SUBURBAN HEALTH INEQUITY The Case of Nassau County, New York Martine Hackett Ph.D., MPH, CHES Assistant Professor, Department of Health Professions School of Health Professions & Human Services Introduction
The Community Speaks: Photo Voice
Suburbs are now home to a more diverse populations in terms of age, ethnicity, household size, and poverty status. By 2008 more poor people lived in suburbs than in urban centers. Health outcomes area influenced by these changes. Nassau County, Long Island, a suburb of New York City, is one of the richest counties by median household income in the United States, but it is also home to pockets of underserved communities where residents suffer from disproportionately high rates of mortality and morbidity. These differences are not just due to individual behaviors, but are influenced by the political, social and economic factors within suburban spaces.
Suburban health inequity: stuck in the middle
Disparities data
ROOSEVELT
Overweight or Obese
Obese
Weight Intention by Status Sixth Grade, Roosevelt Middle School (
Residential Racial Segregation on Long Island
What Can We Do? Digital Storytelling Suburban Health Stories website
“They [the delis] all serve the same thing, they don’t serve anything fresh, like vegetables and fruit. There is really not any other stores in the area. They’ve got a premium.”
The Relationship Between Place & Health Residential segregation is the “fundamental cause of health disparities” (Williams & Collins, 2001)
Infant Mortality Rate
Where do we see the results of residential segregation on health? •Built environment •Housing hazards •Environmental hazards •Fewer options for healthy foods •Safety •Vigilance/chronic stress
Digital Stories to Educate about Health Inequity on Long Island
11553 Childhood Asthma discharge rate=53.2
“When you say you live in Roosevelt, some people think its like a ghetto neighborhood. Some times it really isn’t.”
UNIONDALE
Childhood Asthma Hospitalization
NEW CASSEL
Teen Pregnancy Rate
Why? •Segregation determines SES by affecting quality of education and employment opportunities. •Segregation can create negative neighborhood and housing conditions. •Conditions linked to segregation can constrain the practice of health behaviors and encourage unhealthy ones. •Segregation can adversely affect access to medical care and to highquality care. TEMPLATE DESIGN © 2008
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Suburban Health Equity Needs a Social Justice Focus “There are so many place to cheat you out of your money in Uniondale and so few good places to spend it.”
“The community center helps how people spend their time. Some people do bad stuff because they are bored. Now with the new community center, it helps kids to stay out of trouble.”
Health inequity refers to those inequalities in health that are deemed to be unfair or stemming from some form of injustice. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices and the elimination of health and healthcare disparities.