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.
Health Priorities and Narrative
Leadership for health comes primarily from the county’s integrated health and social services agency (HHSA) and local healthcare systems.
Live Well San Diego has expanded as the county’s flagship health promotion initiative, with an intensified focus on aging in recent years.
Robust efforts help individuals facing homelessness and recent migrants receive the services they need, and efforts are integrated with initiatives to address mental health challenges.
Health Priorities and Narrative
Over the past five years, Live Well San Diego continues to guide the vision and collaborative action for health in the county.
Concerns about rising homelessness have increased over the past five years, as well as concerns about behavioral and mental health challenges highlighted by the pandemic.
Racial equity has become a more explicit element of the local approach to health equity, from HHSA, to county and city governments, to nonprofits. Leaders have implemented changes to structures, staffing, and investment in response.
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.
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
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