San Diego County, California

Stretched out along the sunny southwest Pacific Coast, San Diego County is considered a national standard for collaborative community health planning.

From its cliffside bike paths to its eastern farmlands and deeply multicultural city neighborhoods, the county is one of the more physically active, healthy, and engaged communities in the state and nation. It benefits from an integrated County Health and Human Services Agency, including Public Health Services, that engages in comprehensive strategic planning. It also secures and coordinates funding for cross-sector partnerships aimed at improving community health.

Relative to the rest of the nation, the county as a whole ranks well in terms of physical activity and health. Because of its sunny and mild climate and its highly accessible bike routes, hiking trails, and other outdoor physical activity infrastructure, San Diego County’s population tends to be physically active and healthy. But a closer look reveals that stark racial and ethnic disparities do exist.

Overview

Population and Demographics

Population: 3,183,143

SOURCES:
U.S. Census Bureau; photography courtesy Flickr user dpbirds, CC BY-NC-ND 2.0.

Context and Actions

Community Context and Challenges

Socioeconomic and health indicators reveal unequal incomes, educational attainment, employment opportunities, poverty rates, and access to health care among subgroups of county residents.
Among white residents, 9% report fair or poor health, compared to significantly higher rates reported by Black (21%), Asian (24%), and Hispanic (23%) residents.
As of 2014, the county had a shortfall of 127,930 homes considered to be affordable to very low-income and extremely low-income households, with 70% of very low-income households paying more than 50% of their income in rent.
Compared with the average city in the United States, it will cost someone 44% more to maintain the same standard of living (e.g., housing, food, health care, taxes) in San Diego County.

SOURCES:
U.S. Census Bureau. (2014). 2010–2014 American Community Survey 5-Year Estimates.

UCLA Center for Health (2014)

Taking Action

The County of San Diego has a vision for making “a region that is Building Better Health, Living Safely, and Thriving.”

Significant multi-sector strategies and processes are in place to help navigate the health disparity challenges and maintain the county’s standing as a leader in public population health. Despite widespread and measurable success, significant challenges remain to address racial and ethnic health disparities, housing affordability, and a high cost of living.

NOTE:
These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gauge ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

Strategic Planning

What sets San Diego County apart from other communities across the country is its commitment to strategic planning. The integrated Health and Human Services Agency’s (HHSA) strategic processes have directly led to increased funding, coordination and a more effective commitment to a shared, community-wide vision of health.

Live Well San Diego

Live Well San Diego was first conceived as a 10-year plan and has now evolved to become the vision for the whole county of San Diego.

As a unified vision for collective health Promotion, Live Well San Diego has successfully engaged county government, health care providers, community and faith-based organizations, businesses, school districts and more to change community and organizational cultures and create positive measurable change in community health outcomes.

Population Growth Challenges

San Diego County is a desirable place to live due to its climate, access to natural and built resources, employment opportunities and diverse cultural mix. However, these features also contribute to significant challenges related to population growth, including the effects of gentrification and displacement, the increased costs of living and the lack of affordable housing.

Consolidating Efforts

Under the impetus of Welfare Reform in 1998, county officials consolidated public health, several human services departments and behavioral health services into HHSA to eliminate programmatic silos, bureaucracy and duplication of efforts. This consolidation is helping to move the county toward a more integrated and collaborative approach to addressing health.

Going Forward

Questions for Consideration

San Diego County stands as a prime example of the strengths and benefits of collaborative strategic planning to achieve population health. The county continues to be successful in bringing partners together to plan and implement multifaceted public health initiatives and policies. Evidence of a strong public health network and community infrastructure that supports public health has helped San Diego County successfully bring in funding from a wide variety of sources, including state and federal health agencies, with much of this funding then being redistributed to partner organizations, further building their capacity to implement strategies that will improve the health and well-being of San Diego residents.

Although San Diego County has achieved many successes, the county still faces numerous challenges, including stark health disparities by race/ethnicity, limited access to affordable housing, a very high cost of living, gentrification of downtown San Diego, and high rates of homelessness. Additional surveillance, data and information gathering, analysis, and reporting are needed to help identify the most effective methods and partnerships and also help guide the community’s efforts and resource allocations. Continued monitoring of activities and outcomes in San Diego County could provide insights into the degree to which meaningful change is taking place and can be sustained.

The following questions could provide insights into the degree to which meaningful change is taking place and can be sustained:

Are organizations that serve the many subgroups within San Diego County (e.g., those that live in unincorporated areas, recent immigrants) actively engaged in strategic planning and program implementation? If so, what organizations have been most successful in advocating for these residents, and who is missing from the table?
With a diverse set of stakeholders and partners engaged in Live Well San Diego, what has the collective impact been of their efforts? What is the impact of these efforts on different sub-populations? Specifically, low-income residents, Hispanic residents and Black residents?
What resources are available and have been shown to be effective in meeting the health and well-being needs of those experiencing health disparities? Specifically, low-income, Hispanic and Black residents?
How is San Diego County meeting the unique needs of undocumented immigrants who live in the county or are transiting through the county in search of other opportunities throughout California and the United States?
What are the facilitators of and challenges with working with a large and diverse set of partners to implement a coordinated population health vision?
How does military presence and spending—and the fluctuation of that spending—affect county planning, programming, and the delivery of resources?
How are organizations in San Diego County using data to inform their strategic-planning and decision-making processes?