Health Equity in San Diego

Celebrating 20 Years of Commitment to Health Equity

Over the past 20 years, Public Health Services (PHS) has remained committed to achieving health equity in San Diego. Beginning in 2001, the Reduce and Eliminate Health Disparities with Information (REDHI) Initiative was developed to address disparities in the health status of different racial and ethnic groups.

In the early 2000’s, health data began to be examined by age, gender, geography, race/ethnicity, and socioeconomic status. By 2016, PHS accomplished milestones fundamental to achieving health equity, including adoption of Health Equity as a priority (2008), development of City and County Local Health Officers (CCLHO) Health Equity Framework (2010), the Health Equity Infrastructure for Accreditation (2014), created the Office of Health Equity (2015) and publication of Public Health Equity Reports (2016). In 2019, PHS Branch health equity goals were added to the PHS Strategic Plan. All of these efforts supported the County’s declaration of Racism as a public health crisis, in early 2021.

Timeline of Health Equity Efforts in San Diego

The COVID-19 pandemic further validated health equity as an important and timely topic. The pandemic has brought to light some of the health inequities that exist in San Diego County, as well as the nation. The existing PHS health equity framework has been a crucial contribution to San Diego’s robust response to COVID-19 and efforts to reduce COVID-19-related disparities, through established community partnerships and targeted education and outreach.

Identifying health disparities and inequities are critical in developing prevention and intervention measures, ultimately leading to a healthier San Diego, and ultimately true health equity. This webpage includes data, resources, and tools available to the public to explore health data through the lenses of health equity. Data is available by age, gender, geography, race/ethnicity, and socioeconomic status. As more resources and data become available, additional lenses will be added, including sexual orientation and gender identity (SOGI) and disability status. 

It is only through working together that health disparities and inequities can be understood and addressed. I welcome you to join us on this essential journey so that all San Diegans can Live Well.

 

Wilma J. Wooten, M.D., M.P.H.
Public Health Officer
Public Health Services

Health Equity Framework

Health equity is a key component of the Live Well San Diego vision, as well as a longstanding practice in Public Health Services (PHS). The newly developed Equity Framework includes the five Areas of Influence of the Live Well San Diego framework but is expanded by including additional measures of social determinants of health (SDOH), such as income, housing status, and access to healthcare. According to the Centers for Disease Control and Prevention (CDC), health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”1 The equity framework acknowledges that SDOH may impact aspects of a person’s life and often lead to disparities in health and well-being outcomes, irrespective of biological or genetic factors. With the goal of equity in mind, disparities in systems and health and well-being outcomes may be identified and become more balanced.

The Equity Framework aims to better understand systemic inequities with the purpose of providing data for SDOH and related health and behavioral indicators. When SDOH are examined by lenses of health equity, such as by race/ethnicity, disparities become apparent. This framework can also be applied to other vulnerable populations, such as those with disabilities, the young and the elderly, and those of low socioeconomic status. The inclusion of more measures in the Equity

Framework helps to better understand the root causes of health inequities so that actions may be taken to ensure health and well-being for all San Diego County residents. To view the Equity Framework Overview Brief, please click here

Health Equity Reports

HealthEquityReports2022

For over 20 years, the Public Health Services department, in the County of San Diego Health and Human Services Agency, has been tracking population health data by age, gender, geography, race/ethnicity, and, more recently, by socioeconomic status. This 2022 health disparities report series is an update to reports published in 2016 and has been expanded to include indicators of                well‐being, in addition to disease burden.

The Exploring Health Disparities in San Diego County series includes detailed reports with data and information for each of the lenses of health equity: Age, Gender, Geography, Race/Ethnicity, and Socioeconomic Status.

Health Equity Dashboards

Racial Equity

On January 12, 2021, the County of San Diego Board of Supervisors declared racism a public health crisis. The Board acknowledges “that racism underpins health inequities throughout the region and has a substantial correlation to poor outcomes in multi-facets of life” and declares that “the County has a responsibility to tackle this issue head on in order to improve the overall health of our residents.” To view the January 12, 2021 Board Letter, please click here.

Research has shown that racial and ethnic minority groups experience higher rates of illness and death due to a variety of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease.2 Examining population and community data by race/ethnicity is the first step to identify racial disparities and address how to close the gaps.

The racial equity dashboards below are interactive Tableau dashboards that help to visualize the demographic data, social determinants of health, and health outcomes disaggregated by race/ethnicity or race and ethnicity. Individual dashboards can be downloaded as images, PDFs or PowerPoint slides. The racial equity framework and outcomes brief provides background and findings from the data included in the dashboards.

Health Equity Dashboard Series: Racial Equity Dashboards, San Diego County

See the below images to learn how to use the Racial Equity Dashboards:

Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Population

Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are diverse and include people of all demographic backgrounds. Members of the LGBTQ community are at increased risk for a number of poor health outcomes compared to heterosexual and cisgender people as a result of social and structural inequities.3

The interactive Tableau dashboards below help to visualize demographic, health and well-being, and healthcare access data disaggregated by sexual orientation and gender identity. Data for the adult population comes from the California Health Interview Survey (CHIS), 2016-2020, and data for the youth population is from the Youth Risk Behavior Surveillance System (YRBSS), 2015-2019. The dashboard also introduces the terminology used to describe sexual orientation and gender identity and emphasizes the importance of identifying and addressing health inequities among the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population. 

The Adult LGBQ Population in San Diego County Brief, 2016-2020

The LGBT Youth Population in San Diego Unified School District, 2015-2019

The LGBTQ Health and Well-Being Dashboard

Socioeconomic Status

The relationship between health and wealth has been studied extensively in the field of public health. Access to healthcare and quality of healthcare is influenced by financial status, and therefore, financial status is an important contributor to health disparities across the United States.4 Health disparities are often worsened by social inequalities between those with low and high socioeconomic status (SES). Examining SES and its relationship to health at the community level can strengthen our capacity to develop policies, programs, and interventions that support healthy lives. 

Cost of Living for Older Adults

Cost of living can vary by age. The cost of living tool below helps to highlight the economic issues faced by the aging population in San Diego County. It helps determine the basic costs of living for older adults (those aged 65 years and over) and to visualize the amount spent on basic necessities for older adults in each Health and Human Services Agency (HHSA) region, subregional area (SRA), and San Diego County overall. Select household composition, housing tenure, and geography to explore the differences in the expenditure on basic necessities. The briefs provide background information and key findings from the data included in the dashboard.

Cost of Living for Older Adults, San Diego County, 2021 Brief

Socioeconomic Status Dashboard Series: Cost of Living for Older Adults (Ages 65 Years and Over), San Diego County Dashboard 

See the below images to learn how to use the Cost of Living for Older Adults Dashboard:

 

Self-Sufficiency Standard

Currently, the federal government’s poverty thresholds and guidelines are used to determine poverty rates throughout the United States. While the measure is defined as the minimum amount of annual income that is needed for individuals and families to pay for essentials, its calculation does not consider essential household expenses such as housing, medical, and childcare costs, or the geographic variability in the cost of living.5 The self-sufficiency standard is an affordability measure that serves as an alternative to the federal government’s poverty thresholds.6 The self-sufficiency standard measures how much income is needed for a household of a certain composition to adequately meet their basic needs without public or private assistance.

The self-sufficiency standard dashboard below is an interactive tool helps to visualize the minimum wage required for self-sufficiency based on the average amount spent on basic necessities in each Health and Human Services Agency (HHSA) region, subregional area (SRA), and San Diego County overall. The self-sufficiency briefs provide background and key findings from the data included in the dashboards.

San Diego County Self-Sufficiency Standard Brief: Single-Adult Household, 2021 

San Diego County Self-Sufficiency Standard Brief: Household with Two Adults and Two Children, 2021 

San Diego County Self-Sufficiency Standard Brief: Household with Two Adults, 2021

San Diego County Self Sufficiency Standard Brief: Single Parent Household with Two Children, 2021

Socioeconomic Status Dashboard Series: San Diego County Self-Sufficiency Standard Dashboard

See the below images to learn how to use the San Diego County Self-Sufficiency Standard Dashboard:

Socioeconomic Disparities by Census Tract

The Socioeconomic Disparities by Census Tract Dashboard below examines demographic, housing, employment, and income/benefit data from 2019 for all census tracts in San Diego County, highlighting those that are considered Qualified Census Tracts.

The American Rescue Plan Act of 2021 (ARPA) defined select census tracts as Qualified Census Tracts based on income and poverty measures. Specifically, a Qualified Census Tract is defined as any census tract in which at least 50 percent of households have an income less than 60 percent of the Area Median Income, or which has a poverty rate of at least 25 percent. 

Socioeconomic Disparities by Census Tract 

See images below to learn how to use the dashboard:

People Experiencing Homelessness (PEH)

In 2020, there were approximately 7,600 people experiencing homelessness (PEH) in San Diego County on any given night.7 PEH face a variety of health risks, including poverty, chronic disease, overcrowding in shelters, and mental and health substance use disorders.8 Collection and examination of data identifying PEH and their health outcomes is crucial to understanding this population’s health disparities.

Hospital and Emergency Department Discharge Data for Persons Experiencing Homelessness

Hospitals in San Diego County are beginning to adopt the practice of indicating select social determinants of health in patients’ medical records through defined codes (ICD-10 Z codes). This information was utilized to examine hospital and emergency department (ED) discharge data for persons experiencing homelessness in 2020.

Each of the below dashboards examines aggregated demographic data, hospital and facility data, and data on top diagnosis groups for individuals in San Diego County whose records indicated they were experiencing homelessness. This data is specific to individuals who were homeless who sought emergency or hospital care in 2020, and this is not comprehensive of all hospitals or all patients but will continue to increase as the use of ICD-10 Z codes increases.

Current (2020):

Previous (2019):

 

Poverty 

Poverty in San Diego County, Areas of Concentrated Poverty and Food Insecurity, 2022 

Poverty Dashboard-1: Areas of Persistent Poverty (APP) and Historically Disadvantaged Communities (HDC)

This interactive tool helps to highlight the areas of persistent poverty, historically disadvantaged communities, and areas with low access to food. Hover over a census tract to view census tract name, Health and Human Services Agency (HHSA) Region, Subregional Area (SRA), Supervisorial District to which it belongs, Gini Index, the proportion of population below 100% Federal Poverty Level (FPL), the proportion of population below 200% FPL, and proportion of households receiving food stamps. Alternatively, use the search bar below the map to search for a census tract. Refer to the images below to learn how to use the Poverty Dashboard:

How to use interactive poverty dashboard

Poverty in San Diego County, Family and Child Poverty, Deep Poverty, Housing, and Employment

Poverty Dashboard-2: Family and Child Poverty, Deep Poverty, Housing, and Employment 

This interactive dashboard focuses on the HP2030 objectives - proportion of households spending more than 30 percent of household income on housing and employment proportion in working-age population in San Diego County. Additionally, this dashboard focuses on visualizing data on proportion of population, ages under 18 years, living below 100% FPL, proportion of families with children living below poverty level, and proportion of individuals with income less than 50% poverty level at the census tract level in San Diego County. Hover over a census tract to view interpretation. Alternatively, use the search bar to search for a census tract. Refer to the images below to learn how to use the Poverty Dashboard:

Poverty Dashboard

1 Centers for Disease Control and Prevention (CDC). March 11, 2020. Health Equity.
https://www.cdc.gov/chronicdisease/healthequity/index.htm

2 Center for Disease Control and Prevention (CDC). November 23, 2021. Racism and Health.
https://www.cdc.gov/healthequity/racism-disparities/index.html

3 Centers for Disease Control and Prevention (CDC), About LGBT Health, 2014.
https://www.cdc.gov/lgbthealth/about.htm  

4 Office of Disease Prevention and Health Promotion. Healthy People 2020 Poverty.
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty

5 Office of the Assistant Secretary for Planning and Evaluation. Frequently Asked Questions Related to the Poverty Guidelines and Poverty, 2021.
Frequently Asked Questions Related to the Poverty Guidelines and Poverty | ASPE (hhs.gov)

6 Center for Women’s Welfare (CWW). Self-Sufficiency Standard.
http://www.selfsufficiencystandard.org/

7  San Diego Regional Task Force on the Homeless. 2020 WEALLCOUNT Report. August 2020. https://www.rtfhsd.org/wp-content/uploads/2020-WeAllCount-Report-10.pdf

8 National Health Care for the Homeless Council, Frequently Asked Questions, 2022.
https://nhchc.org/understanding-homelessness/faq/