mid-shore rural data -...

Rural Health: An Analysis of Health Inequities in the Mid-Shore Region

Rural Health SummitChesapeake College

August 30, 2016Dr. Shalewa Noel-Thomas

Office of Minority Health & Health Disparities

Outline

• Define social determinants of health

• Define health inequities

• Identify social determinants of health experienced by rural communities

Mid-Shore Region Data

• Mid-Shore racial and ethnic distributions

• Mid-shore determinants of health data

• Disparities in health outcomes in the mid-shore Counties

Social Determinants of Health

• Social determinants of health are “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are shaped by a wider set of forces: economics, social policies, and politics”.

WHO, 2016

What are Health Inequities?

• Health inequities are avoidable inequalities in health between groups of people that are a result of systemic, avoidable and unjust social and economic policies and practices that create barriers to opportunity.

WHO, 2016

Race/Ethnic Groups as % of Jurisdiction 2014 MD Department of Planning data:

http://planning.maryland.gov/msdc/Pop_estimate/estimate_10to14/CensPopEst10_14.shtml

77%65%

78%87%

78%

53%

14%28%

15%7%

13%

29%

6.4% 4.6% 4.3% 3.4% 6.3% 9.3%

0%

20%

40%

60%

80%

100%

Caroline Dorchester Kent Queen Anne's Talbot Maryland

NH White NH Black NH AIAN NH Asian NH NHOPI NH Multi Hispanic

http://planning.maryland.gov/msdc/Pop_estimate/estimate_10to14/CensPopEst10_14.shtml


• Social and economic factors “get under the skin” to cause disease

– Poverty

– Income

– Unemployment

– Educational attainment

– Health literacy

– Social and racial injustices


• Adequate community infrastructure to ensure public safety and promote wellness

• Access to:

– safe and healthy homes

– safe and affordable transportation

– healthy and affordable food

– health insurance

– health care services

RHIhub, 2016

Determinants of Health: Percent of Households in Poverty, By Race and Jurisdiction, 2010-14 pooled; ACS data

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_5YR_S1702&prodType=table

0%

10%

20%

30%

40%

50%

Caroline Dorchester Kent Q Anne's Talbot Maryland

NH White Black Asian Hispanic


Determinants of Health: Median Household Income in Dollars By Race and Jurisdiction, 2010-14 pooled ACS data


0

20,000

40,000

60,000

80,000

100,000

120,000




Determinants of Health: Unemployment Rate By Race and Jurisdiction, 2010-14 pooled ACS data


0%

10%

20%

30%




Determinants of Health: Percent without Health Insurance By Race and Jurisdiction, 2010-14 pooled ACS data


24%

15%

23%

11%

50%

13%

42%

47%

56%

19%

36%

31%

0%

20%

40%

60%

80%




Health Outcomes

King County, 2015

Life Expectancy at Birth in Years,By Race and Jurisdiction, 2012-14 pooled

MD VSA data on SHIP: http://dhmh.maryland.gov/ship/Pages/home.aspx

76 79 81 80 82 8077 75 75 74

77 78

0

25

50

75

100


NH WhiteNH Black

(More is Better)

http://dhmh.maryland.gov/ship/Pages/home.aspx

7

5

2

5

8

4

20

10

28

17

19

11

0

5

10

15

20

25

30


NH White NH Black

Infant Deaths per 1000 Live Births,By Race and Jurisdiction, 2010-14 pooled

MD VSA data http://dhmh.maryland.gov/vsa/Pages/reports.aspx

(More is Worse)

http://dhmh.maryland.gov/vsa/Pages/reports.aspx

Age-Adjusted Heart Disease Death Rate per 100,000By Race and Jurisdiction, 2012-14 pooled


205185

139

168

138

169186

228238 235 228

197

0

50

100

150

200

250

300


NH White

NH Black

(More is Worse)


Age-Adjusted Cancer Death Rate per 100,000,By Race and Jurisdiction, 2012-14 pooled


193 186

145

177

152163159

242

174162

195183

0

50

100

150

200

250

300


NH White

NH Black

(More is Worse)


ED Visit Rates

165269

120 110167

108

666

994

741

1,086

309

0

300

600

900

1200NH White

NH Black

Age-Adjusted Diabetes ED Visit Rateper 100,000, By Race and Jurisdiction, 2014

HSCRC data on SHIP: http://dhmh.maryland.gov/ship/Pages/home.aspx

(More is Worse)


186 213 187 142 182113

752

1,065 1,111

654

802

415

0

300

600

900

1200NH White

NH Black

Age-Adjusted Hypertension ED Visit Rateper 100,000, By Race and Jurisdiction, 2014


(More is Worse)


46

69

39 42 49

27

201

289

222

200

249

109

0

100

200

300


NH White

NH Black

Age-Adjusted Asthma ED Visit Rateper 10,000, By Race and Jurisdiction, 2014


(More is Worse)


131

236

164

101

147128

164

517

158 161

277

173

0

100

200

300

400

500

600


NH White

NH Black

Age-Adjusted Addiction-related ED Visit Rateper 10,000, By Race and Jurisdiction, 2014


(More is Worse)


473

818

352 335

451

337349

987

472405

597

291

0

300

600

900

1200


NH White

NH Black

Age-Adjusted Mental Health-related ED Visit Rateper 10,000, By Race and Jurisdiction, 2014


(More is Worse)


Disparities in ED Visit Rates

• Provider availability

– Culturally and linguistically appropriate care

• Attitudes toward the medical system

• Use of ED as a usual source of care

• Chronic disease management at home

– Health literacy

• Rates of un-insurance

• Health insurance literacy

So What?

• Attention to the social determinants of health

• Inclusion of vulnerable communities in planning and policy-making

• Community outreach, education & engagement

– Culturally and linguistically appropriate

• Health in all policies approach

– Multi-sectoral collaboration

mid-shore rural data -...

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