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.
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 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.
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
Health Equity Dashboards
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.
Equity Framework and Outcomes Brief (March 2023)
See the below images to learn how to use the Racial Equity Dashboards:
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.
This map helps visualize the estimated Healthy Places Index (HPI) by subregional area in San Diego County.
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.
Subregional Area (SRA)
Economic Hardship Index (EHI): Index of economic conditions based on crowded housing, dependency, education, income, poverty, and unemployment with a higher value indicating worse economic conditions.5-7 This map helps visualize the estimated EHI by subregional area in San Diego County. The estimated EHI compares economic conditions between subregional areas.
*Estimated economic hardship index values were calculated based on aggregating census tract data.
The Economic Hardship Index (EHI) by Census Tract, 2021 Dashboard contains a map of the distribution of the EHI across census tracts in San Diego County. The estimated Economic Hardship Index by census tract map (see map below) shows the variation in levels of economic hardship and allows identification of communities with greater economic hardship. The dashboard provides the data for each of the components of EHI and the life expectancy of the subregional area (SRA) and HHSA Region the census tract is in. Additionally, the dashboard ranks the census tracts from highest to lowest EHI.
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.
See the below images to learn how to use the Cost of Living for Older Adults Dashboard:
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.8 The self-sufficiency standard is an affordability measure that serves as an alternative to the federal government’s poverty thresholds.9 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 Briefs
See the below images to learn how to use the San Diego County Self-Sufficiency Standard Dashboard:
The Socioeconomic Disparities in San Diego County Dashboard below displays interactive maps of Qualified Census Tracts, percentage of the population under 200% of the federal poverty level (FPL) by census tracts, Difficult Development Areas by zip code tabulation area, and Health Equity Zip Codes.
Hover over the maps for additional information, zoom in on selected areas, and reset the map using the home button at the top left of each map.
In 2020, there were approximately 7,600 persons experiencing
homelessness (PEH) in San Diego County on any given
night.10 PEH face a variety of health risks, including
poverty, chronic disease, overcrowding in shelters, and mental and
health substance use disorders.11 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 2021.
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 2021, 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.
Poverty is an important social determinant of health (SDOH) because it frequently interacts with various other SDOH which, together, influence health behaviors and outcomes. Communities with high rates of poverty have higher rates of morbidity and mortality. These health inequities increase as poverty rates increase.
The Poverty Brief and Dashboard Series below highlights important public health topics related to poverty.
Poverty in San Diego County-1: Areas of Concentrated Poverty, Housing
Affordability, and Food Insecurity
This interactive tool helps to highlight the areas of concentrated poverty, low housing affordability, and areas with low access to food. Hover over an area on each map to view the census tract name, Health and Human Services Agency (HHSA) Region, Subregional Area (SRA), and the Supervisorial District to which it belongs.
Dashboard instructions here.
Poverty in San Diego County-2: Family and Child Poverty, Deep Poverty,
Housing, and Employment
This interactive dashboard focuses on the HP2030 objectives - proportion of households spending 30 percent or more 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, aged 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.
Dashboard instructions here.
Poverty in San Diego County-3: Poverty and Health
Brief: Poverty and Health
This interactive dashboard focuses on social vulnerability index, 3-4-50 chronic diseases and socioeconomic status, health conditions in low-income areas, and health outcomes and socioeconomic status. Click or hover over a census tract to view interpretation. Alternatively, use the search bar to search for a census tract.
Dashboard instructions here.
1 Centers for Disease Control and Prevention (CDC).
March 11, 2020. Health Equity.
2 Center for Disease Control and Prevention (CDC).
November 23, 2021. Racism and Health.
3 Centers for Disease Control and Prevention (CDC), About
LGBT Health, 2014.
4 Office of Disease Prevention and Health Promotion.
Healthy People 2020 Poverty.
5 America’s Health Rankings analysis of U.S. Census Bureau, American Community Survey, United Health Foundation, AmericasHealthRankings.org, accessed 2023.
6 Montiel LM, Nathan RP, Wright DJ. An update on urban hardship. Albany (NY): The Nelson A. Rockefeller Institute of Government; 2004.
7 Nathan, Richard P., and Charles Adams. 1976. “Understanding Central City Hardship.” Political Science Quarterly 91 (1): 47–62. https://doi.org/10.2307/2149158.
8 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)
9 Center for Women’s Welfare (CWW). Self-Sufficiency
10 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
11 National Health Care for the Homeless Council, Frequently Asked Questions, 2022. https://nhchc.org/understanding-homelessness/faq/