Place Matters for Health: Geographic Health Patterns in Genesee County Daniel J. Kruger, PhD...

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Place Matters for Health:Geographic Health Patterns in Genesee County

Daniel J. Kruger, PhDUniversity of Michigan School of Public Health

Genesee County Public Health Week ConferenceMay 7, 2013

John Snow

England, 1813 - 1858

Voted “the greatest doctor of all time”Hospital Doctor magazine-March 2003 survey

John Snow’s map of water pumps John Snow’s map of water pumps and cholera casesand cholera cases

Cholera case

Water pump

John Snow’s map of water pumps John Snow’s map of water pumps and cholera casesand cholera cases

Cholera case

Water pump

Broad StreetPump

John Snow MemorialJohn Snow Memorial

Genesee County, Michigan

SPEAK TO YOUR HEALTH!Community Survey

Comparing health indicators across geographical areas

Survey MethodologySurvey Methodology2003-20092003-2009

• Random sample Random sample of households in Genesee Countyof households in Genesee County

• 20 residents per Census Tract in Flint20 residents per Census Tract in Flint

• 10 residents per Census Tract outside of Flint10 residents per Census Tract outside of Flint

• Telephone interviewsTelephone interviews conducted by the Michigan conducted by the Michigan Public Health Institute Public Health Institute

• Adults ages Adults ages 18 years and older18 years and older

• Final sample size = Final sample size = 1700 residents 1700 residents

• 900 in Flint and 800 Out-County900 in Flint and 800 Out-County

• Data analyses can be weighted Data analyses can be weighted to take into account to take into account sampling strategy and demographic distribution sampling strategy and demographic distribution

Survey MethodologySurvey Methodology20112011

• Random sample Random sample of households in Genesee of households in Genesee CountyCounty

• Adults ages Adults ages 18 years and older18 years and older

• Telephone interviewsTelephone interviews conducted by the conducted by the Michigan Public Health InstituteMichigan Public Health Institute

• Mailed hard copy surveys Mailed hard copy surveys compiled by MPHIcompiled by MPHI

• On-line survey On-line survey linked to GCHD homepagelinked to GCHD homepage

• Results weighted Results weighted to take into account sampling to take into account sampling strategy and demographic distribution strategy and demographic distribution

Survey TopicsPhysical Health and chronic health conditionsPhysical Health and chronic health conditions

Mental Health Mental Health

Health Care Access, Coverage, Satisfaction, Trust Health Care Access, Coverage, Satisfaction, Trust

Physical and Mental Health ScreeningPhysical and Mental Health Screening

Health Promoting Behaviors (nutrition, exercise, etc.)Health Promoting Behaviors (nutrition, exercise, etc.)

Health Adverse Behaviors (tobacco use, etc.) Health Adverse Behaviors (tobacco use, etc.)

Sleep QualitySleep Quality

Spirituality, Religion, and Health Spirituality, Religion, and Health

Experiences of discriminationExperiences of discrimination

Financial health Financial health

Violence, crime, relations with police, and incarcerationViolence, crime, relations with police, and incarceration

Neighborhood ConditionsNeighborhood Conditions

Disease Burden• Heart disease• Stroke• Cancer • Depression• Anxiety• Diabetes• Asthma• Sleep disorder• Sarcoidosis• Sickle cell anemia• Lupus

Proportion who eat at least5 fruits and vegetables per day

Proportion of respondents who eat at least5 fruits and vegetables per day

Kruger, D.J., Greenberg, E., Murphy, J.B, DiFazio, D.A., & Youra, K.R. (in press). Local concentration of fast food outlets is associated with poor nutrition and obesity. American Journal of Health Promotion.

Those who lived near more fast food outlets: •Were more likely to be overweight and obese•Ate fewer fruits and vegetables

Minutes of exercise per week

Proportion who have a park in their neighborhood that they feel safe using for physical activity

Fear of crime

Proportion who sleep less than 7 hours a night

48505 48506

Diabetes Risk by EXPORT ZIP Code in 2003 Percent of Respondents Classified as High Risk

In Targeted Diabetes Intervention Areas

24.1 – 29.9%

30.0 – 34.9%

35.0 – 36.8%

48505 48506

Diabetes Screening by EXPORT ZIP by EXPORT ZIP CodePercent of Respondents Who Say They Were

Screened for Diabetes in the Past Year

76 – 82%

71 – 72%

60 – 70%

48505 48506

Project EXPORT Activities by ZIP CodeMap Indicates Percent of Respondents

Classified as High Risk in 2003

24.1 – 29.9%

30.0 – 34.9%

35.0 – 36.8%

2005 Community Survey Results2005 Community Survey Results

Diabetes RiskDiabetes RiskPercent of Respondents 45+ Percent of Respondents 45+ Classified as High Risk for Classified as High Risk for

Diabetes by ZIP Code Diabetes by ZIP Code Genesee County, 2005Genesee County, 2005

61 – 80%

51 – 60%

30 – 50%

Insufficient Data

2005 Data

Kruger, D.J., Brady, J.S., & Shirey, L.A. (2008). Using GIS to facilitate community-based public health planning of diabetes intervention efforts. Health Promotion Practice, 9, 76-81.

Diabetes DiagnosesDiabetes DiagnosesPercent of respondents Percent of respondents

45+ who have been 45+ who have been diagnosed with diabetes diagnosed with diabetes Genesee County, 2005Genesee County, 2005

26 – 35%

16 – 25%

1 – 15%

Insufficient Data

2005 Data

Diabetes ScreeningDiabetes ScreeningPercent of respondents Percent of respondents

45+ high risk for diabetes and 45+ high risk for diabetes and have not been screened, have not been screened, Genesee County, 2005Genesee County, 2005

31 – 50%

21 – 30%

1 – 20%

Insufficient Data

2005 Data

Diabetes ScreeningDiabetes ScreeningPercent of respondents Percent of respondents

45+ high risk for diabetes and 45+ high risk for diabetes and have not been screened, have not been screened, Genesee County, 2005Genesee County, 2005

31 – 50%

21 – 30%

1 – 20%

Insufficient Data

2005 Data

2 Indicates EXPORT Activities

Importance of the built environment

Elevated blood lead levels in older housing stockElevated blood lead levels in older housing stock

Percentage of Housing Units Percentage of Housing Units Constructed Pre-1940Constructed Pre-1940

31 - 47%31 - 47%21 - 30%21 - 30%

11 - 20%11 - 20% 0 - 10%0 - 10%

No ExposureNo ExposureSome ExposureSome Exposure

Lead Poisoned (10-19)Lead Poisoned (10-19)Lead Poisoned (20+)Lead Poisoned (20+)

Elevated Blood Lead Levels

Kruger, D.J., Shirey, L.A., Taylor, S. Kruger, D.J., Shirey, L.A., Taylor, S. (in press). GIS facilitates community-(in press). GIS facilitates community-based child lead screening efforts. based child lead screening efforts. Michigan Journal of Public HealthMichigan Journal of Public Health..

Flint Environmental Block Assessment

VacantResidential structures

Residential structures in disrepair or not salvageable

VacantCommercial structures

Commercial structures in disrepair or not salvageable

The built environment affects social conditions The built environment affects social conditions and mental healthand mental health

EBA Data Community Survey Data

Kruger, D.J., Reischl, T.M., & Gee, G.C. (2007). Neighborhood social conditions mediate the Kruger, D.J., Reischl, T.M., & Gee, G.C. (2007). Neighborhood social conditions mediate the association between physical deterioration and mental health. association between physical deterioration and mental health. American Journal of Community American Journal of Community Psychology, 40, Psychology, 40, 261-271.261-271.

Density of deteriorated structuresDensity of deteriorated structures

Density of pre-mature birthsDensity of pre-mature births

Density of low birth weight birthsDensity of low birth weight births

The built environment and birth outcomes

Correlations with density of structural deterioration

Race Pre-maturity Low birth weight

All .441*** .500***

Black .354*** .336***

White .228** .026

N = 169; ** indicates p < .01, *** indicates p < .001. Controlling for maternal education, paternal education, and private insurance status.

Kruger, D.J., Munsell, M.A., & French-Turner, T. M. (2011). Using a life history framework to understand the relationship between neighborhood structural deterioration and adverse birth outcomes. Journal of Social, Evolutionary, and Cultural Psychology, 5, 260-274.

The built environment and birth outcomesBlack births were overrepresented in areas with high structural deterioration

Race Top 25% Top 5%

Black 49% 20%

White 22% 6%

Proportion of births by area level of deterioration

Kruger, D.J., Munsell, M.A., & French-Turner, T. M. (2011). Using a life history framework to understand the relationship between neighborhood structural deterioration and adverse birth outcomes. Journal of Social, Evolutionary, and Cultural Psychology, 5, 260-274.

Thank you!

Daniel J. Kruger, PhDUniversity of Michigan School of Public HealthKRUGER@UMICH.EDU

Place Matters for Health: Geographic Health Patterns in Genesee County Daniel J. Kruger, PhD...

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