DATE: June 10, 2003
TO: Board of Supervisors
SUBJECT: Steps to a Healthier US (Districts One and Four)
The burden of chronic disease plagues our healthcare system, straining limited resources and driving up the cost of healthcare. Obesity, diabetes and asthma are among the most pressing health challenges that we face today. The prevalence rates of these often preventable diseases continue to rise, outpacing resources. The nation’s epidemic of chronic disease calls for communities to assist in preventing and reversing this alarming trend. Through community and school-based interventions, San Diego County can contribute to the reduction of the staggering number of individuals who battle obesity, diabetes and asthma and the personal, health and economic costs associated with these chronic diseases.
The Department of Health and Human Services, acting through the Center for Disease Control, has announced the availability of approximately $13,650,000 in federal funding for a five-year cooperative program to implement Steps to a Healthier US. Approval of today’s recommendation will begin this important process. Additional information will be presented to the Board of Supervisors for review and approval, if the grant proposal is successful.
Chairman Greg Cox and Supervisor Ron Roberts:
Direct the Chief Administrative Officer to establish a partnership between the City of San Diego, the San Diego Unified School District and local community-based organizations to begin community discussions and a planning process for the submission of a grant proposal for the Steps to a Healthier US Initiative.
There is no fiscal impact associated with this recommendation.
The burden of chronic disease plagues our healthcare system, straining resources and driving up the cost of healthcare. The health problems resulting from obesity and asthma threaten to overturn the many achievements in the health of Americans in recent decades, according to the U.S. Surgeon General.
Over the last 20 years obesity has risen to an epidemic level. Despite health risks, research indicates that the situation is worsening. The total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in the year 2000. Locally, the San Diego Unified School District reports that up to 36 percent of students are overweight and this staggering number will translate to drastically increased rates of diabetes as the population ages. The rise in incidence of Type 2 (adult onset) diabetes in children ages 9-19 went from 2% of new cases in 1980 to 30-50% of new cases in 2000. Evidence shows that diet and exercise could reduce this rate in children by 60-80%. It is critical that, as a community, we work to reverse this costly trend; a trend that not only threatens our community resources, but also the health and well-being of our residents.
The increasing trend in obesity relates to the drastic increase in asthma. In the U.S., asthma accounted for nearly one quarter million hospitalizations, and 1.8 million emergency room visits in 2000. In San Diego County, 290,000 residents suffer from asthma and it is the most common cause of school absenteeism.
While obesity, diabetes and asthma has risen for both genders and across all ethnic and age groups, there is a greater prevalence among African-American and Latino populations. Low-income households also demonstrate a higher rate of these diseases.
The federal government, acknowledging this escalating crisis, has announced the availability of funding for a five-year grant program called Steps to a HealthierUS to address these three chronic diseases and their impacts, with a particular focus on areas with health disparities. Three entities are eligible for awards including local health departments of large cities and urban communities, state health departments for small city and rural communities and one tribal application. This will be a very competitive grant process as it is expected that only 9-12 urban areas across the country will be given approval and funding.
San Diego’s Grant Application
Three ZIP codes in the County of San Diego have been identified as facing an increased risk of these often preventable diseases. Moreover, there is a health disparity between these locations and other areas of the County. The rationale for selection of the intervention area is as follows:
According to the grant requirements, the first item listed for “preference in funding” for the grant states “Inclusion of populations disproportionately affected by chronic disease (diabetes, obesity, and asthma) and associated risk factors.”
In this County as elsewhere in the nation, the ethnic/racial populations that are disproportionately affected by diabetes and obesity (and their risk factors) include Hispanics, African-Americans and Native Americans and by asthma, African Americans. Another group that is disproportionately affected is the lower income population. Therefore, an analysis was done to determine the numbers of these populations in ZIP codes in the County as well as the percents that these populations are of the overall population of each ZIP code.
Other factors under consideration were that the intervention community has to be contiguous and have a population of between 150,000 to 400,000 people. Also, the criteria for selection emphasize the need for the grantee’s interventions to be effective, stating “This…is designed to establish community-based, coordinated, comprehensive health promotion, prevention, and control programs of sufficient intensity and durability to create sustainable change and thereby achieve the ‘Healthy People 2010’ objectives (related to the target diseases).”
Therefore, the intervention community chosen includes ZIP codes 92105, 92113 and 92114 because:
- These 3 ZIP codes are contiguous on at least part of their borders.
- These 3 ZIP codes rank in the highest group for number and percent of population for all the following -African-American population, Hispanic population and families in poverty. (The number of Native Americans in any one ZIP code in the County was not even 1,000 and ZIP codes with 500 Native Americans are not ZIP codes with large numbers of African- Americans or Hispanics.)
- The total population size of this intervention area is about 185,000. A smaller population size was chosen in order to increase the intensity of the services provided which will increase the likelihood that this intervention area population will achieve the Healthy People 2010 objectives.
With funding provided by the Department of Health and Human Services, these locations of concern will receive assistance through community and school-based interventions. In schools, a full-time school coordinator or counselor will be available as will adequate physical education to all students. Communities would be afforded social support, improved access to, and utilization of quality health care services.
In this uncertain time of deep State budget cuts and lost funding, it is important that we seek out ways to ensure the health and well being of San Diego County residents.
Approval of today’s recommendation will begin the process and implementation of Steps to a HealthierUS that will address this need.
We urge your support!
Supervisor, Fourth District