November 14, 2018

Cancer and heart disease are the leading causes of death for Multnomah County residents, but black residents are at higher risk than their white neighbors, the county’s lead epidemiologist told commissioners Tuesday during a briefing on mortality and public health.

Epidemiologist Frank Franklin, Ph.D., left, briefs the Board on leading causes of death in Multnomah County alongside Public Health Director Rachael Banks.

The manner in which people die only tells a small part of the story about why people die, Frank Franklin, Ph.D said.

“Two-thirds of a person’s of health status is independent of the individual,” he said; independent factors including socioeconomic status, education, employment, environment and social support. The consequences of social and environmental factors on a person's physical health means public health needs to broaden its examination beyond mortality.

“Traditional data regarding mortality, morbidity and associated behavior must be anchored with data capturing meaningful measures of social determinants of health,” he said. “Death data is only the tip of the iceberg.”

The causes of death in Multnomah County roughly mirror national trends. By far most people die from cancer and heart disease, followed distantly by accidental deaths, respiratory and cerebrovascular diseases, Alzheimer's, diabetes, suicide and the flu.

Multnomah County reports fewer gun-related deaths than the national average, while Oregon reports a rate comparable to the national average. The county reports slightly more suicides than the national average, but fewer than the state average.

Black residents, meanwhile, are dying of the same afflictions at a higher rate; the only exceptions being suicide and Alzheimer's disease. Black residents died of cancer at a rate nearly 50 percent higher than white residents, and died of heart disease at a rate more than 25 percent higher.

The undated numbers build on the findings from a 2014 Health Department study of racial and ethnic disparities, itself a sweeping condemnation of bias and unequal access to healthcare, a health environment, opportunity and security.

Public Health Director Rachael Banks told the Board, “It’s clear we have disparities, the largest of those are black and white. And we know we can do something about these things.”

Tuesday's presentation comes as the Board of Commissioners adopt a more proactive role as the Board of Health, which operates under Oregon law as the Local Public Health Authority. The Board of Health has the power to pass local ordinances, set fees and collect fines on issues affecting people’s health.  Upcoming presentations to the Board of Health include:

“One reason we wanted to start this conversation is to give commissioners and the public an idea of what areas, as Board of Health, we want to look into,” Chair Deborah Kafoury said. “Having a broad high-level view is really important as we move forward. We want to send staff out to look at what other communities are doing, what tools we have to address these issues. We want to get to action, to what we can do to make a difference.”