Download - Dr. Bezruchka: Tukwila School District Intercultural Speakers Series

8/9/2019 Dr. Bezruchka: Tukwila School District Intercultural Speakers Series

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Stephen Bezruchka MD, MPHDepartments of Global Health & Health Services

School of Public HealthUniversity of Washington


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Agenda

My background

Population Health Quiz

Health Olympics

Determinants of health

Economic Inequality & First 1000 days

Education Olympics

Determinants of educational outcomes

Next steps:

INTERRUPTASK QUESTIONS


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Problem to address

Why has US world

leadership ineducational outcomes

in schools declined?


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Main IdeaUS educational outcomes are not great

despite spending $$$, NCLB, Race to Top

Student capabilities to learn arecompromised by early life circumstances

Economic inequality creates this situation

We must consider structures in US societyafter WWII when there was more equity.


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Health QUIZTrue

False

A 15 year old girl in the US has a smallerchance of dying before reaching age 60than a similarly aged girl in Sri Lanka.

During the period of 1987 to 2007 lifeexpectancy for women declined in about30% of US counties (which was not so forthe previous 20 years).

Maternal mortality in the US has increased50% over the last 15 years.


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Sri Lanka US #Adult Female Mortality 1970-2010#


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Ezzati et. al 2008#

Female# Male#

US County Mortality Trends 1992-6-2002-6#Age-Adjusted mortality rates ($75 yrs)/100000 #

Kindig & Cheng 2013#


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Ezzati et. al 2008#

Female#

US County Mortality Trends 1992-6 / 2002-6#Age-Adjusted mortality rates ($75 yrs)/100000 #

Kindig & Cheng 2013#


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Australia, Canada, Japan, Sweden #US Maternal Mortality 1970-2010#


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Economist April 25, 2012#


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0 2 4 6 8 10 12

Japan

France

Germany

Spain

Greece

UK

Czech Republic

Portugal

Belgium

Hungary

ItalyDenmark

Netherlans

Australia

Poland

Canada

Korea

New Zealand

USA

*Austria, Finland, Ireland, Norway, Sweden and Switzerland had fewer than 20 deaths reported and therefore

rates were not calculated.

Youth violence OlympicsHomicide rates among youth aged 10-29 (most

recent year available) from the World Health Organizations World Report on

Violence and Health, 2002*


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Age distribution and overall rates of homicide:England and Wales compared with Chicago.

(age and sex of perpetrator)

Source: Cronin H.


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Age distribution and overall rates of homicide:England and Wales compared with Chicago.

(age and sex of perpetrator)

Source: Cronin H.


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INFANT

MORTALITY

OLYMPICS


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How healthy is the US?Health Olympics

Number one Gold1-5 _______

6-10 _______

11-15 _______

16-20 _______21-25 _______

26-30 _______

31+ _______


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How healthy is the US?Health Olympics


6-10 _______

11-15 _______

16-20 _______21-25 _______

26-30 _______

31+ _______


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1st & 4th yr US medical studentknowledge of Population Health

(2002)Question INCORRECT

US has higher life expectancythan any other nation?

32%

US has lower infant mortalitythan any other nation?

34%

Agrawal, J. R., J. Huebner, et al. (2005). "Medical students' knowledge of the U.S. health care system and their preferences for

curricular change: a national survey." Acad Med 80(5): 484-8.


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POPULATION HEALTH

Health Inequalities (poorer

people have poorer health)

Early Life: critical for adult health


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Harvey 2005


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Wilkinson & Pickett 2009 Spirit Level#

US MORTALITY RATES BY ZIP CODE INCOME#


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Index of:

Life expectancy

Math & Literacy

Infant mortality

Homicides

Imprisonment Teenage births

Trust

Obesity

Mental illness incl.drug & alcoholaddiction

Social mobility

Health and Social Problems are Worse in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk


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TEEN BIRTHOLYMPICS


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IOM Shorter Lives, Poorer Health2013#

Teen (15-9) Birth Rates 2010#


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Homicides


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Homicides


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Teen Births


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US Teen Births


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Pickett AJPH 2005

Violence and Teen Birth Rates related

Higher TEEN BIRTHS

HigherHOMIC

DERates


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PRETERM

BIRTH

OLYMPICS


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MacDorman & Mathews 2009

PTD % Excluding


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Born Too Soon. 2012#

PRETERM BIRTHS/100#


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Muglia et al. 2010#

PRETERM BIRTHS


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LOW BIRTH

WEIGHT

OLYMPICS


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LOW BIRTH WEIGHTIOM Shorter Lives, Poorer Health2013#


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People who createINEQUALITY

KILL


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Kondo et al. 2009#

Deaths attributable toexcess income inequality

1 / 3


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Early life lasts a lifetime


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Poor first 1000 days

Increased Risk of

Pre-term Delivery

Stillbirth

Low Birth Weight

Caesarian Section

Infant MortalityBehavioral Problems

Poor School Performance

Earlier reproduction

Cardiovascular DiseaseObesity

Metabolic syndrome

DiabetesHypertension

Common Cancers

Early death

EARLY LATER LIFE


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Related to (caused by) entire life history ofwoman before she become pregnant

Impacted by parents

Impacted by grandparents

Impacted by previous generations

Poor pregnancy conditions


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Hart & Risley 1995#


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LOW BIRTHWEIGHT

Educational impact


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1000 days#

6708$ 9:7;$8 :) 8:


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1000 days#

6708$ 9:7;$8 :) 8:


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How educated is the US?EDUCATION Olympics


6-10 _______

11-15 _______

16-20 _______21-25 _______

26-30 _______

31+ _______


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OECD 2006

OECD 2006

US Test Scores #

Adjusted for Poverty#


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OECD 2006

OECD 2006

2012 PISA R l


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OECD 2006

OECD 2006

2012 PISA Results#


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OECD 2006

OECD 2006


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Wilkinson et. al.


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OECD 2006

OECD 2006


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EDUCATION


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EDUCATION

INEQUALITY

SAT Scores Income Inequality


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OECD 2006

OECD 2006

SAT Scores Income Inequality


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OECD 2006

OECD 2006


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Enrollment: 2,900 + Students

Gender: 51.8% Male/ 48.2% Female

Race/Ethnicity:

American Indian/Native 0.7%Asian/Pacific Islander 28.3%

Black/African American 19.5%

Hispanic 26.4%

White 15.4%

Mixed/Multi Race 6.1%Poverty/F &R: 77.6%

Special ed: 9.2%

Tran. Bilingual: 38.6%

Washington State Report Card 2012-2013


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Ed ti l Di d t


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Educational Disadvantage

relative poverty

in early life

CHILD POVERTY OLYMPICS


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CHILD POVERTY OLYMPICS



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Math Literacy Scores 15 yr olds


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OECD 2006

OECD 2006

Ed ti l Di d t


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Educational Disadvantage

Wrong focus

in US society


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Heckman. 2008#


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NYT 050515


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r > g#Rate of return on capital#

Greater thanRate of return on growth#

Income Inequality Anglo-saxon countries 1910-2010


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Piketty 2014#

Income Inequality Anglo saxon countries 1910 2010

Income Inequality Europe, Japan 1910-2010


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Piketty 2014#

q y p , p

Income Inequality Northern, Southern Europe, 1910-2010


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Piketty 2014#

q y , p ,

Minimum Wage France US 1950-2013


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Piketty 2014#

g

Top Income Tax Rates 1900-2013


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Piketty 2014#

p


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EquityEquality

distinction

Eq it


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http://sherinefahmy92.wordpress.com#

Equity

orEquality?


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Equity


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Equity

orEquality?


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Harvey 2005


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NYT 050515


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NYT 050515


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FAMILY BENEFIT

SPENDING

OECD


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6.87.0

2001-2

OECD 2009


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6.87.0

2001-2

OECD 2009

1,168,354homeless #t d t ll d


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students enrolled #

US preschools, #+ K-12 in 2011-2#

NYT 131026#

1.46 millionhouseholds living on$2 or less in incomeper person per dayin given monthRECORD

Educational Advantage


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Educational Advantage

What to do?

Regaining Olympic Gold


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Regaining Olympic Gold

Create awareness of societal determinants

Community/National focus NOT individual

Decrease economic inequality

Support early life

Learn from others (Canada, Finland)

Educational system reform

State or national funding parity

Recruit best students to be teachers