Knowledge for Equity

Conference (K4E)November 13,

2012

B r eann a Mo r r i so n , MP LCHC Po l i cy Ana l y s tCOMMUNITY HEALTH

COUNCILS LOS ANGELES, CA

USING DATA TO CLOSE THE RACIAL

HEALTH EQUITY GAP

Introduction to CHCCHC Model for Social Change

The Role of Data in Changing the Environment

The Role of Data in Changing Access to Healthcare

COMMUNITY HEALTH COUNCILS

A non-profit, community based health policy and

advocacy organization dedicated to

improving the health of underserved communities.

COMMUNITY HEALTH COUNCILS POLICY AREAS

Nutrition & Physical Activity

Access and Quality of Healthcare

Expansion of

Healthcare Coverage

Environmental Health

CHC MODEL FOR SOCIAL CHANGE

QUANTIFYING HEALTH INEQUITY

The Reality of RacialEthnic Health Disparities

DEMOGRAPHCS BY AREA OF COMPARISON

61.3%

7.0%

16.6%

11.4%

3.7%

WEST LA

WhiteAfrican AmerLatinoAsian/PIOther

3.3%

31.0%

62.4%

1.9% 1.4%

SOUTH LA

WhiteAfrican AmerLatinoAsian/PIOther

SOUTH LA

1.3 million population

94.5 square miles

Pop density: 13,996/sq mile

33.5% of the population is

18 years of age or under

West LA

651,084 people

210 square miles

Pop density: 3,087/sq mile

16.8% of population is 18 years of age or

under

TARGET AND CONTRAST AREAS

9

Health OutcomesLA

County West LA South LAObesity  

Percent of children grades 5, 7 & 9 who are obese 22.9 16.6 28.9Percent of adults who are obese 22.2 10 35.4

Diabetes  Percent of adults ever diagnosed with diabetes 8.7 4.8 12.3Diabetes death rate 24.7 12.8 37.9

Cardiovascular Disease  Percent of adults ever diagnosed with hypertension 24.7 19.3 29Coronary heart disease death rate 167.6 132.6 217.6Stroke death rate 41 34.4 51.9

Reproductive Health  Rate of births to teens 15-19 years 40 9.4 74.1

Injury  Homicide rate among young adults 15-34 years 23.2 ** 64.7Death rate attributed to motor vehicle crashes 9.6 5.9 12.7

Cancer  Lung cancer death rate 34.6 30.7 41.8Breast cancer death rate 20.7 21.7 26.8Cervical cancer death rate 3.3 ** 4.6Colorectal cancer death rate 15.3 12.3 21.4

Communicable Disease  Pneumonia/Influenza mortality rate 26.1 23.9 31.4Incidence of AIDS among 13+ years old 12.8 10.3 16.4HIV infection-related mortality rate 4.1 ** 6.8Incidence of chlamydia 421.6 208.7 922.2Incidence of gonorrhea 96.1 63.4 270.2Incidence of tuberculosis 8.4 3.7 10.6

All cause mortality 660.6 547.1 831.3** if <20 deaths, a rate cannot be calculated

Source: Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. Key Indicators of Health by Service Planning Area; June 2009.

Area Life Expectancy at Birth (Years)

Ranking (n= 103)

Quartile

Los Angeles County 80.3    Council District 5 83.6 13 1Council District 11 83.2 19 1Council District 4 82.6 25 1Council District 3 81.8 31 2Council District 13 81.8 32 2Council District 12 81.2 38 2Council District 1 80.9 44 2Council District 14 80.7 56 3Council District 6 80.3 63 3Council District 7 79.9 70 3Council District 2 79.7 71 3Council District 10 79.1 81 4Council District 15 77.9 91 4Council District 9 77.0 96 4Council District 8 75.2 102 4

LIFE EXPECTANCY BY COUNCIL DISTRICT

WHAT ARE THE DRIVERS

Housing segregation Lack of regulatory oversight and planningDiscriminatory corporate and financial

practices Public and private divestment Public policyTax and fiscal policy

13

MOVING TOWARDS EQUITY

THE ROLE OF DATA IN CHANGING THE

ENVIRONMENT

INEQUITIES IN THE BUILT ENVIRONMENT

Category South LA West LA

Disparity

Physical Environment Resources

-43% 42% 85

Nutrition -106% 101% 207

Physical Activity Options -55% 24% 79

Public Safety -17% 7% 24

Housing -40% 16% 56

Schools -43% 63% 106

Air and Land Quality 5% 39% 34

FOOD RETAIL RESOURCES

South LA

6% 15%

3%

76%

Full ServiceMeat, Fish, PoultryProduce Corner Store

West LA

18%

9%3%70%

Full ServiceMeat, Fish, PoultryProduce Corner Stores

16

MEASURE SOUTH LA WEST LA LA COUNTYPercent Fast Food

71.8% 40.7% 47.7%

Fast Food Restaurants per Square Mile

4.97 4.13

Built Environme

nt

Poor Access to Physical Activity

Low Access to Healthy

Food

OBESITYDIABETES

HIGH CHOLESTER

OLHEART

DISEASECANCER

CONNECTING THE BUILT ENVIRONMENT TO HEALTH

Exposure to

Hazardous

Substance

2010 General Plan Amendment prohibits a new fast food restaurant within a 1/2 mile radius, or 2, 640 linear feet, from any existing Fast Food Restaurant.

Ordinances Proposed in 2012 Community Plan Update No more than one (1) establishment permitted within a ¼ mile

radius of another free standing establishment” (CPIO sub-districts) “Prohibits…all new free standing fast food establishments seeking

to locate directly adjacent, across a street, alley or intersection from a public elementary, middle or high school, including charter and magnet schools” (CPIO sub-districts)

Drive through fast food establishments shall be limited to a maximum of 1 within a 750 foot radius of an existing free standing fast food use” (Crenshaw Specific Plan Amendment)

REGULATION OF FAST FOOD RESTUARANTS IN SOUTH LA

IMPACT: PROGRESS TOWARDS HEALTH EQUITY

More Stores• 6 New

South LA Grocery Stores since 2007

Slowed Fast Food Growth• Only 1

stand alone fast food restaurant since 2008

Increasing Healthy

Food Access

IMPACT: PROGRESS TOWARDS EQUITY

Year EH Building Permits

2010 5.96%

2011 4.49%

Jan-June 2012

2.44%

Moving Towards Equity

THE ROLE OF DATA IN CHANGING HEALTHCARE RESOURCES

INEQUITIES IN THE HEALTHCARE RESOURCE ENVIRONMENT

Category South LA West LA DisparityHealthcare Environment Resources

-43% 72% 115

Healthcare Facilities -28% 59% 87

Healthcare Workforce -76% 182% 258

Healthcare Financing -65% 22% 87

Healthcare Coverage -30% 38% 68

Primary & Preventive Care Access

-34% 27% 61

Primary & Preventive Care Utilization

-24% 103% 127

24

1995 LA County closes 33 county primary care clinics

Establishes contracts with Community Clinics to provide care for uninsured

Allocation of Contracts: $27.12 per uninsured patient in

South Los Angeles $34.05 per uninsured patient in

West Los Angeles

INEQUITY IN PUBLIC POLICY

2001 2002 2003 2004 2005 2006 2007 2008 20090

1

2

3

4

5

6

7

8

SPA 6

All SPAs Except 6

SPA 5

Infa

nt M

orta

lity

Rate

per

100

0 Liv

e Bi

rths

NICU ClosedMLK Closed

Figure 1: Infant Mortality Rates over time in SPA 6 vs All SPAs Except 6 and SPA 5

MODEL IN ACTION: COMMUNITY ASSESSMENTS

DISPARITIES IN INFANT MORTALITY

Data Source: Los Angeles County Department of Public Health: Title V Perinatal Indicators (2009); Modified to emphasize South Los Angeles2001 2002 2003 2004 2005 2006 2007 2008 2009

60

70

80

90

SPA 6

All SPAs Except 6

SPA 5

Rate

of L

ow B

irth

Wei

ght B

irths

(>25

00g)

Figure 2: Rate of Low Birth Weight (>2500) Neonates Over Time in SPA 6 vs. All SPAs Except 6 and SPA 5

The Problem

LESSONS LEARNEDOUTCOMES & SUCCESS

WHAT CAN COMMUNITY ACHIEVE

1 •Passage of nation’s strongest regulation of density of fast food restaurants

2 •Passage of nation’s strongest regulation of oil drilling in urban setting

3 •Opening of 6 new grocery stores

Lark Galloway-Gilliam, Executive Director

Breanna Morrison, Policy Analyst

3731 Stocker Street, Suite 201Los Angeles, CA 90008

323.295.9372

www.chc-inc.orgTHANK YOU

Community Health Councils