Health Equity Concerns

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Adverse Childhood Experiences

Childhood trauma occurs across racial and socio-economic lines, however it does disproportionately impact certain populations.

Diabetes

About one in eight adults in Washington has diabetes, across all ethnic and racial groups. Some groups have higher prevalence than non-Hispanic whites, including Native Hawaiian/Other Pacific Islanders, Hispanics, non-Hispanic blacks, and American Indians/Alaska Natives.

Type 1 diabetes is more prevalent in non-Hispanic white youth than other racial or ethnic groups.

Washington’s Hispanic/Latino population has a significantly higher risk of type 2 diabetes. Services that are culturally and linguistically appropriate and geographically accessible may not be keeping pace with demand in this growing population.

Adults with annual incomes less than $25,000 were twice as likely to have diabetes as those with incomes of $75,000 or more. A similar disparity exists between those with high school education or less and those with a college degree. Access to preventive services and to environments conducive to healthy lifestyle, as well as stress resulting from discrimination and poverty, may contribute to the disparity. Health education and support that accommodates the needs of populations with lower income/education levels are important considerations.

People with both behavioral health issues and diabetes are more likely to experience barriers that impact success of treatment. As a result, many experience more complications and die at younger ages than people without behavioral health issues. Integration of physical and behavioral health, with the patient at the center of care, can be instrumental in addressing this disparity.

Obesity
  • People with lower incomes or less than a college education are also more at risk for obesity.
    • Adult obesity rates are higher in populations with lower income, with a range of 33% for the lowest household income category to 23% for the highest category.
    • Adult obesity rates are higher in populations with lower education, with a range of 33% for the lowest level of education to 21% for the highest education level category. (2014 – 2016 BRFSS).
  • People with lower incomes or less than a college education are also more at risk for obesity.
    • Adult obesity rates are higher in populations with lower income, with a range of 33% for the lowest household income category to 23% for the highest category.
    • Adult obesity rates are higher in populations with lower education, with a range of 33% for the lowest level of education to 21% for the highest education level category. (2014 – 2016 BRFSS).
Opioids
  • Washington State rates of opioid overdose death vary by race/ethnicity. Data indicate American Indian/Alaska Native rates were highest, Hispanic and Asian populations were lowest. (2011-15)*
  • Those who die from heroin overdose tend to be younger than those who die from prescription opioids.*
  • Low-wage workers in physically demanding jobs may use opioids so they can avoid missing work.*
  • Rural communities are challenged by a shortage of treatment providers and counseling infrastructure.*
  • Access to alternative pain treatments such as physical therapy or acupuncture is limited for some populations. Factors include insurance coverage, sick leave, transportation and/or childcare.*

* Sources:

DOH Death Certificates, includes all intent of drug-related deaths with the additional ICD-10 codes of T40.0, T40.1, T40.2, T40.3, T40.4, or T40.6

DOH Death Certificates, methodology identifies opioid deaths using both ICD-10 codes and the literal text on the death certificate, and excludes intentional deaths due to opioid overdose

HRSA 2016

HRSA 2016

NIH Mar 2017

Tobacco

One in four (23%) adults with an annual household income less than $35,000 smoke cigarettes, while only about one in 12 (8%) adults in households making $75,000 or more smoke. Lower income households also have a higher prevalence of secondhand smoke exposure, may have less access to resources to help them quit, and may have more tobacco marketing in their neighborhood than higher income households.

American Indians, Alaska Natives, Pacific Islanders, people who identify as lesbian, gay, or bisexual also have a higher prevalence of smoking than other Washington residents. These populations also have higher rates of exposure to secondhand smoke, may have less access to resources, and experience more targeted marketing by the tobacco industry.

Prevalence of smoking among youth in Washington State has decreased but higher prevalence of smoking and exposure to secondhand smoke exists among students who:

  • Have lower grades (C’s, D’s, and F’s),versus students with higher grades (A’s and B’s)
  • Have experienced harassment (in general or because of their perceived sexual orientation) versus students who have not experienced harassment
  • Speak Russian or Ukrainian at home, versus students who speak English at home
Well Child Visits

Statistically, foster children and those who are homeless are less likely to complete regular well child visits due to their unstable circumstances.

Well Child Visit rates vary among populations. American Indian/Alaska Natives receive well child visits at a rate of 49%, Asian Americans at a rate of 68%. 

Those who speak Russian complete well child visits at a rate of 54%. Those who speak Korean have a rate of 76%. 

There are discrepancies in well child rates among Washington State’s counties, even those with similar demographics. County comparisons are available on the “Measure Mapping” link of the Healthier Washington Data Dashboard.

A primary concern is access to care. Lack of access is impacted by barriers such as lack of time, transportation, workplace flexibility and language or literacy levels. Cultural differences can also affect perceptions around the value of well child visits. 

Multisector partners will need to collaborate on efforts to address access, remove barriers, and increase awareness among our most vulnerable populations.