December 12, 2014

County Chief Diversity and Equity Officer Ben Duncan (second from left); Sonali Balajee of the Office of Diversity and Equity; Dept. of County Human Services Director Liesl Wendt; Chief of Staff to Commissioner Smith Gary Chenault on Dec. 11.

People of color in Multnomah County face “extremely sobering’’ disparities that lead to more illness, fewer opportunities and shorter lives, the Health Department reported Thursday.

The findings, from the Report Card on Racial & Ethnic Health Disparities in Multnomah County were presented to the Board of County Commissioners at an often emotional hour-long briefing.

African Americans experience grave differences in almost all 33 measures, but disparities also persist for Latinos, Native Americans/Alaska Natives and Asian Americans/Pacific Islanders.

“The number and breadth of the disparities across this range of indicators highlights the need of a multi-layered, cross sectional strategy to address them. This is not just a Health Department issue,’’ said Dr. Julie Maher, Program Design and Evaluation manager who led the analysis. “This is an extremely sobering picture for our communities of color.’’

A core function of a public health department is to collect population health data and report it back to the community. The information is intended to help decision makers create policy, planning and programs.

The report is the fifth Health Department disparities report in a decade. It is also the most comprehensive because it recognizes that a person’s health is shaped by more than their genetics, individual behavior and health care.

Analysts reviewed 33 indicators around health including underlying causes of poor health such as economic status, education, literacy, air quality, access to healthy food and health care.

“This report is not about healthcare, it’s about health,’’ said Health Department Director Joanne Fuller. “We’re really talking about... the totality of people’s lives. That totality includes racism and discrimination that research shows has a deep and lasting impact on people’s health.”

 Gerald Deloney, co-chair of the Communities of Color, said that as disturbing as the findings are, people of color were not surprised.

“We live this on an everyday basis and we know how bad that it really is.”

Among the findings:

● Black/African Americans experience 2 ½ times the infant mortality and diabetes mortality than non-Latino Whites and six times the rates of homicide. African Americans were also four times as likely to have children living in poverty, and were twice as likely to be unemployed, have children not meeting third-grade reading standards and live in a single-parent household.

● Native American/Alaska Natives were three times as likely to have children in poverty and have twice the rates of unemployment, teen births and smoking.

● Latinos had 3 ½  the teen birth rate and twice the rate of children in poverty, children not meeting third-grade reading standards and homicide. Latinos did better than white residents in hospitalization rates and had less incapacity due to mental and physical health issues. They fared as well as whites in physical activity, smoking, mental health, gonorrhea and birth weight.

● Asian/Pacific Islanders had twice the rate of needing health insurance than whites and were more likely to live in areas of poor air quality and neighborhoods that lacked healthy food retailers. Asian Americans did better than whites in 11 indicators including ninth graders who graduated high school, heart disease, cancer, teen births and hospitalizations.

Suzanne Hansche, the Elders in Action representative to the Oregon Health Equity Alliance, asked the board to support Alliance’s legislative agenda as part of their approach to reducing disparities. Among the key items: a “Ban the box,’’ bill that would stop someone with a criminal conviction from being automatically disqualified for work and a policy that supports paid sick leave. She also asked the board to invest in community efforts and programs outside the Health Department.

The Health Department also presented its next steps including:

● Increasing the Board of County Commissioners’ capacity to act as the Board of Health.

● Increasing investment in early childhood and adolescence.

● Creating a public health advisory board and formal Community Health Improvement Plan to authentically engage the community and build on community-based strengths.

● Increasing culturally-specific and community specific approaches including trauma-informed care.

Rujuta Gaonkar, manager of the Health Equity Initiative shares her heartfelt testimony at Thursday's board meeting.

“The disparities my colleagues have spoken of are unacceptable,’’ said Rujuta Gaonkar, manager of the Health Equity Initiative at the Multnomah County Health Department. “Moreover they are avoidable.” She said that as the single parent of color of a four-year old, her son sees the future as limitless. “I don’t want that to change and the reality is that I also have a job that affords me paid sick leave, I have access to healthy food, and affordable, high-quality education. I want to be able to say that for every child growing up in Multnomah County and right now, I cannot.’’

We have some sense of the map forward, but by no means all the answers,’’ Joanne Fuller said. “This needs to be the collective work of communities, community organizations, our county, the city and other institutions.”

Commissioners reacted strongly to the report. Here is a text of their remarks:

Commissioners Loretta Smith: 

“As the single parent of a son who is 24 years old.  I can totally identify. As you think about the trajectory your kids might have, it stuns you.

As we were watching ‘Can’t Breath, hands up’ all across the United States, I would tell my colleagues I love to have my son come home from school in Seattle. But I also hated when he came home because I couldn’t go to sleep during the day or night until he actually came home. There were a couple incidents when the police pulled him over, one in particular when he wasn’t doing anything but driving a car they thought he shouldn’t been driving, which was his mom’s. He was so shaken up he called and said, ‘Come get me.’ He was only around the corner and he couldn’t get it together, I had to go get him….

So in terms of trauma, I don’t think people understand young black men are at risk and they have been for many years. People are now recognizing they’re a target and never get the benefit of the doubt, it is just assumed they are doing something wrong. That’s something as a black mother we have to think about all the time.

For me, to be able to sit on a commission with my fellow commissioners who have the same values as I do about this issue and department heads and people in the health department, who know this is important stuff, I thank you for all your effort.”

Commissioner Jules Bailey:

“It is incredibly important to have this briefing as we head into the budget process. We know our society is failing people of color and it’s been failing a long time, we’ve never not failed people of color. We’ve seen it in the headlines and in our loved ones and I have to acknowledge from white and male privilege that this is something we have to do something about and the time to start is now. We as a community are sick and have been too often treating symptoms of the disease and not root causes. We can’t be healthy until all of us are well."

Commissioner Judy Shiprack:

“I feel deeply disappointed in our community and feel deeply disappointed with the cohort I represent. It is very disappointing to me that we have not made more progress than we have. A four-year-old child is a good place to start. You don’t raise your children with despair you always raise your children up with hope. I know the work we’re doing in justice system and trauma informed care and work to make this a collective effort, we can’t do this in silos -- we don’t live in silos. I feel hopeful that we can do that.”

Chair Deborah Kafoury:

“We know behind all of these statistics and numbers are people, children and families. That’s why it’s hard to hear. And it’s also hard to hear because we have this tendency in Portland to be nice, to listen to really hard stories and statistics and facts and feel really bad about it and then go back to doing things the same way they’ve always been done. I just want to commit to you that we are going to do something different. You’ve heard it. We are not going to be here a year from now hearing these same stories without having made an effort and a huge effort and real change.

We know it won’t be easy, it didn’t come yesterday, there has been decades and decades of institutional racism in our community, but if we don’t have the courage to admit it and stand firm and to say, ‘We’re going to make a change,’ it’s never going to be any better.

You have my commitment and the commitment of the members of this board and you will see a different budget, you will see true effort and partnership. We’re going to work with the Health Department and with the communities of color and with the community. We are going to do things differently.”