Health Disparities in "SPA 6": South Central L.A.
By: Roberto Ramos
My interest in medicine began with my mother’s home remedies such as the Vicks VapoRub on my chest during colds or the highly concentrated vitamin B injections that were supposed to cure everything from fatigue to headaches. Determined to become a doctor, I sought medical exposure while attending Santa Clara University and volunteered at a free clinic in East San Jose, CA. The clinic provided care to uninsured and often undocumented patients.
Despite having knowledge of medical care challenges in my community of South Central LA through family experiences, and being theoretically informed from literature, this experience in San Jose exposed me to the challenges in caring for the underserved. These include lack of resources, continuity of care, and cultural barriers.
The patients were sick, a great portion of the patients that I encountered had chronic ailments such as Type 2 Diabetes, high blood pressure, and heart disease. These experiences combined with my interest in medicine made me realize that I could make a difference as a physician, and that I was needed in underserved areas. In 2014, I earned admission into the dual degree PRIME-Charles Drew University/UCLA medical education program. I completed my third year in the summer of 2017 and will be pursuing a Masters in Public Health at UCLA this Fall. My ultimate goal is to become a Family Medicine Physician and provide care to residents in South LA.
Did you know that if you live in areas like South Central, Lynwood, or Compton your life expectancy is 6.6 years lower than if you lived in Beverly Hills, Santa Monica, or Malibu? This is exactly the case according to the County of Los Angeles Department of Public Health Community Health Assessment of 2015*. This is an example of what is generally referred to as a health disparity.
My interest in medicine began with my mother’s home remedies such as the Vicks VapoRub on my chest during colds or the highly concentrated vitamin B injections that were supposed to cure everything from fatigue to headaches. Determined to become a doctor, I sought medical exposure while attending Santa Clara University and volunteered at a free clinic in East San Jose, CA. The clinic provided care to uninsured and often undocumented patients.
Despite having knowledge of medical care challenges in my community of South Central LA through family experiences, and being theoretically informed from literature, this experience in San Jose exposed me to the challenges in caring for the underserved. These include lack of resources, continuity of care, and cultural barriers.
The patients were sick, a great portion of the patients that I encountered had chronic ailments such as Type 2 Diabetes, high blood pressure, and heart disease. These experiences combined with my interest in medicine made me realize that I could make a difference as a physician, and that I was needed in underserved areas. In 2014, I earned admission into the dual degree PRIME-Charles Drew University/UCLA medical education program. I completed my third year in the summer of 2017 and will be pursuing a Masters in Public Health at UCLA this Fall. My ultimate goal is to become a Family Medicine Physician and provide care to residents in South LA.
Did you know that if you live in areas like South Central, Lynwood, or Compton your life expectancy is 6.6 years lower than if you lived in Beverly Hills, Santa Monica, or Malibu? This is exactly the case according to the County of Los Angeles Department of Public Health Community Health Assessment of 2015*. This is an example of what is generally referred to as a health disparity.
Figure 1: Map of LA County Service Planning Areas (SPA). Emphasis on South LA (orange) and West LA (blue) Areas. Map created using TIGER Data from LA County website.
A more precise definition of health disparities is a higher burden of illness, injury, disability, or mortality experienced by one population relative to another*. And the consequences of this should remind us of what Dr. Melody Goodman, professor of biostatistics at New York University once said “Your zip code is a better predictor of your health than your genetic code.”
Given the large size of Los Angeles County, the Department of Public Health has divided it into eight geographic areas, which they call Service Planning Areas (SPAs). Allow me to provide examples of health disparities by comparing two neighboring SPAs, SPA-5 and SPA-6.
SPA-5 residents are majority White and is made up of areas like Beverly Hills, Santa Monica, Malibu, Pacific Palisades, Culver City, Playa del Rey, and Venice. SPA 6 is mostly Latino and African-American and includes the areas Athens, South Los Angeles (South Central), Compton, Hyde Park, Crenshaw, Florence, Lynwood, Paramount, and Watts. (See Figure 1 for a map of Los Angeles County’s SPAs)
SPA-6 is of particular interest to me because it is where my family resides, and it is where I intend to eventually practice as a primary care physician. It also happens to have some of the worst health statistics in Los Angeles County. For example it has a high percentage of adults diagnosed with high blood pressure or diabetes, and the highest percent of obese adults in the county. SPA-6 also has the highest Diabetes and Stroke death rates in Los Angeles County while SPA-5 has the lowest (see Figures 2, 3, 4).
Given the large size of Los Angeles County, the Department of Public Health has divided it into eight geographic areas, which they call Service Planning Areas (SPAs). Allow me to provide examples of health disparities by comparing two neighboring SPAs, SPA-5 and SPA-6.
SPA-5 residents are majority White and is made up of areas like Beverly Hills, Santa Monica, Malibu, Pacific Palisades, Culver City, Playa del Rey, and Venice. SPA 6 is mostly Latino and African-American and includes the areas Athens, South Los Angeles (South Central), Compton, Hyde Park, Crenshaw, Florence, Lynwood, Paramount, and Watts. (See Figure 1 for a map of Los Angeles County’s SPAs)
SPA-6 is of particular interest to me because it is where my family resides, and it is where I intend to eventually practice as a primary care physician. It also happens to have some of the worst health statistics in Los Angeles County. For example it has a high percentage of adults diagnosed with high blood pressure or diabetes, and the highest percent of obese adults in the county. SPA-6 also has the highest Diabetes and Stroke death rates in Los Angeles County while SPA-5 has the lowest (see Figures 2, 3, 4).
Figure 2. Percent of adults who are obese and percent diagnosed with high blood pressure or diabetes in SPA 5, SPA 6, and LA County. Data gathered from the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. Key Indicators of Health by Service Planning Area; January 2017.*
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Figure 3. Diabetes and Stroke death rates in SPA 5, SPA 6, and LA County (Note that age has been adjusted per 100,000 population). Data gathered from the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. Key Indicators of Health by Service Planning Area; January 2017.*
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Figure 4. Life expectancy in 2010 for residents of SPA 5, SPA 6, and LA County. Data gathered from the Los Angeles County Department of Public Health, Office of Planning, Evaluation, and Development. Community Health Assessment 2015; March 2015.*
For instance, the number
one cause of premature death (less than 75 years of age) in SPA 6 is homicide. From
2007-2011, SPA 6 had the highest number of deaths by homicide in the county at
892, compared to SPA 5, which in the same year span had the lowest number of
homicides in the county at 44 (see Figure
5). Thus, it comes with no surprise that
more than 97% of SPA 5 residents perceive their neighborhood to be safe, while
only around 40% of SPA 6 residents share that belief (see Figure
6).
Figure 5. Number of deaths by homicide from 2007-2011 in SPA 5 and SPA 6. Data gathered from the Los Angeles County Department of Public Health, Office of Planning, Evaluation, and Development. Community Health Assessment 2015; March 2015.*
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Figure 6. Percent of adults who perceive their neighborhood to be safe from crime in SPA 5, SPA 6, and LA County. Data gathered from the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. Key Indicators of Health by Service Planning Area; January 2017.*
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These conditions and perceptions have health consequences. It has been documented that living with ongoing stress can lead to high blood pressure which overtime damages the blood vessels, heart, and kidneys while also increasing the risk of heart attack, heart failure, and sudden death. We also know that constant exposure to violence can take a toll on your mental health and is a risk factor for developing Post-Traumatic Stress Syndrome (PTSD). We have youth that are plagued with PTSD and suffer of depression, anxiety, and sleep issues. This carries into adulthood, which can have detrimental effects on quality of life. (Click here to read more about PTSD in students attending Manual Arts High School in South LA).
It is a false and bigoted statement to say that the residents of SPA 6 are just more violent than others. I think these beliefs stem from the portrayal of our communities in the media. A simple Google News search of South Los Angeles usually yields reports of shootings or other violent crimes. These reports however, rarely talk about the root causes of violence and may leave their audience subconsciously believing that people in those communities are prone to violence and do not experience trauma. Sometimes, you get narratives from good intended people that say that folks in violent neighborhoods are tough and can handle mental strain or even health strain. This can be equally damaging.
Factors such as poverty and unemployment are measurable conditions that can provide more insight into the roots of violence. SPA-6 has the lowest median household income at $36,400 and the second highest percentage of unemployed adults in the county! In comparison, the median household income in SPA-5 is $86,572 (see Figure 7). SPA 6 has the highest percent population with household incomes less than 100% federal poverty level at 33.6%. Living under poverty is associated with poor health such as an increased likelihood of having chronic illness and a lower life expectancy.
It is a false and bigoted statement to say that the residents of SPA 6 are just more violent than others. I think these beliefs stem from the portrayal of our communities in the media. A simple Google News search of South Los Angeles usually yields reports of shootings or other violent crimes. These reports however, rarely talk about the root causes of violence and may leave their audience subconsciously believing that people in those communities are prone to violence and do not experience trauma. Sometimes, you get narratives from good intended people that say that folks in violent neighborhoods are tough and can handle mental strain or even health strain. This can be equally damaging.
Factors such as poverty and unemployment are measurable conditions that can provide more insight into the roots of violence. SPA-6 has the lowest median household income at $36,400 and the second highest percentage of unemployed adults in the county! In comparison, the median household income in SPA-5 is $86,572 (see Figure 7). SPA 6 has the highest percent population with household incomes less than 100% federal poverty level at 33.6%. Living under poverty is associated with poor health such as an increased likelihood of having chronic illness and a lower life expectancy.
Figure 7. Median Household Income for residents of SPA 5 and SPA 6. Data gathered from the Los Angeles County Department of Public Health, Office of Planning, Evaluation, and Development. Community Health Assessment 2015; March 2015.*
Furthermore, adults that experience economic hardship during childhood are more likely to report a greater number of negative childhood experiences. The Adverse Childhood Experiences (ACE) study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente in 1995-97 examined 10 different types of childhood traumas experienced by study participants including abuse, neglect, and family/household challenges with long term follow-up of health outcomes. The ACE study found an association between high ACE scores and poor health for the rest of an individual’s life. For instance, an ACE score greater than 4 is associated with an increased likelihood of suffering of conditions such as chronic lung disease, depression, alcoholism, liver disease, and suicide. Basically, there is a link between negative childhood events and the development of chronic illness, mental health issues, or social problems*. There is a need for researchers to further explore and create data regarding SPA 6 resident ACE scores. (Click here to read more about the ACE study)
Educational attainment is also linked to health since those with higher education levels are likely to engage in healthier behaviors, and live longer*. In SPA 6, 41% of adults have less than a high school education compared to SPA-5 which has the largest proportion of adults with college or post-graduate degrees at around 56% (see Figure 8). People with lower education levels are more likely to have chronic conditions such as heart disease or diabetes and have a greater chance of becoming disabled*.
Educational attainment is also linked to health since those with higher education levels are likely to engage in healthier behaviors, and live longer*. In SPA 6, 41% of adults have less than a high school education compared to SPA-5 which has the largest proportion of adults with college or post-graduate degrees at around 56% (see Figure 8). People with lower education levels are more likely to have chronic conditions such as heart disease or diabetes and have a greater chance of becoming disabled*.
Figure 8. Educational achievement of residents in SPA 5 and SPA 6. Data gathered from the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. Key Indicators of Health by Service Planning Area; January 2017.*
In SPA 6, 38% of adults aged 18-64 are medically uninsured (see Figure 9), one of the highest rates of uninsured adults in the county! Unfortunately, SPA 6 also has a large proportion of the population living with chronic illness. SPA 6 is considered a medically under-served community with many areas designated as Health Professional Shortage Areas (HPSAs). A primary care HPSA has a primary care provider ratio of at least 3,500 patients to 1 health provider*. Essentially, we have a very sick population that does not have enough health providers to take care of them.
Figure 9. Percent of adults ages 18-64 who are uninsured, and who were not able to obtain prescription medications because of affordability in SPA 5 and SPA 6. Data gathered from the Los Angeles County Department of Public Health, Office of Planning, Evaluation, and Development. Community Health Assessment 2015; March 2015.*
SPA 6 is particularly personal to me since it is my hometown, where all my loved ones live. As a medical student, I often drive from UCLA to visit my family on weekends. When I near my home in South Central, I have noticed some streets and buildings dilapidated, graffiti overrunning the walls, and a plethora of tobacco shops, liquor stores, and fast-food restaurants beckoning to the many Latinos and African-Americans that reside there. As a resident of the area, it was no surprise to learn that it has some of the worst health statistics in Los Angeles County. Anyone can take the same route I take on weekends and understand how factors such as physical, social, cultural environments and access to health care have played a role in the health of the community. It still amazes me how close these two neighborhoods are too each other and yet how different they are. I always wonder why it has to be this way, why is a zip code now the best predictor of health? How can two neighboring communities have such different health profiles? It does not make sense, and should not be the reality.
References: *
References: *
- Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. Key Indicators of Health by Service Planning Area; January 2017.
- Los Angeles County Department of Public Health, Office of Planning, Evaluation, and Development. Community Health Assessment 2015; March 2015.
- Los Angeles County GIS Data Portal, Department of Public Health, Retrieved Spetember 21st, 2017. https://egis3.lacounty.gov/dataportal/2012/03/01/service-planning-areas-spa-2012/
- Violence Prevention. (2016, June 2014). Retrieved September 20, 2017, from http://www.cdc.gov/violenceprevention/acestudy/about.html
- The ACE Score. (n.d.). Retrieved September 20, 2017, from http://www.acestudy.org/the-ace-score.html
- Ubri, P. and Artiga, S. (2016). Disparities in Health and Health Care: Five Key Questions and Answers. [online] The Henry J. Kaiser Family Foundation. Available at: http://www.kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/ [Accessed 20 Sep. 2017].
