understanding the factors that impact health: … tamho... · united states 2018. 0 2000 4000 6000...

December 12-13, 2019 Addressing Social Determinants to Improve Overall Health in Tennessee | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

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TAMHO 2019 Annual ConferenceSOCIAL DETERMINANTS OF HEALTH | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

UNDERSTANDING THE FACTORS THAT IMPACT HEALTH:

LESSONS FROM TENNESSEE AND AMERICA’S POOREST STATE

Randy Wykoff, MD, MPH & TM

Dean and Professor, College of Public Health, Director, Center for Rural Health Research, East Tennessee State

University, Johnson City, Tennessee

47.3

77

0

10

20

30

40

50

60

70

80

90

1900 1950 2000

Life Expectancy Change in the 20th Century

0

50

100

150

200

250

300

Cause of Death—United States 1909

0

50

100

150

200

250

300

Cause of Death—United States 2005

78.978.7 78.6

75

75.5

76

76.5

77

77.5

78

78.5

79

79.5

80

2014 2015 2016

Life Expectancy Change in the 20th Century

In 2019, for Life Expectancy

the United States Ranks:

39thBehind---

Monaco, Japan, Singapore, San Marino, Iceland, Andorra, Guernsey, Israel, Switzerland, South Korea, Australia, Italy,

Luxembourg, Sweden, Canada, France, Jersey, Liechtenstein, Norway, Spain, Austria, Bermuda, Netherlands, Cayman

Islands, Isle of Man, New Zealand, Belgium, Slovenia, Finland, Denmark, Ireland, Germany, Portugal, United

Kingdom, Greece, Taiwan, Turks and Caicos

Life Expectancy

CIA Factbook 2019

Life Expectancy: All 222 Countries in the World: Male and Female

45.00

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

Internation Male Life Expectancy International Female Life Expectancy

81

76

1. Minnesota 5653

2. California 5734

3. Connecticut 5923

4. Washington 5942

5. New York 5978

6. Massachusetts 6097

7. Hawaii 6104

8. New Jersey 6225

9. Colorado 6352

10. Nebraska 6401

11. Oregon 6511

12. Rhode Island 6561

13. Vermont 6563

14. Utah 6565

15. Idaho 6723

16. Iowa 6812

17. Wisconsin 6821

18 Virginia 6877

19 North Dakota 7047

20 New Hampshire 7067

21 Illinois 7127

22 Texas 7199

23 Kansas 7350

UNITED STATES 7432

24. Maine 7464

25. South Dakota 7499

26. Arizona 7502

27. Wyoming 7636

28. Maryland 7655

29. Florida 7790

30. Nevada 7899

31. Montana 7900

32. Delaware 7992

33. Pennsylvania 8013

34 Michigan 8102

35 North Carolina 8177

36 Georgia 8391

37 Alaska 8666

38 Missouri 8717

39 Indiana 8774

40 Ohio 8998

41 South Carolina 9232

42 New Mexico 9301

43 Tennessee 9756

44 Oklahoma 9992

45 Arkansas 10,099

46 Louisiana 10,125

47 Kentucky 10,479

48 Alabama 10,720

49 Mississippi 11,082

50 West Virginia 11,136

America’s Health Rankings 2018: https://assets.americashealthrankings.org/app/uploads/2018ahrannual_020419.pdf

Premature Death Rates (YPLL):

United States 2018

0

2000

4000

6000

8000

10000

12000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

USA

TENN

The Premature Death Rate in Tennessee is 31.3% Higher Than the National Rate


Premature Death Rates (YPLL):

United States 2018

Data: 2018 County Health Rankings: http://www.countyhealthrankings.orgmChart: ETSU College of Public Health and ETSU Department of Computing

89 of the 95 (94%) counties in Tennessee have a higher early death rate than the national median.

http://www.countyhealthrankings.orgm/

• Tennessee ranks 43rd (and is 31.3% worse than the National rate). . . .

• And 94% of the counties are in the bottom half, nationally,

• In the Nation that ranks 39th in the world . . .

Premature Death Rate in Tennessee

Early LifeExperiences

Education

Income

Work

Housing

Community

Race and Ethnicity

Economy

SanitationBehaviorAccess

Injury

Genetics

Bureau of Labor Statistics: www.bls.gov/newsrelease/cfoi.t05.htm

0

2

4

6

8

10

12

14

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Fatal Occupational Injuries: 2015 and 2016

USA

TENN

The Occupational Fatality Rate in Tennessee is 14% Higher Than the National Rate

http://www.bls.gov/newsrelease/cfoi.t05.htm

Childhood Immunization Rate (2018)

0

50

100

150

200

250

300

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Primary Care Physicians Per 100,000

USA

TENN

The Rate of Primary Care Physicians in Tennessee is 89.5% of the National Rate



33 of the 95 (35%) counties in Tennessee have a higher ratio of primary care physicians per capita than the national median.


Rate of Adult Smoking


5

10

15

20

25

30

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

USA

TENN

The rate of adult smoking in Tennessee is 32% higher than the national rate


94 of the 95 (99%) counties in Tennessee have a higher smoking rate than the national median.


Rate of Adult Obesity

The State of Obesity: Trust for America’s Health: 2019 : https://www.tfah.org/wp-content/uploads/2019/09/2019ObesityReportFINAL.pdf

5

10

15

20

25

30

35

40

45

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

USA

TENN

The rate of adult obesity in Tennessee is 11.3% higher than the national median

https://www.tfah.org/wp-content/uploads/2019/09/2019ObesityReportFINAL.pdf


71 of the 95 (75%) counties in Tennessee have a higher adult obesity rate than the national median.


Drug Deaths


5

10

15

20

25

30

35

40

45

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

USA

TENN

The rate of drug deaths in Tennessee is 30.2 % higher than the national rate

Estimated Death Rates for Drug PoisoningsBy County: 1999 - 2014

0

5

10

15

20

25

30

35

40

45

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Percent of Adults with a College Degree

USA

TENN

The Percent of Adults in Tennessee Who Have a College Degree is 83.6% of the

National Rate

US States by Educational Attainment: Wikipedia: https://en.wikipedia.org/wiki/List_of_U.S._states_by_educational_attainment

https://en.wikipedia.org/wiki/List_of_U.S._states_by_educational_attainment


74 of the 95 (75%) counties in Tennessee have a lower rate of some college than the national median


65

67

69

71

73

75

77

79

81

83

85

Wh

ite

Men

Bla

ck

Men

Wh

ite

Wo

men

Bla

ck

Wo

men

High School or Less

Some College

College or More

Expected Age at Death for People 25 and Older

by Race, Gender and Education: 2010

“Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017” Sasson I, Hayward MD. JAMA 2019 322: 756-763.

4.26 yrs5.35 yrs

8.19 yrs

7.99 yrs

Percent of High School Sophomores Who Complete

College in Ten Years Based on Parents’ Education Level

Education Matters for Health: Robert Wood Johnson Foundation. September, 2009

5.913.3

25.7

49.4

65.473.3

0

10

20

30

40

50

60

70

80

65

67

69

71

73

75

77

79

81

83

85

Hig

h

Sch

oo

l

Som

e

Colle

ge

Coleg

e

Changes in Expected Age at Death (at Age 25)

White Men: 2010 - 2017


+0.58yrs

-0.89yrs

-1.05yrs

65

67

69

71

73

75

77

79

81

83

85

Hig

h

Sch

oo

l

Som

e

Colle

ge

Coleg

e


Black Men: 2010 - 2017


+0.90yrs

-0.48yrs

-0.3yrs

75

77

79

81

83

85

87

89

Hig

h

Sch

oo

l

Som

e

Colle

ge

Coleg

e


White Women: 2010 - 2017


+0.78yrs

--0.59yrs

-1.13yrs

75

77

79

81

83

85

87

89

Hig

h

Sch

oo

l

Som

e

Colle

ge

Coleg

e


Black Women: 2010 - 2017


+1.69yrs

--0.33yrs+0.64yrs

Cause of Life Expectancy Change

White Men and Women with a High School Degree or Less: 2010 - 2017



White Men and Women with Some College: 2010 - 2017



White Men and Women with College or More: 2010 - 2017


0

5

10

15

20

25

30

1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647484950

Children Living in Poverty

USA

TENN

The Percent of Children Living in Poverty in Tennessee is 15.2% Higher Than the National

Rate


Relative Risk of Dying Before the Age of 65

By Income: United States

Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the United States

0

0.5

1

1.5

2

2.5

3

3.5

0

50000

100000

150000

200000

250000

PoorestFifth

2ndPoorest

Fifth

MiddleFifth

2ndRichest

Fifth

RichestFifth

1967

1976

1986

1996

2006

2016

Selected Measures of Household Income

Disparities: 1967 – 2016

2016: Ratio = 16.5:1

48% INCREASE

1967: Ratio = 11.4:1

Income and Poverty in the United States, 2016. U.S. Census Bureau https://www.census.gov/content/dam/Census/library/publications/2017/demo/P60-259.pdf

We need to work together to enhance economic

opportunity and improve educational achievement;

We need to work together to implement evidenced-

based programs related to diet, exercise, smoking and

substance abuse; and

We need to work together to assure access to health

care, especially primary care, mental health and

preventive services;

What Can We Do To Improve Health

in the United States?

Premature Death(YPLL):2% Wealthiest Counties vs 2% Poorest Counties

2016 County Health Rankings: http://www.countyhealthrankings.org/

0

5000

10000

15000

20000

1stPercentile

10thPercentile

20thPercentile

30thPercentile

40thPercentile

50thPercentile

60thPercentile

70thPercentile

80thPercentile

90thPercentile

99thPercentile

1 County

3 Counties

5 Counties

7 Counties

4,621

12,088

Life Expectancy: All 222 Countries in the World: Male and Female

45.00

50.00

55.00

60.00

65.00

70.00

75.00

80.00

85.00

90.00

Internation Male Life Expectancy International Female Life Expectancy

76.0

69.75

83.1

79.3

Where Do Men Live Longer Than in America’s “Poorest

State?”

Appalachian Regional Commission: https://www.arc.gov/research/SourceandMethodologyCountyEconomicStatusFY2007FY2020.asp

The County Economic Status Designation

9- 10 14 47-48 14 9- 10

https://www.arc.gov/research/SourceandMethodologyCountyEconomicStatusFY2007FY2020.asp

The County Economic Status Designation: Tennessee:

15.18

19.4221.28

22.7725.34

0

5

10

15

20

25

30

Attainment Competitive Transitional At-Risk Distressed

Adult Smoking Rate Tennessee:

By Economic Level

County Health Rankings 2019https://www.countyhealthrankings.org/

Smoking rate is 66.9% higher in our distressed counties

https://www.countyhealthrankings.org/

86.05

64.42

51.343.83

36.95

0

10

20

30

40

50

60

70

80

90

100


Percent of Adults with Some College: Tennessee:

By Economic Level


The education rate is less than half as high in our

distressed counties


3.8

15.13

21.54

27.28

31.37

0

5

10

15

20

25

30

35


Children Living in Poverty: Tennessee:

By Economic Level


The child poverty rate is 8 times higher in our distressed counties


201.21

271.98

325.31352.43

369.34

0

50

100

150

200

250

300

350

400


Heart Disease Death Rate: Tennessee:

By Economic Level


The heart disease death rate is 84% higher in our distressed counties


151.99

197.15

229.18243.62 250.42

0

50

100

150

200

250

300


Cancer Death Rate: Tennessee:

By Economic Level


The Cancer death rate is 65% higher in our distressed

counties


4052

7621

9681

1114511975

0

2000

4000

6000

8000

10000

12000

14000


Early Death Rate (YPLL): Tennessee:

By Economic Level


The early death rate is almost three times higher in

our distressed counties


Richest and Poorest 10 Counties in America with their SAMHSA “Sub-state” Areas

There are 35 counties included in the “richest” sub-state areas

There are 154 counties included in the “poorest” sub-state areas

18.13

17.195

15

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

Med

ian

Per

cen

tage

of

Sub

stat

e Po

pu

lati

on Substates Containing 10

Poorest Counties

Substates Containing 10Richest Counties

Any Mental Illness: “Richest” vs “Poorest” Sub-State Areas

3.98

3.84

3

3.2

3.4

3.6

3.8

4

4.2

Med

ian

Per

cen

tage

of

Sub

stat

e P

op

ula

tio

n Substates Containing 10Poorest Counties

Substates Containing 10Richest Counties

Serious Mental Illness: “Richest” vs “Poorest” Sub-State Areas

0

10

20

30

40

50

60

70

80

90

20000 30000 40000 50000 60000 70000 80000 90000 100000

Ove

rdo

se M

ort

alit

y R

ate

per

10

0,0

00

P

op

ula

tio

n

Median Household Income, Dollars ($)

United States: Drug Overdose Deaths compared to Median Household Income

2

2.5

3

3.5

4

4.5

5

5.5

6

0 10 20 30 40 50 60 70 80 90 100

Po

or

Men

tal H

ealt

h D

ays

Poor Mental Health Days Poorest 2% and Richest 2% of Counties

3.0

4.7

57%

The “Virginia Health Bulletin” 1908 and 1909

Randy Wykoff, MD, MPH & TM

Professor and Dean

College of Public Health

Director

Center for Rural Health Research

East Tennessee State University

(423) 439-4243

[email protected]

Please Feel Free to Contact Me. . .

mailto:[email protected]

December 12-13, 2019 Addressing Social Determinants to Improve Overall Health in Tennessee | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

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TAMHO 2019 Annual ConferenceSOCIAL DETERMINANTS OF HEALTH | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

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understanding the factors that impact health: … tamho... · united states 2018. 0 2000 4000 6000...

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