Health Disparities in Contra Costa County

July 2009

What are health disparities?

Health disparities refer to differences in health outcomes (death, illness, injury and birth-related outcomes)Most often these differences are examined as differences by race/ethnicity because that data is most readily available. But there as measures get better there is increasing recognition of the role that socioeconomic status (measured by education, income, wealth etc) plays in determining a population’s health

What are the causes of health disparities?

There are many ideas about what leads to health disparities. It depends on how health disparities are defined.The most consistent causes: Differences in resources (education, income,

wealth, support) Differential treatment based on language,

culture or race/ethnicity

Low resources

Discrimination

Living in unhealthy physical, social and economic environments

-Chronic Stress -Unhealthy behavior (smoking, excessive drinking, eating unhealthy food)-Exposure to pollutants and carcinogens-Lack of access to needed goods and services

Increased Rate of Illness, Injury and Death

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One View of Health Disparities

Distribution of Population by Race/EthnicityContra Costa, 2005-07

52.9

21.2

13.19.1

51.8

21.9

13.29.1

50.9

22.4

13.38.9

-5

5

15

25

35

45

55

White Hispanic Asian AfricanAmericanPercent

Contra Costa Overview

Contra Costa California

Population 1,019,640 36,553,215

Percent White 50.9 42.5

Percent Black 8.9 6.0

Percent Hispanic 22.4 36.2

Percent Asian 13.3 12.2

Median HH Income 76,435 59,948

Percent >HS grad 12.1 19.8

Another language at home

31.5 42.6

Distribution of Births by Race/EthnicityContra Costa, 2007

3437

14.98.7

0

30

60

White Hispanic Asian/PacificIslander

AfricanAmerican

Percent

What do we know about health disparities by race/ethnicity in Contra Costa?

African-Americans and those living in cities with high rates of poverty, in general do less well compared to other race/ethnic groups or those living in cities with lower rates of poverty.Those cities and areas of Contra Costa with higher levels of poverty and the resulting lower levels of physical, social, economic and institutional resources, tend to have higher rates of mortality from many diseases.The Hospital Council report provides information about differences in health outcomes by race/ethnicity and by city

170.5

239.4*

129.3 113.8

177.1

0

50

100

150

200

250

300

African American Latino/Hispanic Asian White Countywide

Per 100,000

Cancer Death Rate by Race/Ethnicity

Contra Costa, 2002-2004

Overweight 5th GradersContra Costa, 2002-2004

35.8*38.2*

22.1 19.7

27.5

0

10

20

30

40

50

African American Latino/Hispanic Asian White Countywide

Percent

15.16.8

23.824.8

75.3*

57.6*56.8*

32.8*

16.6

28.2*31.9*

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County

wide

Per 1,000 teen girls

Births to Teens (Age 15-19) Contra Costa, 2002-2004

48.6*

7.8

2.47.8

0

10

20

30

40

50

60

African American Latino/Hispanic White Countywide

Per 100,000

Homicide by Race/Ethnicity Contra Costa, 2002-2004

What should be done about health disparities?

Work to reduce or reduce the effect of the main causes of health disparities:

Differences in resources (education, income, wealth, support)

Differential treatment based on language, culture or race/ethnicity

Specifically health care institutions should: Provide high-level culturally, linguistically appropriate

care to all of its clients Work with community partners and partners from other

sectors (recreation, education, transportation, housing, etc) to improve the physical, social and economic environment in which those with low-income live

What is CCHS doing about health disparities?

Reducing Health Disparities Initiative (RHDI) Language Access

Video and phone translation Cultural Humility Training Service Excellence/RHD policy African-American Health Initiative (AAHI)

Connected Activities Life Course Built Environment Environmental Justice Healthcare Safety Net (Basic Health Care)

African American Health Initiative

Action Steps Recruit and Retain African American

staff Provide Cultural Humility Training Identify Key Indicators for Specific

Actions Establish Partnerships with

Community Expand the Health Conductors Project

Connected Activities

Life Course Life Course Initiative focuses on adding life and

generational perspective to health promotion activities

Building Economic Security Today (BEST) project focuses on providing information and tools for asset development to FMCH clients

Built Environment This project is working with city planners in

Richmond and Concord to change the physical environment in a way that improves health behavior and outcomes (Example: Health Element in Richmond General Plan)

Connected Activities

Environmental Justice Has developed a framework for working on

environmental issues in communities (Example: Dirty Diesel)

Health Safety Net Provides basic health care to those who

have little or no resources to pay for care (Example: Basic Health Care)