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October 7, 2010 at 3:30 PM

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Health, poverty and inequality in wealthy Seattle

Posted by Kristi Heim

Update (10/11) More details about the Global to Local project were announced today, including $1 million funding pledge from Swedish Medical Center, and $400,000 that Sen. Patty Murray included for supplies and equipment in a bill before the Senate Appropriations Committee.

Global health is a rapidly growing field in the Seattle area, with hundreds of millions of dollars, if not billions, supporting local organizations working all over the world. Most of the funding for research goes toward problems in poor countries with higher burdens of disease.

But even with some of the best health care in the world, the U.S. also has pockets of the country where health conditions mirror those of developing countries. African Americans and American Indians/Alaska Natives, for example, have almost double the infant mortality rate for whites. In fact, Seattle/King County is home to some of the greatest disparity of any American city.

Dr. David Fleming, director of Public Health -- Seattle & King County and former deputy director of the Centers for Disease Control and Prevention (CDC), pointed out some of the inequalities he has found in access to health.

The charts below were developed by King County Public Health staff working in policy development and epidemiology. Clicking on the charts will enlarge them. The data measures rates of smoking, inactivity and poverty, as well as lack of health insurance, and correlates those factors with race and income.

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Such disparities lead to increased stress, which can also cause premature births, said Dr. Thomas Hansen, chief executive of Seattle Children's Hospital. That correlates with new research that shows stress during pregnancy can take a heavy toll later in a baby's life and may lead to replication of poverty in the next generation.

Using global health ideas and approaches to solve local health issues was the subject of a recent panel discussion, which I reported on here.

Some of the ideas suggested for the "G2L (Global to Local)" strategy include community health workers who are trained to bring services like home visits, case management and health education to neighborhoods, a resource center combining health care and economic development, low- or no-interest loans to finance small businesses such as green grocers, and mobile-phone based health information for emergencies and for patient monitoring.

"Increasingly we may be dealing with a two-way street of information and knowledge transfer," Fleming said.

A symposium at Swedish Medical Center next week, "Innovation in the Age of Reform: Redesigning Health-Care Delivery," will explore the issue.

Swedish is also positioning itself to be a player in global health. For its 100th anniversary, Swedish plans to unveil its pilot "Global to Local Project" to survey local communities about their health priorities, and test new approaches such as community health workers. The project is led by the Washington Global Health Alliance, Seattle & King County Public Health, Swedish Medical Center and HealthPoint. The surveys are currently being done in Tukwila and SeaTac. Residents of those areas have lower life expectancies than surrounding communities and higher rates of chronic disease, according to data from the project.

A recent study co-authored by Christopher Murray, who is now director of the Institute for Health Metrics and Evaluation at UW, identified "Eight Americas," with a difference in life expectancy of 33 years between the best off (Asian women in New Jersey) and worst off (Native American men in South Dakota).

"Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the U.S.," the study concluded, "health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries."

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