Community Context 

On the southwest Pacific Coast near the border with Mexico, San Diego County is home to a diverse mix of urban areas (including the city of San Diego—the country’s eighth-largest city), suburbs, rural areas, tribal lands, and agricultural regions. 

Fewer than half of residents are White, and roughly one out of four are immigrants, including refugees. The local economy is diversified in industries like life sciences; manufacturing and technology; telecommunications and cybersecurity; and tourism. There is a large military and border control presence, because of the U.S. 11th Naval District headquarters and the county’s proximity to the Mexican border.

The mix of communities within San Diego County—and the presence of military and law enforcement infrastructure—has resulted in a diverse political mix. The city of San Diego and coastal towns lean more heavily Democratic, while the surrounding county has historically leaned Republican (though the most recent election cycle resulted in a majority Democrat County Board of Supervisors for the first time in many years). 

The State of California expanded its Medicaid program (Medi-Cal) in 2014; and an Older Adult Expansion went into effect in May 2022. Other health priorities for the county include looking after an aging population and substance use and associated mental and physical health challenges. 

The county benefits from temperate to warm weather year-round, and has a wealth of infrastructure for physical activity, including public beaches, trail systems, and bike-friendly urban neighborhoods. The county ranks well in terms of overall health, but there are significant racial and income disparities in exposure to health hazards, access to transportation, and opportunities for healthy activities. 

Affordable housing shortages have exacerbated access issues in many areas of the county; coupled with a substantial veteran population, homelessness is an ongoing challenge.

Community Actions

San Diego County’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, San Diego County continues to benefit from the capacity of well-funded and innovative government agencies, healthcare systems, and nonprofit organizations. San Diego has been taking steps toward better health, well-being, and equity with significant activity at the county level—led directly by the county and other government bodies, but also by coalitions, nonprofit, and academic partners—related to collective action for health, homelessness and mental health services, transportation and mobility, and food systems and access. Stakeholders have long identified the importance of the social determinants of health, but over the past five years, the role of place and access to health-promoting amenities in the health narrative has become solidified and the connection of mental and physical health is being recognized more squarely by local health leaders and residents. The county’s approach to health equity has evolved, from acknowledging the importance of addressing health equity, to establishing anti-racist commitments and actions and reexamining approaches to community representation and engagement.

Lessons Learned: Where is San Diego County Five Years Later?

Over the past five years, leaders in San Diego County have enhanced collaborative efforts to address pressing community health and well-being issues, including homelessness, mental health, and food security. Despite longstanding, cross-sectoral approaches to promoting health—and many residents prioritizing living healthy lifestyles—the community was continuing to see significant health disparities. Since 2017, local leaders have expanded efforts to increase equitable access to services and health-promoting amenities as part of a broadening understanding of the drivers of health. They have also explicitly named systemic racism as one of those drivers. However, there is still substantial need in the community due to rising housing affordability challenges, particularly in well-served areas of the county. New commitments to equity and access to environments that promote health, existing government structures, and new approaches to community engagement may help to turn attention toward structural changes. 

San Diego County’s journey to promote health, well-being, and equity is one that illustrates how a community can embed collaboration into its government structures but also one that sheds light on how a shared vision and apparent prioritization of health are not always sufficient to make rapid progress. Other communities can learn from San Diego County’s approaches and challenges to inform their own journeys.

San Diego County is leveraging a long-time commitment to health, along with collaborative structures and increased community engagement, to make progress toward addressing health and well-being. However, inequality within the vast county is driven by legacy policy choices, coupled with current affordability challenges; and collaboration is challenged by the diverse needs of different residents. 

Facilitators:

  • Strong “culture of health” among residents

  • Integrated HHSA coordinates a strategy to promote health and its various drivers

  • Greater community representation and participation in decision-making

  • Extensive data sharing and reporting

Barriers:

  • Large county, with urban, rural, and tribal areas and many organizations and constituencies 

  • Ongoing (and worsening) challenges with high costs of living 

  • Difficult-to-navigate behavioral and mental healthcare systems

  • Past zoning created unhealthy environments and inequitable exposure to health risks