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Wroking towards Health Equity


On average, middle class Americans live shorter lives than those who are wealthy, and that’s not right. Money can’t buy happiness, and it shouldn’t buy a longer or healthier life. 

The United States is the only industrialized country that doesn’t require employers to provide paid sick leave. When they get sick, 47% of the U.S. private sector workers must choose between staying home or losing a days pay.

One of the best predictors today of how long we will live is our zip code.

In San Mateo County, residents in East Palo Alto and North Fair Oaks can expect to live about seven fewer years than residents in Atherton, Hillsborough or Portola Valley and residents in other cities in the County fall somewhere in the middle.

There are many reasons for why this is, and most have to do with income. Low income people tend to live in neighborhoods where the healthy choice is really hard to make.  In these neighborhoods, there are not many parks or recreation centers, grocery stores are far away and fast food outlets are everywhere. In many of these places, the streets aren’t safe and crime keeps people indoors.  

This is called health inequity, and it isn’t just about the rich and the poor. Middle class Americans also live shorter lives than wealthy Americans. Regardless of people’s income, African Americans, Latinos and Pacific Islanders in San Mateo County have higher rates of preventable diseases than Asian and Caucasian residents in our County.  The relationship between income, race and health is inseparable.

To keep people from getting sick in the first place, we must make the healthy choice the easiest choice. Right now, the healthy choice is the hardest to choice to make. 

San Mateo County Health System has worked to figure out what is needed most, given our limited resources. One of these analyses is based on a map of city-by-city life expectancy in San Mateo County.  The places where life expectancy is lowest have the least opportunities for people to make choices that allow for a long, healthy life.

Another analysis is based on a series of maps outlining income in  San Mateo County. The places with the lowest incomes are the places with the fewest opportunities to buy fresh, healthy food and get physical activity.

What Does the Research Say?

  • In the United States, people earning the highest income can expect to live, on average, at least six and a half years longer than those earning the lowest income. Even those with middle incomes will die, on average, two years sooner than those at the top. Source
  • Low-income adults are 50% more likely to suffer heart disease than top earners. Source
  • On average, there are four times as many supermarkets in mostly white neighborhoods as there are in mostly Black or Latino neighborhoods. Source


  • Understanding and talking about health equity is really difficult. The film series, Unnatural Causes: Is Inequality Making Us Sick? makes this complicated issue much simpler by helping us understand what the issues are.  The Health System has copies of the Unnatural Causes video series that we can loan to you. Sign up to request to borrow Unnatural Causes.
  • The relationship between where people live and their health can be hard to explain. It gets even harder when you add in the relationships between health, wealth, race and ethnicity. The Robert Wood Johnson Foundation did a lot of work to simplify this issue, and created  A New Way to Talk About the Social Determinants of Health. This primer helps us learn how to talk about health inequities in a more simple, straightforward way.
  • PolicyLink is a national research and action institute working to advance economic and social equity. Their report,  Why Place and Race Matter  showcases communities across the country who are working on local health equity issues.
  • African American Community Health Advisory Council is an organization in San Mateo County that is addressing health inequities by working with faith based organizations and communities of color.  They are famous for their annual Soul Stroll event. 
  • Peninsula Interfaith Action is San Mateo County’s branch of the national organization PICO.  Peninsula Interfaith Action works on housing, health care and other issues impacting low-income communities by working through faith based organizations. 
  • One East Palo Alto brings together service organizations in the City of East Palo Alto to work together on improving neighborhood conditions. 
  • Bay Area Regional Health Inequities Initiative is made up of all of the Bay Area Health Departments.  This group works on data analysis projects, identifying the social determinants of health and training and facilitating health equity work in local Health Departments.
  • San Mateo County Health System Behavioral Health and Recovery Services Office of Health Equity is working on addressing health equity using mental health and recovery resources and by engaging the mental health and recovery community in their work. 
  • The Centers for Disease Control (CDC) and Prevention Institute released the "Practitioners Guide for Advancing Health Equity" as a resource for public health practitioners working to advance health equity through community health interventions. This guide focuses on policy, systems, and environmental improvements designed to improve the places where people live, learn, work, and play.