HomeMy WebLinkAboutmortality-disparities-report-march2024-slidesAlameda County
Examining the Increase in Mortality
from 2018-2019 to 2020-2021
1
Alameda County Health Care Services Agency
Colleen Chawla, Director
Nicholas Moss, MD MPH, Health Officer
Chuck McKetney, Interim Director, Community Assessment, Planning, and Evaluation
HCSA Public Health Department
Kimi Watkins-Tartt, Director
Julia Raifman, Director, Community Assessment, Planning, and Evaluation
Matt Beyers, Supervising Epidemiologist, Community Assessment, Planning, and Evaluation
Yilak Fantaye, Epidemiologist, Community Assessment, Planning, and Evaluation
Elaine Bautista, Epidemiologist, Community Assessment, Planning, and Evaluation
Austin Wingate, Public Information Manager
2
Introduction
•CAPE
•Centering equity
•Connecting with community
•Data to action
•Continuous improvement – we welcome feedback
•Data reflect historical and present-day injustices and stark
inequities in mortality
•We aim for data to inform policies and programs to improve health and
reduce disparities
•We aim for data to empower community
3
Table of contents
•Key points
•Structural drivers of health
•Growing disparities in life expectancy
•The unequal toll of COVID-19 and other communicable diseases
•Non-communicable diseases as a leading cause of mortality and
rising deaths due to external causes
•Persistent disparities for mothers, pregnant people, and infants
•Summary
4
Key points
Disparities in mortality are driven by historical and present-day
national, state, and local public policy choices and institutional
practices that shape inequities in the conditions in which people live,
work, learn, and play in Alameda County. Disparities in mortality are
not primarily the result of individual choices or behaviors.
Decline in life expectancy
Lower COVID-19 mortality in Alameda County
Increased deaths at young ages
Chronic diseases remain the leading causes of death
Structural drivers of health
5
6
Bay Area Health Inequities Initiative (BARHII) Framework
Social inequities
shaped by
historical and
modern-day
national, state,
and local policies
Institutional
inequities
Living
conditions
Risk
behaviors
Disease
and
injury
Mortality
Source: BARHII Framework. Available at: https://barhii.org/framework/
Disparities in mortality are driven by historical and
present-day public policy choices and institutional
practices that shape inequities in the conditions in which
people live, work, learn, and play. Disparities in mortality
are not primarily the result of individual choices or
behaviors.
7
Historical and present-day injustices
•Slavery
•Redlining
•Home zoning policies
•Regressive tax policies
285.0
132.9
61.6
44.9
0.0
50.0
100.0
150.0
200.0
250.0
300.0
1989 1992 1995 1998 2001 2004 2007 2010 2013 2016 2019 2022
Me
d
i
a
n
w
e
a
l
t
h
i
n
1
0
0
0
s
Year
Median wealth by race and ethnicity in the United States, 1989 to 2022
White
Another race or
ethnicity
Hispanic/Latino/a/
x
Black
8
Growing wealth inequities in the US
Historical policies and practices have shaped large racial and ethnic disparities in wealth, poverty,
and health in the United States and in Alameda County. These disparities shape where people live,
work, learn, and play, as well as vulnerability to disasters such as the COVID-19 pandemic.
Source: Board of Governors of the Federal
Reserve System. (2023). Greater Wealth,
Greater Uncertainty: Changes in Racial
Inequality in the Survey of Consumer
Finances, Accessible Data.
https://www.federalreserve.gov/econres/notes/
feds-notes/greater-wealth-greater-uncertainty-
changes-in-racial-inequality-in-the-survey-of-
consumer-finances-accessible-
20231018.htm#fig1
Note: Other races and ethnicities were not
reported in the analysis.
Racial and ethnic disparities in
wealth in the United States are
large and grew in absolute
magnitude from 2019 to 2022
9
Racial and ethnic inequities in poverty
Source: American Community Survey (ACS)
Notes: The ACS does not break out the races mutually exclusive of Hispanic/Latino/a/x except for White.
17.8%
15.1%
11.8%11.0%
7.6%6.7%
9.3%
0%
5%
10%
15%
20%
African
American/Black
Pacific Islander Hispanic/Latino/a/x Native American Asian White All races
Pe
r
c
e
n
t
i
n
p
o
v
e
r
t
y
2021 Alameda County poverty rate by race and ethnicity
There are large racial and ethnic disparities in
poverty rates by race and ethnicity.
10
Racial and ethnic inequities in rent burden
54.2%
49.8%47.4%
43.0%
39.1%37.2%
43.7%
0%
10%
20%
30%
40%
50%
60%
African American/
Black
Native American Hispanic/
Latino/a/x
Pacific Islander White Asian All racesPe
r
c
e
n
t
o
f
r
e
n
t
e
r
s
w
i
t
h
h
i
g
h
r
e
n
t
b
u
r
d
e
n
Alameda County percent of renters with high rent burden, 2017-2021, by race and ethnicity
There are large racial and ethnic disparities in
rent burden by race and ethnicity.
11
Structural inequities drive health inequities
In an inequitable structural context, disasters often exacerbate
disparities. Purposefully designed policies and programs can
counteract inequities.
Learning about how mortality changed during the first two years of
the COVID-19 pandemic can inform work to improve health and
reduce health disparities in times of crisis and in all times.
As the 2022-2025 Alameda County Health Improvement Plan
highlights, there is a need to improve economic security and
opportunities, access to care, and community safety to improve
health and well-being and reduce mortality.
Growing disparities in life
expectancy
12
13
Alameda County has a higher life expectancy relative to the
United States, and experienced less of a decline in 2020-2021
82.7
81.7
78.8
76.1
81.8
78.5
72
74
76
78
80
82
84
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Li
f
e
e
x
p
e
c
t
a
n
c
y
(
y
e
a
r
s
)
Year
Life expectancy over time in Alameda County,
California, and the United States
COVID pandemic
- 1.0 year
- 3.3 years
- 2.7 years
Alameda County
California
United States
Life expectancy in
Alameda County was
longer than life
expectancy in California
and the United States
prior to the COVID-19
pandemic. In 2020,
there was less of a
decline in life
expectancy in Alameda
County than in
California and the
United States. While life
expectancy continued to
decline in 2021 in
California and the
United States, life
expectancy began to
recover in Alameda
County.
14
Already large racial and ethnic disparities in life
expectancy in Alameda County grew worse in 2020-2021
The already-large gap
in life expectancy by
race and ethnicity
grew from 13.2 years
in 2018-2019 to 15.9
years in 2020-2021
87.1 86.4
82.8 82.082.8
81.582.4
79.9
77.9
74.273.9
70.8
74.8
70.5
65
70
75
80
85
90
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
a
t
B
i
r
t
h
(
Y
e
a
r
s
)
Time Period
Alameda County life expectancy by race and ethnicity,
2018-2019 and 2020-2021
Asian
White
All Races
Hispanic/Latino/a/x
Native American
African American/Black
Pacific Islander
15.9
years
13.2
years
15
Racial and ethnic disparities in Alameda County
relative to California and the United States
While overall mortality in
Alameda County is lower
than in the United States
and California, mortality
for African American/Black
and Pacific Islander
people in Alameda County
was higher than for
African American/Black
and Pacific Islander
people in California and
the United States
459.7
864.0
724.2
1,072.9
1,118.8
873.7
857.4
466.4
768.5
735.9
950.5
1,082.5
963.8
732.4
417.2
606.1
689.0
984.1
1,171.8
1,251.8
614.8
0 500 1,000 1,500
Asian
White
Hispanic/Latino/a/x
Native American
African American/Black
Pacific Islander
All Races
Age-Adjusted Mortality Rate per 100,000 Population
Ra
c
e
a
n
d
E
t
h
n
i
c
i
t
y
All-Cause Mortality Rates in Alameda County,
California, and the United States, by Race and Ethnicity,
2020-2021
Alameda County
California
United States
16
Life expectancy disparities in Alameda County relative to
the United States
While overall life expectancy in Alameda County is higher
than in the United States, the life expectancy for African
American/Black and Pacific Islander people in Alameda
County was lower than for African American/Black and
Pacific Islander people in the United States
87.1 86.4
82.8 82.08…
79.9
77.9
74.273.9
70.8
74.8
70.5
65
70
75
80
85
90
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
a
t
B
i
r
t
h
(
Y
e
a
r
s
)
Time Period
Alameda County life expectancy by race and
ethnicity,
2018-2019 and 2020-2021
Asian
White
All Races
Hispanic/Latino/a/x
Native American
African
American/BlackPacific Islander
88.4
85.6
83.8
79.178.9 76.9
80.7
75.6
79.2
76.775.3
71.5
77.0
71.1
65
70
75
80
85
90
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
a
t
B
i
r
t
h
(
Y
e
a
r
s
)
Time Period
United States life expectancy by race and ethnicity,
2018-2019 and 2020-2021
Asian
Hispanic/Latino/a/x
White
Pacific Islander
All Races
African American/Black
Native American
17
Life expectancy disparities in Alameda County relative
to California
While overall life expectancy in Alameda County is higher
than in California, the life expectancy for African
American/Black and Pacific Islander people in Alameda
County was lower than for African American/Black and
Pacific Islander people in California
87.1 86.4
82.8 82.08…
79.9
77.9
74.273.9
70.8
74.8
70.5
65
70
75
80
85
90
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
a
t
B
i
r
t
h
(
Y
e
a
r
s
)
Time Period
Alameda County life expectancy by race and
ethnicity,
2018-2019 and 2020-2021
Asian
White
All Races
Hispanic/Latino/a/x
Native American
African
American/BlackPacific Islander
88.0
85.483.9
78.9
81.7
79.078.9
76.978.6
74.0
79.0
73.9
75.8
72.1
65
70
75
80
85
90
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
a
t
B
i
r
t
h
(
Y
e
a
r
s
)
Time Period
California life expectancy by race and ethnicity,
2018-2019 and 2020-2021
Asian
Hispanic/Latino/a/x
All Races
White
Pacific Islander
Native American
African American/Black
85.1 84.2
65.0
70.0
75.0
80.0
85.0
90.0
95.0
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
a
t
B
i
r
t
h
Time Period
Alameda County female life expectancy by
race/ethnicity, 2018-2019 and 2020-2021
Asian
White
All Races
Hispanic/Latino/a/x
Pacific Islander
Native American
African
American/Black
80.5
78.8
65.0
70.0
75.0
80.0
85.0
90.0
95.0
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
a
t
B
i
r
t
h
Time Period
Alameda County male life expectancy by race/ethnicity,
2018-2019 and 2020-2021
Asian
White
All Races
Hispanic/Latino/a/
x
Native American
African
American/Black
Pacific Islander
18
Life expectancy by sex: Racial and ethnic disparities in life
expectancy were larger and grew further for males in 2020-
2021
19.4
years
13.1
years15.2
years
11.3
years
Life expectancy is longer for females than males in Alameda
County. Racial and ethnic disparities in life expectancy are
especially large for males in Alameda County.
Neighborhood poverty is the percent of individuals in poverty by census tract. Native American and Pacific Islander averages
are depicted in the table rather than the figure by neighborhood poverty due to small population size.
Most
affluent
Least
affluent
African American/Black people in
neighborhoods with high poverty
rates experience the worst mortality,
but African American /Black people in
the lowest-poverty neighborhoods still
experience worse mortality than
people of other races and ethnicities,
even in high-poverty neighborhoods.
19
Racial and ethnic disparities persisted across
neighborhood poverty level Mortality Rate
1,251.8Pacific Islander
1,171.8African
American/Black
984.1Native American
689.0Hispanic/Latino
606.1White
417.2Asian1037
1373
534
968
565
868
399 441
0
200
400
600
800
1,000
1,200
1,400
1,600
<5.0% 5.0-9.9% 10.0-19.9% 20.0-29.9% 30.0%+
Ag
e
-
A
d
j
u
s
t
e
d
R
a
t
e
p
e
r
1
0
0
,
0
0
0
Neighborhood Poverty Group
Mortality Rate Social Gradient, 2020-2021
African
American/Black
White
Hispanic/Latino/a/x
Asian
20
Disparities in life expectancy by neighborhood
poverty increased in 2020-2021
8.8
The gap in life
expectancy in the highest
and lowest poverty
neighborhoods grew from
5.6 years in 2018-2019 to
8.8 years in 2020-202184.8 84.183.4
81.981.3
79.7
79.2 77.7
79.3
75.3
70
75
80
85
90
2018-2019 2020-2021
Li
f
e
E
x
p
e
c
t
a
n
c
y
(
Y
e
a
r
s
)
Years
Life Expectancy by Neighborhood Poverty Level
<5.0%
5.0-9.9%
10.0-19.9%
20.0-29.9%
30.0%+
8.8
years
5.6
years
21
The mortality rate for homeless people in Alameda
County is nearly 6 times that of the general population
3,366.2
572.1
0
500
1000
1500
2000
2500
3000
3500
4000
Homeless people in
Alameda County
Alameda County overall
Ag
e
-
a
d
j
u
s
t
e
d
m
o
r
t
a
l
i
t
y
r
a
t
e
p
e
r
1
0
0
,
0
0
0
p
e
o
p
l
e
Population
Mortality rate in the homeless population relative
to the general population in Alameda County,
2021
5.9X
Source: Alameda County 2021 Homeless Mortality Report
Alameda County Homeless Mortality 2021
Rising
homelessness is
a threat to
population health
22
Mortality increased in 2020-2021, exacerbating
racial/ethnic disparities
Mortality increased,
and racial and ethnic
disparities in mortality
increased
417.2
606.1
689.0
984.1
1,171.8
1,251.8
614.8
392.9
569.0
575.4
786.2
1,009.1
985.4
561.5
0 500 1,000 1,500
Asian
White
Hispanic/Latino/a/x
Native American
African American/Black
Pacific Islander
All Races
Age-Adjusted Mortality Rate per 100,000 Population
Ra
c
e
a
n
d
E
t
h
n
i
c
i
t
y
All-Cause Mortality Rate by Race and Ethnicity in
Alameda County, 2018-2019 and 2020-2021
2018-2019
2020-2021
23
Mortality increased in 2020-2021, exacerbating
racial/ethnic disparities
Most (73%) of the overall
increase in the death
rate in Alameda County
was due to COVID-19.
Pacific Islander, African
American/Black, and
Native American people
had large increases in
mortality due to COVID-
19 and due to other
causes.
29.6
23.5
87.7
100.9
73.9
119.5
38.8
-5.3
13.6
25.8
97.0
88.8
146.8
14.6
-50 0 50 100 150 200 250 300
Asian
White
Hispanic/Latino/a/x
Native American
African American/Black
Pacific Islander
All Races
Ra
c
e
a
n
d
E
t
h
n
i
c
i
t
y
Change in Mortality Rates due to COVID-19 vs Other
Causes by Race and Ethnicity, 2018-2019 to 2020-2021
COVID-19 Other Causes
(72.7% COVID)
Age-Adjusted Mortality Rate per
100,000 Population
Change2020-20212018-2019
-2.1%121.4124.0CancerFive leading causes
0.0%113.1113.0Heart disease
8.2%42.839.6Stroke
NA38.8NACOVID-19*
-9.4%31.735.0Alzheimer’s disease
9.5%614.8561.5All causesStatistically significant
change in rate NA38.8NACOVID-19*
65.6%19.311.6Unintentional overdose
25.5%11.28.9Chronic liver disease and
cirrhosis
80.4%9.25.1Homicide
* The percentage increase could not be calculated for COVID-19 because there were no COVID-19 deaths in the 2018-2019 period.
Change in Mortality Rate for Leading Causes and Statistically
Significant Changes, 2018-2019 to 2020-2021
25
Alameda County leading causes of death by age group
All Ages85+75-8465-7455-6445-5435-4418-34<18Rank
CancerHeart
diseaseCancerCancerCancerCancerUnintentional
overdose
Unintentional
overdose
Perinatal
complications1
2,2778286226213581487010130
Heart
diseaseCancerHeart
disease
Heart
diseaseHeart diseaseHeart diseaseCancerHomicideCongenital
conditions2
2,111458479392252102417015
StrokeAlzheimer’s
diseaseStrokeCOVID-19COVID-19Unintentional
overdoseHeart diseaseMotor vehicle
crash
Abnormal
clinical
findingsa3
7864291961529968364811
COVID-19StrokeCOVID-19StrokeUnintentional
overdoseCOVID-19HomicideSuicideHomicide4
72537816411175473638<10
Alzheimer’s
diseaseCOVID-19Alzheimer’s
diseaseDiabetesDiabetes
Chronic liver
disease &
cirrhosis
SuicideOther injurybCancer5
5782361218874392824<10
a. Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (excluding SIDS)
b. Injury other than homicide, suicide, unintentional motor vehicle crash, and unintentional overdose
Leading causes of death and average number of deaths in Alameda County in 2020-2021
26
There are large racial and ethnic disparities across leading
causes of death
242.5
192.7
119.5
84.4 79.0
29.1
207.3
191.3
73.9
47.6
84.3
40.0
178.8
123.4
100.9
30.2 31.6 39.1
116.5
129.0
23.5 14.2
35.1 36.0
114.2 111.6
87.7
26.8
49.4 35.0
73.1
94.5
29.6 15.3
37.2 23.1
113.1 121.4
38.8
19.9
42.8 31.7
0
50
100
150
200
250
300
Heart disease Cancer COVID-19 Diabetes Stroke Alzheimer's and other
dementiasAg
e
-
a
d
j
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d
m
o
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t
a
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Leading cause of death
Age-adjusted mortality rate for leading causes of death in 2020-2021, overall and by race and
ethnicity
Pacific Islander African American/Black Native American White Hispanic/Latino Asian All Races
27
7,201
4,837
3,737
2,899
1,851
5,395
3,027 2,884
1,880
1,108
4,644 4,244
2,997 2,879
1,475
2,676
1,879
1,155
537 463
2,465
1,995 1,924
957 775
2,036
1,091
526 505 272
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
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Pacific Islander Native American African American/Black White Hispanic/Latino Asian
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a
r
Alameda County age-adjusted years of life lost per 100,000 people per year, by race and ethnicity
Hispanic/Latino/a/x
There were large racial and ethnic disparities in premature
mortality for leading causes of death, 2020-2021
2. The unequal toll of
COVID-19 and other
communicable diseases
28
29
Alameda County had a lower rate of COVID-19 mortality
relative to the US, overall and for each race and ethnicity
Alameda County had an
age-adjusted COVID-19
death rate that was 41% the
age-adjusted COVID-19
death rate in the United
States and 46% the age-
adjusted COVID-19 death
rate in California. The age-
adjusted COVID-19 death
rate was lower in Alameda
County than in California
and the United States for
each race and ethnicity.80.2
62.6
139.5
153.8
180.0
149.4
94.7
52.6
58.1
103.7
158.2
124.2
164.7
84.2
23.5
29.6
73.9
87.7
100.9
119.5
38.8
0 50 100 150 200
White
Asian
African American/Black
Hispanic/Latino/a/x
Native American
Pacific Islander
All Races
Age-Adjusted Mortality Rate per 100,000 People
Ra
c
e
a
n
d
E
t
h
n
i
c
i
t
y
COVID-19 Mortality Rates in Alameda County, California, and
the United States, by Race and Ethnicity
Alameda County
California
United States
5.1x
30
There was an 18 year gap in the median age of death due to
COVID-19 by race and ethnicity
18.5 years
64.5 68.0
74.5 76.0 81.0 83.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Pacific Islander Hispanic/Latino/a/x African
American/Black
Native American Asian White
Me
d
i
a
n
a
g
e
o
f
d
e
a
t
h
Race and ethnicity
Alameda County median age of death due to COVID-19, 2020-2021
31
COVID was a top 5 cause of death in 2020-2021 for age
groups 45 and older in Alameda County
All Ages85+75-8465-7455-6445-5435-4418-34<18Rank
CancerHeart
diseaseCancerCancerCancerCancerUnintentional
overdose
Unintentional
overdose
Perinatal
complications1
2,2778286226213581487010130
Heart
diseaseCancerHeart
disease
Heart
diseaseHeart diseaseHeart diseaseCancerHomicideCongenital
conditions2
2,111458479392252102417015
StrokeAlzheimer’s
diseaseStrokeCOVID-19COVID-19Unintentional
overdoseHeart diseaseMotor vehicle
crash
Abnormal
clinical
findingsa3
7864291961529968364811
COVID-19StrokeCOVID-19StrokeUnintentional
overdoseCOVID-19HomicideSuicideHomicide4
72537816411175473638<10
Alzheimer’s
diseaseCOVID-19Alzheimer’s
diseaseDiabetesDiabetes
Chronic liver
disease &
cirrhosis
SuicideOther injurybCancer5
5782361218874392824<10
a. Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (excluding SIDS)
b. Injury other than homicide, suicide, unintentional motor vehicle crash, and unintentional overdose
32
COVID-19 mortality was higher in neighborhoods with more
poverty
26.5
37.8
50.8
68.1 68.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
<5.0% 5.0-9.9% 10.0-19.9% 20.0-29.9% 30.0%+
CO
V
I
D
-
1
9
d
e
a
t
h
s
p
e
r
1
0
0
,
0
0
0
p
e
o
p
l
e
Percent of neighborhood households in poverty
Alameda County 2020-2021 COVID-19 death rates by
neighborhood poverty
0
1
2
3
4
5
6
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
HI
V
m
o
r
t
a
l
i
t
y
r
a
t
e
p
e
r
1
0
0
,
0
0
0
p
e
o
p
l
e
Year
Age Adjusted Mortality Rate due to HIV in Alameda County, California and USA
Alameda County
California
United States
33
HIV mortality has declined over time in Alameda County,
California, and the United States
34
Death rates due to influenza vary by year in Alameda
County, California, and the United States
3.1
3.4
3.9
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021De
a
t
h
s
p
e
r
1
0
0
,
0
0
0
p
e
o
p
l
e
(
u
n
a
d
j
u
s
t
e
d
)
Year
Influenza deaths per 100,000 people in Alameda County, California, and the United
States
Alameda County
California
United States
Rising deaths due to
external causes
35
36
There were large relative increases in death rates at young ages
2018-2019 to 2020-2021 in Alameda County, primarily due to non-
COVID causes
0%
3%
7%
8%
8%
8%
7%
7%
2%
36%
28%
13%
4%
8%
2%
0%
0% 40%
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
Percent change in deaths due to COVID-19 and due to other
causes from 2018-2019 to 2020-2021, by age group
Non-COVID-19
COVID-19
Relative increases in
mortality rates due to
COVID-19 were
consistent across all
age groups over 35.
There were large
relative increases in
mortality in younger
age groups due to
non-COVID causes,
primarily overdose
and homicide
(following national
trend)
30%
70%
33%
7%
14%
5%
3%
0%
0%
2%
5%
4%
6%
9%
8%
9%
-80% -40% 0% 40% 80%
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
African
American/Black
COVID-19 Non-COVID-19
-17%
5%
23%
21%
8%
26%
-3%
7%
2%
6%
4%
11%
9%
11%
7%
8%
-80% -40% 0% 40% 80%
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
Asian
COVID-19
Non-COVID-19
-30%
57%
44%
31%
10%
12%
-7%
6%
0%
2%
18%
22%
23%
22%
17%
10%
-80% -40% 0% 40% 80%
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
Hispanic/Latino
COVID-19 Non-COVID-19
22%
5%
38%
-1%
-5%
3%
9%
-7%
0%
1%
2%
2%
3%
4%
5%
5%
-80% -40% 0% 40% 80%
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
White
COVID-19
Non-COVID-19
-5%
41%
35%
12%
5%
9%
4%
-1%
0%
3%
8%
8%
8%
8%
7%
7%
-80% -40% 0% 40% 80%
<18
18-34
35-44
45-54
55-64
65-74
75-84
85+
All Races
COVID-19 Non-COVID-19
37
The largest relative increases in mortality 2018-2019 to 2020-2021
were among Black/African American and Hispanic/Latino/a/x
young people in Alameda County
Hispanic/Latino/a/x
Note: The number of deaths for Pacific Islander and Native American people were too low to include.
38
Overdose, homicide, and motor vehicle crashes were leading causes of death at
young ages in Alameda County in 2020-2021 (& increased relative to 2018-2019)
All Ages85+75-8465-7455-6445-5435-4418-34<18Rank
CancerHeart
diseaseCancerCancerCancerCancerUnintentional
overdose
Unintentional
overdose
Perinatal
complications1
2,2778286226213581487010130
Heart
diseaseCancerHeart diseaseHeart
diseaseHeart diseaseHeart diseaseCancerHomicideCongenital
conditions2
2,111458479392252102417015
StrokeAlzheimer’s
diseaseStrokeCOVID-19COVID-19Unintentional
overdoseHeart diseaseMotor vehicle
crash
Abnormal
clinical findingsa3
7864291961529968364811
COVID-19StrokeCOVID-19StrokeUnintentional
overdoseCOVID-19HomicideSuicideHomicide4
72537816411175473638<10
Alzheimer’s
diseaseCOVID-19Alzheimer’s
diseaseDiabetesDiabetes
Chronic liver
disease &
cirrhosis
SuicideOther injurybCancer5
5782361218874392824<10
a. Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (excluding SIDS)
b. Injury other than homicide, suicide, unintentional motor vehicle crash, and unintentional overdose
39
Overdose increased in Alameda County in 2020-2021,
following state and national trends
29.9
19.2
25.3
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Ag
e
-
A
d
j
u
s
t
e
d
R
a
t
e
p
e
r
1
0
0
,
0
0
0
P
o
p
u
l
a
t
i
o
n
Unintentional overdose mortality in Alameda County, California,
and the United States, 2005-2021
Alameda County
California
United States
40
There are large and increasing racial and ethnic disparities
in unintentional overdose mortality in Alameda County
61.4
23.019.3
3.00
10
20
30
40
50
60
70
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in unintentional overdose mortality rates by race and ethnicity
in Alameda County
African American/Black
White
All Races
Hispanic/Latino
Asian
* Since there are few unintentional overdose deaths among Native Americans and Pacific Islanders, we had to aggregate eight years
of data for each. For 2014-2021, the Native American rate was 28.5/100,000 and the Pacific Islander rate was 12.4/100,000.
Hispanic/Latino/a/x
41
Homicide increased in Alameda County in 2020-2021,
exceeding a national trend
8.2
9.2
6.4
0
2
4
6
8
10
12
14
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Ag
e
-
A
d
j
u
s
t
e
d
R
a
t
e
p
e
r
1
0
0
,
0
0
0
P
o
p
u
l
a
t
i
o
n
Year
Homicide mortality in Alameda County, California, and the United States, 2005-
2021
Alameda County
California
United States
42
There are large racial and ethnic disparities
in the homicide rate in Alameda County
28.5
50.7
11.1
2.61.30
10
20
30
40
50
60
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in homicide mortality rates by race and ethnicity in Alameda County
African
American/Black
Hispanic/Latino
White
Asian
Note: The number of homicide deaths for Pacific Islander and Native American people were too low to include.
Hispanic/Latino/a/x
43
Increase in homicide at young ages in Alameda County in
2020-2021
Source: CAPE. Mortality data.
12.1
20.8
8.5
15.2
5.1
9.0
0
5
10
15
20
25
30
35
40
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
S
p
e
c
i
f
i
c
R
a
t
e
P
e
r
1
0
0
,
0
0
0
P
o
p
u
l
a
t
i
o
n
Homicide Rate by Age Group in Alameda County
2006-2021
0-18
19-25
26-44
45-64
65-84
85+
All Ages
44
Motor vehicle fatalities were lower in Alameda County than in
California and the United States and increasing across settings
13.3
7.8
12.0
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Ag
e
-
A
d
j
u
s
t
e
d
R
a
t
e
p
e
r
1
0
0
,
0
0
0
P
o
p
u
l
a
t
i
o
n
Year
Motor vehicle traffic mortality rate in Alameda County, California, and the United
States, 2005-2021
Alameda County
California
United States
45
There are large and increasing racial and ethnic disparities in
motor vehicle crash mortality in Alameda County
23.9
8.97.45.6
2.7
0
5
10
15
20
25
30
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in motor vehicle crash mortality rates by race and ethnicity in Alameda County
African American/Black
Hispanic/Latino
All Races
White
Asian
* Since there are few motor vehicle crash deaths among Pacific Islanders, we had to aggregate eight years of data.
For 2014-2021, the Pacific Islander rate was 18.4/100,000. There were too few deaths among Native American
people to include in the figure.
Hispanic/Latino/a/x
46
The suicide mortality rate is lower in Alameda County than
in California and the United States and has remained
relatively constant over time
14.1
9.0
10.1
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Ag
e
-
a
d
j
u
s
t
e
d
s
u
i
c
i
d
e
m
o
r
t
a
l
i
t
y
r
a
t
e
p
e
r
10
0
,
0
0
0
p
e
o
p
l
e
Year
Temporal trends in suicide mortality rate in Alameda County, California, and the United
States, 2005-2021
Alameda County
California
United States
47
There are racial and ethnic disparities in suicide mortality in
Alameda County
11.4
5.8
7.2
11.7
0
2
4
6
8
10
12
14
16
18
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in suicide mortality rates by race and ethnicity in Alameda County
African
American/Black
Asian
Hispanic/Latino
White
Note: The number of suicide deaths for Pacific Islander and Native American people were too low to include.
Hispanic/Latino/a/x
48
Neighborhood poverty is associated with mortality rates
due to external causes
0
10
20
30
40
50
Unintentional
Overdose
Homicide Unintentional Motor
Vehicle Crash
Suicide
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
pe
r
1
0
0
,
0
0
0
P
o
p
u
l
a
t
i
o
n
Injury Mortality Rate by Neighborhood Poverty Level
<5.0%5.0-9.9%10.0-19.9%20.0-29.9%30.0%+
5.0X
11.6X
2.2X 1.2X
Data
suppressed
due to
small numbers
Chronic diseases remain
leading causes of death
in middle and older age
49
50
Chronic diseases remain leading causes of death in middle
and older age in Alameda County
All Ages85+75-8465-7455-6445-5435-4418-34<18Rank
CancerHeart
diseaseCancerCancerCancerCancerUnintentiona
l overdose
Unintentional
overdose
Perinatal
complication
s1
2,2778286226213581487010130
Heart
diseaseCancerHeart
disease
Heart
disease
Heart
disease
Heart
diseaseCancerHomicideCongenital
conditions2
2,111458479392252102417015
StrokeAlzheimer’
s diseaseStrokeCOVID-19COVID-19Unintentiona
l overdose
Heart
disease
Motor
vehicle crash
Abnormal
clinical
findingsa3
7864291961529968364811
COVID-19StrokeCOVID-19StrokeUnintentional
overdoseCOVID-19HomicideSuicideHomicide4
72537816411175473638<10
Alzheimer’
s diseaseCOVID-19Alzheimer’s
diseaseDiabetesDiabetes
Chronic liver
disease &
cirrhosis
SuicideOther injurybCancer5
5782361218874392824<10
a. Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (excluding SIDS)
b. Injury other than homicide, suicide, unintentional motor vehicle crash, and unintentional overdose
51
Cancer mortality is lower in Alameda County than in
California and the United States and is declining
across settings
120.8
146.6
132.4
110
160
210
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in age-adjusted cancer mortality rates in Alameda
County, California and the United States, 2005-2021
Alameda County
California
United States
52
While cancer mortality is declining over time in Alameda County,
racial and ethnic disparities in cancer mortality persist
191.3
129.0121.4
111.6
94.5
0
50
100
150
200
250
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in cancer mortality rates by race and ethnicity in Alameda County
African
American/Black
White
All Races
Hispanic/Latino
Asian
* Since there are few cancer deaths among Native Americans and Pacific Islanders, we had to aggregate eight years of data for
each. For 2014-2021, the Native American rate was 123.4/100,000 and the Pacific Islander rate was 191.3/100,000.
Hispanic/Latino/a/x
53
There are racial and ethnic disparities in the median
age of death due to cancer
11 years
65.0
69.0
72.0 73.0
75.0 76.0
58.0
60.0
62.0
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
Pacific Islander Hispanic/Latino/a/x African
American/Black
Asian Native American White
Me
d
i
a
n
a
g
e
o
f
d
e
a
t
h
Racial and ethnic disparities in median age of death due to cancer
54
Heart disease mortality is lower in Alameda County than in
California and the United States and stable over time in
Alameda County
111.6
173.8
147.8
0
50
100
150
200
250
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in age-adjusted heart disease mortality in Alameda County, California
and the United States, 2005-2021
Alameda County
California
United States
55
While heart disease mortality is declining over time in Alameda
County, racial and ethnic disparities in heart disease mortality
persist
207.3
116.5
114.2
73.1
0
50
100
150
200
250
300
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in heart disease mortality rates by race and ethnicity in Alameda
County
African
American/Black
White
All Races
Hispanic/Latino
Asian
* Since there are few heart disease deaths among Native Americans and Pacific Islanders, we had to aggregate eight years of data for
each. For 2014-2021, the Native American rate was 178.8/100,000 and the Pacific Islander rate was 242.5/100,000.
Hispanic/Latino/a/x
56
There are racial and ethnic disparities in the median age of
death due to heart disease
20.0 years
64.0 69.0 72.0 77.0
83.0 84.0
0
10
20
30
40
50
60
70
80
90
Native
American
Pacific
Islander
African American/
Black
Hispanic/
Latino/a/x
White Asian
Me
d
i
a
n
a
g
e
o
f
d
e
a
t
h
Median age at death due to Heart Disease
57
Stroke mortality in Alameda County is similar to California
and the United States, and increasing across settings
43.4
41.1
42.1
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in stroke mortality in Alameda County, California, and the United
States, 2005-2021
Alameda County
California United States
While stroke mortality rates are higher in Alameda
County than in California and the United States, this is
partly because cancer and heart disease mortality rates
are lower. People die of stroke at older ages.
58
While stroke mortality is consistent over time in Alameda
County, racial and ethnic disparities in stroke mortality persist
and African American/Black stroke mortality is increasing
84.3
49.4
37.235.1
0
10
20
30
40
50
60
70
80
90
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in stroke mortality rates by race and ethnicity in Alameda County
African American/Black
Hispanic/Latino
All Races
Asian
White
* Since there are few stroke deaths among Native Americans and Pacific Islanders, we had to aggregate
eight years of data for each. For 2014-2021, the Native American rate was 31.6/100,000 and the Pacific
Islander rate was 79.0/100,000.
Hispanic/Latino/a/x
59
Chronic lower respiratory disease mortality is lower in
Alameda County than in California and the United
States, and declining across settings
19.1
34.7
26.1
0
5
10
15
20
25
30
35
40
45
50
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Ag
e
-
A
d
j
u
s
t
e
d
M
o
r
t
a
l
i
t
y
R
a
t
e
Year
Temporal trends in age-adjusted chronic lower respiratory disease mortality in Alameda
County, California and the United States, 2005-2021
Alameda County
California
United States
19.2
25.4
25.5
0.0
10.0
20.0
30.0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Ag
e
-
A
d
j
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d
M
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t
a
l
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R
a
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e
Year
Diabetes Mortality in Alameda County, California and United States
2005-2021
60
Diabetes mortality is lower in Alameda County than in
California and the United States
Alameda County
CaliforniaUnited States
61
While diabetes mortality is consistent over time in Alameda
County, racial and ethnic disparities in diabetes mortality
persist
47.6
26.8
15.314.2
0
10
20
30
40
50
60
2006-2007 2008-2009 2010-2011 2012-2013 2014-2015 2016-2017 2018-2019 2020-2021
Ag
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-
A
d
j
u
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d
M
o
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t
a
l
i
t
y
R
a
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e
Year
Temporal trends in diabetes mortality rates by race and ethnicity in Alameda County
African American/Black
All Races
Hispanic/Latino
Asian
White
* Since there are few diabetes deaths among Native Americans and Pacific Islanders, we had to aggregate eight years of data for each.
For 2014-2021, the Native American rate was 30.2/100,000 and the Pacific Islander rate was 84.4/100,000.
Hispanic/Latino/a/x
62
There are large racial and ethnic disparities in the
median age of death due to diabetes
16.5 years
61.5
67.0 69.0 71.0 75.0 78.0
0
10
20
30
40
50
60
70
80
90
Native American Hispanic/Latino/a/x African
American/Black
Pacific Islander White Asian
Me
d
i
a
n
a
g
e
o
f
d
e
a
t
h
Racial and ethnic disparities in median age of death due to diabetes
63
Chronic liver disease mortality is lower in Alameda County than
in California and the United States and increasing across
settings
10.6
14.5
16.0
0
2
4
6
8
10
12
14
16
18
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021Ag
e
-
A
d
j
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t
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d
M
o
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t
a
l
i
t
y
R
a
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e
Year
Chronic liver disease and cirrhosis Mortality in Alameda County, California
and United States
2005-2021
Alameda County
California United States
64
Neighborhood poverty is associated with chronic disease deaths
0
20
40
60
80
100
120
140
160
180
200
Heart Disease Malignant Neoplasms
(Cancer)
Cerebrovascular
Diseases (Stroke)
Diabetes Mellitus
Ag
e
-
A
d
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M
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pe
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1
0
0
,
0
0
0
P
o
p
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a
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i
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Chronic Disease Mortality Rate by Neighborhood Poverty Level
<5.0%5.0-9.9%10.0-19.9%20.0-29.9%30.0%+
1.9X 1.3X
1.6X
1.7X
Persistent disparities for mothers,
pregnant people, and infants
65
66
The infant mortality rate is lower in Alameda County
than in California and the United States, and declining
across settings
3.3
4.2
5.6
0
1
2
3
4
5
6
7
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20
In
f
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m
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1
0
0
0
l
i
v
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b
i
r
t
h
s
Time period
Temporal trends in infant mortality in Alameda County, California, and the United States
Alameda County
California
United States
67
Persistent racial disparities in infant mortality in Alameda
County
Note: Rates could not be reported for Native American and Pacific Islander populations to maintain confidentiality with low numbers.
8.9
2.83.4
2.62.7
0
2
4
6
8
10
12
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20 2019-21
In
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M
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,
0
0
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s
)
Time period
Alameda County temporal trends in infant mortality rate, by race and ethnicity
African
American/
Black
Hispanic/
Latino/a/x
All Races
Asian
White
68
Severe maternal morbidity rate is higher in Alameda
County than in California and the United States, and
increasing across settings
143.2
98.5
84.7
0
20
40
60
80
100
120
140
160
2016-18 2017-19 2018-20
Se
v
r
e
e
m
a
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o
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p
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1
0
,
0
0
0
l
i
v
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bi
r
t
h
s
Time period
Temporal trends in severe maternal morbidity in Alameda County, California, and the United
States Alameda County
California
United States
Severe maternal morbidity includes severe and potentially
life-threatening complications during labor and delivery.
Severe maternal morbidity is higher and has increased faster
in recent years in Alameda County compared to California
and the United States
69
Alameda County racial and ethnic disparities in severe
maternal morbidity
224.4
151.5
146.2
140.2
122.1
0
50
100
150
200
250
2016-2018 2017-2019 2018-2020 2019-2021
Se
v
e
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M
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M
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v
i
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r
i
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s
)
Time period
Temporal trends in severe maternal morbidity in Alameda County,
by race and ethnicity, 2016 to 2021
African American/Black
Hispanic/Latina
Overall
Asian/Pacific Islander
White
Note: Estimates are provided by the California Department of Public Health for overlapping 3-year periods. Data begin in 2016, when new International Classification of Disease (ICD) codes were introduced (ICD-10). Rates were not available for Native American and Pacific Islander populations due to data suppression.
Hispanic/Latino/a/x
70
Summary
•Alameda County residents benefit from higher life expectancy and
lower mortality relative to residents of California and the United
States.
•Historical and present-day structural inequities and injustices
drive substantial racial and ethnic inequities in life expectancy
and mortality that worsened during the COVID-19 pandemic
•There are also inequities in mortality by neighborhood poverty
level, especially for leading causes of death at young ages
•Alameda County has identified economic security, access to
health care, and communities free from violence as priorities for
improving health
71
Mortality during the COVID-19 pandemic
•Alameda County experienced less of an increase in mortality from 2018-2019 to 2020-2021 than the United States and California. At the same time, there are large racial and ethnic disparities in mortality rates within Alameda County.
•Alameda County also had lower rates of COVID-19 mortality relative to the United States and California. At the same time, there were large racial and ethnic disparities in COVID-19 deaths within Alameda County.
•Evidence indicates that high vaccination coverage, mask policies, and equitable prevention and treatment approaches were associated with reduced COVID-19 deaths
•Alameda County prioritized equity through hyperlocal community engagement with African American/Black and Hispanic/Latino/a/x communities disproportionately affected by COVID-19, working to improve access to COVID-19 testing, vaccination, and treatment in these communities.
•Continuing to deliver up to date COVID-19 vaccinations and other vaccinations with a focus on equity remains important for reducing mortality and mortality inequities in the years ahead.
72
Alameda County Public Health Department (ACPHD)
Programs
Examples
•Comprehensive Perinatal Services Programs with 22 clinics: Pregnant people who are eligible for Medi-Cal can enroll in health education, nutrition education, and support for issues like jobs, emotions, relationships, and housing.
•The BElovedBIRTH Black Centering is group prenatal care created by and for Black people, who are affected by worse pregnancy outcomes in Alameda County. BElovedBIRTH Black Centering patients are also offered doulas, lactation consultants, mental health supports, and nutritional supports.
•Women, Infants, and Children (WIC) program supporting nutritious food for low-income residents
•Healthy Living for Life program serving mainly CalFresh-eligible residents
•Healthy Retail Program supports more than 20 retail stores throughout the county in stocking healthy foods in areas that may otherwise be food deserts
•Asthma Program: Social workers assess homes for asthma triggers and provide remediation supplies (like HEPA air filters and mattress covers) and support minor home repairs that improve indoor air quality.
Targeted universalism: Everyone in the county is served and there are additional services
provided for populations disproportionately affected by morbidity and mortality. ACPHD is
focused on reducing gaps in health and services.
73
Policies can reduce structural inequities
Potential examples
•Engage and partner with communities that are most affected by inequities and center their experience and ideas in the formation of solutions
•Reparations
•Restore land rights
•Baby bonds
•Expanded child tax credits
•Universal basic income
•Using restorative justice to work toward instilling trust in public systems
•Policies and programs to increase the supply of affordable housing
•Improve education and skills development
•Reduce pollution and exposure to environmental hazards
•Improve immigration policy
•Support access to culturally affirming health care that is accessible in language, provider type, cost, and time, and that supports both physical and psychosocial needs
In addition to ACPHD programs, broader policies and actions that impact the structural drivers of health
are critical interventions for decreasing premature death and health inequities
ACPHD is committed to using these data to inform improved
population health and health equity
We encourage you to use the data and to reach out to us if we can
provide support:
•See the report and other data at https://acphd.org/data-reports/
•General questions about this report and the work of the Alameda
County Public Health Department: HCSA-PIO@acgov.org
•Data questions: CAPE-Epidemiology@acgov.org
•We are committed to continuous improvement and appreciate
feedback
Thank you
Thank you for your contributions to public health and health equity in Alameda County
75