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July 5, 2011 > Report examines root causes of disease

Report examines root causes of disease

Health begins where we live, work, learn and play

Submitted By Gwendolyn Mitchell and Laurel Anderson

The Santa Clara County Public Health Department's "Health and Social Inequity in Santa Clara County" report examines many socio-economic factors and their effect on health. They 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.

Evidence shows an individual's health can be attributed only in part to medical care or genes. Social determinants, such as where we live, work, learn and play are major factors affecting health. However, choices and opportunities in these key areas of life are limited by status or privilege.

"As local policy makers, we must serve all our residents' needs. The county's diversity is a great asset but must be taken into account when providing social services and health services," said President Dave Cortese, Santa Clara County Board of Supervisors. "The Health and Social Inequity Report highlights the differences that result when governments take the one-size-fits-all approach. It's a call to action to explore and advance policy solutions to reduce or eliminate health inequities."

While Santa Clara County is a healthy, wealthy and educated county on the whole, closer examination of the data reveals social and health inequities exist among certain racial/ethnic groups and low-income residents.

For example, better educated and more affluent residents 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 for more than five years; less-educated, less-affluent residents are more likely to be without health insurance; low-income residents 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 of low academic achievement; children in low-income families are more likely to suffer poor health, affecting their academic performance and ability to eventually earn a decent wage.

"The time is right to address social inequities 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 investment in prevention, we must look at local policies and practices to help level the field so everyone has equal opportunities for good health. It's an important public health strategy and is 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 bulk of expenditure is for treatment and other direct services rather than prevention. These services focus on the individual and do not address the underlying environmental conditions or causes.

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 inter-related 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 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 socio-economic status or class; those with a lower socio-economic 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 so 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 Santa Clara County has a narrower life-expectancy gap between rich and poor, action is needed before the 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 socio-economic status. However, these advantages may be lost over the years as these populations integrate culturally in the United States.

Despite the smaller gap in life expectancy, the report also identifies rising rates of chronic diseases and related risk factors among county residents, various racial/ethnic groups and 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. Such alarming trends heighten the need for action.

The report is intended to start a community-wide dialog about social inequities and how community conditions can be changed for the better. To do that, public policy makers, business and community leaders, nonprofit organizations, institutions and others in the community need to embrace the notion that good health starts in our neighborhoods, schools and workplaces.

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, visit

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