Health and Safety
The eight indicators in this topic quantify racial disparities in health and safety, and suggest ways we can make progress toward equitable outcomes
The eight indicators in this topic quantify racial disparities in health and safety, and suggest ways we can make progress toward equitable outcomes. The indicator reports that follow will allow the City of St. Louis and all stakeholders to evaluate policies from a fact-based, verifiable perspective. We’ll be able to learn from the data, see what’s working and what’s falling short, and use these insights to double down on good investments and experiment with new policies.
The Health and Safety topic looks at disparities in access to tools that support health and health outcomes in terms of injuries, illnesses, and death.
Black residents in the City of St. Louis are more likely to lack access to the tools that support health, from insurance to housing to safe places to walk and play. Black residents are more likely to be uninsured and more likely to experience homelessness. In addition, they are more likely to be killed or injured while walking.
Black residents are more likely to suffer from health problems that are a product of their environment. As mentioned in the Child Well-being topic, black children are more likely to have asthma and lead poisoning. Black adults are more likely to develop chronic diseases that cannot be prevented by vaccines and cannot be cured by medicine.
Black residents are more likely to suffer from violence. The most common reason for black women in St. Louis to visit hospitals is for treatment of injuries caused by assault. Black residents are significantly more likely to be victims of violent crime.
Black residents are more likely to die at every age, including infants. The racial disparities in health outcomes correlate with historical racial biases in healthcare, and persistent disparities in social determinants of health, which are the conditions in the places where people live, learn, work, and play.
Health metrics that appear in other topics include: Child Food Insecurity, Child Lead Poisoning, Child Asthma, Youth STD Rates, Access to Healthy Food, and Access to Parks.
For the Equity Indicators Project, the measures chosen focus on racial disparities. For this topic, the indicators are reflective of the Ferguson Commission’s calls to action around health and safety, but not all health-related calls to action are addressed within the scope of this project.
What is our equity score for this topic?
The higher the score on a scale from 1 to 100, the closer we are towards achieving equity.
Which Calls to Action from the Ferguson Commission report are reflected in this topic?
The Ferguson Commission report calls to action related to the Health and Safety topic include:
- Increase Health Insurance Coverage and Access by ensuring the Children’s Health Insurance Program (CHIP) is reauthorized, expanding Medicaid eligibility, providing gap coverage, and enrolling more people in the Affordable Care Act marketplace.
- Build Safe Neighborhoods by supporting sustained, citizen-led efforts.
- Build Healthy and Affordable Housing by supporting the Missouri Housing Development Commission’s 2015-16 Qualified Allocation Plan.
- Expand the Statewide Housing Trust Fund by doubling the current real estate transaction filing fee (from $3 to $6) in order to provide additional and effective funding to house working families in the region.
- Strengthen the Community Reinvestment Act by enforcing the fair housing and antitrust laws and centralizing control, among other recommendations.
- Review the Missouri Family Support Division by Creating a Missouri Blue Ribbon Commission to conduct a thorough and inclusive review of the current operating model and outcomes.
- Reform Juvenile Disciplinary Procedures and Practices by adopting policies and programs that address the needs of children and youth most at risk for crime or violence and eliminate aggressive law enforcement tactics that stigmatize youth and marginalize their participation in schools and communities.
- Deliver Trauma-Informed Care by designing hospital-community partnerships to help heal young people impacted by violence with case management, mentorship, and evidenced-based trauma interventions.
- End Shame and Stigma by developing a media campaign to minimize shame and stigma related to hunger, mental health/illness, homelessness, obesity, poverty, incarceration, etc.
What institutions and organizations were assessed?
The indicators in this topic do not assess any particular institutions or organizations.
Where did the data come from?
The data used in this topic comes from the Missouri Department of Health and Senior Services, the City of St. Louis Human Services Department, and the St. Louis Metropolitan Police Department.
What stakeholders were consulted?
Stakeholders consulted include the City of St. Louis Health and Human Services Departments, East-West Gateway, the St. Louis Integrated Health Network, the St. Louis Mental Health Board, and Generate Health.
What metrics do we know are missing?
Important metrics that are not part of this project include measures of preventive healthcare, mental health, substance abuse, maternal mortality, and obesity.
We know whether people have health insurance, but not whether they have sufficient healthcare. We know when people use emergency rooms, but not when they have received preventive care. We know how many people use treatment services, but not how many people are in need of services. These data gaps are due to a lack of coordinated data collection across the healthcare system.
According to the Missouri Department of Mental Health, while there is "data on those who receive treatment, data on mental health in the general population is very limited." In addition, they found, "The availability of county‐level data on substance use is limited." Qualitatively, we know that there is limited access to mental health assessments and that there are waiting lists for treatment. The St. Louis Mental Health Board has determined there is unmet need for behavioral health programs and services, particularly for youth. The U.S. Department of Health and Human Services last produced a report on prevalence of substance use and mental disorders for the St. Louis region in 2012.
Obesity data is also hard to access and analyze by racial groups. The CDC Behavioral Risk Factor Surveillance System collects county-level obesity data; however, the sample size is so small that racial disparities are rarely able to be reported. In 2015, the City of St. Louis conducted a unique study of obesity using data from the Missouri Department of Motor Vehicles. They found significant geographic disparities in rates of overweight and obese individuals.
Health and Safety Equity Indicators
|HS1: Infant Mortality
Black babies are three times as likely as white babies to die before their first birthday.
|HS2: Health Insurance
Black residents are twice as likely to not have health insurance as white residents.
|HS3: Violent Crime Victimization
Black residents are more than 2.5 times as likely as white residents to be a victim of a violent crime.
Black residents are nearly four times as likely to be homeless as white residents.
|HS5: Pedestrian Injuries
Black residents are twice as likely to be killed or injured by cars while walking as white residents.
|HS6: Chronic Disease Emergency Room Visits
Black residents are more than three times as likely to visit an emergency room for suffering related to chronic disease as white residents.
|HS7: Women’s Health
Black women are twice as likely to experience major health events as white women.
|HS8: Mortality Rate
In any given year, black residents are 34% more likely to die from all causes than white residents.
|2018 Equity Score