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Public Health Department Report Examines Root Causes of Disease

Health Begins Where We Live, Work, Learn, and Play

SANTA CLARA COUNTY, CALIF. – Santa Clara County Public Health Department released a groundbreaking report today that looks at the root causes of disease. The Health and Social Inequity in Santa Clara County report examined many factors and their effect on health. These factors include: race and ethnicity, income, education, employment, immigration, housing, access to health care, and neighborhood conditions. Using existing local and national data, the report shows that social determinants can have a powerful influence on an individual’s health and well-being.

According to the report, residents with low incomes as well as certain racial and ethnic groups do not have equal opportunities for good health. These residents also experience poorer health outcomes than wealthier residents.

Evidence shows that only a small portion of an individual’s health can be attributed to medical care or genes. Social determinants play a significant role in health status. This means that where we live, work, learn, and play are major factors in determining how healthy we are. However, choices and opportunities in these key areas of life are limited by status or privilege. Our health is fundamentally tied to the social, economic and institutional conditions in which we live.

“As local policy makers, we must serve the needs of all our residents. Santa Clara County’s diversity is a great asset. But it must be taken into account when providing social services and health services,” said President Dave Cortese, County of Santa Clara Board of Supervisors. “The Health and Social Inequity Report highlights the social and health inequities that result when governments take the one size fits all approach. It is a call to action to explore and advance policy solutions that reduce or eliminate health inequities.” While Santa Clara County is a healthy, wealthy, and educated county on the whole, a closer look at the data reveals that social and health inequities exist among certain racial/ethnic groups and low-income residents. For example:

  • County residents with more education and higher incomes report better health and lower rates of chronic disease
  • Recent immigrants enjoy better health than American-born residents and other immigrants who have lived here longer than five years
  • Residents with low incomes and less education are more likely to be without health insurance
  • Residents with low incomes tend to have higher rates of obesity and smoking
  • Higher percentages of African-American and Hispanic residents live in poor neighborhoods compared to the general public
  • Students in school districts with higher poverty rates are at greater risk for low academic achievement
  • Children in low-income families are more likely to suffer poor health, affecting their ability to do well in school and eventually earn a decent wage

“The timing is right for addressing social inequities as a way to prevent premature death and disease,” said Dan Peddycord, Director of the Santa Clara County Public Health Department. “As our nation adopts a comprehensive health reform strategy that supports investing in prevention, we need to look at local policies and practices that can help to level the field so everyone has equal opportunities for good health. It’s an important public health strategy, and it’s the right thing to do.”

In Santa Clara County, as in so many other counties across the U.S., healthcare costs are rising rapidly. Currently, the vast majority of our healthcare dollars are spent on treatment and other direct services rather than prevention. These services are focused on the individual and don’t address the underlying conditions or causes in the surrounding environment such as racism, classism, and neighborhood conditions.

“Public health strategies to combat infectious diseases have helped to dramatically reduce mortality rates over the last century, but we are now at risk of losing ground due to the rise in chronic diseases like diabetes,” said Dr. Marty Fenstersheib, Health Officer for Santa Clara County. “That’s why it’s critical to address the root causes of health problems, which includes social inequities.”

The report is part of a growing effort among public health professionals to address social inequities as a way to improve public health. The Bay Area Regional Health Inequities Initiative (BARHII), a collaboration of local health departments in the Bay Area, has developed a framework for understanding and measuring health inequities, which takes into account the complex and interrelated factors that influence the health of a community.

The BARHII model shows how social factors like racism, immigration status, institutional power, and neighborhood conditions contribute to health. These social factors are considered “upstream” factors. “Downstream” factors include genetics, direct medical services, and individual risk behaviors like smoking. Upstream factors have a major influence downstream. For example, racism or discrimination may limit a person’s opportunities so that they end up in a neighborhood with more crime and few places to exercise safely or buy healthy food, making it more difficult to avoid chronic diseases like diabetes.

Using existing data and the BARHII model as a framework, the report examines eight social determinants of health: race/ethnicity, education, income, employment, immigration, housing, access to health care, and neighborhood conditions.

A growing body of evidence shows that differences in health outcomes among racial groups are due to the differences in lived experiences rather than genetic differences. The primary reason is believed to be a long history of racial discrimination and inequality in the U.S. How groups of people are perceived and treated in society is associated with their socioeconomic status or class, and those with a lower socioeconomic status tend to suffer poorer health. On the other hand, those with more education and higher incomes tend to enjoy better health outcomes.

However, while some neighboring counties see wide gaps in life expectancy based on income, this is not the case for Santa Clara County. For example, in some other counties, life expectancy is 81 years for those in high-income neighborhoods compared to 69 years for those in low-income neighborhoods. But in Santa Clara County, the gap is only three years: 82 compared to 79 years.

While the gap in life expectancy between the rich and poor in Santa Clara County is not as wide as other areas, the time to act is now before this gap starts to widen. The report provides some explanations for the smaller gap, including healthier immigrants, integrated neighborhoods, and racial/ethnic diversity. Another explanation is the Latino paradox, which shows that more recent Latino immigrants are healthier than the average population despite their generally low socioeconomic status. However, these advantages may be lost over the years as these populations acculturate in the United States.

Despite the smaller gap in life expectancy, the report also shows rising rates of chronic diseases and related risk factors among county residents and various racial/ethnic groups, as well as in our immigrant population. As immigrants spend more time in the U.S., their health tends to decline as they lose protective factors such as healthier diets. In addition, children of immigrants tend to fare worse than their parents and grandparents when it comes to their health. These and other alarming trends compel us to take action now.

The report is intended to start a community-wide dialog about social inequities and ways our community can work together to change community conditions and reduce these inequities. To do that, public policy makers, business and community leaders, nonprofit organizations, institutions, and others in our community need to embrace the notion that good health starts in our neighborhoods, schools, and workplaces.

“A new focus on the policies, institutions, systems, and environmental conditions that shape our community and thereby influence our health can have more substantial and sustainable impact on health status,” said Peddycord. “They can also have a far greater influence on the health of entire populations, than the traditional focus on individual behaviors and treatment. Much like we can design a highway to be safer to drive we can shape a community to have a far more positive impact on health.”

The report was developed by the Public Health Department in collaboration with The Health Trust and other diverse stakeholders from multiple sectors. For a copy of the report, please visit the Public Health website.

Media Contact: Gwendolyn Mitchell/Laurel Anderson, Office of Public Affairs, (408) 299-5119; Molly Carbajal, Public Health 408.792.5207
Posted: May 12, 2011