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
Socioeconomic Status.
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.
The Racial Equity Dashboard below visualizes demographic data, social determinants of health, and health outcomes disaggregated by race/ethnicity or race and ethnicity. Individual sections 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 dashboard. While only a glimpse at the true problem, the data captures racial inequities within each domain of the Areas of Influence and identified that disparities exist in the health and well-being outcomes stratified by race/ethnicity, or race and ethnicity, across San Diego County.
Racial Equity Framework and Outcomes Brief (September 2024)
Racial Equity Dashboard, San Diego County
See the below images to learn how to use the Racial Equity Dashboard:
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.2
The interactive Tableau dashboards below help to visualize demographic, health and well-being, and healthcare access data disaggregated by sexual orientation. Data for the adult population comes from the California Health Interview Survey (CHIS), 2018-2022. Data for the youth population comes from the California Healthy Kids Survey (CHKS), 2021-2023. The dashboards also introduce the terminology used to describe sexual orientation and gender identity and emphasize the importance of identifying and addressing health inequities among the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population.
Adult LGBQ Population:
The Adult LGBQ Population in San Diego County Brief, 2018-2022
The Adult LGBQ Population in San Diego County, 2018-2022 Dashboard
LGBTQ Youth Population:
The LGBTQ Youth Population in San Diego County Brief, 2021-2023
The LGBTQ Youth Population in San Diego County, 2021-2023 Dashboard
This map helps visualize the estimated Healthy Places Index (HPI) by subregional area in San Diego County.
Download the PDF version of the Healthy Places Index (HPI) Quartiles by Subregional Area map.
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.3 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.
Economic Hardship Index
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.4-6 This map helps visualize the estimated EHI by subregional area in San Diego County. The estimated EHI compares economic conditions between subregional areas.
Download a PDF version of the Economic Hardship Index Fact Sheet.
Download a PDF version of the Economic Hardship Index by Subregional Area map.
*Estimated economic hardship index values were calculated based on aggregating census tract data.
Census Tracts
The Economic Hardship Index (EHI) by Census Tract, 2022 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.
View the Economic Hardship Index (EHI) by Census Tract, 2022 Dashboard
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, 2023 Brief
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.7 The self-sufficiency standard is an affordability measure that serves as an alternative to the federal government’s poverty thresholds.8 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 that 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.
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San Diego County Self-Sufficiency Standard Briefs
San Diego County Self-Sufficiency Standard Brief: Single-Adult Household, 2023
San Diego County Self-Sufficiency Standard Brief: Household with Two Adults and Two Children, 2023
San Diego County Self-Sufficiency Standard Brief: Household with Two Adults, 2023
San Diego County Self Sufficiency Standard Brief: Single Parent Household with Two Children, 2023
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:
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 2023, there were approximately 10,264 persons experiencing
homelessness (PEH) in San Diego County on any given
night.9 PEH face a variety of health risks, including
poverty, chronic disease, overcrowding in shelters, and mental and
health substance use disorders.10 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 2022.
The dashboard below 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 2022, 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. Additionally, the dashboard includes data from the 2022 and 2023 Point-in-Time Count for San Diego County, 2022-2023 homeless student data from the California Longitudinal Pupil Achievement Data System, and mortality data from 2022 Vital Records Business Intelligence System (VRBIS). The accompanying brief highlights key findings from the dashboard.
Current Dashboard and Accompanying Brief (2022-2023):
Persons Experiencing Homelessness in San Diego County Dashboard, 2022-2023
Persons Experiencing Homelessness in San Diego County Brief, 2022-2023
Previous Dashboards:
2021
Persons Experiencing Homelessness: 2021 Hospital and Emergency Department Discharge Data
2020
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.
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Poverty in San Diego County-1: Areas of Concentrated Poverty, Housing
Affordability, and Food Insecurity
Poverty Dashboard - 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.
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Poverty in San Diego County-2: Family and Child Poverty, Deep Poverty,
Housing, and Employment
Brief: 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 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.
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Poverty in San Diego County-3: Poverty and Health
Brief: Poverty and Health
Poverty Dashboard-3: 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.
https://www.cdc.gov/chronicdisease/healthequity/index.htm
2 Centers for Disease Control and Prevention (CDC), About
LGBT Health, 2014.
https://www.cdc.gov/lgbthealth/about.htm
3 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
4 America’s Health Rankings analysis of U.S. Census Bureau, American Community Survey, United Health Foundation, AmericasHealthRankings.org, accessed 2023.
5 Montiel LM, Nathan RP, Wright DJ. An update on urban hardship. Albany (NY): The Nelson A. Rockefeller Institute of Government; 2004.
6 Nathan, Richard P., and Charles Adams. 1976. “Understanding Central City Hardship.” Political Science Quarterly 91 (1): 47–62. https://doi.org/10.2307/2149158.
7 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)
8 Center for Women’s Welfare (CWW). Self-Sufficiency
Standard.
http://www.selfsufficiencystandard.org/
9 Regional Task Force for Homelessness, Point-in-Time Count, 2023. https://www.rtfhsd.org/reports-data/
10 National Health Care for the Homeless Council, Frequently Asked Questions, 2022. https://nhchc.org/understanding-homelessness/faq/
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