Transcript Document

OFFICE OF HEALTH EQUITY (OHE)
Established to align state resources, decision making, and programs to accomplish all
of the following:
• Achieve the highest level of health and mental health for all
people, with special attention focused on those who have
experienced socioeconomi c disadvantage and historical injustice,
including, but not limited to, vulnerable communities and
culturally, linguistically, and geographi call y isolated communities.
•
Work collaborati vely with the Health in All Policies (HiAP) Task
Force to promote work to prevent injur y and illness through
improved social and environmental factors that promote health and
mental health.
•
Advise and assist other state depar tments in their mission to
increase access to, and the quality of, culturally and linguistically
competent health and mental health care and ser vices.
•
Improve the health status of all populations and places, with a
priority on eliminating health and mental health disparities and
inequities.
OFFICE OF HEALTH EQUITY ADVISORY COMMITTEE
C O N S I S T S O F A B R O A D R A N G
C L I N I C I A N S A N D C O N S U M E R S
T H E O F F I C E A N D A D V I S E I N T
O F T H E O

Sergio Aguilar-Gaxiola, MD, PhD, Director, Center for
Reducing Health Disparities and Professor of Clinical
Internal Medicine, University of California, Davis School of
Medicine

Paula Braveman, MD, MPH, Director, Center on Social
Disparities in Health and Professor of Family and
Community Medicine, University of California, San
Francisco
E O F
W H O
H E D
H E S
2 5 H E A L T H E X P E R T S , A D V O C A T E S ,
W I L L H E L P A D V A N C E T H E G O A L S O F
E V E L O P M E N T A N D I M P L E M E N T A T I O N
T R A T E G I C P L A N

General Jeff, Founder, Issues and Solutions and serves on
the Board of Directors of the Downtown Los Angeles
Neighborhood Council (DLANC)

Carrie Johnson, PhD, Director/Clinical Psychologist, Seven
Generations Child and Family Counseling Center at United
American Indian Involvement in Los Angeles, California

Neal Kohatsu, MD, MPH, Medical Director, California
Department of Health Care Services

Dexter Louie, MD, JD, MPA, Founding Member and Chair,
Board of the National Council of Asian Pacific Islander
Physicians

Delphine Brody, Former Program Director of Mental Health
Services Act (MHSA) Client Involvement, public policy, and
self-help technical assistance for the California Network of
Mental Health Clients

Jeremy Cantor, MPH, Program Manager, Prevention
Institute of Oakland

Francis Lu, MD, Luke and Grace Kim Professor in Cultural
Psychiatry, Emeritus, University of California, Davis

Yvonna Càzares, Manager, California PTA


C. Rocco Cheng, PhD, Corporate Director, Prevention and
Early Intervention Services, Pacific Clinics
Gail Newel, MD, MPH, Medical Director, Maternal Child
and Adolescent Health, Fresno County Department of
Public Health


Kathleen Derby, Legislative Analyst, California State
Independent Living Council
Teresa Ogan, MSW, Supervising Care Manager, California
Health Collaborative Multipurpose Senior Service Program


Aaron Fox, MPM, Health Policy Manager, LA Gay and
Lesbian Center
José Oseguera, Chief, Plan Review and Committee
Operations, Mental Health Services Oversight and
Accountability Commission

Sandi Gàlvez, MSW, Executive Director, Bay Area Regional
Health Inequities Initiative - CHAIR


Alvaro Garza, MD, MPH, Public Health Officer, San Benito
County Health and Human Services Agency
Hermia Parks, MA, RN, PHN, Director, Public Health
Nursing/Maternal, Child Adolescent Health, Riverside
County Department of Public Health

Cynthia Gòmez, PhD, Founding Director, Health Equity
Institute, San Francisco State University
Diana E. Ramos, MD, MPH, Director, Reproductive Health,
Los Angeles County Public Health

Willie Graham, Pastor, Christian Body Life Fellowship
Church
Patricia Ryan, MPA, Former Executive Director, California
Mental Health Directors Association

Ellen Wu, MPH, Executive Director, Urban Institute

Linda Wheaton, Health in All Policies Task Force, Director,
Department of Housing and Community Development


CALIFORNIA REDUCING DISPARITIES PROJECT
(CRDP)

The California Reducing Disparities Project (CRDP) is a key statewide policy
initiative to improve access, quality of care, and increase positive outcomes for
racial, ethnic, LGBTQQ, and cultural communities in the public mental health
system.

The implementation will have a strong community participatory evaluation
component.

After successful, California will be in a position to better serve unserved,
underserved, and inappropriately served communities and to replicate the new
strategies, approaches, and knowledge across the state and nation.
CRDP STRATEGIC PLAN
• A synthesis of the population reports, their findings, and
recommendations
• A vision for reducing mental health disparities
• A roadmap to transforming our public mental health system into
one that better meets the needs of all Californians
• Key strategies to achieve the vision
• Recommendations for the implementation of CRDP Phase II
CALIFORNIA REDUCING DISPARITIES PROJECT
PARTNERS
HEALTH EQUITY ~ HEALTH AND SAFETY CODE - SECTION 131019.5
•
Efforts to ensure that all people have full and equal access to opportunities that
enable them to lead healthy lives.
HEALTH AND MENTAL HEALTH DISPARITIES
•
Differences in health and mental health status among distinct segments of the
population, including differences that occur by gender, age, race or ethnicity,
sexual orientation, gender identity, education or income, disability or functional
impairment, or geographic location, or the combination of any of these factors.
HEALTH AND MENTAL HEALTH INEQUITIES
•
Disparities in health or mental health, or the factors that shape health, that are
systemic and avoidable and, therefore, considered unjust or unfair.
VULNERABLE COMMUNITIES
•
Include, but are not limited to, women, racial or ethnic groups, low-income
individuals and families, individuals who are incarcerated and those who have
been incarcerated, individuals with disabilities, individuals with mental health
conditions, children, youth and young adults, seniors, immigrants and refugees,
individuals who are limited-English proficient (LEP), and lesbian, gay, bisexual,
transgender, queer, and questioning (LGBTQQ) communities, or combinations of
these populations.
VULNERABLE PLACES
•
Places or communities with inequities in the social, economic, educational, or
physical environment or environmental health and that have insufficient
resources or capacity to protect and promote the health and well-being of their
residents.
HEALTH IMPACT OF RESOLVING RACIAL DISPARITIES
The Health Impact of Resolving Racial Disparities - An Analysis of US
Mortality Data
 “The US health system spends far more on the “technology” of care (e.g.,
drugs, devices) than on achieving equity in its delivery….The prudence of
investing billions in the development of new drugs and technologies while
investing only a fraction of that amount in the correction of disparities
deserves reconsideration. It is an imbalance that may claim more lives
than it saves.”
 Researchers have estimated that medical advances in the 1990s saved
the lives of 177,000 Americans over the course of that decade.
 If the gap in mortality rates between whites and African Americans had
been erased, 886,000 lives would have been saved – a fivefold increase.
ECONOMIC IMPACT OF PREMATURE DEATH
Health inequities cause premature death and create economic
burdens for the United States.
Between 2003 and 2006:
The combined costs of health inequalities and premature death were
$1.24 trillion.
Eliminating health disparities for minorities would have reduced direct
medical care expenditures by $229.4 billion.
California population by
race/ethnicity, 2010.
California population projection by
race/ethnicity, 2060.
Multi-Race
3%
Multi-Race
4%
White
40%
Latino
38%
Latino
48%
White
30%
Black
4%
Asian
13%
Native
Hawaiian
and other
Pacific
Islander
0.4%
Black
6%
American
Indian
0.4%
Source: U.S. Census Bureau 2010 and California Department of Finance, Demographic Research Unit.
Asian
14%
Native
Hawaiian
and other
Pacific
Islander
0.4%
American
Indian
0.4%
Age-adjusted death rates by race/ethnicity, California, 2002-2010
Age-adjusted death rates per 100,000 population
1200
1000
Black
800
White/Other/Unknown
Pacific Islander
Hispanic
600
American Indian
Asian
400
2+ Races
200
0
2001
2003
2005
2007
2009
Source: California Department of Public Health, Death Records, and California Department of Finance.
Rates are per 100,000 population in specified groups. Age-adjusted rates are calculated using Year 2000 U.S. standard population.
Age-adjusted death rates for top leading causes of
death in California, by race/ethnicity, 2009.
250
Age-Adjusted Death Rate*
200
Black
White/Other/
Unknown
150
100
50
0
Causes of Death
Source: State of California, Department of Public Health, Death Records
*Rates are per 100,000 population in specified groups. Age-adjusted rates are calculated using year 200 U.S. standard population
Hispanic
Asian
Life expectancy in California by race/ethnicity, 2006-2008.
90
86.1
Age in Years
85
83.1
80.1
79.3
80
77.5
75
73.3
70
65
Asian
Americans
Latinos
Source: Burd-Sharps and Lewis, A Portrait of California, 2011
Whites
Native
Americans
African
Americans
California
MORE THAN ACCESS TO CARE
Health is driven by multiple factors that are intricately linked – of which medical care is one component.
Drivers of Health
Personal Behaviors
40%
Family History and
Genetics
30%
10%
Medical
Care
Determinants of Health and Their Contribution to Premature Death. Adapted from McGinnis et al. Copyright 2007
WHAT ARE SOCIAL DETERMINANTS OF HEALTH?
According to the World Health Organization…
 The social determinants of health are the conditions in which people are born, grow,
live, work and age. These circumstances are shaped by the distribution of money,
power and resources at global, national and local levels.
A New Way to Talk About…
 Health starts where we live, learn, work and play.
 “Not just for people working in the field, but for policy-makers.”
ADDRESSING “KEY FACTORS” OR “SOCIAL
DETERMINANTS” AS THEY RELATE TO HEALTH AND
MENTAL HEALTH DISPARITIES AND INEQUITIES
•
•
•
•
•
•
•
•
•
•
•
•
•
•
(A) Income security
(B) Food security and nutrition
(C) Child development, education, and literacy rates
(D) Housing
(E) Environmental quality
(F) Accessible built environments
(G) Health care
(H) Prevention efforts
(I) Assessing ongoing discrimination and minority stressors
(J) Neighborhood safety and collective efficacy
(K) The efforts of the Health in All Policies Task Force
(L) Culturally appropriate and competent services and training
(M) Linguistically appropriate and competent services and training
(N) Accessible, affordable, and appropriate mental health services.
“THE HAVE AND HAVE-NOTS OF HEALTH ON DISPLAY
IN EAST SACRAMENTO, OAK PARK”
Visible differences between the two neighborhoods.
The 95819 and 95817 ZIP codes, which encompass much of east Sacramento and Oak Park,
respectively, share a border.
 Each has about 15,000 residents.
 In 2010, Oak Park residents are more than three times as likely to go to the emergency room for asthma, diabetes or
high blood pressure.
TALE OF TWO CITIES
MARIN CITY
•
Statistics consistently show that Marin is one of the healthiest counties in the
state and the country. But those statistics mask an uncomfortable truth: Marin
also has some of the most severe health disparities in the state. Simply put:
Where you live in Marin plays a role in how long you live.
MARIN CITY STATS
• 2, 509 Population (census tract
0604112900)
• 63% of African Americans living in
poverty (at or below 185% federal
poverty level)
• 7 of schools (k-8, preschools)
• 0 of public parks
• 0 of farmers markets
• 0 of supermarkets/large grocery
stores
• 4 of fast food outlets near schools
• 2 of other food sources (CVS and
Dollar Tree)
“THE PROBLEM IS CLEAR: THE WATER IS
FILTHY”
“No tomes el agua!” — “Don’t drink the water!”
Seville, with a population of about 300
 One of dozens of predominantly Latino unincorporated communities in the Central Valley plagued for
decades by contaminated drinking water.
Today, one in five residents in the Central Valley live below the federal poverty line.
 Many spend up to 10 percent of their income on water.
UNEVEN DISTRIBUTION OF HOUSEHOLD
WEALTH ACROSS RACIAL ETHNIC GROUPS IN
CALIFORNIA
Household Wealth in California by Race/Ethnicity,
2010
Households in California by Race/Ethnicity,
2010
Other
2%
Latino
27%
Other
3%
Asian
12%
Black
6%
White
52%
Latino
16%
Asian
13%
White
67%
Black
2%
African American households represent 6% of California households, but hold about 2% of household wealth.
Net worth (wealth) is the sum of the market value of assets owned by every member of the household minus liabilities
owed by household members.
A household consists of all the people who occupy a housing unit
Source: Source: SIPP (Panel 2008, Wave 7), ACS (table QT-P11) 2010 Census
THE WEALTHIER A COUNTY IS, THE LONGER ITS
INHABITANTS LIVE.
1 IN 4 CALIFORNIA CHILDREN LIVING IN
POVERTY IN 2012
Percentage of People Living Below Poverty by Age, California, 2005-2012.
25
<18
20
CA
US
15
%
18-64
65+
10
5
0
2004
Source: ACS
2006
2008
2010
2012
2014
CLIMATE CHANGE WILL IMPACT ALL CALIFORNIANS BUT
THE MOST VULNERABLE WILL SUFFER THE MOST
• Climate change will magnify existing health inequities rooted
in social determinants of health; adaptation draws on many
of the same resources
• In LA County, more African Americans and Latinos live in
high risk areas compared to whites and average incomes
are about 40% lower
NEIGHBORHOOD SAFETY AND EFFICACY
NUMBER OF VIOLENT CRIMES PER 1,000 POPULATION BY COUNTY, CALIFORNIA, 2010
YOLO
Santa Rosa
SONOMA
NAPA
Napa
SOLANO
Fairfield
Vallejo
MARIN
SACRAMENTO
San Rafael
Concord
CONTRA COSTA
Berkeley
Oakland
SAN FRANCISCO
San Francisco
ALAMEDA
Hayward
Fremont
San Mateo
SAN MATEO
Sunnyvale
Santa Clara
San Jose
SANTA CLARA
0
12.5
25 Miles
SANTA CRUZ
O
Source: Federal Bureau of Investigation: Uniform Crime Reports, 2010. Analysis by CDPH-Office of Health Equity and UCSF, Healthy Community Indicators
Project.
HOW DO WE GET THERE?
A PUBLIC HEALTH FRAMEWORK FOR REDUCING HEALTH INEQUITIES
ACHIEVING HEALTH & MENTAL HEALTH EQUITY AT
EVERY LEVEL
Transforming the conditions in which people are
BORN, GROW, LIVE, WORK and AGE
for optimal health, mental health & well-being.
Health Care
Prevention
Mental Health Services
HEALTHY PEOPLE
Culturally/Linguistically
Appropriate and
Competent Services
Individual/Family
Income
Security
Home/School/Worksite/Neighborhood
HEALTHY COMMUNITY
1
HEALTHY ENVIRONMENT
Housing
Child development,
education, and literacy
rates
Food Security/
Nutrition
Town/City/County/Rural
Built Environments
Neighborhood
Safety/Collective
Efficacy
Environmental Quality
HEALTHY SOCIETY
State/Federal/Institutions/Foundations
Discrimination/Minority
Stressors
Questions?
Wm. Jahmal Miller, MHA
Deputy Director – Office of Health Equity
California Department of Public Health
1615 Capitol Avenue | Sacramento, CA 95814
Office: 916-558-1821 | Fax: 916-558-1762
Email: [email protected]
OHE Website:
www.cdph.ca.gov/programs/pages/ohemain.aspx