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New Rankings Show Healthiest and Least Healthy Counties in California

March 19, 2019

Report Explores the Impact of Severe Housing Cost Burden on Residents

Marin County ranks healthiest in California and Lake County is the least healthy county in the state, according to the annual County Health Rankings, released today by the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute (UWPHI). The Rankings are available at www.countyhealthrankings.org.
An easy-to-use snapshot that compares counties within states, the Rankings show that where you live influences how well and how long you live. Housing is part of the foundation for living long and well. High housing costs can force some families to live in unsafe or overcrowded housing or even into homelessness. This year’s Rankings State Reports show stark differences across and within counties in the opportunity to afford a home. The affordability burden is particularly acute for those with low incomes as well as people of color. This year’s analyses show that a lack of opportunity for a safe, secure, and affordable home is tied to poor health.
“When housing is unaffordable, it impacts all other social determinants of health—from education to employment,” said Mary A. Pittman, DrPH, President and CEO of the Oakland-based Public Health Institute, which helps disseminate the County Health Rankings in California. “The housing affordability crisis in California is a public health crisis. Moving forward, we must invest in healthy and affordable housing, protect the residents who are most at risk, and ensure that these residents and communities can fully participate in the shaping of housing policy.”
Severe housing cost burden measures whether a family is spending more than half of its income on housing; among California’s children living in poverty, 65 percent were living in a household experiencing severe housing cost burdens. High housing costs make it difficult for families to afford other essentials that contribute to good health, such as healthy food, medicine, or transportation to work or school. Looking at differences by place and race offers a more complete picture of health. In California, 21 percent of households spend more than half of their income on housing costs but when we look by race, even deeper differences emerge. Households headed by Black residents are most burdened by severe housing costs—30 percent of Black households spend more than half of their income on housing costs, compared to just 17 percent of White resident households.
One California leader on the issue of housing is the nonprofit Bay Area Regional Health Inequities Initiative (BARHII), the coalition of San Francisco Bay Area public health departments. BARHII is supporting local efforts to create housing affordability. Efforts developed by BARHII include: publishing a research brief on housing affordability, displacement, and family health with the Federal Reserve Bank of San Francisco; partnering with San Francisco Foundation to convene the region’s equity advocates and tenant organizations to shape CASA (the Bay Area’s housing planning process), and the development of the new regionally adopted policy framework that creates housing affordability through the 3Ps of tenant protections, housing preservation, and production of new housing. The BARHII Healthy Planning Guide and Healthy Built Environment training cohorts help health departments work with planners to develop policies that can create healthier environments; and a Local Housing Policy Menu, created in partnership with PHI’s Public Health Alliance of Southern California, details various policies that can be used in local jurisdictions to help address the housing crisis.
According to the 2019 Rankings, the five healthiest counties in California are:
  1. Marin County
  2. San Mateo County
  3. Santa Clara County
  4. Placer County
  5. Orange County

The five counties in the poorest health are:

  1. Lake County
  2. Siskiyou County
  3. Modoc County
  4. Trinity County
  5. Plumas County
“Our homes are inextricably tied to our health,” said Richard Besser, MD, RWJF president and CEO. “It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing. This leaves them with fewer dollars to keep their families healthy. Imagine the stress and pain that come with unplanned moves. We are all healthier and stronger together when everyone has access to safe and affordable housing, regardless of the color of their skin or how much money they make.”
In addition to the county-level data, the Rankings also features What Works for Health, a database of more than 400 evidence-informed strategies to support local changemakers as they take steps toward expanding opportunities. Each strategy is rated for its evidence of effectiveness and likely impact on health disparities. The Take Action Center also provides valuable guidance for communities who want to move with data to action.
“All communities have the potential to be places where everyone enjoys full and equal opportunity. But the data show that’s not happening in most communities yet. Children of color face a greater likelihood of growing up in poverty, and low-income families struggle to pay rent and get enough to eat,” said Sheri Johnson, PhD, acting director of County Health Rankings & Roadmaps. “It is time to do the difficult work of coming together to undo policies and practices that create barriers to opportunity. The Rankings can help communities ground these important conversations in data, evidence, guidance, and stories about challenges and success.”
About the Public Health Institute

The Public Health Institute, an independent nonprofit organization, is dedicated to promoting health, well-being and quality of life for people throughout California, across the nation and around the world.


For more information about the Robert Wood Johnson Foundation visit rwjf.org.

For more information about the University of Wisconsin Population Health Institute visit uwphi.pophealth.wisc.edu.