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

2. 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)

3. Ranking of Spokane Neighborhoods for Teenage Pregnancy RankNeighborhoodPercentLower CIUpper CI 1West Central17.22^*14.2720.61 2Logan15.95^*13.0319.33 3Chief Garry Park15.28^*12.2518.82 4East Central14.90^*12.6817.39 5Riverside14.43^*9.6620.72 6Hillyard12.87^*10.1116.16 7Nevada/Lidgerwood11.79^*10.3513.37 8Emerson/Garfield11.76^*9.3314.64 9Browne’s Addition11.526.9317.98 10Whitman11.427.6516.40 11Bemiss10.47*8.3113.01 12Millwood10.42*8.5612.56 13North Hill10.17*8.2912.35 14Minnehaha9.826.1614.87 15East Valley9.707.2212.75 16University9.657.7911.82 17Edgecliff9.457.4811.78 18Chattaroy/Deer Park9.347.0312.15 19West Valley8.847.0910.89 Spokane County8.73*8.399.07 20West Hills8.634.4615.08 21Mead/Green Bluff/Mt. Spokane8.417.0010.01 22Latah Valley8.223.0217.89 Washington State8.19+8.118.28 23Cliff/Cannon8.015.9210.59 24Opportunity7.896.149.99 25Northwest7.456.148.96 269 Mile/Colbert7.245.878.83 27Upriver6.602.6613.61 28Cheney/Medical Lake6.25+>5.047.66 29West Plains6.01+>4.797.46 30Lincoln Heights5.69+>4.317.37 31Otis Orchard/Liberty Lake5.57+>4.526.79 32Newman Lake5.46+>3.837.56 33Southgate5.10+>3.367.43 34North Indian Trail4.63+>2.797.24 35Rockwood4.60+>2.388.03 36Balboa/S. Indian Trail4.461.799.19 37South Palouse4.31+>2.936.12 38Comstock2.38+>1.034.69 39Manito1.33+>0.363.41 405 Mile0.71+>0.092.58

4. Teenage Pregnancy (15 to 19 Years of Age), Spokane County Neighborhoods, 2005-2009 RankNeighborhoodPercentLower CIUpper CI 1West Central17.22^*14.2720.61 2Logan15.95^*13.0319.33 3Chief Garry Park15.28^*12.2518.82 4East Central14.90^*12.6817.39 5Riverside14.43^*9.6620.72 Spokane County8.73*8.399.07 Washington State8.19+8.118.28 36Balboa/S. Indian Trail4.461.799.19 37South Palouse4.31+>2.936.12 38Comstock2.38+>1.034.69 39Manito1.33+>0.363.41 405 Mile0.71+>0.092.58 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

5. RankNeighborhoodPercentLower CIUpper CI 1West Central41.24^*36.5946.32 2Riverside40.80^*32.4550.64 3Browne’s Addition36.36^*27.7546.81 4Hillyard33.39^*28.8338.46 5Logan32.36^*28.1437.04 6Chief Garry Park31.25^*26.8536.16 7East Central28.77^*25.6532.16 8Whitman28.74^*22.5336.14 9Emerson/Garfield28.24^*24.3832.52 10Millwood26.33^*23.3229.61 11Nevada/Lidgerwood24.60^*22.5026.84 12Bemiss24.16^*20.8227.88 13Edgecliff22.85^*19.7226.33 14North Hill22.03^*19.2225.14 15Cliff/Cannon21.08*17.6025.05 16West Valley20.28*17.5823.28 17West Hills20.14*13.3929.11 18Upriver19.81*12.2630.28 19Chattaroy/Deer Park19.52*16.1223.44 20Latah Valley19.18*10.4832.18 21University18.67*16.0421.61 Spokane County18.20*17.7218.69 22East Valley16.92*13.5920.82 23Opportunity15.68*13.1618.53 24Minnehaha15.18*10.5121.21 25Northwest14.24*+12.4016.67 26Mead/Green Bluff/Mt. Spokane13.48*+11.6815.47 27West Plains13.48*+11.6115.56 28Cheney/Medical Lake12.30*+10.5814.22 29Lincoln Heights12.18+10.1114.54 309 Mile/Colbert11.79+10.0213.78 Washington State10.13+10.0310.22 31Newman Lake9.86+7.6112.57 32Rockwood8.43+5.2812.76 33Balboa/S. Indian Trail8.28+4.4114.16 34Otis Orchard/Liberty Lake7.78+>6.549.20 35South Palouse7.37+>5.529.64 36North Indian Trail6.83+>4.549.87 37Comstock5.65+>3.408.83 38Southgate4.73+>3.066.99 395 Mile4.66+>2.487.97 40Manito4.00+>2.076.99 Ranking of Spokane Neighborhoods for Maternal Smoking

6. Maternal Smoking, Spokane County Neighborhoods, 2005-2009 RankNeighborhoodPercentLower CIUpper CI 1West Central41.24^*36.5946.32 2Riverside40.80^*32.4550.64 3Browne’s Addition36.36^*27.7546.81 4Hillyard33.39^*28.8338.46 5Logan32.36^*28.1437.04 Spokane County18.20*17.7218.69 Washington State10.13+10.0310.22 36North Indian Trail6.83+>4.549.87 37Comstock5.65+>3.408.83 38Southgate4.73+>3.066.99 395 Mile4.66+>2.487.97 40Manito4.00+>2.076.99 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

7. 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 255.8249.2Riverside^374.7Hillyard^372.1 Nevada/ Lidgerwood^ 351.3East Central^330.7Edgecliff323.5 2. Malignant neoplasms188.1183.5 Chief Garry Park^ 271.9Whitman^267.9Minnehaha^263.8East Central^228.3Edgecliff^228.1 3. Chronic lower respiratory diseases 54.645.6Riverside^104.4Hillyard^96.7East Central^86.0Bemiss^83.1 Emerson/ Garfield^ 79.5 4. Unintentional injury49.138.1Riverside^164.3West Hills^110.2East Central^85.5West Central^84.6Hillyard70.6 5. Alzheimer’s disease35.239.3 North Indian Trail^ 69.5 Emerson/ Garfield^ 68.3South Palouse^62.2Manito50.1 Mead/Green Bluff/Mt. Spokane^ 49.4 6. Diabetes mellitus26.324.3 Emerson/ Garfield^ 59.3Whitman^56.7 Nevada/ Lidgerwood^ 52.4 Chattaroy/ Deer Park^ 48.6 Chief Garry Park 38.7 7. Suicide15.712.8Riverside^46.4Cliff/Cannon^28.6Hillyard^26.5 Browne’s Addition 25.5Logan25.5 8. Influenza and pneumonia 14.514.1 Emerson/ Garfield^ 34.4West Central24.0Edgecliff^23.8University^23.2 Chief Garry Park 22.0 9. Chronic liver disease and cirrhosis 10.39.3Riverside^44.7West Hills27.0East Central^24.6 Browne’s Addition 21.8Hillyard20.7 10. Parkinson’s disease7.98.1 North Indian Trail^ 17.0 Emerson/ Garfield 16.6Cliff/Cannon11.9Minnehaha10.9South Palouse10.7 ^Significantly higher than Spokane County

8. Overall Age-Adjusted Mortality Rate (per 100,000), Spokane County Neighborhoods RankNeighborhoodAge-Adjusted RateLower CIUpper CI 1Riverside1,364.1^*1,254.01,489.6 2East Central1,102.3^*1,039.71,168.1 3Emerson/Garfield1,071.1^*996.91,149.8 4Hillyard1,026.7^*946.21,112.4 5Nevada/Lidgerwood1,026.1^*985.51,068.1 6Edgecliff969.7^*915.31,026.7 7Chief Garry Park966.7^*868.31,073.6 8West Central944.3^*871.61,021.7 9Whitman914.5*789.01,055.5 10Chattaroy/Deer Park871.9^*812.5934.8 11Cliff/Cannon868.1^*813.9926.0 12Mead/Green Bluff/Mt. Spokane860.0^*824.0897.3 13Logan840.2*783.4900.7 14Bemiss817.2*754.0884.6 15West Hills803.9697.9925.4 16Opportunity802.2*760.4846.1 17Upriver796.2678.6933.8 18Minnehaha792.8676.1925.3 Spokane County790.1*782.0798.2 19University784.4744.0826.6 20East Valley769.8709.1834.6 21West Valley759.1714.3806.4 22Millwood757.9714.6803.4 23Cheney/Medical Lake757.3719.0797.3 249 Mile/Colbert754.0720.2789.2 25West Plains752.9690.1820.5 Washington State751.6749.4753.8 26North Indian Trail748.2687.4813.4 27South Palouse732.1+692.5774.1 28Northwest731.0+699.7763.6 29Otis Orchard/Liberty Lake721.0+687.3755.9 30Latah Valley716.1623.2837.3 31Browne’s Addition710.5620.8815.7 32Balboa/S. Indian Trail708.8+644.8780.9 33Newman Lake706.6+647.2770.5 34North Hill683.7+>641.7728.1 35Lincoln Heights677.6+>643.2713.8 36Manito661.8+>591.1739.6 37Comstock594.0+>544.5648.0 385 Mile570.0+>465.8695.7 39Rockwood559.3+>494.7631.0 40Southgate520.1+>476.6566.8

9. Overall Age-Adjusted Mortality Rate (per 100,000), Spokane County Neighborhoods, 2005-2009 RankNeighborhoodPercentLower CIUpper CI 1Riverside1,364.1^*1,254.01,489.6 2East Central1,102.3^*1,039.71,168.1 3Emerson/Garfield1,071.1^*996.91,149.8 4Hillyard1,026.7^*946.21,112.4 5Nevada/Lidgerwood1,026.1^*985.51,068.1 Spokane County790.1*782.0798.2 Washington State751.6749.4753.8 36Manito661.8+>591.1739.6 37Comstock594.0+>544.5648.0 385 Mile570.0+>465.8695.7 39Rockwood559.3+>494.7631.0 40Southgate520.1+>476.6566.8 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

10. Life Expectancy by Neighborhood, Spokane County – Comparison 90s vs. 00s Life Expectancy 1990-1999Rank2000-2009 Life Expectancy 77.55State 79.19 77.35Spokane 78.41 82.39South Palouse1Southgate 84.03 81.29Comstock2Rockwood 82.79 81.19Southgate35 Mile 82.32 81.11North Indian Trail4Comstock 82.20 80.82Cheney/Medical Lake5Balboa/S. Indian Trail 81.13 80.735 Mile6Manito 80.82 80.07Balboa/S. Indian Trail7Newman Lake 80.72 80.06Rockwood8Lincoln Heights 80.55 79.64Newman Lake9North Hill 80.54 79.58Latah Valley10North Indian Trail 80.49 79.479 Mile/Colbert11Otis Orchard/Liberty Lake 80.25 79.45Manito129 Mile/Colbert 79.78 79.21Mead/Green Bluff/ Mt. Spokane13South Palouse 79.62 79.11West Hills14Northwest 79.58 78.95Lincoln Heights15Browne’s Addition 79.27 78.94West Plains16Cheney/Medical Lake 79.27 78.81Northwest17West Plains 79.19 78.52Minnehaha18Latah Valley 79.17 78.41Chattaroy/Deer Park19Opportunity 79.09 78.3University20University 79.03 78.16Opportunity21Millwood 79.01 78.12Otis Orchard/Liberty Lake22West Valley 78.71 78.07Millwood23Easy Valley 78.23 77.95Upriver24Minnehaha 77.98 77.92West Valley25Upriver 77.67 77.47East Valley26Mead/Green Bluff/Mt. Spokane 77.49 76.79North Hill27Chattaroy/Deer Park 77.20 75.91Nevada/Lidgerwood28Logan 77.11 75.28Cliff/Cannon29Bemiss 76.96 75.27Logan30West Hills 76.72 75.27Whitman31Cliff/Cannon 76.51 75.07Edgecliff32Whitman 76.48 74.38Bemiss33Edgecliff 75.62 74.20Chief Garry Park34Nevada/Lidgerwood 74.51 74.10West Central35West Central 74.49 73.57Hillyard36Emerson Garfield 74.32 73.32Browne's Addition37Chief Garry Park 73.78 73.24Emerson Garfield38Hillyard 73.62 72.39East Central39East Central 72.92 65.38Riverside40Riverside66.17

11. Life Expectancy, Spokane County Neighborhood Comparison, 1990 to 1999 vs. 2000 to 2009 Life Expectancy 1990-1999Rank2000-2009 Life Expectancy 77.55State 79.19 77.35Spokane 78.41 82.39South Palouse1Southgate 84.03 81.29Comstock2Rockwood 82.79 81.19Southgate35 Mile 82.32 81.11North Indian Trail4Comstock 82.20 80.82Cheney/Medical Lake5Balboa/S. Indian Trail 81.13 73.57Hillyard36Emerson Garfield 74.32 73.32Browne's Addition37Chief Garry Park 73.78 73.24Emerson Garfield38Hillyard 73.62 72.39East Central39East Central 72.92 65.38Riverside40Riverside66.17 Data Source: Community Health Assessment Tool (CHAT), Office of Financial Management, Washington State Department of Health

12. 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

13. 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 1993-1994

14. Adrian E. Dominguez, M.S. Epidemiologist Spokane Regional Health District Disease Prevention and Response Community Health Assessment, Planning, and Evaluation adominguez@spokanecounty.org 509.324.1670 adominguez@spokanecounty.org Adrian E. Dominguez, M.S. Epidemiologist Spokane Regional Health District Disease Prevention and Response Community Health Assessment, Planning, and Evaluation adominguez@spokanecounty.org 509.324.1670 adominguez@spokanecounty.org