WHY IS IT SO HARD TO TALK ABOUT HEALTH INEQUALITY ON LONG ISLAND?

Martine Hackett, Ph.D., MPHHofstra University

School of Health Sciences & Human Services

Department of Health Professions

Nassau County Minority Health Conference

April 7, 2014

It’s hard to talk about health inequality because…

People don’t know what health inequality is

People don’t know what causes health inequality

People don’t know what to do about it

There are significant differences in health outcomes by race/ethnicity in Nassau County.

Premature Deaths in Nassau County by race/ethnicity, 2009-2011

White Black Hispanic0%

10%

20%

30%

40%

50%

60%

70%

27%

56%58%

<75 years. Source: NYS DOH, Nassau County Health Indicators by Race/Ethnicity, 2009-2011 http://www.health.ny.gov/statistics/community/minority/county/index.htm

Diabetes Mortality in Nassau County by race/ethnicity, 2009-2011

White Black Hispanic0

5

10

15

20

25

9.4

21.8

10.5

Rate per 100,000. Source: NYS DOH, Nassau County Health Indicators by Race/Ethnicity, 2009-2011 http://www.health.ny.gov/statistics/community/minority/county/index.htm

Infant Mortality Rate Nassau County by race/ethnicity, 2009-2011

White Black Hispanic0

2

4

6

8

10

12

14

16

NYC Black Infant Mor-tality Rate, 8.6

13.4

Rate per 1000 live births. Source: NYS DOH, Nassau County Health Indicators by Race/Ethnicity, 2009-2011 http://www.health.ny.gov/statistics/community/minority/county/index.htm

2.73.8

Coronary Heart Disease Mortality Nassau County by race/ethnicity, 2009-2011

White Black Hispanic0

50

100

150

200

250

180.1

226.6

134.3

NYC Black coronary disease mortality

rate, 218.1

Rate per 100,000. Source: NYS DOH, Nassau County Health Indicators by Race/Ethnicity, 2009-2011 http://www.health.ny.gov/statistics/community/minority/county/index.htm

These health differences are due to behaviors, and also where you live, your class status, and how society treats you.

Spatial segregation

Source: Vital Signs, 2009

Spatial segregation

Source: Vital Signs, 2009

The relationship between place & health• Residential segregation is the

“fundamental cause of health disparities” (Williams & Collins, 2001)

• Built environment• Housing hazards• Environmental hazards• Fewer options for healthy foods• Lower high school graduation

rates• Safety • Vigilance/chronic stress

11554.9 Infant

deaths per 1,000 births

1155311.5 Infant deaths per 1,000 births

Source: NYS DOH, Nassau County Perinatal Outcomes by Zip Code 2009-2011

11554 Teen

pregnancy rate=9.6

11553Teen

pregnancy rate=56.8

Source: NYS DOH, Nassau County Perinatal Outcomes by Zip Code 2009-2011

11554 Childhood Asthma

discharge rate=13.711553

Childhood Asthma

discharge rate=53.2

Source: NYS DOH, Asthma Hospital Discharge rate per 10,000 population, Nassau County, Age 0-17, 2008-2010

“Those are places where there really isn’t a trash can, you throw it in places where people don’t really care. People throw garbage where they think it is abandoned. Maybe if there if there was someone there cleaning it would help.”

“They [the delis] all serve the same thing, they don’t serve anything fresh, like vegetables and fruit. There is really not any

other stores in the area. They’ve got a premium.” ”

“People dump on these sites. The contamination gets into peoples homes and causes illnesses and genetic problems.

I worry about this.”

“When you say you live in Roosevelt, some people think its like a ghetto neighborhood. Some times it really isn’t.”

Health equality requires a commitment to social justice to create healthier living

environments for everyone

When social factors are equalized, health disparities dissipate (LaVeist, et al., 2011)

Identification and awareness of the differences among populations regarding health outcomes and health determinants are essential steps towards reducing disparities in communities at greatest risk. (World Health Organization, Social Determinants of Health Report, 2011)

Where do we go from here?

Making it Easier to Talk about Health Equality

Commitment

Partnerships

Better Health for

ALL of Nassau County