Health Inequities in Spokane County Health Inequities in Spokane County Community Health Association of Spokane May 14, 2012

Why Neighborhoods/Place? What We Heard “My neighborhood is better than it was when I was a kid. It’s been about six months since we’ve had a shooting within 5 blocks of my house. That’s a good distance between shootings. I remember being 2-3 years old watching out my window, watching people shoot at each other.” Focus Group Participant (income <35k)

Ranking of Spokane Neighborhoods for Teenage Pregnancy RankNeighborhoodPercentLower CIUpper CI 1West Central17.22^* Logan15.95^* Chief Garry Park15.28^* East Central14.90^* Riverside14.43^* Hillyard12.87^* Nevada/Lidgerwood11.79^* Emerson/Garfield11.76^* Browne’s Addition Whitman Bemiss10.47* Millwood10.42* North Hill10.17* Minnehaha East Valley University Edgecliff Chattaroy/Deer Park West Valley Spokane County8.73* West Hills Mead/Green Bluff/Mt. Spokane Latah Valley Washington State Cliff/Cannon Opportunity Northwest Mile/Colbert Upriver Cheney/Medical Lake6.25+> West Plains6.01+> Lincoln Heights5.69+> Otis Orchard/Liberty Lake5.57+> Newman Lake5.46+> Southgate5.10+> North Indian Trail4.63+> Rockwood4.60+> Balboa/S. Indian Trail South Palouse4.31+> Comstock2.38+> Manito1.33+> Mile0.71+>

Teenage Pregnancy (15 to 19 Years of Age), Spokane County Neighborhoods, RankNeighborhoodPercentLower CIUpper CI 1West Central17.22^* Logan15.95^* Chief Garry Park15.28^* East Central14.90^* Riverside14.43^* Spokane County8.73* Washington State Balboa/S. Indian Trail South Palouse4.31+> Comstock2.38+> Manito1.33+> Mile0.71+> Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health, Birth Certificates ^Significantly higher than Spokane County *Significantly higher than Washington State +Significantly lower than Spokane County >Significantly lower than Washington State

RankNeighborhoodPercentLower CIUpper CI 1West Central41.24^* Riverside40.80^* Browne’s Addition36.36^* Hillyard33.39^* Logan32.36^* Chief Garry Park31.25^* East Central28.77^* Whitman28.74^* Emerson/Garfield28.24^* Millwood26.33^* Nevada/Lidgerwood24.60^* Bemiss24.16^* Edgecliff22.85^* North Hill22.03^* Cliff/Cannon21.08* West Valley20.28* West Hills20.14* Upriver19.81* Chattaroy/Deer Park19.52* Latah Valley19.18* University18.67* Spokane County18.20* East Valley16.92* Opportunity15.68* Minnehaha15.18* Northwest14.24* Mead/Green Bluff/Mt. Spokane13.48* West Plains13.48* Cheney/Medical Lake12.30* Lincoln Heights Mile/Colbert Washington State Newman Lake Rockwood Balboa/S. Indian Trail Otis Orchard/Liberty Lake7.78+> South Palouse7.37+> North Indian Trail6.83+> Comstock5.65+> Southgate4.73+> Mile4.66+> Manito4.00+> Ranking of Spokane Neighborhoods for Maternal Smoking

Maternal Smoking, Spokane County Neighborhoods, RankNeighborhoodPercentLower CIUpper CI 1West Central41.24^* Riverside40.80^* Browne’s Addition36.36^* Hillyard33.39^* Logan32.36^* Spokane County18.20* Washington State North Indian Trail6.83+> Comstock5.65+> Southgate4.73+> Mile4.66+> Manito4.00+> Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health, Birth Certificates ^Significantly higher than Spokane County *Significantly higher than Washington State +Significantly lower than Spokane County >Significantly lower than Washington State

Causes of Mortality (Age Adjusted Rate per 100,000) in Spokane County with Top Five Neighborhoods, Cause of Death Spokane County Rate Washington State Rate Rank 1Rank 2Rank 3Rank 4Rank 5 NeighborhoodRateNeighborhoodRateNeighborhoodRateNeighborhoodRateNeighborhoodRate 1. Major cardiovascular disease Riverside^374.7Hillyard^372.1 Nevada/ Lidgerwood^ 351.3East Central^330.7Edgecliff Malignant neoplasms Chief Garry Park^ 271.9Whitman^267.9Minnehaha^263.8East Central^228.3Edgecliff^ Chronic lower respiratory diseases Riverside^104.4Hillyard^96.7East Central^86.0Bemiss^83.1 Emerson/ Garfield^ Unintentional injury Riverside^164.3West Hills^110.2East Central^85.5West Central^84.6Hillyard Alzheimer’s disease North Indian Trail^ 69.5 Emerson/ Garfield^ 68.3South Palouse^62.2Manito50.1 Mead/Green Bluff/Mt. Spokane^ Diabetes mellitus Emerson/ Garfield^ 59.3Whitman^56.7 Nevada/ Lidgerwood^ 52.4 Chattaroy/ Deer Park^ 48.6 Chief Garry Park Suicide Riverside^46.4Cliff/Cannon^28.6Hillyard^26.5 Browne’s Addition 25.5Logan Influenza and pneumonia Emerson/ Garfield^ 34.4West Central24.0Edgecliff^23.8University^23.2 Chief Garry Park Chronic liver disease and cirrhosis Riverside^44.7West Hills27.0East Central^24.6 Browne’s Addition 21.8Hillyard Parkinson’s disease North Indian Trail^ 17.0 Emerson/ Garfield 16.6Cliff/Cannon11.9Minnehaha10.9South Palouse10.7 ^Significantly higher than Spokane County

Overall Age-Adjusted Mortality Rate (per 100,000), Spokane County Neighborhoods RankNeighborhoodAge-Adjusted RateLower CIUpper CI 1Riverside1,364.1^*1,254.01, East Central1,102.3^*1,039.71, Emerson/Garfield1,071.1^*996.91, Hillyard1,026.7^*946.21, Nevada/Lidgerwood1,026.1^*985.51, Edgecliff969.7^*915.31, Chief Garry Park966.7^*868.31, West Central944.3^*871.61, Whitman914.5*789.01, Chattaroy/Deer Park871.9^* Cliff/Cannon868.1^* Mead/Green Bluff/Mt. Spokane860.0^* Logan840.2* Bemiss817.2* West Hills Opportunity802.2* Upriver Minnehaha Spokane County790.1* University East Valley West Valley Millwood Cheney/Medical Lake Mile/Colbert West Plains Washington State North Indian Trail South Palouse Northwest Otis Orchard/Liberty Lake Latah Valley Browne’s Addition Balboa/S. Indian Trail Newman Lake North Hill683.7+> Lincoln Heights677.6+> Manito661.8+> Comstock594.0+> Mile570.0+> Rockwood559.3+> Southgate520.1+>

Overall Age-Adjusted Mortality Rate (per 100,000), Spokane County Neighborhoods, RankNeighborhoodPercentLower CIUpper CI 1Riverside1,364.1^*1,254.01, East Central1,102.3^*1,039.71, Emerson/Garfield1,071.1^*996.91, Hillyard1,026.7^*946.21, Nevada/Lidgerwood1,026.1^*985.51,068.1 Spokane County790.1* Washington State Manito661.8+> Comstock594.0+> Mile570.0+> Rockwood559.3+> Southgate520.1+> Data Source: Washington State Department of Health, Death Certificates ^Significantly higher than Spokane County *Significantly higher than Washington State +Significantly lower than Spokane County >Significantly lower than Washington State

Life Expectancy by Neighborhood, Spokane County – Comparison 90s vs. 00s Life Expectancy Rank Life Expectancy 77.55State Spokane South Palouse1Southgate Comstock2Rockwood Southgate35 Mile North Indian Trail4Comstock Cheney/Medical Lake5Balboa/S. Indian Trail Mile6Manito Balboa/S. Indian Trail7Newman Lake Rockwood8Lincoln Heights Newman Lake9North Hill Latah Valley10North Indian Trail Mile/Colbert11Otis Orchard/Liberty Lake Manito129 Mile/Colbert Mead/Green Bluff/ Mt. Spokane13South Palouse West Hills14Northwest Lincoln Heights15Browne’s Addition West Plains16Cheney/Medical Lake Northwest17West Plains Minnehaha18Latah Valley Chattaroy/Deer Park19Opportunity University20University Opportunity21Millwood Otis Orchard/Liberty Lake22West Valley Millwood23Easy Valley Upriver24Minnehaha West Valley25Upriver East Valley26Mead/Green Bluff/Mt. Spokane North Hill27Chattaroy/Deer Park Nevada/Lidgerwood28Logan Cliff/Cannon29Bemiss Logan30West Hills Whitman31Cliff/Cannon Edgecliff32Whitman Bemiss33Edgecliff Chief Garry Park34Nevada/Lidgerwood West Central35West Central Hillyard36Emerson Garfield Browne's Addition37Chief Garry Park Emerson Garfield38Hillyard East Central39East Central Riverside40Riverside66.17

Life Expectancy, Spokane County Neighborhood Comparison, 1990 to 1999 vs to 2009 Life Expectancy Rank Life Expectancy 77.55State Spokane South Palouse1Southgate Comstock2Rockwood Southgate35 Mile North Indian Trail4Comstock Cheney/Medical Lake5Balboa/S. Indian Trail Hillyard36Emerson Garfield Browne's Addition37Chief Garry Park Emerson Garfield38Hillyard East Central39East Central Riverside40Riverside66.17 Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health

A Framework for Health Inequity Upstream Downstream Race Class Gender Immigration status National Origin Sexual orientation Disability Race Class Gender Immigration status National Origin Sexual orientation Disability Discriminatory Beliefs (ISMS) Corporations & other businesses Government agencies Schools Corporations & other businesses Government agencies Schools Institutional Power Neighborhood conditions  Social  Physical Residential segregation Workplace conditions Neighborhood conditions  Social  Physical Residential segregation Workplace conditions Social Inequities Smoking Nutrition Physical activity Violence Chronic Stress Smoking Nutrition Physical activity Violence Chronic Stress Infectious disease Chronic disease Injury (intentional / unintentional) Infectious disease Chronic disease Injury (intentional / unintentional) Infant mortality Life expectancy Infant mortality Life expectancy Social Factors Health Status Genetics Individual Health Knowledge Healthcare Access Medical Model Risk Factors & Behaviors Disease & InjuryMortality Socio-Ecological

Health is more than absence of disease; it is about economics, education, environment, empowerment, and community. The health and well being of the people is critically dependent upon the system that serves them. It must provide the best possible health with the least disparities and respond equally well to everyone." Joycelyn Elders U.S. Surgeon General

Adrian E. Dominguez, M.S. Epidemiologist Spokane Regional Health District Disease Prevention and Response Community Health Assessment, Planning, and Evaluation Adrian E. Dominguez, M.S. Epidemiologist Spokane Regional Health District Disease Prevention and Response Community Health Assessment, Planning, and Evaluation