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Public health in our backyard: How would DC rank if it were a country?

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Flag_map_of_Washington_DCThose of us who work in global health too often forget about the burden of disease much closer to home. In an attempt to remind us of our own public health crises, this post will examine the public health landscape of the District of Columbia (home of the O’Neill Institute), asking the question: how would DC rank on public health measures if it were a separate country?
Maternal Mortality Rate
Rate: 41 deaths / 100,000 live births (2010)
Country: Moldova
We begin with one of the most basic health indicators – how many women die as a result of childbirth? So how does the capital of the world’s richest country fare on this measure? Not well at all. DC has roughly the same maternal mortality rate of Moldova, a country with a GDP per capita about 7% that of the United States. Norway, a country with roughly the same GDP per capita experiences only about 4 deaths per 100,000 births, 10% of the DC rate.
Infant Mortality
Rate: 8 per 1,000 births (2010)
Country equivalent: Macedonia
The infant mortality picture is a bit brighter. Having peaked at an abysmal 23.1 per 1,000 births, the District has made remarkable progress in lowering infant mortality rate. There is still much progress to be made, but the trend is in the right direction.
Homicide Rate
Rate: 16.5 homicides / 100,000 population (2013) (District only)
Country equivalent: Namibia
Homicide rates, on the other hand, show a far less encouraging picture. Each year about 16.5 people can be expected to be murdered for every 100,000 people living in the District. This places us at around the homicide rate as Namibia. By way of comparison, here’s how the U.S. State Department has described Namibia:

Crime is a serious concern in Windhoek and other areas throughout Namibia. The State Department has identified Namibia as a “Critical” residential and non-residential crime threat location on a scale of low, medium, high, and critical.

All in all, not particularly good company.
HIV Prevalence
Rate: 3.2% (among adults) (2012)
Country equivalent: Rwanda
Rwanda flag map
In the Washington, DC metro area, 3.2% of adults are HIV-positive, and this number jumps to 4.7% among African-Americans. This makes the HIV prevalence in the District higher that of the Rwanda, which receives funding both from PEPFAR and from the Global Fund to fight its epidemic.
Income Inequality
Gini index: 53.5 (2012) (District only)
Country equivalent: Paraguay
Although admittedly not a direct measure of public health, there has been extensive research on the links between income inequality, morbidity and mortality. The GINI coefficient measures how unequal the distribution of income is within a society, with 0 representing a perfectly equal distribution (i.e. everyone receives the same amount of money), and 100 representing a perfectly unequal one (i.e. a single person receives all the money). The District, with a Gini index of 53.5 is significantly more unequal than any U.S. state.
Ultimately, all of the other measures of poor public health may trace back to this simple injustice – and solutions are likely to require a far broader reform of the District than simply increased awareness or public health funding.

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