PLACE, RACISM, AND POVERTY MATTER FOR HEALTH INPLACE, RACISM, AND POVERTY MATTER FOR HEALTH IN ALAMEDA COUNTYALAMEDA COUNTY

ACPHD Mission and Vision: The mission of the Alameda County Public Health Department (ACPHD) is to work in partnership with the community to ensure the optimal health and well-being of all people through a dynamic and responsive process respecting the diversity of the community and challenging us to provide for present and future generations. We have a vision of health equity in our county, where every resident – no matter who you are, where you live, how much money you make, or the color of your skin – has opportunities to lead a healthy, fulfilling, and productive life.

One important way we are working to achieve our mission and vision is by staying on top of the latest data about social and health issues in our county. This helps us and our partners track progress or see areas where we need more help in addressing barriers to health.

However, we know that data are just one part of achieving health equity. Health department staff, residents, community-based organizations, policymakers, government agencies, and businesses all play an important role in achieving health equity.

While this document uses data to focus on the challenges we face, it is important to remember there are many people working for change across Alameda County, including the dedicated partners and residents we work with. Health interventions are all around us – from programs that help youth graduate from high school to people working to reform our criminal justice system to home visiting programs that meet residents where they live to collectively improve their health.

We believe that people working within Alameda County Public Health Department, our partners, and residents should have access to data, which is why we are sharing this information. But we know our main goal isn’t just talking about the problems we face – It is working together to ensure that everyone in Alameda County has an opportunity for a healthy and happy life.

Place Matters for Health: The opportunity to live a long, healthy, and productive life is not evenly distributed throughout Alameda County. The poorest health outcomes are concentrated in certain places, including parts of North, West, and East Oakland, unincorporated Alameda County, and South Hayward.

North & West Oakland

EastOakland

Unincorporated Alameda County

Hayward

WHAT IS YOUR ROLE?

Healthy Food

Education

Residents

Parks and Activities

Housing

Transpor-tation

We each have a role in

achieving health equity

Childcare

Safe Neighbor-hoods

PolicyMakers

Economic Justice

Mental Health

Criminal Justice

Clean Air

Medical Care

Land Use

Jobs

LocalGroups

History Matters for Health: In the United States, we have an ongoing history of discriminatory policies and practices tied to race, ethnicity, and socioeconomic status that have produced differences in access to resources and opportunities for health across neighborhoods.

Neighborhood Poverty Matters for Health: In Alameda County, neighborhood poverty greatly impacts health outcomes. What we see is a clear social gradient in health – This means with each step up in neighborhood poverty, there is a decline in life expectancy. On average, there is a 7-year difference in life expectancy between the most and least affluent neighborhoods in the county.

83

80

7876

72

74

76

78

80

82

84

86

<10% 10-20% 20-30 30%+

Life

Expe

ctan

cy (i

n Ye

ars)

Neighborhood Poverty Level% of residents living in poverty

7 year difference in life expectancy

Some Historical Roots of Racial Residential Segregation and Persistent Poverty

Racial steering andblock-busting practices by real estate agents

Displacement caused by federal highway

construction and other urban renewal projects

Redlining practicesby banks and home insurance agents

Middle class and whiteflight to the suburbs

Discriminatory mortgageunderwriting by the FHA/ VA

Disinvestment and concentrated poverty in urban centers

Racial Segregation Matters for Health: Reflecting conditions of long-standing racism and racial residential segregation, Blacks and Latinos are more likely to live in high-poverty neighborhoods than Whites and Asians. These racial residential patterns cannot be explained by differences in access to income. If we look among poor people – all of whom have low access to income – poor Whites are more likely to live in affluent neighborhoods than poor Blacks and poor Latinos.

Unequal Neighborhood Conditions Matter for Health: High poverty neighborhoods often have fewer resources and weaker infrastructure to support good health. They can also have high levels of exposure to factors that harm health. In order to achieve more equitable health outcomes, we must work to change unequal economic, social, psychological, and built environment conditions across neighborhoods.

Compared to people living in affluent neighborhoods of Alameda County (where <10% live in poverty), residents of very high poverty

neighborhoods (where 30%+ live in poverty) are:

2X MORE LIKELY TO LACK ACCESS TO EMPLOYMENT

7%

15%

unemployed inaffluent neighborhoods

unemployed in veryhigh poverty neighborhoods

STRUGGLING WITH A 2-FOLD DIFFERENCE IN

HOUSEHOLD INCOME LEVELSAverage annual household income

in affluent neighborhoods=$110,436

Average annual household income

in very high povertyneighborhoods= $46,598

In Alameda County, 1 in 15 White residentslive in high-poverty neighborhoods, compared to

1 in 9 Asians

1 in 4 Latinos

1 in 3 Blacks

9%

34%

of adults in affluent neighborhoods have less than a HS degree

of adults in very high poverty neighborhoods have less than a HS degree

ALMOST 4X MORE LIKELY TO HAVE LESS THAN A

HIGH SCHOOL DEGREE

FACING NEARLY 8X HIGHER RATES OF HOMICIDE

4

30

homicides per 100,000 people living in affluent neighborhoods

homicides per 100,000 people living in affluent neighborhoods

73%

30%

of 3rd graders in affluent neighborhoods are scoring proficient or above on statewide English-Language Arts tests

of 3rd graders in very high poverty neighborhoods are scoring proficient or above on statewide ELA tests

FACING MORE BARRIERS TO ACADEMIC SUCCESS WITH A

2.4-FOLD DIFFERENCE IN 3RDGRADE READING PROFICIENCY LEVELS

Compared to people living in affluent neighborhoods of Alameda County (where <10% live in poverty), residents of very high poverty

neighborhoods (where 30%+ live in poverty) are:

BURDENED BY A 4X HIGHER DENSITY OF INDUSTRIAL CHEMICAL AND FUEL

RELEASE SITES THAT POLLUTE GROUNDWATER AND SOIL

83

332

Industrial chemical and fuel release sites per 100,000 residents in affluent neighborhoods

Industrial chemical and fuel release sites per 100,000 residents in very high poverty neighborhoods

ALMOST 2X AS LIKELY TO BE SEVERELYBURDENED BY

RENTAL HOUSING COSTS

19%

36%

of householdsin affluent neighborhoods are spending ≥50% of their income on rental housing

of households in very high poverty neighborhoods are spending ≥50% of their income on rental housing

OVER 4X MORE LIKELY TO BE LIVING IN OVERCROWDED

HOUSEHOLDS

3%

14%

of householdsin affluent neighborhoods are overcrowded

of households in very high poverty neighborhoods are overcrowded

EXPERIENCING HIGH LEVELS OF CHRONIC STRESS AND 2.7X HIGHER RATES OF SEVERE MENTAL HEALTHCONDITIONS LIKE MAJOR DEPRESSION AND ANXIETY

212

565

visits to the Emergency Departmentfor severe mental disorders per 100,000 in affluent neighborhoods

visits to the ED for severe mental disorders per 100,000 in very high poverty neighborhoods

7X MORELIKELY TO LIVE IN HOUSEHOLDS WITH ZERO VEHICLES AND DEPEND ON

PUBLIC TRANSPORTION TO GET AROUND

2%

14%

of householdsin affluent neighborhoods have zero vehicles

of households in very high poverty neighborhoods have zero vehicles

MORE LIKELY TO HAVE LIMITED ACCESS TO SUPERMARKETS

37

67

Average Limited Supermarket Access (LSA) score in affluent neighborhoodsAverage LSA score in very high poverty neighborhoods (higher LSA score = more limited access)

5X MORE LIKELY TO BE LOCKED UP AS A YOUTH FOR OVERWHELMINGLY

NONVIOLENT OFFENSES

0.5% 1 in 200 youth (ages 10-17) in affluent neighborhoods is incarcerated

2.5% 1 in 40 youth in very high poverty neighborhoods is incarcerated

ACPHD Efforts to Advance Health and Social Equity: Alameda County Public Health Department is working across multiple levels to reduce health and social inequities.

1. We work to prevent disease and mortality by providing healthcare services and expanding access to healthcare in high-need communities.

2. We provide health education and help clients to address major risk factors like smoking, nutrition, and chronic stress.

3. We work to improve neighborhood conditions that put people at risk of risks. For example, in addition to nutrition education, we seek to improve access to healthy foods in neighborhoods with limited supermarkets.

4. Changing these social inequities means asking who has institutional power to make decisions in neighborhoods. Often we find there are willing partners to work to change community conditions.

5. In doing all of this, we strive to address the discriminatory beliefs and structures that affect this whole trajectory. This includes making sure our systems are accessible, transparent, and democratic so all community members can engage in decision-making processes that promote healthy communities of opportunity.

For More Information: Please contact the Community Assessment, Planning, Education, and Evaluation (CAPE) Unit of the Alameda County Public Health Department with any questions, comments, or requests for additional data.

Tammy LeeCommunity Epidemiologist, CAPE Unit

Alameda County Public Health Department

tammy.lee@acgov.org or 510-268-2619