In a sustainable state, all community members have access to affordable, high-quality medical care. Integrated approaches involving prevention and disease management lead to lower disease incidence, improved health outcomes, and reduced hospitalizations. Walkability, neighborhood safety, and access to healthy food and recreation are central elements of land use planning.
Community Health is the pursuit of improving the health of a group of people living in a defined geographical area. Access to high quality, affordable medical care in conjunction with urban planning that is responsive to public health objectives helps people live healthier, more productive lives. Rising healthcare cost along with large numbers of uninsured have made medical bills a main contributor to bankruptcy filings in the United States. Those who are insured have a lower mortality rate and are more apt to receive preventative care than the uninsured.
Chronic diseases, including cancer, heart disease, diabetes, and chronic respiratory disease, are the leading causes of death and disability in San Mateo County and the United States. With the aging of the county’s population, chronic diseases will become more prevalent and place a growing burden on the local healthcare system.
Lifestyle behaviors including poor nutrition, tobacco use, and lack of physical activity are responsible for an estimated 50% of premature deaths. In particular, the obesity epidemic, with its associated diseases and disabilities, is the greatest public health issue in the county, threatening to overturn decades of gains in life expectancy.
Access to Healthcare
- The number of uninsured residents decreased to 8.1% from 10.2% in 2014.
- Employment-based insurance decreased to 47.7% from 67% the prior year.
- Medicaid increased to 21.5% from 4%. In 2014, funding from the Affordable Care Act expanded the Medicaid program (Medicaid.gov).
- Medicaid serves low-income clients and is one of the largest payers of health care in the nation.
- The average increase in insurance rates in the state of California was 4% from 2015-2016, and 4.2% the prior year (Covered California).
Covered California is the state-based marketplace for health insurance, created by the state to implement the Patient Protection and Affordable Care Act (ACA). The marketplace is accessible to individuals who do not qualify for Medi-Cal/Medicaid (those who earn less than 138% of the federal poverty level (FPL) and do not receive insurance through their employer). Individuals earning between 100% and 400% of the FPL receive a tax subsidy that reduces their out-of-pocket expenses. The 2017 open enrollment period added dental insurance to the California marketplace and proved benefits to 137,090 enrollees.
- In 2017, there were 7,130 new enrollees in San Mateo County, compared with 6,950 in 2016, 8,386 in 2015, and 26,671 for the first enrollment period for 2014.
- For enrollees in the low cost (Bronze Tier) Covered California health plans, rates increased by an average of 2.4% from 2014-2015, and 4.6% the prior year.
- 3% of enrollees in San Mateo County chose Silver Tier plans, 37% enrolled in Bronze plans, 7.3% enrolled in Gold plans, and 3.2% in Platinum plans.
- 13% of enrollees in San Mateo County were unsubsidized.
- Of those enrollees who received a subsidy, 28.3% earned between 250%-400% of the FPL.
- The amount of annual Medicare reimbursements paid to medical facilities is a representation of the cost of healthcare for the elderly and those with life-threatening conditions.
Following the Supreme Court’s ruling in the National Federation of Independent Business v. Sebelius in 2012, ACA expansion of Medicaid is an option that can be adopted by the states. California, along with 26 other states and the District of Columbia, has opted to expand its Medicaid programs in order to meet the new federal ACA guidelines. Some of the major changes from the legislation are:
- Coverage of childless adults. Before Medicaid expansion, childless adults were not eligible for Medicaid. Childless adults with incomes below 138% of the federal poverty level (FPL) now qualify.
- Expanded coverage for families. Medicaid covered families earning less than 106% FPL before Medicaid expansion. The expansion raises the threshold to 138% FPL.
- Extended coverage for former foster care children. Former foster care children may now enroll in Medicaid through age 26. There is no income test requirement.
During Covered California enrollment through March 31, 2014, approximately 1.9 million people enrolled in Medi-Cal (the name for California Medicaid) or were transitioned to Medi-Cal from another program. In San Mateo County, 15,765 newly eligible enrolled in Medi-Cal as of May 1, which is more than the 13,000 the county had estimated to be eligible for Medi-Cal. While expanding Medi-Cal will cost the government more in terms of insurance payments, the expansion will also save money by reducing emergency care for the uninsured and providing access to preventive services.
For more information, visit The California Department of Health Care Services.
- The prevalence of asthma and diabetes increased significantly from 1998 to 2013.
- In San Mateo County, asthma is more prevalent among blacks (26%), young adults 18-39 years old (23%), and residents in the North County region (19%). The coast side of the county has lower rates of asthma (14.5%) compared to the rest of the county.
- The rate of diabetes in seniors (23.1%) is much higher than the rate in young adults (2.4%). Prevalence of diabetes is also higher for blacks (14.9%) and people living under 200% of the federal poverty level (17.9%).
- Incidence of cancer declined from 1997-2001 to 2005-2009 for all race/ethnicity groups, except for Asians, who saw their rates increase.
- Hispanic/Latinos now have the lowest incidence of cancer in the county, while whites have the highest.
Causes of Death
- The death rate in San Mateo County Continues to drop and is below the Healthy People 2020 National Standard for every category.
- African Americans saw the biggest drop in mortality (-17%).
- Though heart disease mortality has decreased in the county, disparity between ethnicities persists.
- Years of Potential Life Lost (YPLL) measures premature mortality by giving more weight to deaths that occur at younger ages.
- YPLL declined 33% from 2000 to 2010.
Prenatal and Maternal Care
- The share of adolescents giving birth with adequate prenatal care increased 23% since 2000.
- Infant mortality rates for all groups except African Americans are below the Healthy People 2020 target of 6 per 1,000 live births. Rates for White and Asian infants have decreased since 2008-2010.
Healthy Behaviors and Risk Factors
- While San Mateo County’s emergency department visit rate for asthma is lower than California’s, significant disparities exist within the county by race/ethnicity.
An Unequal Burden
Emergency department visits for asthma are usually a result of poor asthma management, lack of primary care, and exposure to triggers such as air pollution. Many of these triggers—vehicle pollution, mold, rodents, and cockroaches—disproportionately impact low-income families who are more likely to live near freeways or in less expensive rental housing that has not been properly maintained. In San Mateo County, childhood hospitalization rates for asthma (per 10,000 population) were highest in these three zip codes: (For comparison, the state-wide rate is 11.)
- 94303 (East Palo Alto) 15.0
- 94061 (Redwood City) 12.5
- 94025 (Menlo Park) 10.7
- In San Mateo County in 2013, the overall rate of diabetes was 10%, an increase of 150% from 1999. The greatest increase in diabetes was seen in whites, females, and people over the age of 65.
- In 2014, 10.3% of Californians had diabetes (Trust for America’s Health) and in 2012, 9.3% of Americans had diabetes (American Diabetes Foundation).
- The risk of death by heart attack is 50% higher for people with diabetes (Center for Disease Control).
- Rates of diabetes in San Mateo County were lowest for youth and those with income over 400% of the FPL ($92,200 for a family of four).
- Though both the rates of overweight and obese have increased in San Mateo County between 1999 and 2013, the biggest change is the rate of obesity.
- Obesity has increased by 150% between 1999 and 2013, whereas, the population that is overweight but not obese has decreased by 13% over the same time period. 55% of the population was overweight (or obese) in 2013, an increase of 8% since 1999.
- In San Mateo County, the Asian/Pacific Islander population had the lowest rate of overweight and obese in 2013, with 46% and 12% respectively. The White population reported rates of 56% overweight and 21% obese. Blacks and Latinos reported rates of approximately 60% overweight and 30% obese.
- Nationally, more than two-thirds of adults are characterized as overweight (Office of Disease Prevention and Health Promotion).
- Kidsdata.org, a program of Lucile Packard Foundation for Children’s Health, reports that the number of children drinking one or more sugar-sweetened beverage per day was 48% in 2013-2014. This is a increase of 65% compared to 2011-2012.
- Students are tested on California’s fitness standard, comprised of six categories: upper body strength, flexibility, aerobic capacity, body composition, abdominal strength, and trunk strength.
- The majority of San Mateo County school-aged children did not ride a bike or walk to school at all in the past year
- Close to 15% of school-aged children walked or rode a bike more than half of the time in the past year.
Daly City and Burlingame are the first two cities in San Mateo County to receive funding from the countywide initiative: Get Healthy San Mateo County. With this funding, the cities will adopt comprehensive wellness policies that will prohibit the service of sugary drinks and improve the choice of healthy food options for city facilities/gatherings. In addition, innovative policies adopted by the cities will support active public transportation and include opportunities for exercise for staff and clients, such as “walking meetings” and stretch breaks. For more information on the wellness policies, visit gethealthysmc.org.
- Self-reported history of mental or emotional illness has become more common, increasing from 5.1% in 1998 to 7.9% in 2013
- Women, adults under age 65, residents living below 200% of the federal poverty level, and whites have high rates of mental/emotional illness in the county. Asians/Pacific Islanders have the lowest reported rate.
The food environment is an important determinant of food choices available to residents, especially for those with limited transportation and time to shop for food. Residents that are particularly affected by the food environment are children at school, low-income populations, and the elderly or disabled.
Overall, San Mateo County’s food environment is characterized as a “Food Swamp” that offers a high number of opportunities to purchase low quality and highly processed food. However, within San Mateo County there are areas characterized as “Food Deserts”, where residents have low access to healthy food. Healthy food retailers are defined as supermarkets, in contrast to nutritionally deficient food retailers, such as corners stores and liquor stores. Healthy food is defined as fruits and vegetables, low-fat dairy items, meat products, and whole grain foods. The map below shows the food deserts in San Mateo County, as identified by the USDA Economic Research Service.
The San Mateo County Community Health Needs Assessment, provides an overview of the data collected through a telephone survey, where residents self-report health conditions, eating and activity habits, as well as demographic information on income, education, and race/ethnicity. The 2013 survey provided insights into the county’s food environment.
- Access to fresh fruits and vegetables is an important factor for a healthy food environment. Though residents may report eating the recommended amount of fruits and vegetables, fried vegetables and fruit with added sugar contribute to negative health outcomes in the long run. In 2013, the highest rates of “fair” or “poor” access to fresh fruits and vegetables were reported by those with less than a high school education, those living below 200% of the poverty level, Black and Latino residents, and those living in the south county area. Overall, 50% of residents reported an excellent level of “ease of access” to fresh fruits and vegetables.
- The USDA recommends reading nutrition labels to manage daily intake of vitamins, protein, fat, and carbohydrates. Approximately 78.5% of residents in San Mateo County report reading food labels when making grocery decisions, an 8% increase compared to 2008. More women reported reading food labels compared to men, a difference of about 10%. The lowest rates of reading food labels were reported among those with a high school education or below and those with income below 200% of the poverty level.
Robert Wood Johnson Foundation County Health Rankings. (2017). Retrieved from: www.countyhealthrankings.org
San Mateo County Health Department.Community Health Assessment Report. (2013). Retrieved from: (http://www.smchealth.org/
U.S. Census Bureau, American Community Survey, 2015, 1-year estimates. Healthcare Insurance Coverage. Retrieved from: https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml