The Alameda County Place Matters team was initiated by the Alameda County Public Health Department.  The Alameda County Board of Supervisors, the City of Oakland Human Services Division, and Urban Habitat are partnering organizations.  As the team develops a local policy platform in specific policy arenas, new partnerships will be developed.

PERSISTENT HEALTH INEQUITIES IN ALAMEDA COUNTY

Despite improvements in health status across all groups in Alameda County, we continue to observe large and persistent disparities in health based on race, income, neighborhood, education, and other social determinants. There is even some evidence that these health disparities are worsening.  

While significant health disparities can be found that afflict almost every racial and ethnic group, the magnitude of racial health disparities in Alameda County are most profound for African-Americans, Latinos, and Native Hawaiian/Pacific Islanders. Among Alameda County’s specific race/ethnic population groups, African Americans fare the poorest on most key measures of morbidity and mortality.  They have the highest rate of death from all causes, as well as the highest rates of both death and illness from coronary heart disease, stroke, lung cancer, prostate cancer, asthma, motor vehicle crashes, and homicide/assault.  Latinos have disproportionately high rates of diabetes hospitalization and mortality, and the highest rates of overweight and obese adults, overweight youth ages 5-11, and births to teenagers, and finally, the lowest rate of health insurance among adults.  Native Hawaiian/Pacific Islanders have the highest rate of diabetes mortality and the lowest rate of first trimester prenatal care.  While health disparities directly impact communities of color, they are of concern to all of Alameda County because it their presence in the midst of affluence is a contradiction of our communities progressive values.  Furthermore, health disparities are an economic drain on our community.

The root causes of health disparities are complex and closely tied to similar persistent racial and class disparities in education, employment, income, and housing, among others.  It is this relatedness to other social inequities and our recognition of their inherent injustice that leads us to regard them as health inequities, rather than health disparities. Eliminating health inequities will require sophisticated and sustained multi-disciplinary interventions. These must simultaneously address both the conditions in our low-income neighborhoods and the inequitable policies that continue to systematically deprive the residents of these neighborhoods of access to critical social goods such as good schools, better jobs, affordable housing, safe recreational space, clean air, and less crime.

The Alameda County Place Matters team will promote more equitable distribution of social goods by influencing policies in housing, education, economic development, incarceration, land use, and transportation.  Specifically, we will work toward the following goals:

Affordable Housing: An adequate supply of housing is constructed and preserved in proportion to demand for that housing with regards to size and affordability, so that the cultural, racial, and class diversity of the community is maintained.  All housing is safe, habitable, and supports good health.  No household resides in overcrowded conditions, is homeless due to housing costs, or resorts to spending more than 30 percent of the income on housing costs.  
Education:  All school-aged youth have access to a quality education that prepares them to be productive members of the community, provides a safe and stimulating learning environment, and prepares them to achieve their goals and dreams.  Schools expect and ensure that all students graduate.  Life-long learning opportunities are accessible to all residents.  
Economic Development:  All residents have access to high quality, local employment opportunities that provide healthy, safe and meaningful work, so as to increase income and wealth equity.  
Incarceration:  By interrupting the cycle of recidivism and deducing the disproportionate minority contact with the justice system, men of color will no longer be incarcerated at disproportionate rates.  An equitable judicial system will be achieved at each stage of the process, including arrest, trial, sentencing, and reentry.  
Land Use:  Communities are designed to promote and support safe walking and biking, and to provide access to quality affordable food, including fresh fruits and vegetables.  All residents live in communities where the air, soil, and water are clean and provide the conditions for good health.  All residents have access to living wage jobs and culturally appropriate health care services, including prevention, treatment, and emergency response, in their communities.  
Transportation:  Citizens are easily able to go about their daily lives utilizing transportation systems that are accessible from their home and work and that are affordable.  All public transit systems run on-time with well maintained vehicles and shelters.

While achieving equity in these arenas will take sustained effort over many years, our strategy for the next twelve months will provide a strong foundation for long-term action.  We will begin by conducting in-depth assessments of the problems associated with each policy arena, with the intention of completing this step of our strategy for all of our policy domains by the end of December 2007.  These assessments will deepen our understanding of the extent of the problems, their causes and consequences, the link to health inequities, and the policies and services currently utilized for their amelioration.  Using the information exposed in the assessment phase, we will develop a problem statement.  

The problem statement will link the problem to health inequities and will be used to guide roundtable discussions with community stakeholders.  Separate roundtable discussions will be held for each policy domain, but the intended results of each roundtable are the same.  First, they will facilitate relationship building with community stakeholders connected to each policy area.   Second, we will identify the best strategies for addressing the inequities within each policy domain.  As we have already completed the assessment phase of our strategy for affordable housing, incarceration, economic development, and education, we will also complete the roundtable discussions for these policy domains by December 2007.  We aim to complete roundtables for the other two policy domains, land use and transportation, by February 2008.  

Based on the roundtable discussions, we will identify the policy priorities that are both most immediately necessary and achievable.  Additionally, we will determine advocacy roles for our team that compliment the work already being applied within each policy domain.  While our role in achieving the policy priorities will vary with each domain, the work will be unified through a cohesive local policy platform that addresses each of the social determinants of health inequities in our community.  We will choose our policy priorities for all policy domains by May 2008 and will have created a solid local policy platform by July 2008.

Through our efforts to date to implement this strategy, we have already begun working with the Oakland Unified School District Board of Education, the Bay Area Regional Health Inequities Initiative, representatives from City Councilmembers’ offices, and a variety of membership-based and grass roots advocacy organizations such as East Bay Alliance for Sustainable Communities, Urban Habitat, All of Us or None and Public Advocates, just to name a few.  As we move forward, we intend to strengthen our partnerships with these groups, as well as leverage these relationships to network with others who would be interested in working with us.  Additionally, we will also build partnerships with the business sector, including Kaiser and other groups in the health care business, as their support is essential to creating change.  As part of building a partnership with the business sector to reduce health inequities, we will attempt frame the problem in terms of its economic cost to the whole county.  

In order to implement this strategy and ensure that these partnerships are established, we need a high level of administrative support, as well as infrastructure.  Our team enjoys the support of the Office of the Director and current team members include the Public Health Director and Health Officer, the Deputy Director of Planning, Assessment and Health Equity, the Director of Community Health Services, policy analysts, program planners, and evaluators.  In addition to those already involved with the core Place Matters team, we will be expanding to include employees from programs throughout the Alameda County Public Health Department.  Our initial expansion efforts will focus on employees who have expertise in one or more of the policy domains.  

By redirecting our internal resources to this effort, as well as by joining together with agencies and organizations representing a diverse array of disciplines to influence decision-makers in each of these policy arenas, we will promote health equity.  For instance, citing undesirable local land uses, such as land fills and other sources of toxins, in communities of color is directly linked to high asthma rates in these communities.  By working with all our community’s stakeholders to influence local land use policies, we will work to ensure that no community is disproportionately exposed to such toxins. Achieving long-lasting policy changes related to the social determinants of health will assure no racial or ethnic group or economic class is disproportionately burdened by poor health outcomes.