Health Disparities in Appalachia

  • Report: Appalachians’ health ‘dramatically’ poorer than the US as a whole, By Kristi L. Nelson, August 24, 2017, Knoxville News Sentinel: “Heart disease, cancer, chronic obstructive pulmonary disease, drug overdose, diabetes, stroke and suicide – they’re all killing Appalachians at a higher rate than the rest of the country as a whole. On Thursday, the Appalachian Regional Commission, Robert Wood Johnson Foundation and the Foundation for a Healthy Kentucky issued a report, ‘Health Disparities in Appalachia,’ outlining what it called ‘dramatic disparities’ in both health issues and outcomes in the 420-county Appalachian Region, compared to nationwide numbers…”
  • Death comes sooner in Appalachia. It comes much sooner in Eastern Kentucky, By Bill Estep, August 24, 2017, Lexington Herald-Leader: “The years of life Appalachian Kentucky residents lose to health maladies such as heart disease and cancer is 63 percent higher than the national average, according to a report released Thursday. The news was not good in Eastern Kentucky and other parts of Appalachia on just about every indicator of health: heart disease deaths were 17 percent higher in Appalachia than the country as a whole; cancer deaths were 27 percent higher; stroke deaths were 14 percent higher; and the rate of deaths from poisoning, which mostly means from drug overdoses, was 37 percent higher…”

County Health Rankings – Minnesota

Report: Child poverty, STDs, premature death on the rise, By Stephanie Dickrell, March 29, 2017, St. Cloud Times: “Child poverty and STDs are on the rise in Central Minnesota, according to a nationwide report released Wednesday. The County Health Rankings looks at health outcomes, health behaviors and access, as well as social, economic and environmental factors. ‘What the rankings show us is that where we live matters to our health,’ said Aliana Havrilla, a community coach for County Health Rankings and Roadmaps. ‘It’s an easy-to-use snapshot.’  The results for Central Minnesota are mixed, although in general, the region is doing better than the state and the country. There are plenty of areas to improve upon including smoking, obesity, excessive drinking and access to exercise opportunities…”

Poverty, Race, and Mortality

Study: African-American men below poverty line at highest risk for mortality, By Ryan W. Miller, July 18, 2016, USA Today: “African-American men who live below the poverty line had the lowest overall survival of any group, according to new research that looks at the effects of sex, race and socioeconomic status. The study, which sampled both white and black men and women, found that African-American men below poverty levels had almost a 2.7 times higher risk of mortality than African-American men above poverty levels…”

Infant Mortality – Milwaukee, WI

As racial gap widens, infant mortality rate goal virtually beyond reach, By Crocker Stephenson, June 14, 2016, Milwaukee Journal Sentinel: “African-American babies are dying in Milwaukee at a rate that is more than three times that of white babies, according to data released Tuesday by the Milwaukee Health Department. Approaching historic levels, it is the worst racial disparity in infant deaths that the city has seen in more than a decade.  And while the average infant mortality rate for both black and white babies decreased during the three-year period ending in 2015, it now appears all but impossible that the city will reach the goal it set in 2011 of reducing the black infant mortality rate 15% by 2017…”

Income, Geography and Life Expectancy

  • Life expectancy study: It’s not just what you make, it’s where you live, By Jim Zarroli, April 11, 2016, National Public Radio: “Poor people who reside in expensive, well-educated cities such as San Francisco tend to live longer than low-income people in less affluent places, according to a study of more than a billion Social Security and tax records. The study, published in JAMA, the Journal of the American Medical Association, bolsters what was already well known — the poor tend to have shorter lifespans than those with more money. But it also says that among low-income people, big disparities exist in life expectancy from place to place, said Raj Chetty, professor of economics at Stanford University…”
  • Why the poor die young, By Derek Thompson, April 12, 2016, The Atlantic: “‘Geography is destiny.’ Economists once used this theory to try to explain the difference between rich and poor countries. But in the last few years, something like it has become a grand theory for rich and poor within the United States. Researchers have shown that where a family lives dramatically shapes children’s education, income, and their potential to earn more than their parents.  Geography’s most consequential legacy might be life itself. In a new study released Monday morning and reported in The New York Times, the life expectancy of the poorest Americans can differ by many years in neighborhoods that are fewer than 100 miles apart…”
  • The rich live longer everywhere. For the poor, geography matters, By Neil Irwin and Quoctrung Bui, April 11, 2016, New York Times: “For poor Americans, the place they call home can be a matter of life or death. The poor in some cities — big ones like New York and Los Angeles, and also quite a few smaller ones like Birmingham, Ala. — live nearly as long as their middle-class neighbors or have seen rising life expectancy in the 21st century. But in some other parts of the country, adults with the lowest incomes die on average as young as people in much poorer nations like Rwanda, and their life spans are getting shorter. In those differences, documented in sweeping new research, lies an optimistic message: The right mix of steps to improve habits and public health could help people live longer, regardless of how much money they make…”
  • Where living poor means dying young, By Emily Badger and Christopher Ingraham, April 11, 2016, Washington Post: “This city is full of parks that invite exercise and bike lanes that make commuting a workout. It’s home to social services that tend the poor, and taxpayers who willingly fund them. Smoking is banned at restaurants and bars — as well as in workplaces, at bus stops, throughout public housing, at charity bingo games and even inside stores that sell tobacco. These factors may help explain why the poor live longer in the San Francisco area than they do in much of the rest of the country…”
  • A new divide in American death, By Joel Achenbach, Dan Keating, April 10, 2016, Washington Post: “White women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s and 50s in a slow-motion crisis driven by decaying health in small-town America, according to an analysis of national health and mortality statistics by The Washington Post.  Among African Americans, Hispanics and even the oldest white Americans, death rates have continued to fall. But for white women in what should be the prime of their lives, death rates have spiked upward. In one of the hardest-hit groups — rural white women in their late 40s — the death rate has risen by 30 percent…”

Infant Mortality – Butler County, OH

  • Why black babies die at twice the rate of whites in Butler County, By Wayne Baker, January 22, 2016, Hamilton Journal-News: “Black babies in Butler County are dying before the age of 1 at twice the rate of white babies. It’s a troubling and puzzling statistic that local and state health experts say contributes to Ohio’s high infant mortality rate, which is among the worst 10 percent in the nation. This medical and social issue is being addressed by several health agencies in the area and nationwide, but most of the data compiled so far has left the experts puzzled as to why this is happening…”
  • Ohio Medicaid to help Butler County combat infant mortality, By Wayne Butler, February 11, 2016, Hamilton Journal-News: “Local community and political leaders, along with representatives from the five Medicaid managed care plans, joined Ohio Medicaid Director John McCarthy Thursday afternoon to discuss ways to combat high infant mortality rates in Butler County and across the state. The Journal-News reported in a three-part series last month that black babies in Butler County are dying before the age of 1 at twice the rate of white babies…”

Infant Mortality – Milwaukee, WI

Preterm birth kills more Milwaukee babies than other causes combined, By Crocker Stephenson, May 5, 2015, Milwaukee Journal Sentinel: “Preterm birth kills Milwaukee babies more readily than all the other causes of infant death combined, kills a disproportionate number of African-American babies, and each year across Wisconsin absorbs hundreds of millions of dollars that might otherwise be used to promote healthy birth outcomes. That has been the trend for years. According to preliminary data to be released Wednesday by the Milwaukee Health Department, 2014 was no different…”

Joblessness and Life Expectancy

Joblessness shortens lifespan of least educated white women, research says, By Sabrina Tavernise, May 30, 2013, New York Times: “Researchers have known for some time that life expectancy is declining for the country’s least educated white women, but they have not been able to explain why. A new study has found that the two factors most strongly associated with higher death rates were smoking and not having a job. The aim of the study, which is being published Thursday in The Journal of Health and Social Behavior, was to explain the growing gap in mortality between white women without a high school diploma and those with a high school diploma or more…”

State of the World’s Mothers Report

  • To save more newborns, focus on the poor, report says, By Ryan Lenora Brown, May 7, 2013, Christian Science Monitor: “Over the last two decades, the number of children dying before their fifth birthday has decreased dramatically around the globe – falling from 12 million annually in 1990 to 7 million today. But one group remains particularly at risk: newborns born to poor families. In the world’s poorest countries – as well as some of its richest – income is an increasingly large factor in how risky a baby’s first days of life are, according to a report released today by Save the Children, an international nongovernmental organization…”
  • More US babies die on their first day than in 68 other countries, report shows, By Maggie Fox, April 30, 2013, NBC News: “The U.S. is a worse place for newborns than 68 other countries, including Egypt, Turkey and Peru, according to a report released Tuesday by Save the Children. A million babies die every year globally on the same day they were born, including more than 11,000 American newborns, the report estimates. Most of them could be saved with fairly cheap interventions, the group says…”

State Medicaid Expansions

  • Medicaid expansion may lower death rates, study says, By Pam Belluck, July 25, 2012, New York Times: “Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died. The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls…”
  • Study: New Medicaid expansion could be a lifesaver, By Ricardo Alonso-Zaldivar (AP), July 26, 2012, Columbus Dispatch: “States that expand their Medicaid programs under President Barack Obama’s health care law may end up saving thousands of lives, a medical journal report released yesterday indicates. Until now, the Medicaid debate has been about budgets and states’ rights. But a statistical study by Harvard researchers in the New England Journal of Medicine found a 6 percent drop in the adult death rate in Arizona, Maine and New York, three states that have recently expanded coverage for low-income residents along the general lines of the federal health care law. The study found that for every 176 adults covered under expanded Medicaid, one death per year would be prevented…”

Global Premature Births

  • U.S. lags in global measure of premature births, By Donald G. McNeil Jr., May 2, 2012, New York Times: “Fifteen million babies are born prematurely each year, and the United States fared badly in the first country-by-country global comparison of premature births, which was released Wednesday by the World Health Organization and other agencies. Although American hospitals excel at saving premature infants, the United States is similar to developing countries in the percentage of mothers who give birth before their children are due, the study’s chief author noted. It does worse than any Western European country and considerably worse than Japan or the Scandinavian countries. That stems from the unique American combination of many pregnant teenagers and many women older than 35 who are giving birth, sometimes to twins or triplets implanted after in vitro fertilization, the authors said. Twins and triplets are often deliberately delivered early by Caesarean section to avoid the unpredictable risks of vaginally delivering multiple full-term babies…”
  • U.S. excels at saving preemies but yet ranks poorly globally, By Karen Herzog, May 2, 2012, Milwaukee Journal Sentinel: “Even though hospitals in Milwaukee and elsewhere in the United States excel at saving premature infants, the nation fares as poorly as developing countries in the percentage of mothers who give birth before their child is due, according to the first country-by-country comparison of preterm births. The U.S. has the sixth-highest rate of preterm births among 184 countries and the highest among industrialized nations, says the March of Dimes report, ‘Born Too Soon: The Global Action Report on Preterm Birth.’ In Milwaukee, nearly 80% of babies who die before their first birthday are born before 37 weeks’ gestation, according to the Milwaukee Health Department. Premature birth is the No. 1 reason babies in Milwaukee die; a total of 100 babies died in the city in 2011, the Journal Sentinel reported as part of its Empty Cradles series on infant mortality…”

Infant Mortality Rates – Milwaukee, WI

Disparity in infant mortality rates in Milwaukee widens, By Crocker Stephenson and Karen Herzog, April 24, 2012, Milwaukee Journal Sentinel: “Milwaukee’s infant mortality rate dropped to a historic low in 2011. But the rate at which black babies died during their first year of life ticked upward, to nearly three times the rate of white babies. ‘We’re pleased with the overall numbers,’ Mayor Tom Barrett said Tuesday. ‘But we have to put more emphasis on the African-American rate.’ In November, Barrett and Commissioner of Health Bevan Baker set a goal to reduce Milwaukee’s black infant mortality rate by 15% and the city’s overall rate by 10% by 2017. ‘We are on track to meet those goals,’ said Geoff Swain, associate professor at the University of Wisconsin School of Medicine and Public Health and chief medical officer for the Milwaukee Health Department…”

Infant Death Rate – Scotland

Revealed: Infant death rate five times worse in Scotland’s poorest areas, By John Ferguson, February 1, 2012, Daily Record: “Babies from Scotland’s poorest neighbourhoods are almost five times more likely than those from the richest to die before they are one. The shocking statistic was revealed yesterday in an NHS report that analysed the postcodes of newborns for the first time. Of 59,082 births in Scotland in 2010, 15,361 mums lived in the most deprived fifth of postcode areas, while 9453 were from the most affluent. In the poorest areas, 85 children died before reaching one. In the best areas there were 11 deaths…”

Infant Mortality Rates

Tackling infant mortality rates among blacks, By Timothy Williams, October 14, 2011, New York Times: “Amanda Ralph is the kind of woman whose babies are prone to die. She is young and poor and dropped out of school after the ninth grade. But there is also an undeniable link between Ms. Ralph’s race – she is black – and whether her baby will survive: nationally, black babies are more than twice as likely as white babies to die before the age of 1. Here in Pittsburgh, the rate is five times. So, seven months into her first pregnancy, Ms. Ralph, 20, is lying on a couch at home as a nurse from a federally financed program listens to the heartbeat of her fetus. The unusual attention Ms. Ralph is receiving is one of myriad efforts being made nationwide to reduce the tens of thousands of deaths each year of infants before age 1. But health officials say it is frequently disheartening work, as a combination of apathy and cuts to federal and state programs aimed at reducing infant deaths have hampered progress, with dozens of big cities and rural areas reporting rising rates…”

UN Millennium Development Goals

  • Poor countries lead in mother, child spending, Associated Press, September 20, 2011, La Crosse Tribune: “Bangladesh, Ethiopia, Nepal and some of the world’s other poorest countries delivered not only money but new services in the year since U.N. member states pledged more than $40 billion to save the lives of mothers and children, a new study of the spending said Tuesday. The spending report was released at a high-level event chaired by U.N. Secretary-General Ban Ki-moon, who has made raising money for the health of mothers and their children a special project. Ban told a gathering at U.N. headquarters that when he was born in 1944 in South Korea, child mortality was so prevalent that families often waited months to register births to make certain babies would survive…”
  • WHO report hails efforts to curb maternal deaths, By Sarah Boseley, September 19, 2011, The Guardian: “One year on from a major UN meeting to tackle the deaths of women and babies in childbirth, 44 of the world’s poorest countries have made major commitments to the cause, totalling nearly $11bn (£7bn), according to a progress report. The UN secretary general, Ban Ki-moon, called the meeting a year ago because of sluggish progress towards two of the UN millennium development goals – reducing maternal and child mortality. More than $40bn was pledged for a range of strategies from donor governments, the private sector, NGOs and philanthropists. The one-year assessment from the Partnership for Maternal, Newborn and Child Health (PMNCH) of the World Health Organisation highlights progress in the worst-affected countries. Low-income countries made the highest number of commitments overall…”

Infant Mortality – Milwaukee, WI

Milwaukee-based researchers study prenatal exposure to toxins, By Kelly Hogan, August 15, 2011, Milwaukee Journal Sentinel: “Scientists are learning that health is the function of genes and environment. The work of Milwaukee-based researchers suggests that this principle also applies to the health of a growing fetus and a premature infant. Michael Laiosa, assistant professor at the University of Wisconsin-Milwaukee School of Public Health, and neonatologist Venkatesh Sampath, an assistant professor of pediatrics at the Medical College of Wisconsin, want to understand how genetics and the environment affect the health of humans during the most vulnerable stages of development. In Milwaukee, there were 807 infant and fetal deaths between 2005 and 2008, according to the city’s Fetal Infant Mortality Review. A disproportionate number were African-American. Of the 499 who were not stillborn, nearly 54% died from complications of being born too soon…”

Poverty and Mountaintop Mining – West Virginia

Appalachian poverty concentrated around mine sites, WVU study says, By Ken Ward Jr., July 23, 2011, Charleston Gazette: “Poverty in Appalachia is concentrated in the communities around mountaintop removal mines, and people living in those areas suffer greater risk of early deaths, according to a new scientific paper by a West Virginia University researcher. Michael Hendryx, an associate professor in the WVU Department of Community Medicine, compared data on poverty, mortality and mining in counties in West Virginia, Kentucky, Tennessee and Virginia. He was trying to determine if residents near mountaintop removal mines experience greater poverty and higher death rates compared to other kinds of mining or other areas of Appalachia…”

Poverty and Poor Health

Researchers link deaths to social ills, By Nicholas Bakalar, July 4, 2011, New York Times: “Poverty is often cited as contributing to poor health. Now, in an unusual approach, researchers have calculated how many people poverty kills and presented their findings, along with an argument that social factors can cause death the same way that behavior like smoking cigarettes does. In an article published online for the June 16 issue of The American Journal of Public Health, scientists calculated the number of deaths attributable to each of six social factors, including low income…”

Infant Mortality – Milwaukee, WI

Milwaukee infant mortality rate still high, despite years of effort, millions spent, By Crocker Stephenson and Ben Poston, May 7, 2011, Milwaukee Journal Sentinel: “As other communities around the country have found ways to reduce infant mortality, Milwaukee’s rate has remained all but stagnant for nearly two decades, the result of a vacuum of leadership and a scattershot approach to tackling the problem. In Central Harlem, babies once died at a rate twice that of Milwaukee. But through a unified effort, the community has slashed its infant mortality rate by 78% since 1990. The rate there is now about 6 deaths per 1,000 births, lower than the state of Wisconsin as a whole. In Milwaukee – where tens of millions of tax dollars have been spent in the past decade – 11 out of every 1,000 infants die before their first birthday. The city continues to have one of the worst infant mortality rates in the nation, especially for African-Americans, whose babies die at a rate about 2.5 times that of whites. Year after year, the city continues its rudderless and fragmented approach, with over 100 health initiatives that, lacking collective impact, fail to generate communitywide results…”

Premature Birth and Infant Mortality

  • Is stress to blame for preterm births?, By Mark Johnson and Tia Ghose, April 16, 2011, Milwaukee Journal Sentinel: “A tight, persistent pain in the lower abdomen chased Jasmine Zapata from class that morning, forcing her upstairs to rest on a couch at the University of Wisconsin School of Medicine and Public Health in Madison. It was Sept. 20, and Zapata was in her 25th week of pregnancy, just past the midpoint. She neither smoked nor drank. She knew the importance of proper prenatal care – of course she did – and had followed the doctor’s orders to the letter. Zapata, after all, was in her second year of medical school. The 23-year-old Milwaukee native had carried her first pregnancy to term and had a beautiful son to show for it: MJ, now 18 months old. At her last doctor visit the week before, all had been fine. But on this morning when Zapata rose from the couch and went into the bathroom, she saw she was bleeding. By the time the ambulance got to the hospital, she was completely dilated and in fear for her baby daughter. ‘When they were doing an ultrasound, I was mentally preparing myself,’ Zapata said. ‘What if they tell me she’s dead?’ Educated, married, with no chronic illnesses or family history of prematurity, Zapata was not, in most respects, a high risk for premature delivery, the No. 1 cause of infant mortality in Milwaukee. Only one factor suggested risk: Zapata is African-American…”
  • Understanding the risks, Editorial, April 16, 2011, Milwaukee Journal Sentinel: “African-American babies in Milwaukee are dying before their first birthday at more than twice the rate of white infants. This tragic trend line has widened despite years of effort. Poverty, unhealthy environments, lack of prenatal care, smoking or drinking alcohol and chronic diseases such as diabetes all play a role. But researchers now believe that something else is behind these cruel numbers: the accumulated stress of a life lived as a racial minority. This insight argues for approaches that help black women understand the multiple risks they face and that give them tools to cope with these risks. Milwaukee’s black infant mortality rate was 15.7 deaths per 1,000 live births between 2005 and 2008, one of the worst rates in the country and double the rate for white babies…”