1. Life & Death From Unnatural Causes: Does The American Approach to Health Make Sense? Beyond Health Care Coverage: Major Policy Forum To Address Inequality and Health Disparities in America February 23, 2009 Commonwealth Club Tony Iton, M.D., J.D., MPH Director Alameda County Public Health Department

3. Health ≠ Health care Health Disparities ≠ Health Care Disparities

5. Race and Racism Matters: Health Inequities by Race/Ethnicity 2.3 years 4.9 years 7.8 years

7. Life Expectancy by Poverty Group 2000-2003

8. Tract Poverty vs. Life Expectancy

9. Bay Area Poverty vs. Life Expectancy

10. Cost of Poverty in San Francisco Bay Area  Every additional $12,500 in household income buys one year of life expectancy  (Benefit appears to plateau at household incomes above $150,000)  Similar gradients in Baltimore, NYC, Philadelphia, Hennepin County, Colorado, California

13. Alameda County Public Health Department Community Capacity Building Internal Capacity Building Local Policy Agenda HEALTH EQUITY http://www.acphd.org/healthequity

14. Alameda County Public Health Department Community Capacity Building Internal Capacity Building Local Policy Agenda HEALTH EQUITY http://www.acphd.org/healthequity

16. West Oakland Beat 6X 743 Households 41% Poverty 71% African-Am. Sobrante Park Beat 31Z 837 Households 21% Poverty Rate 57% African-Am. 34% Latino

17. Project Description Building social, political and economic power in low-income communities of color

18. Civic Participation Increased in Sobrante Park Between ’04 and ’07

19. Alameda County Public Health Department Community Capacity Building Internal Capacity Building Local Policy Agenda HEALTH EQUITY http://www.acphd.org/healthequity

21. Why We Did the Report  Health and social inequities have an overwhelming negative impact on Alameda County residents  Alameda County Public Health Department is focused on addressing health and social inequities through multiple methods  The release of Unnatural Causes series and the report provide an opportunity for working across multiple sectors to achieve health equity.

22. Report Chapters Executive Summary Introduction Part One: Health Inequities Part Two: Social Inequities Historical Overview What Research Tells Us A Look at Alameda County Data to Action: Policy Implications Social Inequities: Root Causes of Health Inequities Segregation Income & Employment Education Housing Transportation Air Quality Food Access & Liquor Stores Physical Activity & Neighborhood Conditions Criminal Justice Access to Health Care Social Relationships & Community Capacity

23. Income & Employment: Paid Sick Days  40% California workers do not receive a single paid sick day.  Low wage workers most in need of paid sick days are the least likely to receive it. HIA:  Reduce flu spread  Reduce food borne disease, and nursing home and school communicable disease spread

24. Looking At Ourselves Internal Capacity Building

25. Alameda County Public Health Department Community Capacity Building Internal Capacity Building Local Policy Agenda HEALTH EQUITY http://www.acphd.org/healthequity

26. Internal Capacity Building Activities  Sharing the vision  Leadership and Professional Development Programs  PH 101 staff training  Institutional Racism discussions  Strategic Plan focused on Social Justice

27. Public Health 101 Module 1: PH History; Public Health System Core Functions & 10 Essential Services Module 2: Cultural Competency and Cultural Humility Module 3: Undoing Racism Module 4: Health Status/Inequities Social Determinants of Health Module 5: Community Capacity Building

28. DiseaseBehavior Community Death Diseased Societal Decision Processes Death Biased Behaviors (Isms) Medical Model (individuals)Socio-Ecological (society) Emergency Rooms Clinics Health Education Comm. Capacity Building Policy Advocacy ??????

29. Contact Information Tony Iton, MD, JD, MPH Director and Health Officer Alameda County Public Health Department Tony.Iton@acgov.org (510) 267-8019