The economic, environmental and personal factors that affect health and longevity in the East Bay can make a two-decade difference in life expectancy, new studies show. Wide inequities persist, despite numerous attempts to narrow the gaps. Disease rates and life spans vary sharply, research by Alameda and Contra Costa counties reveals:
The stunning disparities are not new to county health leaders, but they will use the data to focus their attention.
What is not so clear are the solutions.
"This very starkly tells us about the difference in death rates for cardiovascular disease and cancer and so on by income and ethnicity," said Dr. Wendel Brunner, Contra Costa County public health director. "What it doesn't tell us is why, and even less does it tell us what to do about it."
The reports expand on the findings of a 2009 Bay Area News Group series titled "Shortened Lives: Where You Live Matters," which identified a 16-year gap in life expectancy among East Bay ZIP codes just a few miles apart.
A broader look
The new county studies were financed by the Hospital Council of Northern and Central California to help hospitals and health leaders target resources. The counties compiled statistics on disease rates, life expectancy and other health indicators by city, race, income and education levels.
Nonprofit hospitals in California are required to analyze community health needs every three years and to develop plans to address those needs. The reports are part of that process, but also take a broader look, said Rebecca Rozen, regional vice president of the Hospital Council.
Because the counties prepared separate reports and used slightly different methodologies, the numbers are not necessarily comparable. But a clear pattern emerged: People in low-income neighborhoods often live much shorter and sicker lives than others.
In Contra Costa County, children born in communities with a high level of poverty have a life expectancy of 75 years, compared with 81 years for other county residents.
Health leaders offer several explanations for such disparities.
"Certainly, higher income is associated with higher levels of health insurance, access to adequate health care, better diets and more opportunities for recreation and exercise," Brunner said.
Personal behavior plays a role, along with whether people receive appropriate health screenings and are diagnosed with cancer and other problems in a timely manner.
But county health leaders also believe that poverty and neighborhoods sapped of resources are crucial factors influencing health. It can be much harder to obtain healthful food and be physically active in low-income communities. Some areas have no major grocery stores. Instead, mom-and-pop-type markets offer little if any fresh produce, and what they do carry may be costly.
Fast-food outlets are often plentiful.
Whether people feel safe in their neighborhoods and can enjoy well-maintained parks and attractive places to walk or bicycle also are factors.
"The violence in our community is stifling families and their ability to go to parks and exercise and feel good about walking at night, or walking period," said Jane Garcia, chief executive officer of La Clinica de La Raza.
Not surprisingly, the studies reveal that obesity rates vary widely. More than 38 percent of low-income adults in Alameda County are obese, compared with 18 percent of those with higher incomes.
In Contra Costa County, 36 percent of fifth-graders are overweight or obese in the Antioch, Pittsburg and West Contra Costa schools.
The numbers are significantly smaller in more upscale areas: In Orinda, 9.6 percent of fifth-graders are overweight or obese, and in the San Ramon Valley Unified School District, that figure is 12.6 percent.
Perhaps less obvious is why education levels are closely linked to people's health. Those with more education tend to live longer, the studies show.
Highly educated people are often able to get better jobs with higher salaries, notes Chuck McKetney, director of Community Assessment, Planning, Education and Evaluation for the Alameda County Public Health Department.
They also may be able to figure out how to navigate the complex health care system to their advantage, McKetney said. Brunner agreed.
"People who are highly educated and have higher income frankly feel more entitled, and they use that when they work the health care system," Brunner said.
Stress and race
The starkest findings involve the health of African-Americans. Mirroring national trends, African-Americans in the East Bay continue to lag well behind others in life expectancy. They also are at higher risk for coronary heart disease, stroke and other conditions.
Asthma hits especially hard. African-American children under age 5 in Alameda County are hospitalized for asthma at three to four times the rate of other children.
African-Americans make up a disproportionate share of the population of low-income areas, experts note, including neighborhoods near freeways and the Port of Oakland, where diesel emissions and aging houses with mold and mildew aggravate asthma.
McKetney said he believes more subtle influences also play a role in the health disparities of African-Americans, including lingering racism and its effect on chronic stress, which can wear down the body over time.
"How they are seen in society is so influential on people's health and the opportunities that they are provided," McKetney said. "We tend to think that racism is done, that we're in some kind of post-racial era, but the reality is that studies that look at housing or health or criminal justice still show us that there's dramatic differences."
McKetney noted that when compared with white women, African-American women often have worse birth outcomes and higher infant mortality even when they have similar incomes, education and occupations.
"The experience and the impact of what it means to be African-American in America obviously is associated with differences in life expectancy -- really, a loss of a significant chunk of the life that a person should have," Brunner said. "This is really unfair. These are enormous health inequities that still persist over generations."
The biggest health inequities involve African-American men, said Dr. Frank Staggers, a retired urologist and chairman of the Alta Bates Summit Medical Center Ethnic Health Institute.
The life expectancy of African-American men in Alameda County is just 69.9 years, compared with 78.9 years for white men, 80.7 years for Latinos, and 85.1 years for Asian-American men.
The higher homicide rates for African-American men account for only a small portion of the gap, McKetney said.
The long life span for Asian-Americans follows a national trend. The reasons for it are not entirely clear, but McKetney speculated that a healthy lifestyle and a lower-fat diet with plenty of rice and vegetables, instead of beef, may play a role.
One of the more puzzling findings involves the life expectancy of Latinos. When judging by income or education levels, Latinos could be expected to have worse health than whites.
Instead, Latinos in the East Bay live on average three to five years longer than whites and often have better health outcomes. Experts call this the "Hispanic paradox."
Researchers across the nation are looking at the health of Latino immigrants to figure out what can be transferred to other ethnic groups.
"The new immigrants do better, and then as they become acclimated and embedded in American culture and the American environment, their health problems become more like the mainstream," Brunner said.
"Much of it may have to do with diet," he added. "Early immigrants hold more traditionally to the diet of the countries they've come from, then start getting into the American high-fat, high-sugar, junk food diet and develop the chronic diseases associated with that."
Garcia believes that the strong bonds of many Latino families also play a role by easing stress and giving beneficial social support.
The studies' findings can be sobering, but McKetney said that they do show progress: The life expectancy of every racial and ethnic group in Alameda County increased during the past five years.
And racial gaps have been shrinking for such conditions as coronary heart disease, stroke, diabetes and many types of cancer.
"All the work that people have done to improve health for everyone, including African-Americans, I think is paying off," McKetney said. "It's just that clearly, there's still a lot of gaps, and a lot of work to be done."
Contact Sandy Kleffman at 925-943-8249.