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New Rankings Map Inequality and Health Status among California Counties

March 16, 2016

Many rural counties in poor health; housing segregation highest in San Francisco

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Oakland (March 16, 2016) – The Bay Area counties of San Francisco and San Mateo have the highest rates of residential segregation in California, according to the seventh annual County Health Rankings, released today by the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute.

The County Health Rankings grade counties across the U.S. based on two sets of factors: health outcomes (length and quality of life) and health factors (more than 30 influencers of health, such as housing, jobs, smoking and access to healthy food). This methodology underscores the fact that multiple factors contribute to good health.

Residential Segregation Highest in Bay Area

The ratio index measuring residential segregation among non-white and white county residents is a new measure for the County Health Rankings this year, using data from 2010-2014. Index values range from 10 to 37 statewide, with higher figures indicating greater residential segregation. San Francisco and San Mateo had the highest rates. Los Angeles, Sacramento, Contra Costa and El Dorado counties have the next highest rates.

“There are growing divides in the Bay Area, including income disparities, access to high-paying jobs, and access to affordable housing. It is troubling to see another divide, based on race,” said Mary A. Pittman, DrPH, president and CEO of the Public Health Institute. “Institutional racism and discrimination against individuals of color are illegal, but they exist—and this has direct impacts on health and well-being. Your zip code should not determine your life expectancy, yet it is often one of the most accurate predictors of health, with communities of color at the greatest disadvantage.”

Rural Counties Least Healthy

This year the five healthiest counties in California are Marin County, followed by San Mateo County, Santa Clara County, Orange County, and Placer County. The five counties in the poorest health, starting with least healthy, are Modoc County, Lake County, Siskiyou County, Trinity County, and Fresno County. Alpine County was not ranked.

“Rural residents are often isolated and lack access to some of the resources their neighbors in urban and suburban areas have,” explained Pittman. “Lawmakers and those of us in public health must double down on our efforts to invest in the health of California’s rural residents by improving their access to healthy foods, quality medical care, health education, and opportunities to be physically active.”

Additional measures of equity and opportunity in the 2016 Rankings include an income inequality ratio (with higher values indicating greater levels of inequality) and percent of the population without insurance.

Income Inequality Ratio across Counties

% Uninsured across Counties

Action at the Local Level

The Rankings serve as an important tool for communities that want to improve health. The Public Health Institute’s Cultiva La Salud utilizes the Rankings data to make the case for expansion of its work increasing health equity in the Central Valley counties of Kern (#52), Kings (#36), Madera (#47), Merced (#49), San Joaquin (#41), Stanislaus (#45) and Tulare (#51) counties.

In Fresno County, Cultiva La Salud heads up a federally-funded initiative with the county health department to help create and strengthen healthy environments through activities including a farm-to-table program and “Rx for Health”—a new referral system that enables physicians to refer patients to community-based lifestyle change programs to improve and manage chronic health conditions. Federal funding for the initiative has not been carried over for the next year, however, and the program has already had to scale back.

“This year’s Rankings highlight many of the unique health challenges facing California’s Central Valley,” said Genoveva Islas, MPH, director of Cultiva La Salud. “We already know what interventions can turn the tide here—that is the good news. What we need now is the political will to support and sustain these efforts.”

The full California 2016 County Health Rankings report includes a snapshot of each county in the state, a color-coded map comparing each county’s overall health ranking, county-level trend graphs detailing change over time for several measures, and stories of how counties have used the Rankings to take action to improve health in their communities. Learn more at countyhealthrankings.org.



If you are interested in arranging an interview with Mary A. Pittman, DrPH, or Genoveva Islas, MPH, contact Jennifer Scroggins at (510) 285-5512 or jennifer.scroggins@phi.org


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.