climate change and health equity: existing disease burden€¦ · public health ~ cl'ph ....
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Climate Change and Health Equity: Existing Disease Burden
Neil Maizlish, PhD Office of Health Equity
California Department of Public Health
Public Health Work Group Sacramento, February 24, 2015
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California Deportment of ::d~ Public Health ~ CL'PH
Climate Change and Health Equity
• What is the existing burden of disease ?
• What are the existing inequities in health outcomes?
• What is producing population vulnerabilities and inequities in the health outcomes?
• How will climate change impact health outcomes and the factors producing health inequities
“Climate change will, absent other changes, amplify some of the existing health threats the nation now faces. Certain people and communities are especially vulnerable, including children, the elderly, the sick, the poor, and some communities of color.” – 3rd National Assessment of Climate Change, 2014
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- Heart d isease
- Cancer
- Stroke
- Respiratory disease
- lll'n'ntentional injmies
- Allzheime:r's disease
2.50 - Diabete5
C .Q
- Influenza & pneumonia ... .!! :J 200 C. 0 C.
8 0 ($ 1.50 0 ... .... Q,ll C. Gil ... l,:J 100 ...
,::, Q,ll
~ :J ·--,::,
.50 l,:J I
Q,ll C'i1
<(
0
11996 1997 1,998 1999 2000, .2001 200.2 2003, 2004 2005 2000 200] 2008 2009 2010
California Department of ::d~ Public Health ~c .. ,,,
Source: California Department of Pubtic Health Vital Records, 2012
Burden of Disease and Injuries: Leading Causes of Death, California
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~
California Department of ::d~ Public Health ~ CL'PH
Disparities in the Disease Burden: Deaths by Race/Ethnicity, California, 2002-2007
Ag
e A
dju
ste
d R
ate
per
100,0
00 1,200
1,000
800
600
400
200
0
African Am.
White Pacific Islander
Latino
American Indian
Asian
2 or More Races
2002 2003 2004 2005 2006 2007 2008
Source: California Department of Public Health ; Department of Finance
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California Department of ::d~ Public Health ~ CL'PH
1111 1111
Disparities in the Disease Burden: Share of Adults with One or More Chronic Conditions , by County and Service Planning Areas of Los Angeles County, 2007
Age-Adjusted
Prevalence (%)
25.9 - 33.8
33.9 - 38.2
38.3 - 40.7
40.8 - 46.2
Los Angeles County Service
Antelope Valley
San Fernando
San Gabriel
West
East
South Bay
Metro
South
Los Angeles County
Planning Areas
Source: Lui C, Wallace S. Chronic Conditions of Californians: California Health Interview Survey. Oakland, CA: California Health Care Foundation, 2010.
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California Deportment of ::d~ Public Health ~ CL'PH
Disparities in Disease Burden: Social Determinants Influence the Share of the California Adults Who Were Ever Told by a Doctor They Have Heart Disease, 2007
Education: Grade School
High School & Voc.
College Graduate
Poverty Level: 0-199%
200-299%
300% or more
Race/Ethnicity: Native Am.
Hawaiian/PI
2 or More Races
African Am.
White
Latino
Asian
% 5% 10% 15% 0
Age-Adjusted Prevalence
Source: California Health Interview Survey (CHIS), 2007
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Tobacco
Poo:r di,et ar11d physical inacfvity
Alcohol consumption
Mkrobial agents
Toxic: agents
Motor veh ide co[l lisions
Fiirearms
1 llidt dirug use
California Department of ::d~ Public Health ~ CL'PH
0 5 110 15
■ 1990,
■ 2000
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Traditional Public Model of Burden of Disease and Injury
• 3-4-50
3 behavioral risk factors (tobacco, poor diet, physical inactivity)
associated with
4 major diseases (heart, cancer, stroke, diabetes) that account for
50% of deaths
Deaths by Attributable Cause, United States
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II
Bay A rea Regio nal Heallh Ine q u i t ies l n i l i al i .. r
UPSTREAM
SOCIAL INEQUITIE S
Class Race/ethnicity lmn1 igrat ion status Gender Sexual orientat ion
. ..
A PUB LI C HEALTH FRAMEWORK FOR REDUCING HEALTH NEQUITIES BAY AREA REGIONAL HEALTH INEQUITIES INITIATIVE
DO NSTREAM
. . .
INSTITUTIONA L POWER
Corp orat ions &
~ Gov ern111e nt
agencies Schoo ls Laws & regulat ions Not-for-prof it organizat ions
Phys ica enviro nment Land use Trans po rt at ion Housing Res idential segregation Expos ure to tox ins
Social enviro nment Experience of class,
racism, gender, i rn Ill ig ration
Culture, incL media V iolence
Economic & Work Env iro nrnent Employment Income Retail businesses Occupat ional hazard s
Serv ice enviro nrnent Health care Educat ion Social se rv ices
,-------- ---------~ Strategic :
~ITT : ----------- -------------' I , Ad i+ • • • " Community capacity building , , ·ocacy : :
I ------------------1 : I I I
Community organizing
CiYic engagement I ________________________ I
Ris e 1 av iors Smoking Poor nut rit ion Low phy sical
act iv ity V io lence Alcohol & other
Dru gs Sexual behav ior
,-------- ---------, : Individual health : : education : I I ! __________________ I
Co mmunicab le disease
Chronic disease Inju ry
(intent ional & &unintentional)
.------- ------- 7 I I I I : Health care , I I I I .._ ______________ I
1------ --- - ------ --: Case management I I -------------------
---------------7 •···· : POLICY I ......
I ______________ J
In fant mort ality
Life expectancy
◄...... .. . .. . .. . .. . .. . .. . ........... . ... .. .............................. . ..... ... .. Emerging Public Health Practice ............................................................................ , .• , .. , .. , .. ,.. Curr;:11t Public He.J.th Practioe ............................ ►
California Deportment of ~ Public Health ~ CL' PH
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California Department of ::d~ Public Health ~ CL'PH
■ □
Some populations have a disproportionate share of risk factors and social determinants that adversely affect health
27
18 13
5
32
23
14
6
Adult
Child Living Below the Poverty Level
Neighborhood doesn't feel safe all
the time
Park/open space not in walking
distance
Ratio of Fast Food Outlets:Grocery
Stores or Farmer Markets
40%
20%
%
40%
20%
%
20%
10%
%
5
3
0
Latino
Latino
19
Latino
4.8
Latino
African Am.
45
African Am.
19
African Am.
5.0
African Am.
Asian White
Asian White
20
Asian White
4.5
Asian White
37 42
33
17
4.2
Source: California Health Interview Survey (CHIS), 2007 9
California Deportment of ::d~
Public Health ~ CL'PH
Tree Canopy Coverage* by Race/Ethnicity, California, 2011
11.5 10.6
8.7 7.6
6.8 6.7 5.7 5.2
7.7
0.0
5.0
10.0
15.0
20.0 Pe
rcen
t o
f A
rea
Data Source: National Land Cover Database, 2006; U.S. Census
NHOPI, Native Hawaiian and Other Pacific Islander
* Census block area weighted by population and aggregated to state total 10
Prevalence of Household Air Conditioning by Race/Ethnicity, California, 2009
68 65
62 58
57 56
65
0
20
40
60
80 Pe
rcen
t o
f h
ou
seh
old
s
White Other Asian/ Latino African Native California Pacific Isl Am. Am.
Data Source: National Land Cover Database, 2006; U.S. Census
NHOPI, Native Hawaiian and Other Pacific Islander
* Census block area weighted by population and aggregated to state total 11
-- + + +
Cumulative Impact
Health/ Burden of
Disease
Socio-economic
Factors 40%
Individual Behaviors
30%
Clinical Care, 20%
Physical & Built
Environ. 10%
Source: Robert Wood Johnson/University of Wisconsin, Commission for a Healthier America, County Health Rankings, 2012
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West Oakland
Life expectancy at birth
> 80.0
□ 74.3-80.0
■ < 743 Oakland Hills
West Oakland Oakland Hills
High school grads 65% 90% ... Unemployment C 12 4 C1I
u Poverty ... 25 7 C1I Q. Home ownership 38 64
Non-White 89 49
Sources: Alameda County Public Health Department, 2008, 2012
California Department of ::d~ Public Health ~ CL'PH
Cumulative Impact of Social Determinants of Health Over the Life Cycle and Generations
Life Expectancy by Census Tract, Alameda County, 2000 A White child from the Oakland Hills can expect to live to 85
years old, whereas an African-American child living in West
Oakland—just a few miles away—can expect to live only to
70.
The child from West Oakland is:
• 1.5 times more likely to be born prematurely
• 7 times more likely to be born
into poverty
• 2 times as likely to live in a home that is rented
• 4 times more likely to have parents with only a high-school
education
• 2.5 times more likely to be behind in childhood
vaccinations
• 4 times less likely to read at
grade level by fourth grade
• 4 times as likely to live in a neighborhood with double the
density of liquor stores and fast
food outlets
• 5.6 times more likely to drop out of school
As an adult, he or she is:
• 5 times more likely to be hospitalized for diabetes
• 2 times more likely to be hospitalized for heart
disease
• 2 times more likely to die of heart disease
• 3 times more likely to die of stroke
• 2 times as likely to die of cancer
.
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How Does Climate Change Interact with Health Inequities and Factors that Produce Them?
• Poorer health is more prevalent in socially vulnerable populations
• Some vulnerable/disadvantaged live in higher climate risk areas (e.g., poor disproportional residing in urban heat islands)
• Some vulnerable populations have lower adaptive capacity
• Inequities in co-benefits or harms of climate mitigation or adaptation strategies, or inaction
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California Deportment of ::d~ Public Health ~ CL'PH
Contact Information
Neil Maizlish ([email protected])
Office of Health Equity
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