Author Archives: Joe Rojas-Burke

About Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health, working to help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network. Send questions or suggestions to or @rojasburke.

New key concept: The inequality of violent injury and death

The statistics are hard to believe.

  • The most dangerous counties in the United States have rates of violent death that are more than 10 times higher than the safest counties.
  • In Los Angeles County, homicide subtracts nearly five years from the expected life span of African American men in some neighborhoods.
  • Across the U.S., death by homicide is more than eight times more common among blacks, and three times more common among Native Americans, compared with white Americans.

What could account for such staggering inequalities? A new key concept in AHCJ’s core topic area on the social determinants of health sizes up the problem, what’s known about root causes, and how people are trying to reduce the unequal burden of violent injury and death.

Note how the risk of violent injury rose with each step of decreasing neighborhood socioeconomic status in this 10-year study of hospitalizations in Memphis, Tenn, and surrounding Shelby County.

Missing context in reports on diabetic amputations

Photo by Victor via Flickr

Photo by Victor via Flickr

People with diabetes in the lowest income neighborhoods of California were 10 times more likely to lose lower extremities to amputation than people with diabetes in the highest income neighborhoods, according to a new paper published in Health Affairs.

Many news outlets covered the story, but none that I read provided much context beyond repeating what the Health Affairs paper had to say, which is a shame because there’s a lot to report. Most ignored the disturbing racial disparity in amputation rates. (HealthDay News did note the study’s finding that less than 6 percent of diabetics in California are black, but they account for about 13 percent of amputations.)

The study authors mapped hot spots of diabetic amputation in Los Angeles and across California, where rates varied from less than one to more than 10 amputations per 1,000 people age 45 and older with diabetes in 2009. Continue reading

Exploring the geography of violent death

Measured by rates of violent death, the most dangerous counties in the United States have rates that are more than 10 times higher than the safest counties.

As you can see in the map below, rates vary from less than 10 to more than 100 violent deaths per 100,000 population, based on homicides, police shootings, and suicides in the years 2004 through 2010. (Counties with rates based on 20 or fewer deaths are unreliable and are marked as suppressed.)


I generated this map and the others below using WISQARS (Web-based Injury Statistics Query and Reporting System), an interactive database system that provides customized reports of injury-related data collected by the Centers for Disease Control and Prevention. The mapping module draws on seven years of data, the amount needed to produce reliable county-level injury-related death rates, according to the CDC, and it is a powerful tool to explore health disparities. Continue reading

Going deep on hospital closures and their human impact

Pittsburgh’s dominant health system closed a hospital in the economically depressed town of Braddock four years ago and soon after opened a new hospital in the more affluent suburb of Monroeville, Pa.

Lillian Thomas

Lillian Thomas

Lillian Thomas of the Pittsburgh Post-Gazette wanted to know how common it was for hospital corporations to abandon disadvantaged towns and inner cities. That was the beginning of a reporting journey that has produced a hard-hitting, ongoing series by Thomas and colleagues at the Post-Gazette and Milwaukee Journal Sentinel.

The first installments revealed how most of the defunct hospitals were small to mid-size community hospitals and public hospitals that had served poor urban neighborhoods. The closures left many low-income neighborhoods without an effective safety net, undermined efforts to recruit doctors and did away with high-wage jobs for local residents. An incredibly detailed interactive map allows readers to track where old hospitals have closed and new ones have opened in cities across the U.S. since 1991.

I asked Thomas to share how she approached the project and mustered the resources to pull it off. Read more …

What do you really know about the social determinants of health?

It’s hard to think clearly about health reform if you ignore the social determinants of health, that is, how each person’s place in the hierarchy of self-determination and power, educational opportunity, neighborhood quality, working conditions, job security, income and wealth shape their vulnerability to illness and premature death. Check your knowledge by taking this true-or-false quiz: Continue reading