Place Matters: Eliminating Health Disparities in Alameda County, California

May 5, 2014, 11:41 AM


Despite certain positive shifts in overall health outcomes for residents in Alameda County, Calif., significant inequities exist, particularly among African-Americans, Latinos and Native Hawaiian/Pacific Islanders, as well as low-income residents.

The Alameda County Place Matters team works throughout Alameda County, including the City of Oakland, the largest city in the county.

Team Objectives include:

  • Affordable housing
  • Quality education
  • Access to economic opportunities
  • Criminal justice reform including reducing the incidence of incarceration
  • Improvements to land use
  • Accessible, safe and affordable transportation

Alameda County Supervisor Keith Carson initiated the Alameda County Place Matters team. The team is currently housed within the Alameda County Public Health Department and supported by health department staff. The initiative has numerous community partners that include community-based organizations; city and county government agencies; and nonprofits.

Among the critical issues the Place Matters team is currently focused on are displacement, the built environment, and development and how those impact health, according to team communications lead Katherine Schaff.

The team is working with community partners and planners on a healthy development checklist that the city of Oakland can use to take health considerations into account during city permitting and decision making to try to ensure more transparency and accountability to residents in that process. She said the goal is to have city planners go through the checklist before projects are approved. The checklist, said Schaff, might have allowed for more time for community comment before plans were authorized for a new crematorium that is expected to add to pollution and exacerbate asthma cases.

“The Bay Area is undergoing rapid transformation and growth and development and we’re really trying to insert ourselves into multiple parts of that process to think more critically about how we’re developing our communities,” she said. “We’re also looking at displacement and gentrification and the impacts on communities, especially communities of color that might have been displaced multiple times over multiple generations and dealt with repetitive trauma that has had profound health impacts.”

A community-based organization, Causa Justa::Just Cause, recently released a report on gentrification and displacement, with the Alameda County Public Health Department and the Place Matters team contributing health impact research and data and policy analysis.

“This is one of the first instances we know of in the country where a community-based organization and a health department have worked together to define gentrification and displacement and analyze the impact at a local level, recommend policies that can be advanced to prevent displacement, and examine the links between gentrification, displacement and public health,” she said.

Schaff said the team is hoping to create a lot of momentum with the report to engage people in the discussion and ultimately lead to policy changes that protect tenants, renters and low-income homeowners, many of whom are “still trying to mitigate some of the issues that came up during the sub-prime mortgage crisis.” The team hopes to get policy leaders to “think about development in a way that improves our communities but also allows people who have lived there for a long time to stay there.”

The team is also working on issues related to foreclosure. “One issue often discussed,” said Schaff, “is that many people in low income communities were more likely to be offered predatory or sub-prime loans because a lot of these communities had very limited access to healthy or mainstream financial products. They were the targets for predatory lending and so it really opened up a hole for sub-prime lenders to come in and push these loans that had extreme implications once the rates went up and people starting losing their homes.”

She said the team is trying to open up access to healthy credit options for residents, including a pilot program that would allow a public health nurse or community outreach worker—for example—to refer clients to lenders working with the county to offer very small loans to clients who have no other affordable options when cash shortages arise. Repaying those loans would help establish credit, which could then help people access mainstream financial products later on. This will “help them stabilize financially and be in more of a position for wealth building or home ownership down the road,” she said. An advisory committee made of local partners is evaluating what the financial product might look like and reviewing models from other communities, with the goal of presenting the concept to the County Board of Supervisors within the next few months.

The team has also been working on housing code enforcement. Schaff said to get help for housing problems such as roaches or mold, a family may have to place the call, and they often will be reluctant for fear of being evicted by a landlord over complaints. Other cities, however, are moving to a model of community driven code enforcement with inspectors going out to certain zip codes with a history of problems so that the burden of addressing housing violations and health hazards doesn’t fall onto tenants. She said the team is still in the research phase to find effective means of code enforcement that truly benefit the community.

“[Oakland has a] huge, huge history of strong community organizing, groups that have been around for decades, residents who have been organizing since the civil rights movement and before, and so we’re very cognizant that we want to add to that and listen to what they’re doing and see where we can fit in with their work and ongoing policy work,” said Schaff. “We have strong community partners and a lot of times they’re leading and the health department supports them, and sometimes we’re taking the lead, but it’s always with a really firm understanding that our work is stronger when we are really aligned with the priorities of community residents and base building organizations. That’s been a priority for us.”

This commentary originally appeared on the RWJF New Public Health blog.