Healthy San Mateo 2010 Sets New Goal

By Scott A. Morrow, M.D.

Health Officer for San Mateo County

The mission of San Mateo County’s Health Services Agency is to protect, maintain, and improve the health of the people of the county. We are responsible for monitoring and assessing the health status of the community and for identifying and preventing potential health problems. Healthy San Mateo 2010 documents health-related data for San Mateo County and provides a benchmark for improvement.

Focusing on trends between 1990 and 2001, Healthy San Mateo 2010 provides an overview of the health status of San Mateo County residents. It was designed to complement the Healthy People 2010 initiative, which presents a national perspective on health promotion and disease prevention. The broad goals of Healthy People 2010 are to increase quality and years of healthy life and to eliminate health disparities between different groups of people. The goal of Healthy San Mateo 2010 is to describe the health status of our communities so that action plans can be developed and interventions implemented to address specific health-related concerns. Here are some highlights of the report.

Reducing health disparities continues to take on growing importance in the county and across the nation as we learn more about the underlying causes for these differences, which include

•   Poverty;

•   Discrimination based on gender, culture, behavior, education, income, disability,   geographic

     location, sexual orientation, or race or  ethnicity;

•   Neighborhood crime;

•   Substance abuse;

•   Lack of access to health care (e.g., insurance, quality, locations of care);

•   Lack of health education and disease prevention and management; and

•   Inadequate housing, transportation.

Analysis of local data about San Mateo County finds that health disparities have been reduced in some areas, but continue to persist in others. More important, this data provides the framework for developing community and institutional strategies to create healthy communities for all county residents.

The total population of the county was estimated at 707,161 persons, representing an 8.6% increase from 1990, compared with a 13.8% growth statewide for the same time period. The proportion of Hispanics increased from 17.8% in 1990 to 21.9% in 2000. During the same time period, the Asian and Pacific Islander population increased from 16.4% to 23.0%, and the black population decreased slightly from 5.2% to 3.8%. Below are selected examples of health disparities data for San Mateo County from the Healthy San Mateo 2010 report.

Maternal and Child Health

•    The proportions of women receiving less than adequate prenatal care have decreased 

      significantly for all race/ethnicities from 1990 to 2002.

•    In 2001, the black infant mortality rate was no longer significantly higher than that for whites,

     declining 27.2% from 1990 to 2001. 

•    For immunizations, individual DTP/aP4 vaccine coverage was higher than for the complete

     4-3-1 series. Overall vaccine coverage has increased significantly from 72.8% in 1996 to

     78.6% in 2001. 

•    The overall prevalence of obese children and adolescents in San Mateo County was 16.6%,

      which is higher than the national prevalence of 15.0%.

•    An additional 17.7% were overweight, bringing the total overweight and obese prevalence to 

     34.3% in the county. The national comparison figure is 30.0%.

•    Low socioeconomic status was associated with increased prevalence of overweight and obese

      children and adolescents.

Infectious Diseases

•    Incidence rates of AIDS have declined significantly nationally, statewide, in San Francisco

     County, and in San Mateo County since the early 1990s.

•    The unadjusted AIDS incidence rate declined by 80.4% from 23.5 per 100,000 people in

     1990 to 4.6 in 2002. The incidence in black males has been significantly higher than in any other

     race. The number of newly diagnosed AIDS cases peaked in 1993 and declined steadily

     through 2002.

•    Since 2000, the incidence of reported chlamydia rose steadily with a significant 52.5% increase

      from 139.5 in 1999 to 212.8 in 2002. 

•    The tuberculosis incidence rate fluctuated from 1990-2000 but did not change significantly. The

      TB incidence rate peaked at 13.1 in 1996 and decreased to 9.4. Since 1985 the proportion of

      TB cases born outside the United States increased from 65.6% to 93.5% in 2000. The

      five-year moving average rate of TB in Asians and Pacific Islanders for 1985-2002 was the

      highest. During 1998-2002, it was approximately three times the rate for the total populations

      and 21 times the rate for the white population.

Cancer

•    The overall incidence rate for all types of cancer remained fairly stable from 1990 to 2000.

     From 1990-2000, the four most prevalent cancers were breast (invasive), prostate,

     colon/rectum, and lung. The incidence of cancer has consistently been significantly lower among

     Asians compared with other race/ethnicities. From 1996 through 2000, the incidence rate for

     Asians was 339.3 per 100,000 people. The highest rates of cancer occurred among whites

     582.8, followed by blacks 506.3, and Hispanics 394.8.

•    The overall incidence rate of female breast cancer increased significantly by 22.6% from 160.5

      in 1990 to 196.8 in 2000. From 1996-2000, breast cancer was the most common cancer with

      the highest incidence rates in Asians, Hispanics, and whites overall. The incidence of breast

      cancer is increasing and is the second leading cause of cancer deaths in females. 

•    Lung cancer is the leading cause of cancer death in the county and causes more deaths per year

      than breast cancer, prostate cancer, and colorectal cancer combined. This disease is almost

      completely preventable. Smoking causes more than 85% of lung cancer deaths and should be

     discouraged at every opportunity. From 1996-2000, the highest rate of male lung cancer was

      in black males at 99.8 per 100,000 people, followed by white males at 73.8, Asian males at

     60.9, and Hispanic males at 57.4.

•    Prostate cancer was most common in the black population, accounting for approximately 23%

     of all cancer cases, while breast cancer accounted for approximately 16%.

•    The overall cancer mortality rates in San Mateo County declined slightly, though not

      significantly, from 1990-2001.

Hospitalizations

•    The overall hospitalization rate decreased significantly by 8.9% from 1092.8 in 1990 to 995.5

      in 2000.

•    Substance abuse-related hospitalization rates was highest among blacks (113.5), followed by

     whites (72.4), Hispanics (40.5), and Asians (14.8). Rates for whites, Hispanics, and Asians

     were stable from 1992-2000; rates for blacks declined significantly by 26%.

Mortality

•   The overall age-adjusted death rate gradually declined from 827.9 in 1990 to 662.8 in 2001.

•   The five-year moving average mortality rate for blacks was consistently higher than for all other

     racial/ethnic groups, though the disparity has lessened.

•   The heart disease mortality rates for blacks and whites decreased significantly from

    1990-2001, while the rates for Hispanics and Asians remained stable.

•   The rate of diabetes mortality has increased from 9.8 in 1990 to 13.1 in 2001; although, this

     increase is not statistically significant.

Injury

•    The overall suicide rate did not change from 1990-2001 for any of the race/ethnicity groups.

     Whites had the highest suicide rate in the county. The black homicide rate peaked in 1997 at

     46.8 per 100,000 people and then decreased significantly to 11.1 by 2001.

Recommendations:

Data from the Healthy San Mateo 2010 report finds that disparities in health continue to exist affecting the health and economic well-being of the entire community. San Mateo County must engage all county stakeholders in a communitywide process to design and implement culturally appropriate strategies and interventions that focus on the underlying, multifactorial causes of health disparities. Although targeted programs are effective on some levels, it is also necessary to develop the appropriate methodology and structure to deal with disparities on a systematic level that address its root causes rather than its effects.

The approach to improving community health and the medical system must be woven into the fabric of the community through education, housing, labor conditions, social justice and equity, transportation, agriculture and the environment, in addition to continued efforts to improve the medical system.

Specific Recommendations Include

To effectively use scarce health care funds, prenatal care access barriers for all county residents, especially Pacific Islanders, blacks, Hispanics, Filipinos, and adolescents must be eliminated.

•    A countywide task force, consisting of all entities that interact with children—education, health,

     city and county government, business, philanthropic organizations, and others—should develop

      recommendations to reduce childhood obesity.

•    Nutrition counseling should be available for families of children who are mildly to moderately

     overweight, and family-based weight-management programs for children who are severely

     overweight should be accessible.

•    Opportunities to increase physical activity should be available to school-aged children to

      reduce the number of overweight and obese children. 

•    Substance abuse is one of the biggest threats to the health of our community. The economic

     burden to our community is estimated at 500-600 million dollars annually in this county alone.

     Although we commit very few resources to prevention and early intervention, many of the

     consequences of substance abuse—along with the associated costs—are preventable with the

     appropriate reallocation of resources. We must provide more education to our children and the

     community about substance abuse.

•    High priority should be given to testing individuals at high risk for HIV and Hepatitis C

      infection in the most accessible locations.

•    HIV/AIDS infection and prevention strategies must be constantly evaluated and improved. We

     are beginning to see “prevention message” fatigue in certain communities.

•    Federal, state, and county resources and infrastructure must continue to be dedicated to

      successfully preventing the spread of TB, or TB rates will rise.

•    County residents should be encouraged to stop smoking, lower dietary fat consumption;

      increase fruits and vegetables consumption (to a minimum of five servings per day); and drink

      little, if any, alcohol.

•    Residents should also be encouraged to exercise regularly with activity the equivalent of at

      least 30 minutes of brisk walking on most days.

Significant resources will need to be reorganized and dedicated to promote communitywide change in innovative ways that are inclusive of all stakeholders. By working together collaboratively to execute coordinated strategies and contribute toward shared goals, we will succeed in improving the health of all San Mateo County residents. 

The Healthy San Mateo 2010 report was prepared by the San Mateo County Health Services Agency. For a copy of the full report, go to http://www.smhealth.org.