How Place, Racism, and Poverty Matter for Health in Alameda … · How Place, Racism, and Poverty Matter for Health in Alameda County Our local data on health and social inequities

How Place, Racism, and Poverty Matter for Health in Alameda County

How Place, Racism, and Poverty Matter for Health in Alameda CountyMatter for Health in Alameda CountyMatter for Health in Alameda County

Our local dataOur local data on health and social

inequitiesq

An update since our 2008 reportour 2008 report

“Life and Death from Unnatural Causes”

The Community Assessment, Planning, Education, and Evaluation (CAPE) Unit of the Alameda County Public Health

Department (ACPHD)

Our Vision of Health Equity

Everyone in Alameda County –no matter who you are, where you live,

h h khow much money you make, or the color of your skin –has opportunities to leadhas opportunities to lead

a healthy, fulfilling, and productive life.

Purpose of this PresentationTo walk you through our latest data on health and social inequities in Alameda County and our interpretations of the data so you can:

1. Increase understanding of what factors need to be addressed t i t iti f h lth th h t C tto improve opportunities for health throughout our County

2. Use the data in your work to advance health and social equity

bl f

3. Spark critical dialogue and collective thinking about solutions

Possible Uses for Data Writing a grant where you must establish need Advocating for change in particular neighborhood conditions Using a health equity lens to frame a social or policy issue Assessing whether your current program or policy work is helping to

improve health equity Talking with somebody who doesn’t understand how place, racism,

and neighborhood poverty matter for health in our County

Health Inequities by PlaceLife Expectancy by Census Tract

Life Expectancy in Oakland by Region

Just a few miles = Over a decade difference in LE

Compared to a White child born in the affluent Oakland Hills…

OEAST OAKLANDLIFE EXPECTANCY 70LIFE EXPECTANCY 70

O S 8OOAKLAND HILLSLIFE EXPECTANCY 85

…an African American child born in East Oakland can expect to live 15 fewer years.

Photo Source: The California Endowment, Health Happens Here

Source: Alameda County Vital Statistics files, 2010‐2012

Why Does Place Matter for Health?

Communities of Opportunity Disinvested Communities

Good Health Status

• Parks• Safe/Walkable Streets• Grocery Stores and

• Limited/Unsafe Parks• Crime• Fast Food Restaurants

Healthy Foods• Good Schools• Clean AirQ lit H i

• Liquor Stores• Poor Performing Schools• Pollution and Toxic E• Quality Housing

• Public Transportation• Good Jobs• Strong Local Businesses

Poor Health St t

Exposures• Transportation Barriers• Absence of High Quality Financial Institutions• Strong Local Businesses

• Financial InstitutionsStatus

• Predatory Lenders

STRUCTURAL RACISM

Key Determinants of Health InequitySTRUCTURAL RACISM

Inequitable

Concentrated and Persistent Poor and

Inequitable Economic Conditions

and Persistent Poverty

Poor and Inequitable Health

Outcomes in Inequitable Psycho‐Social Conditions

Racial Residential Segregation

Low‐Income Communities

of Color

Conditions

Inequitable SegregationBuilt

Environment Conditions

Historical Roots of Racial Residential Historical Roots of Racial Residential Segregation and Persistent Poverty

Discriminatory mortgage underwriting by the

/

Disinvestment andconcentrated poverty

b

Redlining practicesby banks and home Middle class and white

FHA/VA in urban centers

by banks and homeinsurance agents

Racial steering Displacement caused

flight to the suburbs

Racial steeringand block‐busting

practices by real estate agents

Displacement caused by federal highway

construction and other urban renewal projectsreal estate agents urban renewal projects

Racial Redlining in Alameda County

Concentrated

Poor and Inequitable

Concentrated and Persistent

Poverty

Health Outcomes in Low‐Income CommunitiesCommunities

of Color

Definitions of Poverty

Individual Poverty 2013

A single person living alone has a household income of less than $11,490

Individual Poverty, 2013

$ ,

A family of four has a household income of less than $23 550

Neighborhood Poverty

less than $23,550

30%+ are living in poverty

Defined by the percentage of residents living in poverty

Very High Poverty 30%+ are living in povertyVery High Poverty

20‐29.9% are living in povertyHigh Poverty

Affluent <10% are living in poverty

Neighborhood Poverty Level by Census Tract

Very high poverty neighborhoods

High poverty neighborhoods

AffluentAffluent neighborhoods

Persistent Neighborhood Poverty

Definitions of Poverty (continued)

Persistent Neighborhood Poverty

Neighborhood with high poverty

Defined by the number of decades of high neighborhood poverty

Neighborhood with high poverty for 5 decades (1970‐2010)

Persistent High Poverty

hb h d h h hNeighborhood with high poverty for 3‐4 decades

Frequent High Poverty

Neighborhood with high poverty for 2 decades

Intermittent High Poverty

Neighborhood with high poverty for 1 decade

Infrequent High Poverty

Neighborhood with high poverty for 0 decades

No High Poverty

Persistence of Neighborhood Poverty by Census Tract

Life Expectancy by Neighborhood Poverty Level:A Social Gradient in Health

8384

867 year difference in life expectancy

83

8080

82

84

(in Years)

7876

76

78

80

pectan

cy

72

74

Life Exp

<10% 10‐20% 20‐30 30%+

Neighborhood Poverty Level(Very High Poverty)

(Affluent)


% of residents living in poverty

5 Leading Causes of Death in Alameda County, 2008‐2010

1. Cancer24%24%

2. Diseases of the Heart5 the Heart

23%3. Stroke

6%4. Chronic

5. Unintentional

Injuries 4% 6%Lower

Respiratory Diseases

4%

Top 5 account for 62%


5% of total deaths

5 Leading Causes of Death by Neighborhood Poverty Level, 2000‐2010

<10% Poverty (Affluent)

1 Cancer 26%

10‐20% Poverty

1 Cancer 24%2 Diseases of Heart 23%3 Stroke 6%4 CLRD 5%

2 Diseases of Heart 23%3 Stroke 6%4 CLRD 5%

5 Alzheimer's Disease 4%Top 5 account for 63% of deaths

5 Unintentional Injuries 4%Top 5 account for 62% of deaths

20‐30% Poverty

1 Cancer 21%

30%+ Poverty (Very High Poverty)

1 Cancer 22%2 Diseases of Heart 20%3 Stroke 7%4 CLRD 5%

2 Diseases of Heart 22%3 Stroke 7%4 Homicide 5%




Social Gradients in MortalityRates of Death from the Top 5 Leading Causes of Death

250

by Neighborhood Poverty Level

150

200

r 100,000

100

150

Rate per

0

50

N i hb h d

0Cancer Diseases of

HeartStroke CLRD Unintentional

Injury


Neighborhood Poverty Level

<10% 10‐20% 20‐30% 30%+(Very High Poverty)

(Affluent)

Social Gradients in MorbidityRates of Visits to the Emergency Department for S l C di i b i hb h d l*

5,000Select Conditions by Neighborhood Poverty Level*

3,000

4,000

000

2,000

te per 100,0

0

1,000Rat


0Diabetes Asthma Obesity Assault

<10% 10%‐20% 20%+

Source: Alameda County OSHPD files, 2009‐2011

Poverty Level

*ED rates and neighborhood poverty are at the zip code level

(High Poverty)(Affluent)

Neighborhood Poverty Impacts Health Over the Life Course

160 14 000

30%+ Poverty

<10% Poverty

(Very High Poverty Neighborhoods)

(Affluent Neighborhoods)

120

140

160

y Ra

te

10 000

12,000

14,000

ality

Rate

80

100

use Mortality

6 000

8,000

10,000

Cause Morta

40

60

All‐C

au

2 000

4,000

6,000

All‐C

0

20

<5 5‐24 25‐440

2,000

45‐64 65‐84 85+


Age Group Age Group

Leading Causes of Death by Age Groupin Very High Poverty Neighborhoods

Ages 5‐24 % of Deaths1 Homicide 59%1. Homicide 59%2. Unintentional Injuries 22%

Ages 25 44

81% of deaths

Ages 25‐441. Homicide 25%2. Unintentional Injuries 16%3 Cancer 14%

65% of deaths3. Cancer 14%4. Diseases of Heart 10%

Ages 45 64Ages 45‐641. Cancer 24%2. Diseases of Heart 23%3 Unintentional Injuries 7% 60% of deaths3. Unintentional Injuries 7%4. Stroke 6%



Outcomes in Low‐Income CommunitiesCommunities

of ColorRacial Residential SegregationSegregation

Who Lives in Neighborhoods of Varying Poverty Levels by Race/Ethnicity

100%

17%

12%6%

17%27% 31%

5% 5% 6% 5% 5%

80%

90%

100%

All Other Races

29%

22%26%

31%

60%

70%

dents (%

)

Black/AfrAmer

L i /Hi i

25%

29%

22%

36%

40%40%

50%

entage of R

esi Latino/Hispanic

Asian

35%42%

29%

16%

14%20%

30%Perce

White

29%17%

9%

14%

0%

10%

Alameda <10% 10‐20% 20‐30% 30%+(Very High Poverty)

(Affluent)Alameda County

<10% 10 20% 20 30% 30%+

Neighborhood Poverty LevelSource: American Community Survey, 2006‐2010 and Census, 2010

Proportion Living in a High Poverty Neighborhood (where >20% of residents are poor) by Race/Ethnicity

1 in 15 White residents live in high‐poverty neighborhoods, compared to:

1 in 9 Asians

i i

1 in 4 Latinos

1 in 3 Blacks

Source: American Community Survey, 2006‐2010 and Census, 2010

Proportion of Poor People Living in an Affluent Neighborhood (where <10% of residents are poor) by Race/Ethnicity

1 in 2 poor White residents live in affluent neighborhoods, compared to:

1 in 3 poor Asians

1 in 6 poor Blacks

1 in 7 poor Latinos

Source: American Community Survey, 2006‐2010 and Census, 2010

Racial Gaps in HealthLife Expectancy at Birth by Race 1960‐2010Life Expectancy at Birth by Race, 1960‐2010

6 6 yrs85

s) 6.6 yrs

Black

White

75

80

irth (in

Years

4.0 yrsBlack

70

75

ectancy at Bi

60

65

Life Expe

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010


Racism (Not Race) Harms Health

Percentage of Low Birth Weight Babies by Mother's Race/Ethnicity and Place of Birth

US born Foreign born

12%12%

14%

US‐born Foreign‐born

8%7%

10%

12%

6% 6%

7% 7%

5%

7%6%

8%

2%

4%


0%AfrAm Asian Latino White

i bl

Poor and Inequitable

Inequitable Economic Conditions

Health Outcomes in Low‐Income Communities

• Employment• Job Wages

Communities of Color

• Household Income• Wealth

Access to Employment:Unemployment Rate by Neighborhood Poverty Levelp y y g y

15%

20%%)

2.1X Higher

10%

14%15%

12%

16%

nt Rate (%

7%

10%

8%

mploymen

0%

4%

Une

m

0%<10% 10‐20% 20‐30% 30%+


(Affluent)

Source: American Community Survey, 2007‐2011

g y(% of Residents Living in Poverty)

Access to Jobs that Pay Adequate Wages:Top 5 Occupations by Neighborhood Poverty Level

<10% Poverty (Affluent)

Occupation 1. Management(14% of civilian

2. Office & Ad i S

3. Sales & l d

4. Computer & h

5. Business & i i l

pCategory

(14% of civilian employed pop

age 16+)

Admin Support (13%)

Related (11%)

& Math (7%)

Financial (7%)

Median $91 324 $39 497 $44 887 $94 361 $70 869Income $91,324 $39,497 $44,887 $94,361 $70,869

Alameda County Self‐Sufficiency Standard for 1 Adult in 2011 = $27,456

30%+ Poverty (Very High Poverty)2 F d

for 1 Adult in 2011 = $27,456

Occupation Category

1. Office & Admin Support

(11%)

2. Food Preparation & Serving

(11%)

3. Construction & Extraction

(10%)

4. Sales & Related(9%)

5. Building & Maintenance

(8%)


Median Income $28,920 $16,135 $29,495 $23,877 $20,967

Access to Income: Average Annual Household Income by Neighborhood Poverty Level

$110,436$120,000

e

$76,591 $73,439$80,000

old Incom

2.4 Fold Difference

$46,598$40,000e

Hou

seho

$40,000

Average

$0<10% 10‐20% 20‐30% 30%+

Neighborhood Poverty Level(Very High

)(Affluent)


Neighborhood Poverty Level(% of Residents Living in Poverty)

Poverty)

Access to Wealth: Rates of Foreclosure by Neighborhood Poverty Level

31% 32%35%

e

2.4X Higher

21%20%

25%

30%

efau

lt Ra

te

13%

10%

15%

20%

tice of De

0%

5%

<10% 10‐20% 20‐30% 30%+

4‐Yr Not

(Very High Poverty)

(Affluent)

<10% 10 20% 20 30% 30%+Neighborhood Poverty Level(% of Residents Living in Poverty)

Source: CAPE, with data from HUD and from First American Title via Urban Strategies Council, 2006‐2009


Outcomes in Low‐Income

Inequitable Psycho‐SocialConditionsLow Income

Communities of Color

Conditions

• Educational Attainment• School Quality• School Attendance• Crime and Violence• Criminal Justice• Criminal Justice• Stress and Mental Health

Access to Education and Quality Schools:Educational Attainment by Neighborhood Poverty Level

40%e 3.8X Higher

25%

34%

30%

HS Degree 3.8X Higher

9%

18%20%

Less th

an H

9%

0%

10%

% with

L

<10% 10‐20% 20‐30% 30%+Neighborhood Poverty Level(% of Residents Living in Poverty)

(Very High Poverty)

(Affluent)


Academic Performance by Neighborhood Poverty LevelOakland Public School Students3rd Grade English‐Language Arts3 G ade g s a guage ts

72%80%

y

2.4‐fold difference

48%50%

60%

70%

roficiency

48%

31% 30%30%

40%

50%

r Abo

ve P

10%

20%

30%

% At o

r

(Very High )

(Affluent)

0%<10% 10‐20% 20‐30% 30%+

N i hb h d P L l

Source: OUSD , 2011‐12

Poverty)Neighborhood Poverty Level(% of Residents Living in Poverty)

Chronic Absenteeism Rate (% of Students Absent for 10%+ of Enrolled School Days) by Neighborhood Poverty Level

18%20% Over 2X Higher

14%

18% 17%

15%

Absent

8%10%

ronically A

5%% Chr

(Very High )

(Affluent)

0%<10% 10‐20% 20‐30% 30%+


Source: OUSD, 2011‐12

Poverty)g y

(% of Residents Living in Poverty)

Crime and Violence:Homicide Death Rate by Neighborhood Poverty Level

35 7.9X Higher

21

30

25

30

0,00

0

11

21

15

20

te per 100

4

0

5

10Rat

0<10% 10‐20% 20‐30% 30%+


(Affluent)Neighborhood Poverty Level(% of Residents Living in Poverty)

Poverty)


Mass Incarceration:Youth Incarceration Rate by Neighborhood Poverty Level

3.0%5.4X Higher 1 out of 40 youth

incarcerated

2.3%2.5%

2 0%

2.5%

ges 10

‐17

rcerated

1.1%1.5%

2.0%

f You

th Ag

o are Inca

1 out of 200 youthincarcerated

0.5%0.5%

1.0%

% of

who incarcerated

0.0%<10% 10‐20% 20‐30% 30%+

Neighborhood Poverty Level (Very High (Affluent)

Source: CAPE with data from Urban Strategies Council & the Alameda County Probation Department, 2010 (Aug) ‐2011 (June)


( y gPoverty)

( )

Hypertension:Hypertension Hospitalization Rates by Neighborhood Poverty Level*yp p y g y

1 7691,8902,000

1.7X Higher

1 084

1,769,

1,500

2,000

0,00

0

1,0841,000

te per 100

0

500Rat

<10% 10‐20% 20%+Neighborhood Poverty Level(% of Residents Living in Poverty)


*Includes hospitalizations with hypertension as a primary or top 4 associated diagnosisHospitalization rates and neighborhood poverty are at the zip code level


Hypertension:Hypertension Hospitalization Rates by Race/Ethnicityyp p y / y

3,500

2,500

3,000

00

1,500

2,000

per 1

00,00

BlackWhite

i

500

1,000

Rate p Latino

API

0<10% 10‐19.9% 20+%

Neighborhood Poverty LevelNeighborhood Poverty Level(% of Residents Living in Poverty)


Mental Health:Rate of Visits to the Emergency Department for Severe Mental Illness*

5656002.7X Higher

436

400

500

0,000

212200

300

Rate per 100

0

100

R


* I l d i i i h l di d i 4 i d di i

<10% 10‐19.9% 20%+Neighborhood Poverty Level(% of Residents Living in Poverty)

Source: Alameda County OSHPD files, 2009‐2011 with input from Alameda County Behavioral Health Care Services

* Includes ED visits with severe mental disorders as primary or top 4 associated diagnosisED rates and neighborhood poverty are at the zip code level


Outcomes in Low‐IncomeLow Income Communities

of Color

InequitableBuilt

Environment ConditionsConditions

• Housing Quality and AffordabilityT it D d• Transit Dependence

• Street Safety• Supermarkets and Healthy Foods• Clean Air and Water

Access to Quality Housing:Age of Housing by Neighborhood Poverty LevelAge of Housing by Neighborhood Poverty Level

60% Over 2X Higher

35%

49% 49%

40%

50%

ng Units

%)

21%

35%

20%

30%

of Hou

sin

lt <195

0 (

0%

10%

20%

Percen

t Bu

i

0%<10% 10‐20% 20‐30% 30%+


(Affluent)



Household Overcrowding by Neighborhood Poverty Level

12%

16%

olds

Over 4X Higher

11%

14%

8%

12%

f Hou

seho

7%

11%

4%

Percen

t of

3%

0%<10% 10‐20% 20‐30% 30%+

P

( i h( ffl ) Neighborhood Poverty Level(% of Residents Living in Poverty)

O d d S l O d d

(Very High Poverty)

(Affluent)

Overcrowded (1.01‐1.5 per room)

Severely Overcrowded (1.51+ per room)


Access to Affordable Housing:Rental Housing Cost Burden by Neighborhood Poverty Level

59% 61%60%

70% 1.5X Higher

42%49%

35% 36%40%

50%

Reside

nts

1.9X Higher

19%25%

20%

30%

rcen

t of R

0%

10%

<10% 10‐20% 20‐30% 30%+

Pe

<10% 10‐20% 20‐30% 30%+Neighborhood Poverty Level(% of Residents Living in Poverty)

(Very High Poverty)

(Affluent)

Housing cost burden (30%+ of income on rent)

Severe housing cost burden (50%+ of income on rent)


Access to Transportation:Zero Vehicle Households by Neighborhood Poverty Level

14%16% About 7X Higher

8%

12%

useh

olds

cles (%

)

5%

8%8%

ent o

f Hou

Zero Veh

i

2%4%

Perce

with

0%<10% 10‐20% 20‐30% 30%+

Neighborhood Poverty Level(Very High

)(Affluent)



Poverty)

Access to Safe StreetsAdjusted Rate of Pedestrian Injuries & Deaths

by Neighborhood Poverty Levelby Neighborhood Poverty Level

2 2 2 22.5 3.8X Higher

2.2 2.2

2.0

stria

n h Ra

te

1.4

1.0

1.5

sted

Ped

esan

d Deat

0.60.5Ad

jus

Injury

(Very High(Affluent)

0.0<10% 10‐20% 20‐30% 30%+


Source: CAPE with data from SWITRS, 2006‐2010

(Very High Poverty)

(Affluent) Neighborhood Poverty Level(% of Residents Living in Poverty)

Access to Supermarkets:Limited Supermarket Access (LSA) score

by Neighborhood Poverty Level

80Limited

Supermarket Access More Limited Supermarket Access

5967

60

70

core

3743

30

40

50

age LSA Sc

10

20

30

Avera

0<10% 10‐20% 20‐30% 30%+

N i hb h d P t L l

GreatestSupermarket Access

(Very High(Affluent) Neighborhood Poverty Level(% of Residents Living in Poverty)

Source: CAPE with data from the Reinvestment Fund, 2011

(Very High Poverty)

(Affluent)

Exposure to Liquor Stores:Off‐Sale Liquor Outlet Densityby Neighborhood Poverty Levelby Neighborhood Poverty Level

75801.7X Higher

66 6975

607080

Licenses

esiden

ts

43

304050

le Liquo

r 00

,000

Re

102030

Off‐Sa

per 1

0

0<10% 10‐19.9% 20‐29.9% 30%+


Source: CAPE with data from Department of Alcohol Beverage Control, 2013


Exposure to Clean Air:Location of Pollution Sources, including

Highways and Port of Oakland

Exposure to Toxic Chemicals and Fuels:Density of Industrial Chemical (SLIC)

and Fuel (LOP) Release Sites

4X Higher

239

332

250

300

350

mical and

s ,000

pop

)g

239

150

200

250

ndustrial Che

ml R

elease Site

sP sites per 100,

83

115

50

100

Den

sity of In

Fue

(# of SLIC/LO

0<10% 10‐20% 20‐30% 30%+

Neighborhood Poverty Level(% of residents living in poverty)(% of residents living in poverty)

Source: CAPE with data from Alameda County Environmental Health, 2005‐2013 (July)

Place, Racism, and Neighborhood Poverty: How do they Interact?

90Latino

Race and Social Gradients in Health

85

Birth

AsianLatino

75

80

ectancy at

n years)

Total

70

75

Life Expe (in

WhiteBlack

65<10% 10‐20% 20‐30% 30%+


Neighborhood Poverty Level(% of residents living in poverty)

(Very High Poverty)

(Affluent)

Life Expectancy at Birth in Oakland Flats vs. Hills

90

Oakland Flats Oakland Hills

85.3 85.083.8

85.6 85.1 84.1

79 6

85

90

Birth

77.8 78.2

71 6

79.6

75

80

ctan

cy at B

n years)

71.6

65

70

Life Expec (in

60

65

All Races Asian Latino White Black


OWEST OAKLANDLIFE EXPECTANCY 71LIFE EXPECTANCY 71

O S 8OOAKLAND HILLSLIFE EXPECTANCY 85

Photo Source: The California Endowment, Health Happens Here


Compared to a White child in the affluent Oakland Hills, an African American child born in West Oakland is…

2 timesmore likely to be born low birth weight

13 timesmore likely to live in poverty

5 timesmore likelyto be unemployed

12 times less likely h h

4 times less likely to d d l l

3 timesmore likely d f kto have a mother

who graduated from college

read at grade level to die of stroke

INFANT CHILD ADULT

Cumulative impact:14 diff i lif t14 year difference in life expectancy

Source: Alameda County Death files, 2010‐2012; Alameda County Birth files, 2009‐2011; American Community Survey, 2007‐2011; California Dept of Education, 2012‐2013

Increasing Opportunities for Good Health

Communities of Opportunity Disinvested Communities

Good Health Status

• Parks• Safe/Walkable Streets• Grocery Stores and

• Limited/Unsafe Parks• Crime• Fast Food RestaurantsGrocery Stores and

Healthy Foods• Good Schools• Clean Air

Fast Food Restaurants• Liquor Stores• Poor Performing Schools• Pollution and Toxic

• Quality Housing• Public Transportation• Good JobsSt L l B i

Poor Health

Exposures• Transportation Barriers• Absence of High Quality Financial Institutions• Strong Local Businesses

• Financial InstitutionsStatus Financial Institutions

• Predatory Lenders

INCREASING ECONOMIC STABILITY & INCREASING ECONOMIC STABILITY & OPPORTUNITYOPPORTUNITY

Increasing Housing Stability & AffordabilityIncreasing Housing Stability & Affordabilityg g y yg g y y

3268 San Pablo Avenue Oakland, CA 94608(510) 763‐5877

Preventing ViolencePreventing Violence

16335 East 14th Street16335 East 14th StreetSan Leandro, CA 94578(510) 481-4500

Reducing Incarceration & RecidivismReducing Incarceration & Recidivismgg

1221 Preservation Park Way Oakland, CA 94612(510) 891‐0427( )

Acknowledgements:CAPE E id i l + TCAPE Epidemiology+ Team

Elaine BautistaSamantha Bell

Tammy LeeJane MartinSamantha Bell

Matt BeyersJanet Brown

Jane MartinChuck McKetneyRuvani FonsekaJanet Brown

Sangsook ChoRoxanna Guide

Ruvani FonsekaAviva LipkowitzKatherine SchaffRoza Tammer

Questions, Comments, or Ideas?

Please contact:Chuck McKetney

Director, Community Assessment Planning and l ( )Evaluation (CAPE) Unit

[email protected] or 510‐268‐8020

Tammy LeeCommunity EpidemiologistCommunity Epidemiologist

Alameda County Public Health Departmenttammy.lee@acgov or 510‐268‐2619tammy.lee@acgov or 510 268 2619

Documents

How Place, Racism, and Poverty Matter for Health in Alameda … · How Place, Racism, and Poverty Matter for Health in Alameda County Our local data on health and social inequities