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.

Community Actions: A First Look

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.

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.

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?