Income is one way to measure San Francisco’s inequality, another way is mortality rates. And the two are related.
Among the most severe findings in a new report that quantifies the health inequalities in The City is how long people are expected to live based upon their race.
“On average, Asians in San Francisco can expect to live the longest, 87 years,” the 2019 Community Health Needs Assessment said. “Black/African Americans and Pacific Islanders live 11-15 years less, however, with a life expectancy of only 72 to 76 years [respectively].”
African American males had the lowest life expectancy at an average age of 68.
The disparity exists despite African America’s life expectancy gaining the most of all races since 2005. The life expectancy for African Americans between 2005 and 2007 was an average age of 68.5. That increased to age 72.1 during the time period between 2015 and 2017.
For whites, the life expectancy on average is age 81.7.
The report is conducted every three years by the Department of Public Health in collaboration with hospitals and nonprofits and was presented last week to the Health Commission.
Data on hospitalizations show how African Americans suffer more and at earlier ages from chronic diseases.
“Looking at hospitalizations for diabetes, heart failure and hypertension we see that in general rates start to tick up when people are 30 or 40 and only peak in the oldest ages,” Michelle Kirian, an epidemiologist with the Department of Public Health’s Population Health Division, told the Health Commission. “However, amongst black/African Americans rates soar early in their 30s and 40s.”
“Rates for black/African Americans in their 30s and 40s are comparable to those others who are 30 years older,” Kirian continued. “In fact, for diabetes rates are higher amongst young black/African Americans than they are for anyone else at any age.”
In looking at mental health, the report found that hospitalizations for depression are on the rise.
“Depression is the most common mental health condition with the number of hospitalizations exceeding that seen for hypertension or asthma and the rate of hospitalizations increased 20 percent [for a total of 2,631 times] between 2012 and 2016,” Kirian said. “Rate of hospitalizations are highest amongst young adults, black/African Amerricans and those in the Tenderloin and SoMa neighborhoods.”
She said that 23 percent of adults reported needing help for mental health or substance use issues between 2011 and 2016 and 7 percent of adults experienced “serious psychological distress.” Lower income residents are three times more likely to experience “serious psychological distress” than higher income residents, according to the report.
In addition to quantifying health data, the report identifies risk factors.
“Inadequate resources, inadequate education, experience in an unjust criminal justice system, housing instability and more build up in a community and lead to the consistent health disparities that we see,” Kirian said.
The report also identifies San Francisco’s soaring cost-of-living is impacting people’s health.
“Living healthily can be expensive,” Kirian said.
“In looking at the cost of just two needs, childcare and rent, which for many consume more than 50 perecent of household income, we can see that many will not have the resources necessary to buy healthy foods, to take time to go to the gym, to pay co-pays or any of the other requirements to live a healthy life,” Kirian said.
Nearly one in four residents live below 200 percent of the federal poverty, which for a family of four is about an annual income of $50,000. “However, it is estimated that about $120,000 is needed to meet the needs of a family of four.”
She noted that “in addition to the direct effects of poverty, inequality has been shown to have deleterious effects on health and community.”
One measurement of the inequality shows that the wealthiest 5 percent of households earns more than 16 times the poorest 20 percent of households in San Francisco.
“This inequality is especially pronounced when viewing data by race ethnicity as the median income of white households is $111,000 while that of black/African Americans is a mere $28,000,” she said.
Dr. Grant Colfax, who was appointed in January as the director of the Department of Public Health, said the data in the report is “incredibly informative” and that “it will be a helpful roadmap for us going forward.”
Health Commissioner Dr. Edward Chow emphasized the importance of using the data to achieve progress. In the past he said, other reports had identified needs and “we then felt enthused about what would happen next and in the following years almost nothing happened.”
Chow said he would like to see that “not only do we have plans to try and address our disparities and our needs, but that we have plans to tell us how well we have done.”
The Health Commission is expected to vote to adopt the report on May 21.