Community Context 

Stockton—the county seat of the San Joaquin Valley in Northern California—is roughly 50 miles south of Sacramento and about 80 miles west of San Francisco. The city’s population of more than 300,000 people is is diverse racially and ethnically. 

Stockton’s agricultural industry has attracted migrant workers to the area. Stockton’s port and well-established network of railroads play an important role in the city’s economy, as transportation and logistics is one of the city’s top industries. 

A variety of factors, including the 2008 financial crisis and deep municipal deficits led to Stockton declaring bankruptcy in 2012. During this time, the city experienced a wave of layoffs in its police and fire services, an unemployment rate that peaked at 17 percent, the second highest foreclosure rate in the country, and an increase in violent crime. Stockton moved out of bankruptcy in 2015, first electing a mayor with a progressive agenda in 2017, though that agenda moved more conservative with the mayoral election in 2020. 

Throughout the COVID-19 pandemic, the San Joaquin Valley made concerted efforts to equitably provide services to its diverse residents. However, the city of Stockton’s response to COVID-19 was somewhat hindered by the disconnect in messaging from various departments in local government.

Community Actions

Stockton’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, Stockton’s capacity to promote health, well-being, and equity has been principally led by San Joaquin County Public Health Services, in collaboration with various healthcare systems, community coalitions, and active grassroots organizations. Stockton has community-level investment from philanthropic entities, entities which have a clear focus on racial justice, including health equity. With regards to the health narrative in Stockton, a longstanding focus on the social determinants of health has only deepened over the past five years, with better coordination among organizations making the connection among factors such as housing, trauma, economic investment, and health. And in regards to health equity, Stockton’s approach has evolved over the past five years, from considering the role of equity in issues such as community trauma, to beginning to implement policy frameworks that connect social and economic equity with health equity.

Lessons Learned: Where is Stockton Five Years Later?

While Stockton is not in the same position economically as it was after the bankruptcy filing in 2012, there remain significant economic issues that are challenging the community’s ability to fully thrive, retain young people, and continue to revitalize neighborhoods. Critical investments in South Stockton and leadership of grassroots organizations have been essential to the city’s ability to support its diverse population, particularly underserved immigrant groups.

The focus on community trauma and the connection to historical and structural inequity continues to serve as a critical gateway to discuss equity broadly and health equity specifically. Stockton’s journey to promote health, well-being, and equity is one that illustrates how a community needs to leverage grassroots capacity and build on innovations in cross-sector collaboration. Stockton also faces difficulties in realizing positive health outcomes from those investments when there are problems in access to health services and entrenched inequities based on geography and race.

Other communities can learn from Stockton’s efforts to build broad-based community initiatives to support health, including the use of philanthropic and private sector funds, as well as the insight gained from piloting new models, such as universal basic income. Future research could consider the ways in which Stockton is leveraging new city data capacity, neighborhood-level investments, and more authentic community engagement to realize long-term gains in health and health equity outcomes.

Stockton has progressed its work to build broad-based solutions to social issues, connecting topics such as health and trauma with public safety, economic development, and youth well-being, aided by investment from the state and philanthropic entities. There is greater promise in community engagement and data capacity. However, Stockton is grappling with significant questions around racial, ethnic, and geographic inequities and whether and how upstream solutions will effectively address the historical and structural source of those inequities.

Facilitators:

  • Augmented approach to community engagement with greater diversity of organizations

  • Strong cross-sector collaborations focused on social determinants of health

  • Commitment to supporting economic resilience

Barriers:

  • Geographic segregation within city based on race/ethnicity

  • Collective stress and trauma difficult to address

  • Inequities in healthcare access