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THE PREDICTIVE POWER OF PLACE: EFFECTS OF RACIAL AND ECONOMIC SEGREGATION ON DIFFERENCES IN LIFE EXPECTANCY ESTIMATES AT THE NEIGHBORHOOD LEVEL – District of Columbia, 2009-2013

Posted By Emily M. Putzer, MA; Rowena Samala, MPH; Delmar Little, MPH; Fern Johnson-Clarke, PhD, Friday, October 21, 2016
Updated: Thursday, October 20, 2016

Life expectancy is an important population level health outcome for several reasons: It incorporates a wide range of health “problems,” it is a concept largely understood by community residents, and it is available at the “neighborhood” level, increasing relevancy.

The District of Columbia Department of Health participated in a pilot study supported by the Centers for Disease Control and the Council of State and Territorial Epidemiologists that provided technical assistance in determining small area estimates for life expectancy. This research supported and worked in tandem with the community health improvement process that was developing DC Healthy People 2020, the District’s health priority framework that contains over 150 population level health outcome objectives and targets for the year 2020 and 85 recommended strategies.

Because of these benefits of life expectancy as a key indicator, it is really the cornerstone of how we can communicate with diverse groups of District residents and stakeholders around health status, health outcomes, and contributing factors. In shifting the public health paradigm to a more holistic concept of health, incorporating social determinants as key factors influencing health outcomes is crucial to creating impactful policies and programs that improve population health.

A key goal of DC Healthy People 2020 and the DC Department of Health is to advance health equity through a focus on social determinants of health. DC Healthy People 2020 (DC HP2020) works in tandem with our newly-created Office of Health Equity (OHE) and stakeholders to bring about changes in policies (via Health in All Policies), programs, and system-level improvements by providing key health outcome data and recommending evidence-based strategies that will most effectively improve population health outcomes, reduce health disparities, and advance health equity. We know that the most impactful interventions to improve population health include tackling socioeconomic factors and changing the context through policies in order to enable a person’s default behavior to be a healthy behavior. DC HP2020 strategies focus on these two areas as well as improving data infrastructure to better measure key health outcomes for all.



Framing the study using segregation variables vs. “race” or poverty allows us to talk about places and how they enable healthy residents or unhealthy residents. It moves the conversation from, “how can we design public health interventions to target Black (or low-income) populations?” to “how can we change the social/structural makeup of this neighborhood to improve health?” You may have answers to these questions that overlap, but the former question may miss potential solutions such as: responsible community development, housing improvements, school integration policies, increased school funding, minimum wage policies, etc.

While income inequality is generally accepted as a structural challenge in our society, many people look the other way when confronted with the systemic/structural racism that exists. The more research that can allow people to think critically about how our society has been structured to disadvantage certain communities while advantaging others (and how those disadvantages harm health and the advantages support health), the closer we get to restructuring our society and dismantling the harmful systems, to truly allow everyone to reach his/her full potential of health.

Ultimately, we must go past simply documenting disparity. We have been doing that for many years and there has been little progress. We must discover underlying factors, tease out specific social and other neighborhood conditions that point to poor (or excellent) health outcomes, and design and implement programs and policies to effectively target those conditions. Future analyses will include more variables to describe social determinants and neighborhood conditions in order to get a more complete picture of key factors that can help explain differences in health outcomes and point to potential solutions for improving population health.


Authors: Emily M. Putzer, MA; Rowena Samala, MPH; Delmar Little, MPH; Fern Johnson-Clarke, PhD District of Columbia Department of Health
 
Disclaimer: The above contents are solely the viewpoints of the authors and do not necessarily represent the official views of CDC or CSTE.

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