation canconstrain the practice of health behaviors andencourage unhealthy ones. Segregation can adversely affect access tomedical care and to high-quality care. 8. Built environment Housing hazards Environmental hazards Lack of social supports,community Cumulativedisadvantage builds insegregatedneighborhoods 9. Too suburban to be Too many inner-citya problemlike problems to becompared to inner-considered citysuburban 10. Poverty Race/Ethnicity Aging population Aging infrastructure High housing costs,shortage of rentals 11. Familiar thinking about the suburbsinfluences current decisionsdenying currentreality and changes to maintain traditionalways of life Taxes already high for services that areexpected High level of governmental fragmentation 12. Suburban social services and safetynet inadequate Decentralization in times ofeconomic crisis means priorities shiftaway from those in need Fewer public and private resourcesfor suburban health equity Advocacy efforts to connectsegregation, economicopportunities and health outcomesin Nassau County 13. Failure to address Long Islandscurrent challengesand the socialdisparities associated with themthreatens future growth andvitality in the region Health disparities hurt thosedirectly affected by them, but theyalso harm the social and economicwell-being of the greatercommunity. Public health is at the core ofsustainability