How Place, Racism, and Poverty Matter for Health in Alameda County

How Place, Racism, and Poverty Matter for Health in Alameda County

Our local data on health and social

inequities

An update since our 2008 report

“Life and Death from Unnatural Causes”

The Community Assessment, Planning, Education, and Evaluation

(CAPE) Unit of the Alameda County Public Health

Department (ACPHD)

Everyone in Alameda County –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.

Our Vision of Health Equity

Purpose of this PresentationTo walk you through our latest data on health and social inequities in Alameda County and our interpretations of the data so you can:

Possible Uses for Data Writing a grant where you must establish need Advocating for change in particular neighborhood conditions Using a health equity lens to frame a social or policy issue Assessing whether your current program or policy work is helping to

improve health equity Talking with somebody who doesn’t understand how place, racism,

and neighborhood poverty matter for health in our County

1. Increase understanding of what factors need to be addressed to improve opportunities for health throughout our County

2. Use the data in your work to advance health and social equity

3. Spark critical dialogue and collective thinking about solutions

Health Inequities by PlaceLife Expectancy by Census Tract

Life Expectancy in Oakland by Region

Just a few miles = Over a decade difference in LE

Photo Source: The California Endowment, Health Happens Here

Compared to a White child born in the affluent Oakland Hills…

…an African American child born in West Oakland can expect to live 14 fewer years.

OOAKLAND HILLSLIFE EXPECTANCY 85

OWEST OAKLANDLIFE EXPECTANCY 71

Source: Alameda County Vital Statistics files, 2010-2012

Good Health Status

Communities of Opportunity

• Parks• Safe/Walkable Streets• Grocery Stores and

Healthy Foods• Good Schools• Clean Air• Quality Housing• Public Transportation• Good Jobs• Strong Local Businesses• Financial Institutions

Poor Health Status

• Limited/Unsafe Parks• Crime• Fast Food Restaurants• Liquor Stores• Poor Performing Schools• Pollution and Toxic

Exposures• Transportation Barriers• Absence of High Quality

Financial Institutions• Predatory Lenders

Disinvested Communities

Why Does Place Matter for Health?

STRUCTURAL RACISM

Key Determinants of Health Inequity

Concentrated and Persistent

Poverty

Racial Residential Segregation

Poor and Inequitable

Health Outcomes in Low-Income Communities

of Color

Inequitable Economic

Conditions

Inequitable Psycho-Social

Conditions

Inequitable Built

Environment Conditions

Redlining practicesby banks and home

insurance agents

Racial steeringand block-busting

practices by real estate agents

Displacement caused by federal highway

construction and other urban renewal projects

Middle class and white flight to the suburbs

Discriminatory mortgage underwriting by the

FHA/VA

Disinvestment andconcentrated poverty

in urban centers

Historical Roots of Racial Residential Segregation and Persistent Poverty

http://www.google.com/imgres?imgurl=http://www.buro-atelier.com/images/tree.jpg&imgrefurl=http://www.buro-atelier.com/blog/wordpress/?p=28&h=365&w=365&sz=72&tbnid=Cqs1C1vRIP4J::&tbnh=121&tbnw=121&prev=/images?q=tree+roots&hl=en&usg=__hdJV8qbKDQkpWpYLapppHeYkRqg=&sa=X&oi=image_result&resnum=3&ct=image&cd=1

Racial Redlining in Alameda County



of Color

Concentrated and Persistent

Poverty

Definitions of Poverty

30%+ are living in poverty

Neighborhood Poverty

Defined by the percentage of residents living in poverty

Very High Poverty

20-29.9% are living in povertyHigh Poverty

Affluent <10% are living in poverty

€€ €€€

A single person living alone has a household income of less than $11,490

Individual Poverty, 2013

A family of four has a household income of less than $23,550

Neighborhood Poverty Level by Census Tract

Very high poverty neighborhoods

High poverty neighborhoods

Affluent neighborhoods

Persistent Neighborhood Poverty

Neighborhood with high poverty for 5 decades (1970-2010)

Persistent High Poverty

Neighborhood with high poverty for 3-4 decades

Frequent High Poverty

Neighborhood with high poverty for 2 decades

Intermittent High Poverty

Neighborhood with high poverty for 1 decade

Infrequent High Poverty

Neighborhood with high poverty for 0 decades

No High Poverty

Defined by the number of decades of high neighborhood poverty

Definitions of Poverty (continued)

Persistence of Neighborhood Poverty by Census Tract

Life Expectancy by Neighborhood Poverty Level:A Social Gradient in Health


<10% 10-20% 20-30 30%+72

74

76

78

80

82

84

86

83

80

7876

Neighborhood Poverty Level% of residents living in poverty

Life

Exp

ecta

ncy

(in Y

ears

)

7 year difference in life expectancy

(Very High Poverty)

(Affluent)

5 Leading Causes of Death in Alameda County, 2008-2010


1. Cancer24%

2. Diseases of the Heart23%

3. Stroke6%4. Chronic Lower Respi-

ratory Diseases5%

5. Unintentional In-juries

4%

Top 5 account for 62% of total deaths

5 Leading Causes of Death by Neighborhood Poverty Level, 2000-2010

<10% Poverty (Affluent)

1 Cancer 26%2 Diseases of Heart 23%3 Stroke 6%4 CLRD 5%5 Alzheimer's Disease 4%

Top 5 account for 63% of deaths

10-20% Poverty

1 Cancer 24%2 Diseases of Heart 23%3 Stroke 6%4 CLRD 5%5 Unintentional Injuries 4%


20-30% Poverty

1 Cancer 21%2 Diseases of Heart 20%3 Stroke 7%4 CLRD 5%5 Unintentional Injuries 5%


30%+ Poverty (Very High Poverty)

1 Cancer 22%2 Diseases of Heart 22%3 Stroke 7%4 Homicide 5%5 Unintentional Injuries 4%

Top 5 account for 61% of deathsSource: Alameda County Vital Statistics files, 2008-2010

Social Gradients in Mortality


Neighborhood Poverty Level

Cancer Diseases of Heart

Stroke CLRD Unintentional Injury

0

50

100

150

200

250

Rates of Death from the Top 5 Leading Causes of Death by Neighborhood Poverty Level

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

Rate

per

100

,000

(Very High Poverty)

(Affluent)

Social Gradients in Morbidity

Source: Alameda County OSHPD files, 2009-2011


*ED rates and neighborhood poverty are at the zip code level

Diabetes

Asthma

Obesity

Assault

0

1,000

2,000

3,000

4,000

5,000

Rates of Visits to the Emergency Department for Select Conditions by Neighborhood Poverty Level*

<10% 10%-20% 20%+

Rate

per

100

,000

(High Poverty)(Affluent)

Neighborhood Poverty Impacts Health Over the Life Course


<5 5-24 25-440

20

40

60

80

100

120

140

160

Age Group

All-C

ause

Mor

talit

y Ra

te

45-64 65-84 85+0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Age Group

All-C

ause

Mor

talit

y Ra

te0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

45-64 65-84 85+

All-C

ause

Mor

talit

y Rat

e

Age Group

30%+ Poverty

<10% Poverty(Very High Poverty Neighborhoods)

(Affluent Neighborhoods)

Ages 5-24 % of Deaths1. Homicide 59%2. Unintentional Injuries 22%

Ages 25-441. Homicide 25%2. Unintentional Injuries 16%3. Cancer 14%4. Diseases of Heart 10%

Ages 45-641. Cancer 24%2. Diseases of Heart 23%3. Unintentional Injuries 7%4. Stroke 6%

Leading Causes of Death by Age Groupin Very High Poverty Neighborhoods

81% of deaths

65% of deaths

60% of deaths




of ColorRacial Residential Segregation

Who Lives in Neighborhoods of Varying Poverty Levels by Race/Ethnicity

(Very High Poverty)

(Affluent)

Alameda County

<10% 10-20% 20-30% 30%+0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

35%42%

29%17%

9%

25%

29%

22%

16%

14%

22%

17%

26%

36%

40%

12%6%

17%27% 31%

5% 5% 6% 5% 5%

All Other Races

Black/AfrAmer

Latino/Hispanic

Asian

White


Perc

enta

ge o

f Res

iden

ts (%

)

Source: American Community Survey, 2006-2010 and Census, 2010

Proportion Living in a High Poverty Neighborhood (where >20% of residents are poor) by Race/Ethnicity

1 in 15 White residents live in high-poverty neighborhoods, compared to:

€ € € € € € € € €€€ € € €€

€ € € € € €€1 in 9 Asians

€€

€ € € €1 in 4 Latinos

€ € €1 in 3 Blacks

Source: American Community Survey, 2006-2010 and Census, 2010

Proportion of Poor People Living in an Affluent Neighborhood (where <10% of residents are poor) by Race/Ethnicity

1 in 3 poor Asians

€ € €

1 in 2 poor White residents live in affluent neighborhoods, compared to:

€ €

1 in 6 poor Blacks

€ € €€ €€1 in 7 poor Latinos

€ € €€ €€ €Source: American Community Survey, 2006-2010 and Census, 2010

Racial Gaps in HealthLife Expectancy at Birth by Race, 1960-2010

4.0 yrs

6.6 yrs


1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

60

65

70

75

80

85

Black

White

Life

Exp

ecta

ncy

at B

irth

(in Y

ears

)

Racism (Not Race) Harms Health


AfrAm Asian Latino White0%

2%

4%

6%

8%

10%

12%

14%

12%

8%

6% 6%

7% 7%

5%

7%

Percentage of Low Birth Weight Babies by Mother's Race/Ethnicity and Place of Birth

US-born Foreign-born



of Color

Inequitable Economic

Conditions

• Employment• Job Wages• Household Income• Wealth

Source: American Community Survey, 2007-2011

Access to Employment:Unemployment Rate by Neighborhood Poverty Level

<10% 10-20% 20-30% 30%+0%

4%

8%

12%

16%

20%

7%

10%

14%15%

Neighborhood Poverty Level(% of Residents Living in Poverty)

Une

mpl

oym

ent R

ate

(%)

2.1X Higher

(Very High Poverty)

(Affluent)


Access to Jobs that Pay Adequate Wages:Top 5 Occupations by Neighborhood Poverty Level

<10% Poverty (Affluent)

Occupation Category

1. Management (14% of civilian employed pop

age 16+)

2. Office & Admin Support

(13%)

3. Sales & Related

(11%)

4. Computer & Math

(7%)

5. Business & Financial

(7%)

Median Income $91,324 $39,497 $44,887 $94,361 $70,869

30%+ Poverty (Very High Poverty)

Occupation Category

1. Office & Admin Support

(11%)

2. Food Preparation & Serving

(11%)

3. Construction & Extraction

(10%)

4. Sales & Related

(9%)

5. Building & Maintenance

(8%)

Median Income $28,920 $16,135 $29,495 $23,877 $20,967

Alameda County Self-Sufficiency Standard for 1 Adult in 2011 = $27,456


Access to Income: Average Annual Household Income by Neighborhood Poverty Level

<10% 10-20% 20-30% 30%+$0

$40,000

$80,000

$120,000 $110,436

$76,591 $73,439

$46,598


Aver

age

Hous

ehol

d In

com

e

2.4 Fold Difference

(Very High Poverty)

(Affluent)

Access to Wealth: Rates of Foreclosure by Neighborhood Poverty Level

Source: CAPE, with data from HUD and from First American Title via Urban Strategies Council, 2006-2009

(Very High Poverty)

(Affluent)

<10% 10-20% 20-30% 30%+0%

5%

10%

15%

20%

25%

30%

35%

13%

21%

31% 32%


4-Yr

Noti

ce o

f Def

ault

Rate

2.4X Higher



of Color

Inequitable Psycho-Social

Conditions

• Educational Attainment• School Quality• School Attendance• Crime and Violence• Criminal Justice• Stress and Mental Health

Access to Education and Quality Schools:Educational Attainment by Neighborhood Poverty Level


<10% 10-20% 20-30% 30%+0%

10%

20%

30%

40%

9%

18%

25%

34%


% w

ith Le

ss th

an H

S De

gree

3.8X Higher

(Very High Poverty)

(Affluent)

Source: OUSD , 2011-12

Academic Performance by Neighborhood Poverty LevelOakland Public School Students3rd Grade English-Language Arts

(Very High Poverty)

(Affluent)

<10% 10-20% 20-30% 30%+0%

10%

20%

30%

40%

50%

60%

70%

80% 72%

48%

31% 30%


% A

t or A

bove

Pro

ficie

ncy

2.4-fold difference

Source: OUSD, 2011-12

Chronic Absenteeism Rate (% of Students Absent for 10%+ of Enrolled School Days) by Neighborhood Poverty Level

(Very High Poverty)

(Affluent)

<10% 10-20% 20-30% 30%+0%

5%

10%

15%

20%

8%

14%

18% 17%


% C

hron

ical

ly A

bsen

t

Over 2X Higher

Crime and Violence:Homicide Death Rate by Neighborhood Poverty Level

<10% 10-20% 20-30% 30%+0

5

10

15

20

25

30

35

4

11

21

30


Rate

per

100

,000

7.9X Higher

(Very High Poverty)

(Affluent)


Mass Incarceration:Youth Incarceration Rate by Neighborhood Poverty Level

Source: CAPE with data from Urban Strategies Council & the Alameda County Probation Department, 2010 (Aug) -2011 (June)

<10% 10-20% 20-30% 30%+0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

0.5%

1.1%

2.3%2.5%


% o

f You

th A

ges 1

0-17

w

ho a

re In

carc

erat

ed

5.4X Higher

(Very High Poverty)

(Affluent)

1 out of 200 youthincarcerated

1 out of 40 youthincarcerated

Hypertension:Hypertension Hospitalization Rates by Neighborhood Poverty Level*

*Includes hospitalizations with hypertension as a primary or top 4 associated diagnosisHospitalization rates and neighborhood poverty are at the zip code level

<10% 10-20% 20%+0

500

1,000

1,500

2,000

1,084

1,7691,890


Rate

per

100

,000

1.7X Higher



Hypertension:Hypertension Hospitalization Rates by Race/Ethnicity

<10% 10-19.9% 20+%0

500

1,000

1,500

2,000

2,500

3,000

3,500

BlackWhiteLatinoAPI


Rate

per

100

,000


Source: Alameda County OSHPD files, 2009-2011 with input from Alameda County Behavioral Health Care Services


Mental Health:Rate of Visits to the Emergency Department for Severe Mental Illness*

* Includes ED visits with severe mental disorders as primary or top 4 associated diagnosisED rates and neighborhood poverty are at the zip code level

<10% 10-19.9% 20%+0

100

200

300

400

500

600

212

436

565


Rate

per

100

,000

2.7X Higher



of Color

InequitableBuilt

Environment Conditions

• Housing Quality and Affordability• Transit Dependence• Street Safety• Supermarkets and Healthy Foods• Clean Air and Water

Access to Quality Housing:Age of Housing by Neighborhood Poverty Level

<10% 10-20% 20-30% 30%+0%

10%

20%

30%

40%

50%

60%

21%

35%

49% 49%


Perc

ent o

f Hou

sing

Uni

ts

Built

<19

50 (%

)Over 2X Higher


(Very High Poverty)

(Affluent)

Household Overcrowding by Neighborhood Poverty Level

<10% 10-20% 20-30% 30%+0%

4%

8%

12%

16%

Overcrowded (1.01-1.5 per room)

Severely Overcrowded (1.51+ per room)


Perc

ent o

f Hou

seho

lds

Over 4X Higher

3%

7%

11%

14%


(Very High Poverty)

(Affluent)

Access to Affordable Housing:Rental Housing Cost Burden by Neighborhood Poverty Level

<10% 10-20% 20-30% 30%+0%

10%

20%

30%

40%

50%

60%

70%

42%49%

59% 61%

19%25%

35% 36%

Housing cost burden (30%+ of income on rent)

Severe housing cost burden (50%+ of income on rent)


Perc

ent o

f Res

iden

ts

1.5X Higher

1.9X Higher


(Very High Poverty)

(Affluent)

Access to Transportation:Zero Vehicle Households by Neighborhood Poverty Level

<10% 10-20% 20-30% 30%+0%

4%

8%

12%

16%

2%

5%

8%

14%


Perc

ent o

f Hou

seho

lds

with

Zer

o Ve

hicl

es (%

)

About 7X Higher


(Very High Poverty)

(Affluent)

Access to Safe StreetsAdjusted Rate of Pedestrian Injuries & Deaths

by Neighborhood Poverty Level

Source: CAPE with data from SWITRS, 2006-2010

(Very High Poverty)

(Affluent)

<10% 10-20% 20-30% 30%+0.0

0.5

1.0

1.5

2.0

2.5

0.6

1.4

2.2 2.2


Adju

sted

Ped

estr

ian

Inju

ry a

nd D

eath

Rat

e

3.8X Higher

Access to Supermarkets:Limited Supermarket Access (LSA) score


<10% 10-20% 20-30% 30%+0

10

20

30

40

50

60

70

80

3743

5967


Aver

age

LSA

Scor

eLimited

Supermarket Access

GreatestSupermarket Access

Source: CAPE with data from the Reinvestment Fund, 2011

(Very High Poverty)

(Affluent)

More Limited Supermarket Access

Exposure to Liquor Stores:Off-Sale Liquor Outlet Density


Source: CAPE with data from Department of Alcohol Beverage Control, 2013

<10% 10-19.9% 20-29.9% 30%+0

1020304050607080

43

66 6975


Off-

Sale

Liqu

or Li

cens

es

per 1

00,0

00 R

esid

ents

1.7X Higher

Exposure to Clean Air:Location of Pollution Sources, including

Highways and Port of Oakland

Exposure to Toxic Chemicals and Fuels:Density of Industrial Chemical (SLIC)

and Fuel (LOP) Release Sites

<10% 10-20% 20-30% 30%+0

50

100

150

200

250

300

350

83 115

239

332

Neighborhood Poverty Level(% of residents living in poverty)

Dens

ity o

f Ind

ustr

ial C

hem

ical

and

Fu

el R

elea

se S

ites

(# o

f SLI

C/LO

P si

tes p

er 1

00,0

00 p

op)

4X Higher

Source: CAPE with data from Alameda County Environmental Health, 2005-2013 (July)


<10% 10-20% 20-30% 30%+65

70

75

80

85

90

Neighborhood Poverty Level(% of residents living in poverty)

Life

Exp

ecta

ncy

at B

irth

(in y

ears

)

AsianLatino

White

Total

Black

Place, Racism, and Neighborhood Poverty: How do they Interact?

Race and Social Gradients in Health

(Very High Poverty)

(Affluent)

Life Expectancy at Birth in Oakland Flats vs. Hills


All Races Asian Latino White Black60

65

70

75

80

85

90

77.8

85.3 85.0

78.2

71.6

83.885.6 85.1 84.1

79.6

Oakland Flats Oakland Hills

Life

Exp

ecta

ncy

at B

irth

(in y

ears

)

Photo Source: The California Endowment, Health Happens Here

OOAKLAND HILLSLIFE EXPECTANCY 85

OWEST OAKLANDLIFE EXPECTANCY 71


Compared to a White child in the affluent Oakland Hills, an African American child born in West Oakland is…

2 times more likely to be born low birth weight

12 times less likely to have a mother who graduated from college

13 times more likely to live in poverty

4 times less likely to read at grade level

5 times more likelyto be unemployed

3 times more likely to die of stroke

INFANT CHILD ADULT

Cumulative impact:14 year difference in life expectancy

Source: Alameda County Death files, 2010-2012; Alameda County Birth files, 2009-2011; American Community Survey, 2007-2011; California Dept of Education, 2012-2013

Good Health Status

Communities of Opportunity

• Parks• Safe/Walkable Streets• Grocery Stores and

Healthy Foods• Good Schools• Clean Air• Quality Housing• Public Transportation• Good Jobs• Strong Local Businesses• Financial Institutions

Poor Health Status

• Limited/Unsafe Parks• Crime• Fast Food Restaurants• Liquor Stores• Poor Performing Schools• Pollution and Toxic

Exposures• Transportation Barriers• Absence of High Quality

Financial Institutions• Predatory Lenders

Disinvested Communities

Increasing Opportunities for Good Health

Elaine BautistaSamantha Bell

Matt BeyersJanet Brown

Sangsook ChoRoxanna Guide

Tammy LeeJane Martin

Chuck McKetneyRuvani FonsekaAviva LipkowitzKatherine Schaff

Roza Tammer

Acknowledgements:CAPE Epidemiology+ Team

Questions, Comments, or Ideas?

Please contact:

Tammy LeeCommunity Epidemiologist

Alameda County Public Health Departmenttammy.lee@acgov or 510-268-2619

mailto:tammy.lee@acgov

How Place, Racism, and Poverty Matter for Health in Alameda County

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