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Equity: Community Health | SSMC

Equity: Community Health

Why is this Important?

Community Health is the pursuit of improving the health of a group of people living in a defined geographical area. Access to high quality, affordable medical care in conjunction with urban planning that is responsive to public health objectives helps people live healthier, more productive lives. Rising healthcare cost along with large numbers of uninsured have made medical bills a main contributor to bankruptcy filings in the United States. Those who are insured have a lower mortality rate and are more apt to receive preventative care than the uninsured.

Chronic diseases, including cancer, heart disease, diabetes, and chronic respiratory disease, are the leading causes of death and disability in San Mateo County and the United States. With the aging of the county’s population, chronic diseases will become more prevalent and place a growing burden on the local healthcare system.

Lifestyle behaviors including poor nutrition, tobacco use, and lack of physical activity are responsible for an estimated 50% of premature deaths. In particular, the obesity epidemic, with its associated diseases and disabilities, is the greatest public health issue in the county, threatening to overturn decades of gains in life expectancy.

What is a Sustainable State?

In a sustainable state, all community members have access to affordable, high-quality medical care. Integrated approaches involving prevention and disease management lead to lower disease incidence, improved health outcomes, and reduced hospitalizations. Walkability, neighborhood safety, and access to healthy food and recreation are central elements of land use planning.

Key Findings

  • As of 2014, 10.2% of adults (18-64 years) in the county lack healthcare insurance. Low-income earners and people with a high school education or less had the lowest rates of coverage.
  • The prevalence of asthma and diabetes increased significantly from 1998 to 2013. Currently, 18% of county residents have asthma, while 10% are diabetic.
  • Heart disease and cancer remain the most frequent causes of death in the county. Mortality by race/ethnicity shows that the gap between African Americans and other groups is narrowing.
  • The county met the Healthy People 2020 National Standard for age-adjusted death rate for all causes of death.
  • San Mateo County achieved the Healthy People 2020 target of 6 infant deaths per 1,000 live births in all racial/ethnic groups except African Americans (9.8 deaths per 1,000.)
  • Obesity has risen to 22% among adults in 2013.
  • Only 36% of the county’s 7th graders met all 6 Basic Fitness Standards in 2010-2011, down from 41% in 2008-2009.
  • The smoking rate in San Mateo County (10.1%) has declined sharply ince 1998 and is well below California (12.9%) and U.S. (17.3%) levels.

Indicators and Trends
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Access to Healthcare

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Health Insurance Status, San Mateo County, 2014
  • Though the Affordable Care Act has increased access to healthcare, 10.2% of San Mateo County residents are uninsured.
  • The average increase in insurance rates in the state of California was 4% from 2015-2016, and 4.2% the prior year.

Covered California

Covered California is the state-based marketplace for health insurance, created by the state to implement the Patient Protection and Affordable Care Act (ACA). The marketplace is accessible to individuals who do not qualify for Medi-Cal (earn less than 138% of the federal poverty level (FPL) and who do not receive insurance through their employer. Individuals earning between 100% and 250% of the FPL receive a tax subsidy that reduces their out-of-pocket expenses.

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  • Enrollment totals for San Mateo County in 2015 were 24,770, compared to 26,671 for the first enrollment period beginning in 2013.
  • When considering the lower cost Covered California health plans, rates increased by an average of 2.4% from 2014-2015, and 4.6% the prior year.
  • Silver (60.9%) was the most popular metal tier for subsidy eligible enrollees. Some of these enrollees receive a tax subsidy for enrolling in a silver plan. Bronze (41.4%) was the most popular metal tier for enrollees without a subsidy.

Medi-Cal expansion

Following the Supreme Court’s ruling in the National Federation of Independent Business v. Sebelius in 2012, ACA expansion of Medicaid is an option that can be adopted by the states. California, along with 26 other states and the District of Columbia, has opted to expand its Medicaid programs in order to meet the new federal ACA guidelines. Some of the major changes from the legislation are:

  • Coverage of childless adults. Before Medicaid expansion, childless adults were not eligible for Medicaid. Childless adults with incomes below 138% of the federal poverty level (FPL) now qualify.
  • Expanded coverage for families. Medicaid covered families earning less than 106% FPL before Medicaid expansion. The expansion raises the threshold to 138% FPL.
  • Extended coverage for former foster care children. Former foster care children may now enroll in Medicaid through age 26. There is no income test requirement.

During Covered California enrollment through March 31, 2014, approximately 1.9 million people enrolled in Medi-Cal (the name for California Medicaid) or were transitioned to Medi-Cal from another program. In San Mateo County, 15,765 newly eligible enrolled in Medi-Cal as of May 1, which is more than the 13,000 the county had estimated to be eligible for Medi-Cal. While expanding Medi-Cal will cost the government more in terms of insurance payments, the expansion will also save money by reducing emergency care for the uninsured and providing access to preventive services.

For more information, visit The California Department of Health Care Services.

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Chronic Disease

Prevalence of Chronic Illness SMC 1998-2013
  • The prevalence of asthma and diabetes increased significantly from 1998 to 2013.
  • In San Mateo County, asthma is more prevalent among blacks (26%), young adults 18-39 years old (23%), and residents in the North County region (19%). The coast side of the county has lower rates of asthma (14.5%) compared to the rest of the county.
  • The rate of diabetes in seniors (23.1%) is much higher than the rate in young adults (2.4%). Prevalence of diabetes is also higher for blacks (14.9%) and people living under 200% of the federal poverty level (17.9%).
Incidence of Cancer by Race-Ethnicity (5-year moving averages) SMC
  • Incidence of cancer declined from 1997-2001 to 2005-2009 for all race/ethnicity groups, except for Asians, who saw their rates increase.
  • Hispanic/Latinos now have the lowest incidence of cancer in the county, while whites have the highest.

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Causes of Death

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  • The death rate in San Mateo County Continues to drop and is below the Healthy People 2020 National Standard for every category.
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  • African Americans saw the biggest drop in mortality (-17%).
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  • Though heart disease mortality has decreased in the county, disparity between ethnicities persists.
Annual Rates of YPLL-Top 5 Causes SMC.eps
  • Years of Potential Life Lost (YPLL) measures premature mortality by giving more weight to deaths that occur at younger ages.
  • YPLL declined 33% from 2000 to 2010.

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Prenatal and Maternal Care

Percent of Births with Adequate Prenatal Care SMC 2000-2010.eps
  • The share of adolescents giving birth with adequate prenatal care increased 23% since 2000.
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  • Infant mortality rates for all groups except African Americans are below the Healthy People 2020 target of 6 per 1,000 live births. Rates for White and Asian infants have decreased since 2008-2010.

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Healthy Behaviors and Risk Factors

Adult Obesity SMC 1998-2013.eps
  • Obesity rates continue to climb and have reached 22% in San Mateo County. This is slightly lower than the state prevalence of 24% and far below the U.S. level of 36%
Obesity by Race-Ethnicity SMC 2013.eps
  • Obesity rates are highest among Hispanics/Latinos (31%) and African Americans (30%) and lowest among Asians and Pacific Islanders (12%).
Percent of Children who are Overweight or Obese 2011 Table.eps
  • The childhood obesity epidemic continues to pose risks for the health of children. Although the prevalence rate for overweight or obese is lower in the county than in the state as a whole, approximately one in four county children fall into this category with potential long-term implications for diabetes, heart disease, and premature mortality.

Percentage of School Days when Child Biked or Walked to School SMC 2013

  • The majority of San Mateo County school-aged children did not ride a bike or walk to school at all in the past year
  • Close to 15% of school-aged children walked or rode a bike more than half of the time in the past year.

Wellness Policies

Daly City and Burlingame are the first two cities in San Mateo County to receive funding from the countywide initiative: Get Healthy San Mateo County. With this funding, the cities will adopt comprehensive wellness policies that will prohibit the service of sugary drinks and improve the choice of healthy food options for city facilities/gatherings. In addition, innovative policies adopted by the cities will support active public transportation and include opportunities for exercise for staff and clients, such as “walking meetings” and stretch breaks. For more information on the wellness policies, visit gethealthysmc.org.

Percent of 7th Grade Students Meeting Fitness Standards 2010-2011.eps
  • 36% of 7th graders in San Mateo County met all six of the basic fitness standards in 2010-2011. Only 20% of Hispanic/Latino 7th graders accomplished that compared with 57% of Asian students.

Self-Reported History of Mental Illness or Emotional Problems-SMC 2013

  • Self-reported history of mental or emotional illness has become more common, increasing from 5.1% in 1998 to 7.9% in 2013
  • Women, adults under age 65, residents living below 200% of the federal poverty level, and whites have high rates of mental/emotional illness in the county. Asians/Pacific Islanders have the lowest reported rate.
Percent of Adult Population who are Current Smokers 1998-2013.eps

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