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Why Some Cities In California Are Healthier Than Others

The Blue Shield of California Foundation backed a study into how communities shape health. The results were stunning.

Correction: an earlier version of this report misstated the amount of the grant made to Build Healthy Places Network. It has been corrected.

It’s common sense that the healthier a community is socioeconomically, the better health outcomes of its individuals. While that’s a tough thing to quantify, some key organizations are helping tell the story, and bridge the communications gap between health-care providers and communities in order to foster a more collaborative approach going forward, so that underserved areas can have healthier outcomes.

By one measure, about $1 trillion is spent annually in the United States treating avoidable diseases created by conditions resulting from poverty, such as lack of housing, education, medical facilities and economic development, according to Build Healthy Places Network, an organization dedicated to bringing together partners across the health and community development partners.  

"Instead of spending $1 trillon treating preventable conditions caused by poverty, healthcare and community development can work together to address the root causes of poverty and poor health - lack stable, affordable housing, access to healthcare, education, jobs collectively, the social determinants of health (SDOH)."

To advance a more holistic approach to communities and health care, Blue Shield of California Foundation issued a grant of $250,000 to Build Healthy in 2018 to study the value of prevention. The grant was one of 16 allotted to help organizations research the concept.

Blue Shield of California funds the Blue Shield of California Foundation. The nonprofit insurer announced Feb. 11 it pledged $40 million to the foundation.

“Through their work, they’re actually pushing the health-care sector to think bigger about its role, beyond the walls of the clinic,” says Rachel Wick, senior program officer at the foundation.

The Blue Shield grants sought to address the question, what will it take to generate investment in strategies that produce health and wellbeing? “We talk about how prevention works,” Wick says. “It saves money, it saves lives, and people are healthier when we invest early. But unfortunately, the dollars often don’t follow that belief.”

For Build Healthy, the grant allowed it to study four California communities to provide insight on what is needed to create partnerships between community development and healthcare for sustainable investments in health and well-being. One key finding from the work: disinvestment continues to plague historically marginalized communities in California. That results in isolation, economic challenges, financial insecurity—and lack of access to affordable and quality health care, stable housing, good jobs—among other factors. These are collectively the social determinants of health.

Language, income and housing have a outsized impact

San Bernardino was one of four cities studied that have had these types of struggles. Its social determinants lag well behind county and state averages. For example, 51% of residents speak a language other than English at home. Median household income is $41,000, compared with $61,475 for the state average, and the lowest in California for a city of its size (217,000 residents). And 70% of the town’s renters are spending than 30% of their income on housing.

Rachel 2019 Cropped
Rachel Wick

Additionally, San Bernardino’s “hospital referral region,”—an area where citizens have access to at least one facility where major surgeries are performed—ranked 193 out of 306 nationwide in terms of overall health performance. And San Bernardino County ranked 33rd out of California’s 57 counties in terms of longevity of its residents. It ranked 51st in quality of life, and 41st in health outcomes. It’s the fourth most obese county in the entire country, with 38% of adults in the category, compared with a California of 23%. The county also has the third highest heart disease rate in the state.

Build Healthy also examined Coachella, Stockton, and Santa Rosa. Its findings in those cities showed similar results in correlation between the lack of positive social determinants and health care outcomes.

The organization also concluded that developing sustainable, long-term relationships between community development and healthcare takes time and is complicated. Hospitals need to get parts of their own vast organizations to work closely together. There is a need to educate hospitals and healthcare systems on community development sectors, as well as how so-called community development financial institutions can play a role.

Results spur more research, investment

With the grant, Build Healthy also created tools to help accelerate partnerships among community development and health care. One was landscape analysis and asset mapping, which resulted in key data points that showed disparities and opportunities in the four cities. Customized reports were generated to help community development organizations engage with healthcare. “We are using these tools as a way to educate and engage key stakeholders to make the case we share common aims and shared goals,” Flynn says.

And success begets success. The research by Build Healthy helped it obtain another $100,000 grant from J.P. Morgan Chase in October to further its work in San Bernardino. For the initiative, Build Healthy is working with two other organizations to attract additional investment from the health-care sector and develop an inclusive community stakeholder process: the National Community Renaissance, a developer of affordable housing, and National Finance Fund, a nonprofit lender.

The focus is holistic, by taking into consideration all the things that make up a vibrant and healthy community: access to affordable housing, quality schools, and other key components, such as community centers, art facilities and youth programs. “We’re creating a pipeline of projects to bring together community funding organizations, community-based groups, health care, and local government to address persistent challenges,” Flynn says. “To produce good health and well-being outcomes, communities and health care need to work together.”