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Home My WebLink Aboutac-phd-2026-cha-report-final-5-5-26Alameda County Public Health Department • 2025–2027 CHA 1 2025–2027 Alameda County Community Health Assessment Alameda County Public Health Department • 2025–2027 CHA 2 Image Credits Alameda County Public Health Department (ACPHD) acknowledges the following individuals and organizations whose photographic works are used with permission or under a community commons license. All images not listed below were taken by ACPHD with the consent of the people who were photographed, or were purchased for use in this report. Page 5: stethoscope heart, Patty Brito Page 34: rowers on Lake Merritt, J. Pablo Ramirez Page 59: child at dentist, Nadezhda Moryak Page 60: nurse, Laura James Page 61: surgeons, Studio 1222300 Page 85: mother and daughters on steps, PNW Productions Page 90: traffic, Jose Fabula Page 93: community garden sign, David Clode Page 135: family on steps, Any Lane Page 136: three women, Antonius Ferret Helping organizations discover and act on data-driven insights. 1346 The Alameda, Suite 7–507 San José, CA 95126 www.ActionableLLC.com 408-384-4955 | 408-384-4956 Alameda County Public Health Department • 2025–2027 CHA 3 Acknowledgments This Community Health Assessment could not have been completed without the partnership of the many community-based organizations that form the robust safety net in Alameda County. Alameda County Health Public Health Department gratefully acknowledges the organizations that supported the community health assessment by recruiting participants and hosting focus groups and related community engagement events. The complete list of organizations is in Attachment 1. Additionally, the hospitals, health systems, and related organizations that worked in partnership with Alameda County Health Public Health Department and their respective staff are recognized below. • Hospital Council Northern and Central California Rebecca Rozen, Regional Vice President • John Muir Health Jamie Elmasu, MPH, Director, Community Health Improvement Ashley Jackson, Business Data Analyst, Community Health Improvement • Kaiser Permanente Lloyd Nadal, MA, Community Health Lead, East Bay and Greater Southern Alameda Leslie Brown, Community Health Lead, Contra Costa County & Tri-Valley • St. Rose Hospital Michael Cobb, Foundation Executive Director • Stanford Health Care Tri-Valley Denise Bouillerce, Sr. Director, Government & Community Relations, PR/Marketing Shelby Salonga, Manager, Marketing, Public Relations, and Volunteer Services • Sutter Health Mindy Landmark, Community Health Manager Bryden Johnston, MPH, Community Health Coordinator Josue De Avila, MHA, Community Health Manager Kelly Brenk, Senior Director, Community Health • UCSF Benioff Children’s Hospitals, Anchor Institution Mission Wylie Liu, MPH, MPA, Executive Director, Center for Community Engagement Stephanie Sario, MSc, Assistant Director, Community Benefit Alameda County Public Health Department • 2025–2027 CHA 4 • Washington Health Angus Cochran, PhD, Chief, Community Support Services Kayla Gupta, MPH, Community Outreach Manager In addition to the above, the following consultant groups provided technical assistance in data collection, analysis, and report writing. • Actionable Insights, LLC Jennifer van Stelle Brozzo, PhD, Co-Founder and Principal Melanie Espino, Co-Founder and Principal Emma Schifsky, Research & Evaluation Manager Jonathan Rimando, Project Management Intern • Applied Survey Research Kim Carpenter, PhD, Vice President of Research and Evaluation Kim Gillette, MPH, Senior Project Manager Sara Strickhouser, PhD, Project Manager Kimberly Corneille, MA, Senior Research Analys • Jones Psychological Services Margaret (Peggy) Jones, PsyD, Founder and Chief Executive Officer Renato Almanzor, PhD, Collaborator The Public Health Department of Alameda County Health convened an Internal CHA Advisory Board where staff from different divisions participated to inform and guide the CHA process. Participating staff in the CHA process are as follows. Kimi Watkins-Tartt, Director, Public Health Department George Ayala, PsyD, Deputy Director, Public Health Department Evette Brandon, Director, Quality Improvement and Accreditation (QIA) Division Carolina Guzmán, Director, Performance Management and Accreditation, QIA Division Andrea Wise, Program Specialist, QIA Division John Virata, Quality Improvement Associate, QIA Division Alameda County Public Health Department • 2025–2027 CHA 5 Linda Franklin, Management Analyst, QIA Division Kerri Chen, Quality Improvement Coordinator, QIA Division Dena Rifahie, Program Services Coordinator, QIA Division Julia Raifman, Sc.D., SM., Director of Community Assessment, Planning, and Evaluation (CAPE) Matthew Beyers, Supervising Epidemiologist, CAPE Alameda County Public Health Department • 2025–2027 CHA 6 Table of Contents Image Credits ............................................................................................................... 2 Acknowledgments ........................................................................................................ 3 Table of Contents .......................................................................................................... 6 Letter from Public Health Department Director, Kimi Watkins-Tartt .................................. 9 Executive Summary..................................................................................................... 11 Purpose of the Community Health Assessment ......................................................... 11 Community Health Assessment (CHA) Process and Methods ..................................... 11 Key Findings: Top Community Health Needs, 2025–2027 ............................................ 11 Major Conclusions ................................................................................................... 12 Next Steps for Alameda County Public Health in 2026 ................................................ 12 Introduction ............................................................................................................... 14 Community Health Assessment Purpose .................................................................. 14 About Public Health Accreditation Board (PHAB) Recognition .................................. 15 What Is Included in the 2025–2027 CHA Report ......................................................... 16 Community Served ..................................................................................................... 18 Demographics of Alameda County ............................................................................ 19 Languages Spoken in Alameda County ................................................................... 20 Inequities in the County ........................................................................................... 21 Process and Methods .................................................................................................. 24 Data Collection ....................................................................................................... 24 CHA Participant Demographics ............................................................................. 27 How ACPHD Identified Community Health Needs ...................................................... 28 2025–2027 Prioritized Community Health Needs .......................................................... 31 What Shapes Health? .............................................................................................. 31 1. Chronic Conditions .............................................................................................. 34 Challenges: Chronic Conditions ............................................................................ 36 Chronic Conditions: Asthma .............................................................................. 37 Chronic Conditions: Cancer ............................................................................... 39 Chronic Conditions: Cognitive Decline ................................................................ 43 Alameda County Public Health Department • 2025–2027 CHA 7 Chronic Conditions: Heart Disease and Stroke .................................................... 45 Chronic Conditions: Diabetes and Obesity .......................................................... 48 2. Social Determinants of Health .............................................................................. 53 Challenges: Social Determinants of Health ............................................................ 56 Social Determinants of Health: Health Care Access and Quality ........................... 56 Social Determinants of Health: Economic Stability .............................................. 65 Social Determinants of Health: Peaceful Communities ........................................ 75 Social Determinants of Health: Housing and the Unhoused .................................. 80 Social Determinants of Health: Built Environment, Including Unintended Injuries .. 86 Social Determinants of Health: Climate / Natural Environment ............................. 94 Social Determinants of Health: Racism/Discrimination ........................................ 99 3. Behavioral Health ............................................................................................... 107 Challenges: Behavioral Health............................................................................. 109 4. Communicable Diseases .................................................................................... 117 Challenges: Communicable Diseases .................................................................. 118 Communicable Diseases: Sexually Transmitted Infections................................. 118 Communicable Diseases: Respiratory Infections............................................... 120 Communicable Diseases: Vaccine-Preventable Diseases .................................. 123 Community Comments ............................................................................................. 127 Community Feedback ............................................................................................ 127 What Resonated and What Was Surprising (What Stood Out) ................................ 128 What People Are Wondering About ...................................................................... 130 Action-Oriented Feedback ............................................................................... 130 Solutions External to Public Health ................................................................ 130 Summary of Community Engagement Sessions .................................................... 131 Community Partners and Resources .......................................................................... 133 Community Resources ........................................................................................... 133 Conclusion ............................................................................................................... 135 Attachments ............................................................................................................. 139 Attachment 1: List of Community Partner Organizations ........................................... 140 Alameda County Public Health Department • 2025–2027 CHA 8 Attachment 2: Definitions ....................................................................................... 141 Attachment 3: Primary/Secondary Qualitative Data Collection ................................. 142 CHA/CHNA Interviews and Focus Groups ............................................................ 143 Community Leaders, Representatives, and Members Consulted ........................... 145 Attachment 4: Statistical Data Collection and Community Health Charts .................. 167 Secondary Statistical Data Collection .................................................................. 167 A Further Look .................................................................................................... 168 Information Gaps and Limitations ........................................................................ 182 Attachment 5: Secondary Reports and Presentations Consulted ............................... 183 Attachment 6: Secondary Data Indicators Index ....................................................... 184 Attachment 7: Qualitative Research Materials ......................................................... 207 Attachment 8: Community Assets and Resources .................................................... 239 Attachment 9: Public Health Accreditation Board Checklist ...................................... 297 Attachment 10: Endnotes ....................................................................................... 299 Alameda County Public Health Department • 2025–2027 CHA 9 Letter from Public Health Department Director, Kimi Watkins-Tartt January 2026 Community Health Assessment – Building a Healthier Alameda County Together Dear Community Members, On behalf of the Alameda County Public Health Department, I am pleased to share the results of our Community Health Assessment (CHA). This report reflects the voices, experiences, and data that tell the story of health in our county—where we are making progress and where challenges remain. The CHA is more than a document; it is a foundation for action. It brings together community input, public health data, and insights from our partners to highlight key health needs and inequities across Alameda County. The findings underscore the importance of addressing not only access to care, but also the broader conditions that shape health—such as housing, employment, education, and safety. As we move forward, the CHA will directly inform our Community Health Improvement Plan (CHIP), guiding our collective priorities and strategies. We remain committed to advancing health equity, listening to the wisdom of our residents, and working side by side with community partners to create lasting change. I want to extend my deep gratitude to all who participated in this process—residents, community organizations, health care providers, and county staff. Your voices and partnership are essential in shaping a healthier, more just Alameda County. We invite you to review the Community Health Assessment and join us in the next phase of this work. Together, we can build a county where every person has the opportunity to live a long, healthy, and fulfilling life. With appreciation, Kimi Watkins-Tartt Director Alameda County Public Health Department Health.AlamedaCountyCA.gov/ACPHD Alameda County Public Health Department • 2025–2027 CHA 10 1. Executive Summary Alameda County Public Health Department • 2025–2027 CHA 11 Executive Summary Purpose of the Community Health Assessment  Tell the community’s story by collecting both numbers and personal experiences from different sources to better understand what affects people’s health.  Find differences in health outcomes between groups and learn what causes them, to support fair and equal health for everyone.  Use this information to guide the Alameda County Public Health Department’s planning, programs, and policies, and to work with community partners to improve health and well-being.  Meet public health accreditation standards by following clear and evidence-based practices. Community Health Assessment (CHA) Process and Methods Figure 1. The main part of the CHA process is gathering and studying information to make a list of problems that affect the community's health. Talk to community members and read reports information community health needs Key Findings: Top Community Health Needs, 2025–2027 • Social Determinants of Health:  Health Care Access & Quality  Economic Stability  Peaceful Communities  Housing and Homelessness  Built Environment, Including Unintended Injuries  Climate/Natural Environment  Racism/Discrimination • Behavioral Health • • Chronic Conditions:  Asthma  Cancer  Cognitive Decline  Diabetes & Obesity  Heart Disease & Stroke • Communicable Diseases  Sexually Transmitted Infections  Respiratory Infections  Other Communicable Diseases Alameda County Public Health Department • 2025–2027 CHA 12 Major Conclusions • Community members are very concerned about social determinants of health, which are the conditions that affect people’s daily lives, like being able to afford housing and food. • African American/Black and Pacific Islander people in Alameda County have more health problems and die from major diseases more often, especially when they are younger. • People in the community, no matter their race, ethnicity, sexual orientation, gender identity, age, disability, or where they live, say they have problems with their mental and behavioral health. Next Steps for Alameda County Public Health in 2026 • Make the 2025–2027 Community Health Assessment report publicly available on the Alameda County Public Health Department’s website. Also, send it to the group that gives the department its accreditation. • Share the report with people who are affected by it and people who live in the county by giving presentations, publishing it, and using social media. • Work with people in the community and other departments in the agency to create a Community Health Improvement Plan based on what the assessment shows. This plan will be published in 2027. • Monitor the progress of the Community Health Improvement Plan and share regular updates with the community. Alameda County Public Health Department • 2025–2027 CHA 13 2. Introduction Alameda County Public Health Department • 2025–2027 CHA 14 Introduction This Community Health Assessment (CHA) takes a broad view of health conditions and status in Alameda County. It provides local disease and death rates alongside data and information on social determinants of health such as social structures and economic systems, including health services and the social and physical environment. The CHA is conducted in collaboration with Alameda County’s nonprofit hospitals’ comprehensive community health needs assessments (CHNAs) and is one of the requirements for public health accreditation. This document will inform the work of Alameda County Public Health Department (ACHPHD) work to better serve the people of Alameda County. Understanding why health disparities exist enables ACPHD to address root causes and develop better interventions, policies, and infrastructure. Community Health Assessment Purpose The goals of the 2025–2027 CHA are to: • Tell the community’s story through a mixture of data collection methods, including listening to community voices, reviewing existing reports, and gathering statistics from a variety of sources, as the foundation to improve population health. • Identify disparities among different subpopulations and their contributing factors (including root causes) to support efforts to achieve health equity. • Serve as the basis for priority setting, planning, program development, policy changes, funding applications, coordination of community resources, and development of new ways to collaboratively use community assets to improve the equity, health, and well-being of communities’ members. • Meet the Public Health Accreditation Board (PHAB) requirements for reaccreditation, including specific requirements for the CHA. ACPHD, in partnership with local communities and the other Alameda County Health departments, will respond to the information in the 2025–2027 CHA by developing a Community Health Improvement Plan (CHIP). This plan aims to address the community’s critical health needs and protect and improve the health and well-being of its members, especially those who are the most affected by health disparities and inequities. Alameda County Public Health Department • 2025–2027 CHA 15 About Public Health Accreditation Board (PHAB) Recognition PHAB accreditation is grounded in evidence-based standards that help health departments establish their effectiveness and show accountability to communities, policymakers, and others. Its national program evaluates a department’s ability to deliver the 10 Essential Public Health Services1 and the Foundational Capabilities.2 When a health department earns PHAB accreditation, it builds public trust and shows its continuing commitment to quality and performance improvement. Every 5 years, ACPHD undergoes the reaccreditation process through PHAB’s evaluation of the department against a set of national standards. For more information, see PHAB’s website. The CHA is the product of the Assessment pillar of the 10 Essential Public Health Services framework and the first step in the Policy Development pillar (see Figure 2). The CHA specifically addresses three Essential Services: 1. Assess and monitor population health 2. Investigate, diagnose, and address health hazards and root causes 3. Communicate effectively to inform and educate Figure 2. PHAB’s 10 Essential Public Health Services framework centers on equity. Source: PHAB. (2020). Retrieved from https://phaboard.org/infrastructure/public-health-frameworks/the-10-essential-public-health-services/ Alameda County Public Health Department • 2025–2027 CHA 16 What Is Included in the 2025–2027 CHA Report This report documents the following: A description of the demographics of the population served by ACPHD, including percentages by race and ethnicity and languages spoken within the jurisdiction. A description of inequities in factors contributing to the identified health needs, which must include social determinants of health. The process that ACPHD and its partners collaboratively followed to develop the CHA. Comprehensive, broad-based data, including primary and secondary data from two or more different sources. A description of health needs and challenges faced by the population, based on primary and secondary data listed above, which includes an examination of health status and health behavior disparities among subpopulations or sub-geographic areas. Participating partners in the CHA process. This includes multiple organizations representing sectors other than governmental public health, including community members representing populations disproportionately affected by conditions that contribute to poorer health outcomes. Community assets or resources beyond health care and ACPHD that can be mobilized to address health needs. Alameda County Public Health Department • 2025–2027 CHA 17 3. Community Served Alameda County Public Health Department • 2025–2027 CHA 18 Community Served Alameda County is one of nine counties that make up the San Francisco Bay Area in California. It is rich in arts, political activism, world-famous higher education institutions, entrepreneurship, and breathtaking natural terrain. It also boasts an enviable Mediterranean climate. According to the U.S. Census Bureau, the county is home to approximately 1.65 million people3 living within 738 square miles of land4 originally inhabited by members of the Muwekma Ohlone Tribe.5 The charts on the following pages describe these demographics in greater detail. Alameda County is the 7th most populous county in California6 and one of the most ethnically diverse regions in the nation.7 In 2023, people living in Alameda County had an income of $63,442 per capita.3 Nearly 1 in 10 Alameda County residents live below the federal poverty level.3 People who live in or are interested in moving to Alameda County can choose from 14 incorporated cities and six Census- Designated Places to reside. A map of the county is shown below. Figure 3. The map of Alameda County shows major cities and other Census- Designated Places. Map credit: ACPHD Community Assessment, Planning, and Evaluation (CAPE), 2026. White shading indicates unincorporated areas. 9% People living below federal poverty level in 2023 Alameda County Public Health Department • 2025–2027 CHA 19 Demographics of Alameda County The county’s population is extremely diverse. One in 5 people in the county are children. More than 1 in 3 people are immigrants. About 1 in 5 people over age 5 speak limited English. $121,703 Real Cost Measure (RCM) for 4-person household; factors in the costs of housing, food, health care, child care, and other basic needs $1.0M median home sale price On average, close to 1 in 3 households here live below the Real Cost Measure. Over 1 in 10 people in the county live with a disability. Nearly 3 in 5 people here aged 25+ have at least a bachelor’s degree. 19% Under 18 20% Aged 18–64 65% Over 64 15% 36% Sources: United Ways of California: Real Cost Measure, 2021. Redfin.com: Median home sale price, 2024. U.S. Census Bureau: Asian 32.0%White 28.3%Hispanic/Latino/a/x/e 23.3%African American / Black 9.6%Multiracial 5.3%Pacific Islander 0.7% American Indian / Alaskan Native 0.2% 11% Chinese 5% Filipino/a/x 9%Asian Indian 7% Other Asian 1 in 5 people in the county are children Alameda County Public Health Department • 2025–2027 CHA 20 Languages Spoken in Alameda County Alameda County is not only highly ethnically diverse but also linguistically diverse. Aside from English, the threshold languages—those spoken by at least 5% of the county’s population—include Spanish and Chinese. Figure 4. Many languages are spoken in Alameda County. Alameda County Top 10 Primary Languages Besides English, Spoken by People Aged 5 or Older (2018–2022) Source: U.S. Census Bureau, American Community Survey, 5-year estimates, 2018–2022. 0.6% 0.7% 0.9% 1.0% 1.8% 2.3% 3.8% 5.3% 9.3% 15.8% 0%5%10%15%20% French Arabic Korean Persian, Iranian, Farsi Vietnamese Dravidian Filipino, Tagalog Hindi and related Chinese Spanish Percent Speaking Language at Home Alameda County Public Health Department • 2025–2027 CHA 21 Inequities in the County The health and well-being of people living in Alameda County has generally improved over time, but, as this report illustrates, not all population subgroups have felt these benefits equally. The county has large and persistent health inequities, with deep-seated roots that reach back to California and the United States’ early history. People of color—African American/Black, Asian and Pacific Islander, American Indian/Alaskan Native, and Hispanic/Latino/a/x/e people—have faced overlapping structural barriers created by discriminatory, genocidal, and violent practices and policies throughout the 19th, 20th, and 21st centuries. Some examples include: • Historical redlining and racially restrictive covenants limited housing options for African American, Asian American and Pacific Islander, and Hispanic/Latinx people. Segregated zoning codes contribute to a lack of affordable housing today. • Employment discrimination further concentrated racialized poverty by limiting certain groups of workers to low-paying jobs and industries. These jobs often left employees vulnerable to workplace exploitation and discrimination. • Many communities of color, but especially African American/Black people, experienced forms of social discrimination that were often government-approved, including segregation and exclusion from public spaces and educational opportunities. This unfair treatment made these communities susceptible to increased violence and criminalization. • Government agencies have also left a legacy of harm and oppression toward American Indian/Alaskan Native and Indigenous communities. This has contributed to intergenerational trauma and a lack of mental and physical health services in this population. • Policies and practices aimed at restricting language access have created barriers for Asian American and Pacific Islander, Indigenous, and Latino/a/x/e people with limited English proficiency. These obstacles are particularly extreme when navigating public services and health care networks originally designed only for English speakers. People with multiple, or “intersecting,” identities often experience greater health inequities. For example, when racial health inequities are combined with structural inequities facing sexual minorities or people with disabilities, these inequities get even deeper. Current (2025–2026) changes to federal policies and rhetoric will likely worsen population health and health equity. Alameda County Public Health Department • 2025–2027 CHA 22 Overall, Alameda County does much better than the rest of California. On average, its residents enjoy higher incomes and educational attainment. But despite the county having substantial resources (see Attachment 8: Community Assets and Resources), significant inequities persist. There are specific data on disparities in the section on 2025–2027 Prioritized Community Health Challenges/Needs and Attachment 4: Statistical Data Collection and Community Health Charts. Alameda County Public Health Department • 2025–2027 CHA 23 4. Process and Methods Alameda County Public Health Department • 2025–2027 CHA 24 Process and Methods Alameda County Public Health Department partnered with the Hospital Council—Northern and Central California and local hospitals on the primary and secondary data requirements of their Community Health Assessments (CHNAs) and our Community Health Assessment. CHNAs are to nonprofit hospitals what CHAs are to public health departments: They are community health assessments that have comparable purposes and are conducted very similarly. ACPHD coordinated with John Muir Health, Kaiser Permanente, St. Rose Hospital, Stanford Health Care Tri-Valley, Sutter Health, UCSF Benioff Children’s Hospitals, and Washington Health and their consultants during the planning of the CHA. This involved making collective decisions on qualitative data sources (people and groups they would talk to) and sharing both quantitative data (statistics) and qualitative data (community feedback). By collaborating in these ways, these hospitals and ACPHD were able to collect data efficiently and reduce the data-gathering burden on the community. Data Collection The department, its partners and consultants collected data over 12 months during 2024 and 2025. ACPHD then communicated the findings in this report, written in late 2025 and early 2026. Figure 5 shows the phases of the CHA process that are described in this section. With its partners, ACPHD selected a wide variety of secondary and primary data sources. The group chose sources that would allow a better understanding of county-level health needs and challenges in terms of health status and health behaviors and to examine disparities in those two elements among subpopulations and neighborhoods (i.e., sub- geographic areas). ACPHD assessed inequities in the factors that contribute to health needs, including social determinants of health such as economic stability and the built environment. Figure 5. The main part of the CHA process is gathering and studying information to make a list of problems that affect the community's health. Talk to community members and read reports information community health Alameda County Public Health Department • 2025–2027 CHA 25 ACPHD and its consultant, Actionable Insights, (“the team”) analyzed over 350 quantitative health indicators from many different sources to help understand health needs in Alameda County and to assess community priorities. For more information about statistical data collection, see Attachment 5: Secondary Reports and Presentations Consulted. Collectively, the team and ACPHD’s hospital/health system partners conducted nearly 50 “key informant” interviews with local health experts and community service providers. ACPHD and its partners also led thirty-six (36) focus groups with community members, community leaders, and professionals representing or serving the community. In all, over 470 people were consulted for the CHA. For more information about this primary qualitative data collection, see Attachment 7: Qualitative Research Materials. The next chapter describes health needs and challenges. Alameda County Public Health Department • 2025–2027 CHA 26 Figure 6. Qualitative data collection for the CHA was wide-ranging. Alameda County Public Health Department • 2025–2027 CHA 27 CHA Participant Demographics Over 470 people participated in focus groups or interviews for the CHA. About 76% of participants responded to a pre-survey that asked for simple demographics. The charts below show the age ranges, gender, and race/ethnicity of respondents (individuals could choose more than one race).8 Figure 7. CHA participants’ median age was 47.9 (N=261) Figure 8. Almost two-thirds of respondents identified as female. (N=116) Figure 9. More than 1 in 3 respondents were of Hispanic/Latina/o/x/e ethnicity. (N≅340) 6% 14% 25% 18% 15% 11%12% 12–24 25–34 35–44 45–54 55–64 65–74 75+ Age of Responding CHA Participants Female 65% Male 32% Transgender, nonbinary, or genderfluid 3% Other*, 2% American Indian/ Alaskan Native, 2% Pacific Islander, 6% African American/Black, 17% White, 17% Asian, 20% Hispanic/Latino/a/x/e, 35% * “Other” represents Middle Eastern and blank responses. Percentages do not sum to 100 due to overlap. Alameda County Public Health Department • 2025–2027 CHA 28 How ACPHD Identified Community Health Needs ACPHD discovered many health needs in the quantitative and qualitative data. ACPHD and many of the collaborating hospitals and health systems used the same criteria for needs identification, with a poor health outcome being a CHA health need if it met specific criteria. See Attachment 2: Definitions for additional terms and definitions. ACPHD identified a poor health outcome as a health need in the CHA if it met specific criteria described below and depicted in Figure 10. An example is available on the next page. 1. Meets definition: It meets the definition of a health need, and 2. Two or more data sources: At least two data sources for the issue are available, and 3. Top community priority: It meets the community priority criterion: It was prioritized (i.e., voted as one of the top five to discuss) by at least one-third of all interviews and focus groups combined, or 4. Two or more statistics: If it does not meet the community priority criterion above, it meets either of the following statistical data criteria: a. By group: Clear disparities or inequities in the need exist for two or more statistics by Zip code, race/ethnicity, or other subpopulation, or b. Overall: Two or more statistics related to the need are worse (greater or more severe) than the California rate by 5% or more. Figure 10. Health Need Identification Criteria Meets definition 2+ data sources Top community priority or 2+ statistics worse by group or overall Alameda County Public Health Department • 2025–2027 CHA 29 In 2026, this process led to the identification of four categories of community health needs that fit the criteria. That list of needs, in descending community priority order, appears below. • Social Determinants of Health • Behavioral Health • Chronic Conditions • Communicable Diseases Within each need, specific health challenges rose to the top. See the next section for a summary of each need and related health challenges. Example: Applying Health Need Identification Criteria Here is an example of how ACPHD applied these criteria in identifying respiratory infections as a health need in the Communicable Diseases category: 1. Meets definition: Several different communicable diseases met the definition of a health need, including respiratory infections. 2. Two or more data sources: There were data on respiratory infections from three data sources: (i) community members’ input (qualitative data), as well as (ii) COVID-19 mortality rates from ACPHD, and (iii) rates of older adult influenza vaccinations from the Centers for Medicare and Medicaid. 3. It did not meet the community priority criterion: Less than one-third of all interviews and focus groups combined voted to have respiratory infections be one of the top five health needs to discuss. 4. However, respiratory infections did meet one of the two statistical data criteria: a. Neither of the statistics, COVID-19 mortality rates nor rates of older adult influenza vaccinations, were worse overall in Alameda County compared to statewide rates. b. But clear disparities or inequities exist by race/ethnicity for both COVID- 19 mortality rates and rates of older adult influenza vaccinations. By meeting criteria #1, #2, and #4b, ACPHD identified respiratory infections as a health need in the CHA. This need was grouped with sexually transmitted infections and other communicable diseases into the larger health need category of Communicable Diseases. Alameda County Public Health Department • 2025–2027 CHA 30 5. 2025–2027 Prioritized Community Health Needs Alameda County Public Health Department • 2025–2027 CHA 31 2025–2027 Prioritized Community Health Needs The processes and methods described in the previous section led ACPHD to identify four prioritized community health needs and related challenges. They are listed below in the order in which they appear in this section. • Chronic Conditions • Social Determinants of Health • Behavioral Health • Communicable Diseases Each section below summarizes the data, statistics, and community input collected during the CHA. For more figures, see Attachment 5: Secondary Reports and Presentations Consulted. What Shapes Health? ACPHD knows that health outcomes are shaped by: • physical, social, and economic environments • stigma, discrimination, hateful rhetoric, and violence • individual behaviors and risk factors ACPHD sees profound and persistent inequities by race/ethnicity and socioeconomic status. Structural inequities are fundamental obstacles that can affect one’s health and quality of life. The assessment found that social determinants of health underlie many physical and behavioral health needs while also being needs themselves. Many CHA participants repeatedly identified economic issues, including safe and affordable housing, food security, income/employment, and educational access, as key to community health. Another recurring concern across groups was access to health care— including affordability, insurance coverage, provider availability, and quality of care. Figure 11. What Shapes Health? CHA participants consistently prioritized mental health, often with co-occurring substance use, and linked them to stressors like economic hardship and housing instability. They also highlighted how having multiple unmet needs can have a compounding effect (e.g., Long-standing social inequities Institutional inequities Living conditions Risk behaviors Disease and injury Mortality Alameda County Public Health Department • 2025–2027 CHA 32 homelessness leads to poor mental/physical health, which worsens due to limited health care access). Participants viewed certain populations as being more affected than others by these overlapping needs, and participants in all areas consistently named the following groups as being the most impacted: • people and families with low incomes • BIPOC communities (Black, Indigenous, and people of color); of these groups, participants highlighted African American/Black, Hispanic/Latino/a/x/e, and Pacific Islander people • older adults • youth (especially foster youth) • people experiencing homelessness • people with disabilities • recent immigrants (including the undocumented and people not proficient in English) • LGBTQ+ communities Participants also identified geographic disparities. They described southern Alameda County and eastern (i.e., Tri-Valley) parts of Alameda County, including unincorporated areas, as “service deserts,” where access to services, from childcare to substance use treatment, is limited. They noted that geographic areas with higher concentrations of low-income residents, such as East Oakland, West Oakland, and far eastern regions of Alameda County (e.g., Livermore), have greater health disparities and more unmet needs. In particular, they described Oakland as having “dense areas of homelessness” where the number of people needing behavioral health care services is greater than the supply. Alameda County Public Health Department • 2025–2027 CHA 33 Identified Health Need: Chronic Conditions Alameda County Public Health Department • 2025–2027 CHA 34 1. Chronic Conditions According to the Agency for Healthcare Research and Quality, a chronic condition is an illness or health problem that continues for 12 months or more and either makes everyday activities harder or requires regular medical care and special equipment.10 Examples include asthma; cancer; cognitive decline, including Alzheimer’s disease and dementia; diabetes and obesity; and heart disease and stroke. These health issues may have multiple causes and may affect multiple systems in the body. The Centers for Disease Control and Prevention recently noted that “chronic diseases account for most illness, disability, and death in the United States and are the leading drivers of health care costs.”11 Risk factors for chronic conditions include poor nutrition, physical inactivity, cigarette smoking, and excessive alcohol use.12 Prevention starts with avoiding these risks. Healthiest Aspects of Communities. ACPHD and its partners asked CHA participants to describe the healthiest aspects of their communities: • Some identified access to safe spaces for physical activity, such as parks and walkable areas, as a positive feature that encourages exercise and healthy lifestyles. • A few also said that the area’s geographic location and mild climate encourage outdoor activities and supports active lives. • Some CHA participants saw the community’s prioritization of healthy eating and exercise as a strength that distinguishes the area from other regions of the U.S. Alameda County Public Health Department • 2025–2027 CHA 35 Community Challenges. However, some CHA participants reported that they don’t have access to safe spaces for physical activity (see the description of Social Determinants of Health: Built Environment, Including Unintended Injuries in the section on Social Determinants of Health). Participants also expressed concerns about accessing healthy food (see the description of Social Determinants of Health: Economic Stability in the section on Social Determinants of Health). Despite these challenges, both service providers and community members themselves reported positive health changes that had resulted from community programs, such as improved food security, better dietary habits, weight loss, and lower blood-sugar levels. “We get reports back from participants [in our programs] that their food security is improving and that their health is improving as well. Their blood sugars are coming down. They’re losing weight. They’re feeling better in their bodies.” —Key Informant Interviewee “We have a lot of resources for people, spaces for activities and exercise; we really put priorities on exercise and healthy eating in the Bay Area.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 36 Challenges: Chronic Conditions Data in this section illustrates that African American/Black and Pacific Islander people in Alameda County are affected by similarly staggering inequities in mortality rates across leading chronic conditions. Although these data are for Alameda County, this pattern of disparities across mortality due to chronic conditions is typical for the state and indeed the U.S. These data highlight the importance of addressing structural drivers of inequity, as described in the Social Determinants of Health section. Information about the following chronic conditions may be found in this section: • Asthma • Cancer • Cognitive decline • Heart disease and stroke • Diabetes and obesity Alameda County Public Health Department • 2025–2027 CHA 37 Chronic Conditions: Asthma What is the issue? Asthma is a common respiratory disorder that affects the ability to breathe. Inflammation causes airways to swell and narrow, with episodes of reversible breathing problems.13 Symptoms vary from mild to life-threatening. Asthma attacks cause issues ranging from wheezing to extreme breathlessness.14 Triggers include air pollution, wildfire or tobacco smoke, and mold.15 Research also shows that asthma can be aggravated by living where dampness, poor ventilation, pests, and/or pollutants are present.16 According to the American Lung Association, common risk factors for developing asthma are a parent with asthma, a severe respiratory infection in childhood, allergies, or for adults, exposure to certain chemicals at work.17 Community Assets The county has a number of assets and resources to address asthma, namely: • Local hospitals • Federally Qualified Health Centers and other health clinics • Alameda County Public Health: Asthma Start Program • Breathe California • Regional Asthma Management & Prevention (RAMP) For a detailed list of the assets and resources available for all chronic conditions, please see Attachment 8: Community Assets and Resources. Health Impacts Children Are Most Affected. Asthma is a concern, especially for children. A greater proportion of children have been diagnosed with asthma in Alameda County (17%) compared to California overall (12%). Further, the latest data show that the overall rate of children who were hospitalized for asthma is higher in Alameda County than the state. Disparities Exist. Pacific Islander and African American or Black children under 5 are over 6 times more likely to be hospitalized or visit the emergency department with asthma relative to Asian children under 5, who have the lowest rate of hospital visits due to asthma by race and ethnicity. A map showing child asthma emergency department visits and hospitalizations (Figure 12, next page) is quite similar to the 1937 redlining map shown in Social Determinants of Health: Racism/Discrimination section. Alameda County Public Health Department • 2025–2027 CHA 38 Figure 12. Inequities in athma are driven by structural inequities and environmental injustice. Alameda County, Asthma ED Visits and Hospitalizations per 100,000 Children Under Age 5, 2018-2022 Source: ED visit and patient discharge data from CA Health Care Access and Information (HCAI), 2018-2022. Impact of Natural and Built Environments. Although participants rarely singled out respiratory health as a priority, some described seeing an increase in asthma cases, particularly among children. They mentioned the importance of a healthy environment both indoors and out. Some pointed out that climate change and poor air quality, including wildfire smoke, can negatively impact respiratory health, including asthma. For more information, see the sections describing Social Determinants of Health: Built Environment, Including Unintended Injuries, Social Determinants of Health: Climate / Natural Environment, and Social Determinants of Health: Housing and the Unhoused. Alameda County Public Health Department • 2025–2027 CHA 39 Chronic Conditions: Cancer What is the issue? Cancer is a generic term used to describe more than 100 conditions in which abnormal cells divide uncontrollably, invading and killing healthy tissue. These abnormal cells can spread (metastasize) to other parts of the body via the blood and lymph systems.18 Cancer in all of its forms is the 2nd leading cause of death in the U.S., following heart disease.19 High-quality screening can help reduce cancer rates. However, complex factors contribute to disparities in cancer incidence and in death rates across ethnic, socioeconomic, and otherwise vulnerable groups. Personal, behavioral, and environmental factors (e.g., smoking, exposure to carcinogens) can affect cancer risk, but the key risk factors are social determinants of health. These include lack of access to health care, low socioeconomic status, the natural and built environments where people live, and chronic stress caused by institutional racism.20 Community Assets The county has a number of assets and resources to address cancer, namely: • Local hospitals • Federally Qualified Health Centers and other health clinics • CancerCare • Every Woman Counts • HERS Breast Cancer Foundation • The Leukemia and Lymphoma Society • Women’s Cancer Resource Center For a detailed list of the assets and resources available for all chronic conditions, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 40 Health Impacts Disparities Exist. Cancer was the number 1 cause of death in Alameda County in 2024. Overall, the county’s cancer mortality rates are on par with or better than the state’s. However, statistical data indicate substantial disparities for cancer mortality by race/ethnicity in Alameda County. For instance, Figure 13 shows that the overall cancer mortality rate among the county’s Black population is close to double that of the county’s overall rate. However, various social determinants of health may drive some of the inequities in cancer diagnosis and treatment, as illustrated by cancer incidence (diagnosis) rates by race in Figure 14 , next page.21 See Why Disparities Exist, later in this section. Figure 13. People who are African American/Black or Pacific Islander are more likely to die from cancer than people of other racial/ethnic groups in Alameda County. Alameda County Cancer Mortality Rate per 100,000 People, by Race and Ethnicity (2021–2023) Source: ACPHD CAPE, with data from Alameda County Vital Statistics files and CDC Wonder, 2021–2023. In terms of specific forms of cancer in Alameda County, people who are Hispanic/ Latino/a/x/e have the highest incidence of liver cancer (14.2 per 100,000) compared to the countywide rate for all races/ethnicities (9.8). People who are Asian have the highest incidence of thyroid cancer (11.3 per 100,000) compared to any other racial/ethnic group. People who are White have a higher incidence of breast, lymphatic, melanoma (skin cancer), and urinary tract cancer than any other group. People who are African American/ Black have the highest incidence rates of lung, pancreatic, prostate, and uterine cancer compared to other racial/ethnic groups in the county.22 See Attachment 4: Statistical Data Collection and Community Health Charts for more information. 170.2 159.0 126.2 121.3 97.8 89.3 112.8 0 50 100 150 200 Ag e - 1.9x American/ Black Islander Indian/Alaska Native (CA rate) Latino/a/x/e Alameda County Public Health Department • 2025–2027 CHA 41 Figure 14. People who identify as White or African American/Black have higher overall cancer incidence rates than people of other races and ethnicities in Alameda County. Alameda County (AC) Cancer Incidence Rates per 100,000 People, by Race/Ethnicity Source: California Health Maps, 2012–2021. Data for races/ethnicities not shown were suppressed by the source. 453.0 427.4 332.2 304.7 438.8 432.5 330.3 294.6 0 100 200 300 400 500 600 White Black Latinx Asian/Pacific Islander Ag e - CA AC American/ Black Latino/a/x/e Alameda County Public Health Department • 2025–2027 CHA 42 Barriers to Prevention, Detection, and Treatment. Community member participants rarely prioritized cancer as an issue on its own, but their personal accounts revealed potential gaps in timely and comprehensive cancer screenings. While the financial burden of cancer treatment was a significant concern for participants, they were especially worried about people who are uninsured or have low incomes. CHA participants noted that cancer treatment affects economic stability, both short and long term, for patients and their families. When participants discussed cancer, they talked about its emotional toll. They cited a need for better prevention strategies and more cancer education to increase the community’s awareness. Why Disparities Exist. The National Cancer Institute has acknowledged socioeconomic and racial/ethnic disparities in cancer detection, treatment, and outcomes. It has attributed these disparities to a variety of factors: • Institutional racism and conscious or unconscious bias among care providers • Low income • Low health literacy • Lack of insurance • Lack of transportation • Poor access to affordable healthy food The Institute states, “Reducing or eliminating some cancer disparities in the pursuit of health equity will require policy changes to overcome systemic social, racial, and institutional inequalities.”23 “I had prostate cancer. That’s expensive, you know what I mean? Doctors ain’t going to want to treat you for it. Because if you ain’t got any insurance, they don’t want to see you, man.” —Community Member Focus Group Participant “I just think it [cancer] is one of the more important health issues that’s out right now. You should be more aware of it.” —Community Member Focus Group Participant “If the illness doesn’t kill you, the debts kill you.” —Spanish-Speaking Community Member Focus Group Participant “When you go to the hospital and they say, ‘Oh, you have cancer,’ it feels depressing. It’s scary to hear.” —Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 43 Chronic Conditions: Cognitive Decline What is the issue? Cognitive decline refers to a reduction—greater than expected for one’s age—in mental abilities. These include memory, problem-solving, navigation, ability to sustain attention, ability to follow social rules, and conversational expression.24 Alzheimer’s disease (AD), one of the dementias underlying cognitive decline, is one of the top 10 leading causes of death in the U.S.25 It is estimated that about 50% of AD cases have a genetic basis. However, research has indicated that this risk may be reduced by individuals making healthy choices related to diet, exercise, and other habits. This might mean doing enjoyable activities that challenge your brain, abstaining from tobacco, or getting regular medical check-ups. Building and maintaining social connections and developing practices that nurture emotional well- being may also decrease risk.24, 26 Community Assets The county has certain assets and resources to address cognitive decline, including: • Age-Friendly Alameda County • Alameda County Adult & Senior Services • Alameda County Social Services Agency, Area Agency on Aging • Alzheimer’s Services of the East Bay • Bay Area Caregiver Resource Center • Various cities’ aging & family services agencies For a detailed list of the assets and resources available for all chronic conditions, please see Attachment 8: Community Assets and Resources. “There aren’t many physicians who specialize in geriatric care...there’s a real difference between assessing an older person and a younger one.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 44 Health Impacts High Rates and Few Providers. Alzheimer’s disease (AD) is the 5th leading cause of death in Alameda County. Community members who identify as Pacific Islander or Black experience AD at greater rates and have higher rates of hospitalizations and emergency department (ED) visits than other groups.27 Many participants identified older adults as a vulnerable population in regards to cognitive decline. They cited dementia and AD as concerns, as well as common health issues like arthritis, vision and hearing loss, and other age-related conditions. Some participants indicated a need for more geriatricians and other specialized care for older adults. Isolation. People mentioned social isolation and lack of family support as factors that worsen cognitive decline among older adults. This is supported by research showing a link between social isolation and dementia.28 Health Care Quality. Older adults consulted for the CHA said they want dignified delivery of treatment. They also seek better communication with their health care providers and with the staff of community organizations. Figure 15. African American/Black people and White people are more likely to die of Alzheimer’s Disease than people of other racial/ethnic groups in Alameda County. Alameda County Alzheimer’s Disease Mortality Rate per 100,000 People, by Race and Ethnicity (2021–2023) Source: ACPHD CAPE, 2021–2023. “I want to talk about dementia …to address it for our community. We came from Southeast Asia, from India particularly, and like China or other countries, they have a lot of family connections. And there’s very less depression cases in India. There’s very strong, close family structures, which we are missing here.” —Community Member Focus Group Participant 34.0 33.7 27.9 19.7 13.0 8.5 27.7 0 10 20 30 40 Ag e - 10 0 , 0 0 0 P e o p l e American/ Black Latino/a/x/e Islander (CA rate) Indian/ Alaska Native Source: ACPHD CAPE, 2021–2023. Alameda County Public Health Department • 2025–2027 CHA 45 Chronic Conditions: Heart Disease and Stroke What is the issue? Nationally, nearly 128 million people suffer from a form of cardiovascular disease.29 Heart disease is the number 1 killer of both men and women, while stroke is the 4th leading cause of death30 and a significant cause of serious disability for adults.31 Research has established that disparities in cardiovascular health outcomes exist between African American/Black, Hispanic/Latino/a/x/e, and certain Asian populations compared with the White population across the U.S.32 Although some risk factors for heart disease and stroke (e.g., age, race/ethnicity, and gender) are not controllable, others (blood pressure, cholesterol, weight, alcohol consumption, smoking, diet, physical activity) can be managed.33 Left uncontrolled, these risk factors can lead to changes in the heart and blood vessels. Over time, those changes can lead to heart attacks, heart failure, strokes, and other forms of cardiovascular disease.34 Addressing risk factors can help prevent chronic cardiovascular disease.35 Community Assets The county has a number of assets and resources to address heart disease and stroke, many of which address manageable risk factors underlying these issues. Some examples include: • Local hospitals • Federally Qualified Health Centers and other health clinics • LIFE Eldercare, Inc., Senior Support Program of the Tri-Valley, and other nonprofits focused on older adult health • Various cities’ parks and recreation departments For a detailed list of the assets and resources available for all chronic conditions, please see Attachment 8: Community Assets and Resources. “Is there a class about how to prevent and reduce stroke? Because most of us have three things: high cholesterol, high blood pressure, diabetes.” —Vietnamese-Speaking Community Member Focus Group “We know that stress is a contributor... People who live their life in a vise grip...are very vulnerable to hypertension and unmanaged hypertension.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 46 Health Impacts Disparities Exist. Heart disease and cerebrovascular diseases ranked among the top 5 causes of death in Alameda County in 2022. However, stroke mortality is only slightly worse among county residents (43.4 per 100,000) than their statewide peers (42.1). The cardiovascular disease (CVD) mortality rate is lower than the state’s. It’s notable that the mortality rate for heart disease is much higher among the county’s Pacific Islander population than other ethnic groups. A small proportion of key informants and focus group participants prioritized heart disease and stroke. Of these, several noted a high prevalence of hypertension and diabetes, significant risk factors for heart disease and stroke, within their communities. In Alameda County, hypertension ranked separately in the top 10 causes of death. Figure 16. People identifying as Pacific Islander or African American/Black are more likely to die from heart disease than people of other racial/ethnic groups in Alameda County. Alameda County Heart Disease Mortality Rate per 100,000 People, by Race and Ethnicity (2021–2023) Source: ACPHD CAPE, with data from Alameda County Vital Statistics files and CDC Wonder, 2019–2023. “Hypertension and stroke is generally one of the areas where you do see a cultural implication. Our Hispanics and African Americans are the ones most at risk.” —Key Informant Interviewee 215.4 192.7 158.0 118.5 100.5 70.5 107.6 0 50 100 150 200 250 Pacific Islander African American/ Black American Indian/ Alaska Native (CA rate) White Hispanic/ Latino/a/x/e Asian All Races Ag e - 10 0 , 0 0 0 P e o p l e Alameda County Public Health Department • 2025–2027 CHA 47 Figure 17. People identifying as Pacific Islander or African American/Black are more likely to die from stroke than people of other racial/ethnic groups in Alameda County. Alameda County Stroke Mortality Rate per 100,000 People, by Race and Ethnicity (2021–2023) Source: ACPHD CAPE, with data from Alameda County Vital Statistics files and CDC Wonder, 2019–2023. Related Factors and Barriers. Some participants who discussed heart disease highlighted stress and mental health issues as factors. Others pointed to various social determinants of health, including economic insecurity, food insecurity, the built environment, homelessness, lack of health care access, and poor-quality health care. For example, some noted that the cost of medication for heart disease and stroke is a significant barrier for people who are uninsured. This barrier makes it difficult for patients to follow prescribed treatments. Participants saw effective management of chronic illnesses like diabetes and hypertension as crucial for preventing heart disease and stroke. To do this requires access to health care, healthy foods, and safe and affordable places to exercise. 71.4 69.9 42.1 40.9 38.2 33.3 40.2 0 20 40 60 80 Pacific Islander African American/ Black Hispanic/ Latino/a/x/e American Indian/ Alaska Native (CA rate) White Asian All Races 10 0 , 0 0 0 P e o p l e “When you do not have that home, you cannot eat healthy, your meals are going to be processed, and you are going to eat everything ready-made. So you can’t have control in any of the aspects: fat, sugars, salts, and all of that also leads to chronic diseases.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 48 Chronic Conditions: Diabetes and Obesity What is the issue? Diabetes refers to a category of chronic diseases that involve how your body handles glucose (blood sugar), its primary source of energy.36 The Centers for Disease Control and Prevention estimates that more than 40 million people in the U.S. have diabetes and an additional 115 million adults in the U.S. are prediabetic.37 Type 2 diabetes accounts for roughly 90 percent of all diagnosed cases, type 1 represents approximately 5 percent, and gestational diabetes covers the rest. 38 Serious complications of diabetes include heart disease, stroke, kidney failure, adult- onset blindness, and lower-extremity amputations. Type 1 is believed to be caused by a combination of genetic and environmental factors and cannot be prevented. Type 2 and prediabetes (higher-than-normal blood sugar levels) result from the body becoming unable to generate enough insulin to maintain a healthy blood sugar level. Avoidable Type 2 risk factors include being physically inactive or overweight.39 About 1 in 5 children and more than 2 in 5 adults in the U.S. are obese.40 Risk factors include unhealthy diet, inactivity, genetic factors, poor sleep, excessive screen time, long-term stress, underlying medical issues, and the factors described in the section on Social Determinants of Health. Smoking cessation and medication side effects can also contribute.41 Being obese or overweight increases one’s risk for type 2 diabetes, hypertension, stroke, and heart disease40 and can contribute to poor mental health, stigma, and social isolation. Community Assets The county has a number of assets and resources to address diabetes and obesity, many of which address manageable risk factors underlying these issues. Some examples include: • Local hospitals • Federally Qualified Health Centers and other health clinics • Alameda County Nutrition Services – Women, Infants, and Children (WIC) • Alameda County Public Health Department • East Bay Regional Park District and various cities' parks and recreation departments • Various cities' Family Resource Centers For a detailed list of the assets and resources available for all chronic conditions, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 49 Health Impacts Disparities Exist. Alameda County statistics for overweight/obesity risk and for diabetes mortality show the same pattern as heart disease: People who are Pacific Islander or African American/Black have the highest risk and highest mortality rates. As discussed in the next section, people in these populations are also more at risk for many of the social determinants that underlie these chronic diseases. Figure 18. Obesity risk, which is tied to a risk of Type 2 diabetes, begins early. Alameda County Percentage of 5th Grade Students at Risk for Overweight or Obesity, by Race and Ethnicity (2018–2019) Source: California Department of Education, 2018–2019 (more recent data not available). Figure 19. People identifying as Pacific Islander or African American/Black are more likely to die from diabetes than people of other racial/ethnic groups in Alameda County. Alameda County Diabetes Mortality Rate Per 100,000 People, by Race and Ethnicity (2021–2023) Source: ACPHD CAPE, with data from Alameda County Vital Statistics files and CDC Wonder, 2019–2023. 45.7 42.4 40.4 27.0 15.3 14.1 18.8 01020304050 Ag e - Pacific Islander African American/ Black American Indian/ Alaska Native (CA rate) WhiteHispanic/ Latino/a/x/e Asian All Races 37% 25% 25% 37% 37% 48% 51% 62% 0%20%40%60%80% All races Asian White American Indian/Alaska Native Filipino African American/Black Hispanic/Latino/a/x/e Pacific Islander Percentage Overweight or Obese Alameda County Public Health Department • 2025–2027 CHA 50 Affects Many People. More than 1 out of every 4 interviews and focus groups prioritized diabetes, obesity, and healthy lifestyles. Many of the CHA participants who discussed diabetes and obesity noted their high frequency within their communities, among both adults and children. Diabetes prevalence is highest among older adults (19%) in Alameda County, significantly higher than all adults in the county overall (9%).42 Related Factors and Barriers. Participants linked diabetes and obesity to poor diet and, less often, to inactive lifestyles. Such factors are themselves linked to economic challenges, such as food insecurity, or barriers in the built environment, such as being unable to access healthy foods or safe places to exercise. These obstacles, in turn, exacerbate diabetes and obesity rates. Some people pointed out the role of structural racism in producing environments short on healthy food options and safe recreational spaces. A few tied high rates of diabetes and obesity to cultural dietary habits. To support the management of chronic diseases, participants called for better education on nutritional and lifestyle changes. They spoke to the need for culturally sensitive health education. Some were concerned about health care access, including a lack of insurance, in relation to diabetes. Several noted being unhoused as a barrier to managing the disease, as it limits one’s access to proper nutrition and stable living conditions. For example, people noted that insulin (the primary means for controlling blood sugar levels) must be refrigerated to retain its viability, a much bigger challenge for people who are unhoused. “People who actually have been diagnosed with hypertension, it’s almost everybody. The number of people who are prediabetic or who have already been diagnosed with diabetes is just over the top.” —Key Informant Interviewee “We need to eat and exercise, but we have to spend money every month to exercise outside [in safety]. I heard that medical insurance provides free exercise programs, but we don’t have those either.” —Community Member Focus Group Participant “Everyone has diabetes. Especially seniors.” —Tagalog-Speaking Community Focus Group Participant “[Diabetes is] a very common diagnosis in our community. And I think it just is related to the social determinants of health and having access to the right kind of food, having the information about what contributes to diabetes.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 51 How does the community suggest chronic conditions are addressed? • Expand health education and awareness around chronic disease prevention and management, including for diabetes, heart disease, stroke, cancer, dementia. • Support aging populations with expanded programs for dementia and Alzheimer’s, including caregiver training, memory care services, and elder-focused housing. Develop neighborhood-based support networks (“village models”). • Utilize community health workers and peer educators for trust-building and implement health fairs, workshops, culturally relevant trainings. Alameda County Public Health Department • 2025–2027 CHA 52 Identified Health Need: Social Determinants of Health Alameda County Public Health Department • 2025–2027 CHA 53 2. Social Determinants of Health According to the Healthy People 2030 initiative, “Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”43 Examples include: • Safe housing, reliable transportation, and other aspects of neighborhoods • Clean air and access to safe drinking water • Access to healthy foods and opportunities for physical activity • Education, employment, and income • Language proficiency and literacy • Experiences of discrimination and exposure to violence Figure 20. Social Determinants of Health Alameda County Public Health Department • 2025–2027 CHA 54 Social determinants of health drive health disparities and inequities. Promoting healthy choices alone isn’t enough to close these gaps. Public health organizations, working with their partners in education, transportation, housing, and other sectors, must act to improve the conditions that shape people’s everyday environments. Healthiest Aspects of Communities. ACPHD and its partners asked CHA participants to name the healthiest aspects of their communities. Most of their responses were related to SDOH. They frequently mentioned a strong sense of community and civic engagement, citing examples such as a multigenerational commitment to their neighborhoods, parents’ active involvement in schools, and older adults giving time and energy to support neighbors. Many recognized community diversity as a positive characteristic and noted the benefits of cultural richness, inclusivity, and exposure to different perspectives for children and adults. Many participants highlighted community resilience. They described residents as strong, resourceful, and able to persevere through challenges including economic hardship, discrimination, and public safety concerns. Participants also identified mutual aid and support networks as strengths, particularly in times of need or crisis. They described how such networks foster unity within specific communities, such as the Latino population in Livermore. When comparing this county to others, participants cited its access to resources for healthy living as a distinguishing feature. Such resources include spaces for physical activity, healthy food options, and supportive services “What I really love about our community is the civic engagement and the interest in getting involved.” —Key Informant Interviewee “The healthiest characteristics of our community are the resilience of our community and how diverse we are.” —Key Informant Interviewee “Every time someone in our community needs something, we always support each other.” —Spanish-Speaking Community Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 55 for older adults and people with disabilities. CHA participants especially valued environments that promote safety and well-being, including safe neighborhoods and public health initiatives that focus on exercise and healthy eating. CHA participants saw collaboration among nonprofits, service organizations, and grassroots groups as a key asset, observing how it enabled more effective delivery of services and made it easier for groups to adapt to community needs. They felt that lived experience in front-line workers, especially those in health outreach (e.g., promotores / community health workers), was vital for removing barriers to care and fostering trust within their community. Strengths and Challenges. Alameda County has much to celebrate, and it also faces many challenges. The CHA identified the greatest of these challenges, described in this report’s various major health need sections. ACPHD is gearing up to work to address these needs by developing and implementing the 2026–2030 Community Health Improvement Plan (CHIP). The challenges described in this section appear in this order: • Health Care Access and Quality • Economic Stability • Peaceful Communities • Housing and the Unhoused • Built Environment • Climate/Natural Environment • Racism/Discrimination Alameda County Public Health Department • 2025–2027 CHA 56 Challenges: Social Determinants of Health Social Determinants of Health: Health Care Access and Quality What is the issue? Access to affordable, comprehensive, and quality health care is important for health and quality of life.44 For most people, access to care means having insurance coverage, being able to find an available primary or specialty care provider nearby, and receiving care when they need it. Quality health care is safe, effective, patient- centered, timely, efficient, and equitable.45 Limited access to care and compromised care quality make it more difficult for people to reach their full potential and negatively affect their quality of life. Community Assets The county has many assets and resources to address health care access and quality issues. Some examples include: • Local hospitals • Federally Qualified Health Centers and other health clinics • Alameda County Public Health: Family Health Services Black Infant Health Program • Center for Healthy Schools and Communities • Operation Access and other non-profit health resources • Various transportation assets, including bus and train systems, bicycle coalitions, and paratransit providers For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 57 Health Impacts Cost of Care. Participants in about half of all interviews and focus groups named health care access and delivery (part of health care quality) as a priority. They focused on persistent barriers to accessing health care, such as difficulties paying for it. Many noted that not everyone has the same opportunity to receive health care: The high costs of care and medication keep many people from seeking necessary medical attention. Approximately 500,000 people in Alameda County (about 30%) rely on Medi-Cal for their health insurance coverage.46 The service is critical to preventing illness, injury, and premature death for the whole population and especially for marginalized and vulnerable groups. It is also important for children’s health. Medi-Cal pays for services for underserved children who have chronic conditions and complex health needs. It also pays for their preventative health care, which is critical to promoting overall health. Just under one-third of Alameda County community members overall rely on Medi-Cal for their health care, while more than half of the county’s Hispanic/Latino/a/x/e community members do. Figure 21. More than half of the county’s Hispanic/Latino/a/x/e community members rely on Medi-Cal for their health care. Percentage of County Population Covered by Medi-Cal, by Race/Ethnicity (2024) Source: CAPE analysis of AC Behavioral Health Medi-Cal enrollment data and CA Dept. of Finance denominators, 2024. “The whole system of health insurance doesn’t meet the needs of low-income people, even when somebody has full insurance, because of the cost of copays and deductibles.” — Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 58 Several participants mentioned that existing insurance, such as Medi-Cal, often does not cover full dental services, which can lead to out-of-pocket expenses. California Health Interview Survey data show that nearly 22% of people in Alameda County do not have dental insurance, which is better than the statewide figure of about 28%.47 But large disparities by race/ethnicity exist in these statistics. For example, more than 42% of people in Alameda County who identify as Hispanic/Latino/a/x/e live without dental insurance.48 Other Barriers to Accessing Care. Participants identified language barriers as a significant issue, particularly for immigrants struggling to progress through the health care system, including filling out Medi-Cal and Medicare applications. Participants also brought up geographic obstacles and said too few community-based clinics are located underserved areas. Some mentioned that accessible dental services are also not available close to where they live, forcing them to travel long distances or even go outside the U.S. for affordable care. A lack of convenient or safe transportation makes these shortages even more of a hurdle to accessing care. “Language is sometimes a barrier ...When we are lucky enough to understand each other, that's good, isn’t it? But when we are not—I have seen people who want to communicate with the doctors, the nurses; but [the providers] just don’t.” —Community Member Focus Group Participant “I also believe that dental health is important because it is too expensive to go to the dentist. Many people I know have to go to Mexico or other countries to get their teeth fixed because they can’t afford it here. You can’t even afford to pay for a dental cleaning. Oral health is very important because that is where other diseases come from. I think there should be more help and more affordable places for people to go to get their dental needs taken care of.” — Spanish-Speaking Community Member Focus Group Participant Medi-Cal Facts46 28% of Medi-Cal enrollees in Alameda County are children, and 27% of births in Alameda County are covered by Medi- Cal. Over 64,000 Alameda County residents aged 65 or older are covered by Medi-Cal (about 25%). 85% of the homeless population in Alameda County is eligible for Medi-Cal- managed care. Alameda County Public Health Department • 2025–2027 CHA 59 The community also highlighted difficulties in accessing specialty care, including: • Diagnostics such as cardiology studies, pulmonary testing, and MRIs • Geriatric care • Mental health services • Oral/dental health care Both mental health and oral health can greatly affect one’s overall health. For example, related to oral health, the bacteria associated with gum disease has been linked to chronic diseases such as diabetes and Alzheimer’s.49 Quite a few participants noted that poor dental health can lead to health problems in other parts of the body and in the mind, such as nutritional deficiencies due to difficulty eating, and depression. Health experts who participated in the CHA frequently stressed how important it is to integrate medical, dental, and mental/behavioral health services in a single location and that doing so can make it easier for people to access care. Alameda County Public Health Department • 2025–2027 CHA 60 Too Few Providers. CHA participants said there were too few available providers. In Alameda County, the ratio of community members to primary care providers was lower (better) than the ratio among Californians overall, statistics showed. However, the ratio of community members to other primary care professionals (e.g., nurse practitioners) was higher (worse) compared to the state (see charts in Figure 22).50 Figure 22. The ratio of community members to non-physician primary care providers was higher (worse) in Alameda County compared to California overall. Source: Centers for Medicare and Medicaid, National Provider Identification, 2020. AC, 884 CA, 1,234 Primary Care Physician Ratio, 2020 (people per each provider) AC, 1,496 CA, 1,256 Physician Assistants and Nurse Practitioners Ratio,2020 (people per each provider) “People have waited months and months and months for appointments with their primary care provider.” — Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 61 Care Quality Inequities. The rates of preventable hospitalizations were highest for people who are African American/Black or Hispanic/Latino/a/x/e. A higher rate of preventable hospital stays may indicate inequitable access to high-quality health care. Figure 23. Among older adults and people with disabilities, people who identify as African American/Black are hospitalized for preventable causes more often than their peers of all races/ethnicities. Rate of Preventable Hospitalizations in the County per 100,000 Medi-Cal Enrollees (2020) Definition: Rate of hospital stays for ambulatory-care sensitive conditions per 100,000 Medi-Cal enrollees. Enrollees are aged 65+ and/or have at least one disability. Note: Data for races/ethnicities not shown were suppressed by the source. Source: Centers for Medicare & Medicaid, Mapping Medicare Disparities Tool, 2020. 2,172 1,511 2,031 2,369 3,858 All Races Asian White Latinx BlackHispanic/ Latino/a/x/e 2.6x African American/ Black Alameda County Public Health Department • 2025–2027 CHA 62 Participants were concerned about the quality of dental care provided by different insurance plans. For example, some felt that people with public insurance receive inferior treatment compared to people with private insurance. Another common theme among participants was lack of trust in health care providers. Related to this, some participants raised issues of health care quality. They cited poor communication, misdiagnosis, a sense that providers did not care, and even obvious disrespect from them. They felt medical visits were often rushed and that their concerns were not adequately addressed. Participants emphasized how important it is for providers to listen to and understand the community they serve. Several noted that structural racism has produced disparities in health care access and health outcomes, such as biased treatment and more pregnancy-related deaths among Black women. “It’s really the quality of that care [in the hospital]. And then…once they're discharged, they go home, and there’s such a lack of support. They’re not monitored correctly, maybe they have to treat themselves, take care of their own wounds. It’s a lot to ask.” — Key Informant Interviewee, speaking about older adults “When I had private dental insurance, my dentist never … suggested pulling any of my teeth because if he doesn't have that tooth to work on, he doesn’t make any money. But… when you need to go to the dentist because you’re a Medi- Cal or Denti-Cal patient, they want to pull your teeth.” —Community Member Focus Group “We have noticed that many people have died because they think that if they [are admitted] into a hospital they will be deported …because [hospitals] are asking for more and more information.” —Spanish-Speaking Community “Infant mortality …is high amongst Native children. …When they are getting the care they need, we see less infant mortality and less children getting sick.” — Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 63 a Case Study: Maternal/Infant Care Concerns Maternal/infant health outcomes illustrate the issues of health care access and quality described above. Certain maternal and infant health statistics were worse for particular populations in the county versus state rates. For example, mortality is much higher among Alameda County’s Black infant population compared to infants of other races/ethnicities. Figure 24. Inequities in health and mortality begin early in life. Alameda County Infant Mortality by Race/Ethnicity (2020-2022) Source: California Department of Public Health Infant Mortality Dashboard, 2020–2022. Also, mothers had a notably higher rate of severe maternal morbidity (unexpected and life-threatening events that can occur during childbirth) than the California rate (136.7 vs.108.0 per 100,000 females aged 12-55), with the highest rate in Alameda County for Black mothers (229.2 per 100,000). Participants noted that mothers who are low-income and BIPOC (especially Black mothers) face more challenges in securing quality maternal/infant health care. They identified racism and discrimination in health care settings as major issues that influence the quality of care given to mothers and infants. Another common theme shared in discussions was the need for health care providers to act with greater cultural sensitivity and to communicate more effectively, specifically with patients’ mothers who speak limited English. Participants were very concerned about the affordability of maternal/infant health services. Some revealed that economic constraints had kept them from accessing the pre-/post-natal care they had needed. Some stressed how crucial it is that mothers receive mental health support, pointing out that a mother’s poor mental health can amplify other issues and affect the entire family. Alameda County Public Health Department • 2025–2027 CHA 64 How does the community suggest these issues are addressed? • Increase number and capacity of clinics, bringing health services to communities (walk up, school-based, mobile models), expand specialty care (mental, dental, maternal services), improve transportation and telehealth access. • Provide whole person care: integrate services like health care, benefits screenings, parental support, and job assistance in the same place. Provide education/outreach in plain language with simplified navigation for appointments and insurance. • Provide culturally competent care: have staff that is diverse and reflects communities, hire local residents, value lived experience, expand roles for doulas/midwives/community health navigators. Alameda County Public Health Department • 2025–2027 CHA 65 Social Determinants of Health: Economic Stability What is the issue? Economic stability has been defined as people’s ability to sustainably cover their basic needs in a way that allows them dignity and self-respect.51 Higher income and social status, often achieved through higher education, have each been linked to greater health. Research has shown that when people have access to economic stability programs such as SNAP (formerly called food stamps), they have better long-term health outcomes.52 Community Assets The county has many assets and resources to address issues of economic stability. Some examples include: Income/employment: • Alameda County Social Services Agency • Community Resources for Independent Living • Centro de Servicios, Rubicon Programs, and other non-profit employment assets • Various cities’ Family Resource Centers Education: • Public schools at all levels (PreK through college) • Alameda County Early Head Start and Head Start • Boys and Girls Clubs of San Leandro Food security: • Alameda County Community Food Bank and other food pantries • Alameda County Nutrition Services–Women, Infants, and Children (WIC) • Meals on Wheels of Alameda County • Fresh Approach and other food-rescue non-profits For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 66 Health Impacts High Cost of Living Linked to Economic Instability. Economic stability includes education and food security. It was CHA participants’ highest-priority health need in interviews and focus group discussions. The high cost of living emerged as a key theme. Participants shared that wages from full-time employment are often insufficient to pay for basic needs like childcare, groceries, and medical supplies. This leads to economic strain, they added, and can require people to work multiple jobs and cut back on essentials. It can also force families to double or triple up in homes. These strains impact people’s overall well-being. Economic instability can result in an inability to pay rent, eviction, and subsequent homelessness. Participants said the people most at risk of economic instability are: • Individuals on fixed incomes, such as older adults and people living with disabilities • Young adults • Families with children • People who face language barriers • Immigrants • People who lack documentation • People affected by structural racism/discrimination Some participants explained that economic pressures make it difficult for students to focus on education, discouraging or reducing their long-term economic potential. “Parents I've worked with have been able to find employment, but the money they make doesn't meet all of their basic needs.” — Key Informant Interviewee “The safety net of welfare and food stamps doesn’t help them get to a financially secure place. Once they is almost harder than not having that job.” — Key Informant Interviewee “Yesterday somebody who was a brain surgeon in Afghanistan, think they'll ever be able to work as a brain surgeon in the United States? Doubtful, right? You get these people who are highly skilled and they end up having to take much lesser jobs in terms of their skills. I mean they're all skillful, but I remember we had a judge [who] ended up having to drive a forklift in a warehouse.” — Key Informant Interviewee “If your economic situation is poor, then the thought about even going to free community college is difficult because it's time away from working.” — Service Provider, Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 67 Differences in Income. Although participants did not discuss gender differences in wages, Alameda County women face a slightly greater gender pay gap ($0.84 to the dollar) compared to all California women ($0.86).53 Quite a few participants noted how discrimination results in economic disparities and limits access to good jobs and economic opportunities. Data show large disparities in median income by race/ethnicity. For example, an Alameda County Latine household earns a median of $90,651, about 25% less than the countywide figure ($119,600). Figure 25. There are inequities in income across different ethnic groups. Poverty Rate, by Race/Ethnicity, Alameda County and California (2019-2023) Source: U.S. Census Bureau, American Community Survey/Public Use Microdata Sample, 5-year estimates, 2019–2023. 19%20% 13%15% 11%10%9% 12% 19% 17% 13% 12% 9% 7%7% 9% 0% 5% 10% 15% 20% 25% 30% African American/ Black American Indian/ Alaska Native PacificIslander Hispanic/Latino/a/x/e Multiracial Asian White All Races California Alameda County 2.7x Alameda County “What if you're working two jobs? When can you go to the doctor? Never.” — Service Provider, Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 68 Historical policies such as redlining still have an impact, evident in the notable differences in Zip code poverty metrics (Figure 26). People in poverty are more likely to live in areas that appear darker orange on the map below, including neighborhoods in Emeryville, Oakland, and San Leandro. In contrast, people in poverty are less likely to live in the areas that appear light orange. Figure 26. Some areas with the poverty levels in Alameda County reflect historical redlining boundaries. Poverty Rates in Alameda County, by Zip Code (2019–2023) Note: Three Zip codes, two near the University of California, Berkeley, and one for Mills College in Oakland, are mostly students and have high poverty but not the deprivation normally associated with poverty, and are masked. Source: ACPHD CAPE, with data from U.S. Census Bureau, American Community Survey, 5-year estimates, 2019–2023. There are also differences by disability status. In Alameda County, people living with disabilities experience poverty at over twice the rate of people not living with disabilities (18.5% versus. 9.1%). Alameda County Public Health Department • 2025–2027 CHA 69 Food Insecurity. Food insecurity has been consistently going up in Alameda County since the start of the COVID-19 pandemic. Many participants described how economic insecurity and rising prices affect food access. They explained that economic insecurity forces individuals to prioritize other expenses over health and to neglect nutrition. Quite a few participants mentioned that older adults and individuals with disabilities are particularly vulnerable to food insecurity due to fixed incomes. Some said these groups often run out of food before their next benefit payment. Participants associated food insecurity with stress, hopelessness, and feelings of despair, and linked these feelings to broader mental health struggles. “The price of healthy food, I think it’s very difficult. Especially when you’re on a fixed income. …You have a McDonald’s app to get free fries, but it’s like $4 for a salad or something.” —Community Member Focus Group Participant “If the government didn’t help, we’d be starving every day in America.” —Khmer-Speaking Community Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 70 Figure 27. Food insecurity rose after the COVID-19 pandemic and has not yet begun to stabilize or decrease. Percent of Alameda County Population Experiencing Food Insecurity at Some Point During the Year Note: The U.S. Department of Agriculture (USDA) defines food insecurity as “limited or uncertain availability of nutritionally adequate foods or uncertain ability to acquire these foods in socially acceptable ways.” Source: Feeding America, 2018–2023, as provided by Conduent Healthy Communities Institute via the Healthy Alameda County platform. Participants frequently described barriers to accessing healthy food, such as: • Food deserts (areas where grocery stores are not easily accessible), and an oversupply of processed foods • Poor food quality (e.g., items near their expiration date) and lack of culturally diverse choices from food banks and meal delivery services • Some programs provide only two meals a day, which is not enough food • A stigma around seeking food assistance, which can discourage people from getting help • Eligibility requirements too strict 9.1%8.4%9.3% 8.1% 9.6% 11.0% 0% 2% 4% 6% 8% 10% 12% 2018 2019 2020 2021 2022 2023 “[Food insecurity] numbers have not decreased in the last few years. The need is still very high. We are especially noting it with seniors.” — Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 71 Educational Inequities. Many people emphasized that education is critical to improving health outcomes and overall well-being. They saw education as foundational to understanding and accessing health resources. Several stressed the need for better preschool and early childhood education. Participants also expressed concerns about the quality of K–12 education, citing a lack of guidance and support for students. Some mentioned overcrowded classrooms, insufficient funding, and an absence of after-school programs. They highlighted the inequitable distribution of resources in public schools, noting that schools in affluent areas had more resources than those in poorer, often racially segregated neighborhoods. Participants viewed the path to getting a college education as challenging due to financial limitations and the need to balance work/school. Some noted that community colleges offering free tuition or stipends are helpful but do not address all barriers. They highlighted language barriers for non-English speakers as an obstacle to educational success. Elementary school math and reading performance were lower among the county’s BIPOC children (see next page). Disparities also existed in high school non-completion rates. CHA participants were particularly concerned about educational statistics and disparities that differed by race/ethnicity; some said that education can affect future income potential. “I personally fought for my daughter, and it took me nine years to get an IEP [Individualized Education Program] for [her] … you have to fight a lot, and many parents don’t even know where to guide you, or how to fight, or how to demand from the district … that your child has special needs and that he or she has the right.” — Spanish-Speaking “With the education piece, I would like to tie that to economics. The majority of people who are educated are economically advantaged. They have the resources …and know how to be more healthy, and they’re more likely to pass that down to their children versus the people who are disparate [not educated/ advantaged].” — Black Community Member Alameda County Public Health Department • 2025–2027 CHA 72 Figure 28. Math and reading performance were both notably lower among African American/Black and Hispanic/Latino/a/x/e students. Math and Reading Test Results, 3rd Graders in Alameda County, by Race/Ethnicity (2022) Math Reading Source: California Department of Education, Test Results for California’s Assessments, 2022. As cited on KidsData.org. Figure 29. Foster youth had a high school non-completion rate that was over 3 times that of students overall. Alameda County 5-Year High School Non-Completion Rate, by Special Populations (2023–2024) Source: AC CAPE Unit, sourced from California Department of Education dashboards, 2023–2024. Expected 1 2 3 4 Asian White Hispanic/ Latino/a/x/e African American/ Black Av e r a g e G r a d e -Le v e l Asian White Hispanic/ Latino/a/x/e African American/ Black California Alameda County 10.2% 8.6% 14.3% 21.4% 24.1% 35.3% 37.4% 0%10%20%30%40% All students Immigrant youth Socioeconomically Disadvantaged Students with Disabilities English Learners Homeless Youth Foster Youth Percentage of Students Not Completing High School in 5 Years Alameda County Public Health Department • 2025–2027 CHA 73 Figure 30. Hispanic/Latino/a/x/e students had a high school non-completion rate that was more than 4 times that of Asian students. Alameda County 5-Year High School Non-Completion Rate, by Race/Ethnicity (2023–2024) Source: AC CAPE Unit, sourced from California Department of Education dashboards, 2023–2024. 10.2% 4.0% 5.6% 6.5% 12.8% 14.8% 15.1% 16.1% 0%10%20%30%40% All races Asian White Filipino American Indian/Alaska Native Pacific Islander African American/Black Hispanic/Latino/a/x Percentage of Students Not Completing High School in 5 Years Hispanic/Latino/a/x/e All Races Alameda County Public Health Department • 2025–2027 CHA 74 Figure 31. There were disparities in labor force participation data for youth and young adults: Asian and White youth and young adults are more likely to be in school or participating in the labor force than their peers of other races/ethnicities. Alameda County Youth Aged 16–24, Not Employed & Not in School, Percentage by Race/Ethnicity Source: U.S. Census Bureau, American Community Survey, 5-year estimates, 2018–2022. How does the community suggest these issues are addressed? • Provide more support within schools (including on-site mental health counseling, medical screenings (vision, hearing), and therapy) • Address living wage (increased minimum wage) and affordable housing, both of which also impact food insecurity • Expand and improve job training programs, bridging gap between unemployment and employability and offer stipends or paid opportunities during job training (e.g., nursing, CNA, EMT) 4.9% 6.6% 7.8% 8.3% 8.4% 10.2% 16.5% 23.8% 0%5%10%15%20%25% Asian White Multirace Pacific Islander All Races Hispanic/Latino/a/x/e African American/Black American Indian/Alaska Native % Youth/Young Adults Neither Employed nor in School Alameda County Public Health Department • 2025–2027 CHA 75 Social Determinants of Health: Peaceful Communities What is the issue? While the desire for safety is universal, sustaining a peaceful community is far from simple. This is due to a complex mix of systemic, psychological, and social factors that include deep-seated inequalities, past resentments, and lack of long-term community investment. Research has found that community violence is more likely when difficult living conditions and under-resourced communities leave people’s basic needs unmet.54 Those needs include food, housing, health, education, and jobs. Violence and intentional injury are related to poorer physical and mental health for the people involved and the community at large.55 Early violence prevention, including addressing the factors that underlie it, is the key to creating more peaceful and healthier communities.54 Community Assets The county has many assets and resources to support peaceful communities. Some examples include: • Alameda County Court Appointed Special Advocates • Alameda County Deputy Sheriffs’ Activities League • Alameda County Family Justice Center • Fresh Lifelines for Youth and other youth-focused non-profits • The Oakland Ceasefire Program, an initiative formed by partnerships between community-based organizations and law enforcement • Hospital-based violence intervention programs, such as Youth Alive’s Caught in the Crossfire program and Roots Community Health’s ongoing violence intervention supports • Ruby's Place, Safe Alternatives to Violent Environments, and other domestic violence shelters and service providers For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 76 Health Impacts Affects Everyone’s Well-Being. Participants in the CHA prioritized peace and safety from community and family violence in close to 2 out of every 5 interviews and focus groups. Many made it clear how important peaceful communities are for overall well-being. People shared what has them concerned: • Shootings • Domestic violence • Violent crimes Some described how housing instability and overcrowding creates stress that can affect the peace and safety of all people in a residence. Community violence affects their daily lives, participants noted, and makes them feel unsafe in public spaces like parks and schools. Participants spoke about wanting safer environments for their families. As noted in ACPHD’s 2025 Promoting Peaceful Families and Communities report, access to guns contributes to high levels of lethal violence. Both service providers and community members talked about how living in fear of violence and crime significantly impacts mental health and lessens peoples’ ability to thrive and feel safe. Impact of Poverty. Participants frequently mentioned that the presence of unhoused people contributed to their feelings of insecurity in the community. They consistently described how economic instability, poverty, and lack of resources, often described as driven by systemic racism, contribute to neighborhood unrest and community and family violence. As described “[About Afghan] women, …with the trauma and with the pressure of learning to live in America comes a lot of issues. We do see domestic violence. I don't know how often, but it’s frequent.” — Key Informant Interviewee “We had a recent meeting where we talked about … health priorities, and the stories that came from residents … that really touched everybody’s heart were simple statements like, ‘I want to be able to walk my kid to the park without fear of them being injured or hurt.’” — Key Informant Interviewee “By and large, I’d say communities of color... all talk about violence. All of them. And being concerned about it and it being a problem.” — Key Informant Interviewee “People’s sense of safety on BART, I think, is declining. So while the systems are there, and transit is available, I think that there’s a decreasing level of comfortability in using public transit.” — Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 77 in ACPHD’s report (see previous page), living in under-resourced communities increases residents’ risk for violence. Overall, homicide mortality rates in Alameda County are higher in neighborhoods where poverty rates are higher. Figure 32. People in poorer neighborhoods are more likely to die from homicide. Alameda County Mortality Rate Ratio, by Poverty Levels (2019-2023) Note: The comparison group is the lowest-poverty neighborhoods. Source: ACPHD CAPE, with data from Alameda County vital statistics data, 2019-2023. “I don’t know how much you can physically do… to make people feel safe. I carry pepper spray with me everywhere I go, even if it’s in the middle of the day, because there’s always that inkling in the back of your mind, like, if someone’s really determined to make things unsafe or dangerous, then there’s nothing I can do to stop them.” — Youth Participant, Eastern Alameda County Needs Assessment Comparison group 1.1x 1.4x 1.5x1.4x 3.9x 7.0x 0 2 4 6 8 <5.0%5.0-9.9%10.0-19.9%20.0%+ Poverty Level (percentage of census tract in poverty) Mortality Rate Ratio from All Causes Mortality Rate Ratio due to Homicide Alameda County Public Health Department • 2025–2027 CHA 78 Gun Violence and Homicide. Health experts in Alameda County felt community violence is a county-wide concern. Oakland interviewees and focus group participants mentioned gun violence specifically and described the ways it has affected youth and community- serving staff both directly and indirectly. Statistics have shown that the homicide rate is notably higher in Alameda County than in California overall. Specifically with regard to gun violence, although the county experienced increases in gun homicides during the COVID-19 pandemic, preliminary data indicates that there were in 119 gun homicides in 2024, reflecting a 16% decrease from the prior year. However, similar to the overall homicide rate, residents living in Alameda County’s poorest neighborhoods have a gun homicide rate 8 times higher than those living in the wealthiest neighborhoods.56 Figure 33. Homicide and firearm mortality rates are higher in Alameda County than they are statewide. Elevated Homicide and Firearm Mortality Rates per 100,000 People in Alameda County Relative to California (2023) Source: CAPE, with data from Alameda County Vital Statistics files and CDC Wonder, 2023. Gun Violence and Race. Firearm mortality in the county is similarly higher than the state rate. The Black population in Alameda County disproportionately experiences both firearm mortality (27.5 per 100,000) and homicides (50.7 per 100,000). Comparatively, Black males make up roughly 5% of the county’s population but accounted for 48% of all gun homicide deaths from 2019 to 2023.56 5.1 8.0 0 5 10 California Alameda County Ag e - Homicide Rate in California and Alameda County (2023) 8.0 9.2 California Alameda County Firearm Mortality Rate in California and Alameda County (2023) Alameda County Public Health Department • 2025–2027 CHA 79 Violence and Children. In 2022–2023, homicide was among the top 3 causes of death in Alameda County for children and youth under 18 and for young adults aged 18–34. It was the 4th leading cause of death among adults aged 35-44. In particular, guns are the leading cause of death among children (ages 1–17) and transition-aged youth (ages 18–24) in Alameda County.56 Additionally, youth gang membership among 11th graders in Alameda County was somewhat higher (4.4%) than the California benchmark (4.1%). Compared to their statewide peers, a slightly larger percentage of youth (9th graders) also reported being bullied and harassed at school because of bias related gender, race/ethnicity or national origin, religion, sexual orientation, or a physical/mental disability (26% in Alameda County versus 23% in California overall).57 How does the community suggest these issues are addressed? • Expand and strengthen victim support and intervention services, including hospital- based violence intervention programs, relocation support, legal advocacy, mental health care, accessible communication options, culturally/linguistically appropriate resources, and shelter capacity for domestic abuse survivors. • Encourage education and prevention programs to build resilient communities, including afterschool programs, youth engagement initiatives, and community-based education. • Ensure better coordination among hospitals, government agencies, schools, law enforcement, and community organizations to provide timely intervention and support for at-risk families. “I chose [to discuss] community safety because where I live there is a lot of violence. There are shootings at 7 at night, or at any time; there are a lot of shootings. There are a lot of homeless people that bother the people who live around there, plus there is a school, so it affects the people who walk to school. …There is a lot of violence and shooting.” — Spanish-Speaking Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 80 Social Determinants of Health: Housing and the Unhoused What is the issue? The physical condition of a home, its neighborhood, and the cost of rent or mortgage are strongly associated with the well-being, educational achievement, and economic success of those who live inside it.58 Poor health can lead to homelessness, and vice versa. People experiencing homelessness suffer from preventable illnesses at a greater rate. They also require longer hospital stays and have a greater risk of premature death than their peers with housing security.59 Community Assets The county has many assets and resources to address housing issues. Some examples include: • Alameda County Health Care for the Homeless • Abode Services, First Place for Youth, and other nonprofits serving people who are unhoused or at risk of being unhoused • Eden Housing, MidPen housing, and other nonprofit developers who own and manage quality affordable housing • Homeless Action Center, Eden Council for Hope and Opportunity (ECHO), and other nonprofits that offer services related to fair housing and tenants' rights • Open Heart Refuge, South Hayward Parish, and other shelters for people who are unhoused For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 81 Health Impacts Barriers to Housing. Housing was one of the highest-priority health needs mentioned by participants in interviews and focus groups. People emphasized the shortage of affordable housing in Alameda County, describing it as an ongoing, decades-old problem. They spoke about the challenges of buying and owning a home in the Bay Area. Some participants pointed out that renters are a growing demographic in Alameda County. Participants cited rising rental costs and a shortage of affordable housing options as major issues for many. Affordable housing is a critical need, and many families are doubling or tripling up in single residences due to high housing costs. Despite this, some described how efforts to convert motels into low-income housing faced opposition from local residents concerned about safety. Barriers to housing were a major topic of discussion. Participants spoke to individual economic stressors, such as wages failing to keep up with housing costs, and city-and county-level factors, such as how affordable housing projects have difficulty securing financing. They observed that both personal and societal economic factors exacerbate the housing crisis. Poor Housing Conditions. Nearly 25% of Alameda County residents live in a household with one or more severe housing problems. These issues include overcrowding, high housing costs, the lack of a kitchen, or the lack of plumbing facilities. Severe housing problems are linked to other health needs such as communicable and chronic diseases. Several participants talked about observing “They’re living in two, three- bedroom apartments with like 10- plus people in it. I’ve been to homes when I was doing home visiting where they’re putting partitions in the living room to kind of, you know, section off, create more privacy for themselves.” —Key Informant Interviewee “I don’t care how good our staff is. They can provide [youth and young adults] with the most intensive independent living skills to tend to their mental health, but when the [young people] age out on their 25th birthday, unless they’re working a very high-paying tech job—and they’re not—it’s going to be very difficult for them to lock in housing and be able to support themselves.” — Key Informant Interviewee “They have all these new apartments and stuff being built, and it’s like, … are you saving space for our disabled folks, our older folks, our parents [who] are retiring? Not everybody can afford a retirement home.” —Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 82 poor living conditions among the people they served, which included people residing in vehicles or overcrowded housing situations. Effects of Housing Instability, Including Becoming Unhoused. Participants described how housing instability leads to frequent relocations with broad effects: Repeated moves impact children’s education, individuals’ job stability, and overall family stability. Some noted the substantial challenges faced by transition-age (i.e., 18–21 years old) youth exiting foster care when they try to secure stable housing and become responsible tenants. Many participants spoke about the increasing unhoused population. They said increases are particularly acute in urban areas like Oakland. Although the number of people experiencing homelessness in Alameda County decreased from 2022 to 2024, in the City of Oakland the count rose by 9% during that period (see Figure 34, next page). Housing instability and homelessness have major health effects. Focus group participants and key informants regularly underscored the impact these issues have on not just physical but mental well-being. They observed that mental and behavioral health issues can both result from and contribute to homelessness. Lack of access to resources and/or behavioral health care can make such issues more pronounced. Participants see stable housing as a foundation for addressing other needs. “It’s gotten a lot worse, and what we’re seeing is a lot of people, half of our homeless population live in vehicles.” —Community Service Provider Key Informant Interviewee “We’ve had cases where folks have had to leave their housing for just a short period of time for some kind of skilled nursing facility or substance use rehab and not be able to return when they should have been able to return. So, not being able to discharge safely after getting health care.” —Service Provider, Focus Group Participant “Homelessness has changed so much. You get people that are working...there’s families, young people, there’s just aged people. I never knew there were so many senior homeless people.” —Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 83 Figure 34. The number of individuals who are unhoused in Oakland rose between 2022 and 2024, while the overall figure for the county dropped slightly. Number of People Who Were Unhoused in Alameda County Compared to the City of Oakland, 2022 Versus 2024 Source: Applied Survey Research. Alameda County Point-in-Time Count. 2022 and 2024. Figure 35. BIPOC communities are overrepresented in Alameda County’s unhoused population. Alameda County Population Percentage by Race/Ethnicity, All Residents Versus Unhoused (2024) Source: Applied Survey Research. Alameda County Point-in-Time Count. 2024. 5,490 9,450 5,055 9,747 Oakland Alameda County 2022 2024 34%30%22%10%1%1%0%5%30%23%41%3%1%1% Asian White Hispanic/ Latino/a/x/e African American/ Black American Indian/ Alaskan Native Pacific Islander Middle Eastern Percent of Alameda County Population Percent of Unhoused Population, Alameda County Alameda County Public Health Department • 2025–2027 CHA 84 Addressing the Housing Crisis. Some service providers interviewed for the CHA described their focus on housing stability. They provide wraparound services, such as medical, behavioral health, and supportive care to foster individuals’ independence, and avoid evictions unless absolutely necessary. When discussing housing instability and homelessness, participants cited structural racism and economic inequities as contributing factors. They identified the intersection of housing, health, and racial justice as critical to addressing the housing and homelessness crisis. Participants expressed a sense that current government responses to the housing and homelessness crisis are inefficient and cost taxpayers too much. Structural issues, including decisions by governmental agencies and private organizations, contribute to inequitable housing conditions that disproportionately affect marginalized communities. “If you're looking at why we selected this [to discuss], it's because of things like structural and institutional racism specific to our region, like redlining, the way that the cities were constructed. I think that is why we're identifying this as such a health problem.” — Key Informant Interviewee “There should be some kind of regulations for shelters to have to be able to accommodate folks with a disability.” — Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 85 How does the community suggest these issues are addressed? • Expand affordable housing! • Address land use barriers, community resistance to new housing developments, and repurpose vacant/underutilized buildings to affordable housing (tax incentives, public investment). • Offer housing solutions led by people who have experienced homelessness, provide better access to low income housing programs, including incentives or direct family assistance to those trying to secure housing and addressing any discriminatory practices preventing access to housing. Alameda County Public Health Department • 2025–2027 CHA 86 Social Determinants of Health: Built Environment, Including Unintended Injuries What is the issue? As UC Berkeley health expert Dr. Tony Iton has said, “When it comes to your health, your zip code matters more than your genetic code.”60 The built environment refers to the places where people live and work, the neighborhoods in which they spend their time.61 This can include services and utilities, such as sewerage or transportation, housing quality, access to grocery stores, and elements such as sidewalks and streetlights. The lack of sidewalks and streetlights can lead motor vehicle crashes and accidents involving pedestrians, causing unintended injuries and deaths. Although most unintended injuries are predictable and preventable, they are a major cause of premature death and lifelong disability.62 Community Assets The county has many assets and resources to address issues in the built environment. Some examples include: • Alameda County Community Development Agency’s Healthy Homes Department, Lead Poisoning Prevention Program • Alameda County Health’s Environmental Health Department • Alameda County Transportation Commission’s Bicycle Safety Education Program • Alameda County and cities' Public Works agencies • Various local water agencies For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 87 Health Impacts Neglected Public Infrastructure. Describing their built environment, CHA participants pointed out how infrastructure (such as sidewalks and public buildings) in lower-income areas is neglected, and they saw this as related to systemic issues. For example, people said that the historical policy of redlining, which reinforced racial discrimination, has led to a long-term lack of resources to improve infrastructure in racialized poor neighborhoods. Negative Health Effects of Contaminants. Environmental contaminants are another built environment challenge. For example, elevated blood lead levels among children suggest lead contamination in places they spend the most time, such as their home, neighborhood, or school. Contamination can come from paint in older buildings, old water pipes, contaminated soil or dust, toys made with lead, some imported candies, and even some traditional folk remedies. Figure 36. High rates of elevated blood lead levels exist in Alameda County. “Part of a healthy community is just the environment that you’re in and the simple things such as repairing the streets, picking up trash. That makes a difference with how people feel in their community, and it affects their health.” —Key Informant Interviewee 2.0% 3.1% 0% 1% 2% 3% 4% California Alameda County Note: High blood lead levels are defined as 3.5 µg/dL or above. Source: CA Dept. of Public Health Childhood Lead Poisoning Prevention Branch reports, 2016 to 2022. Children Under Age 6 With Elevated Blood Lead Levels in California and Alameda County (2016–2022) “Transportation modalities are one of the heaviest contributors to pollution, air quality. We do know they also are connected with some diseases; people that are exposed to the gases … more frequently, they also develop cardiovascular disease or cancer, for example, due to the heavy metals.” —Key Informant Interviewee CHA participants noted the effect of environmental contaminants and unsafe drinking water on community health. Some reported using bottled water or boiling tap water because they don’t trust the water quality, whether due to old pipes or visible environmental contamination (e.g., industrial activity leading to poor air and soil quality). (See more in the subsection on Climate / Natural Environment and the section on Chronic Conditions.) Alameda County Public Health Department • 2025–2027 CHA 88 Food Deserts. Participants frequently mentioned the difficulty of accessing healthy food options in their communities. They reported challenges such as food deserts, where grocery stores are not easily accessible, and an abundance of processed foods. They mentioned that remote areas and certain neighborhoods have more food insecurity because residents have limited access to grocery stores and related resources. “Geographically, where folks are living, certain things such as higher levels of air pollution, access to healthy grocery stores or healthy food options—a lot of it is a food desert; there’s a million corner stores, and occasionally some of them do have apples and things like that, but for the most part, the nutrition options that are available for folks in certain areas, it’s a part of that structure … in terms of structural racism.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 89 Differing Life Expectancy. The built environment has an effect on people’s lives and health. In Alameda County, the data show a substantial difference in life expectancy by zip code (see Figure 37, below). The highest life expectancy is 88 years in southeast Fremont. Less than 25 miles south, in east Oakland/Elmhurst, life expectancy is 14 years lower, at just 74 years. Figure 37. Life expectancy rates vary substantially by geographic area. Alameda County, Life Expectancy in Years, by Zip Code (2019–2023) Source: ACPHD CAPE, with data from Alameda County vital statistics files, 2019–2023. Oakland/Elmhurst 94603: 73.8 yrs Alameda County Public Health Department • 2025–2027 CHA 90 Motor Vehicle Accidents; Poor Access to Sidewalks and Public Transit. Accidents also present a big challenge. Among young adults aged 18–34 in Alameda County, unintended motor vehicle crash mortality was the 3rd leading cause of death in 2022–2023. The Pacific Islander population had the highest unintended motor vehicle crash mortality rates by race in the county; the African American/Black population had the second highest rate. The rate of death from unintended motor vehicle crashes in neighborhoods with high levels of poverty (30% or more of census tracts) is more than twice the rate of the wealthiest neighborhoods (12.6 per 100,000 compared to 5.6 per 100,000), according to county data. Figure 38. The Pacific Islander population had the highest unintended motor vehicle crash mortality rates by race in the county. Alameda County Motor Vehicle Traffic Mortality Rate per 100,000, by Race and Ethnicity (2019 to 2023) Source: ACPHD CAPE, 2019–2023. 22.1 19.6 9.4 6.7 6.4 3.4 7.4 0 5 10 15 20 25 Pacific Islander African American/ Black Hispanic/ Latino/a/x/e White American Indian/ Alaska Native Asian All Races Ag e - 10 0 , 0 0 0 P e o p l e 6.5x Alameda County Public Health Department • 2025–2027 CHA 91 Figure 39. Higher-poverty neighborhoods in the county generally had higher unintended motor vehicle crash mortality rates. Alameda County Motor Vehicle Traffic Mortality Rate per 100,000, by Neighborhood Poverty and Race/Ethnicity (2019 to 2023) Source: ACPHD CAPE, with data from Alameda County vital statistics files, 2019–2023. *Note: Data for Asians for 30%+ poverty are not included because the numbers of these residents are too small to report reliably. American Indian/Alaska Native and Pacific Islander rates were similarly not included. Quite a few CHA participants expressed concerns about everyday safety in their neighborhoods, including the risk of motor vehicle accidents. They linked more traffic and poor-quality roads with a rise in traffic accidents and difficulties in commuting—affecting their ability to access work, health care, and other essential services. Some also voiced concerns about the risk of pedestrian injuries while performing routine activities in their neighborhood. Although the death rate from pedestrian–motor vehicle collisions in Alameda County is lower than the state’s, county pedestrians who are African American/Black or Hispanic/Latino/a/x/e die from these accidents at higher rates than their peers of other races/ethnicities. This racial inequity exists nationwide. 0 5 10 15 20 25 <5.0%5.0-9.9%10.0-19.9%20.0%+ Po p u l a t i o n Neighborhood Poverty Group African American/Black Hispanic/Latino/a/x/e All Races Asian* White “…Too, our own sidewalks and having safe passages for seniors crossing the street. [Around] International [Boulevard]… the streets are too narrow, usually blocked by holes, or by equipment so that we cannot be seen. And then [not] being able to travel the streets and sidewalks because they're being blocked, it's not accessible to people. So basically we can't travel in our own neighborhood.” —Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 92 Figure 40. County pedestrians who are African American/Black or Hispanic/ Latino/a/x/e die from these accidents at higher rates than their peers of other races/ethnicities. California and Alameda County Pedestrian Mortality Rate per 100,000, by Race/Ethnicity (2019–2023) Source: ACPHD CAPE, with data from Alameda County vital statistics files and CDC Wonder, 2019–2023. CHA participants cited numerous reasons for the risk of pedestrian accidents. They said: • Most neighborhoods in Alameda County were designed primarily for automobiles, resulting in limited walkability. • There are poorly maintained sidewalks that in some areas are blocked by garbage (e.g., in East Oakland, Fruitvale, and near International Boulevard). This makes the sidewalks inaccessible for people using walkers or wheelchairs. • There is a lack of streetlights in some areas. • Public transit options are inadequate; systems like BART are too linear, with scant coverage that leaves residents dependent on buses that can be too expensive and/or do not run often enough. Together, these features make it more difficult and dangerous to access basic services like grocery stores and clinics. Relatedly, the absence of sidewalks in low-income neighborhoods is tied to national pedestrian injury rates,63 and not having access to safe transportation is connected to racial inequities in those rates.64 6.2 6.1 3.5 2.4 2.4 1.4 2.9 5.5 3.3 1.7 1.0 2.1 0 1 2 3 4 5 6 7 AfricanAmerican/Black AmericanIndian/Alaska Native Hispanic/Latino/a/x/e PacificIslander White Asian All RacesAg e - California Alameda County Alameda County Public Health Department • 2025–2027 CHA 93 How does the community suggest these issues are addressed? • Enhance and support alternative transportation methods and green spaces, making them safer, more accessible. • Provide more grocery stores, community gardens, senior centers, and health clinics built in neighborhoods. • Improve environmental safety and sanitation: ensure low income communities have participation in city climate action plans, access to clean drinking water, accessible bathrooms, showers. Alameda County Public Health Department • 2025–2027 CHA 94 Social Determinants of Health: Climate / Natural Environment What is the issue? The U.S. Office of Disease Prevention and Health Promotion reports that, worldwide, nearly 12 million deaths each year can be attributed to environmental issues. 65 These include air, water, food, and soil contamination, unhealthy materials in the built environment such as in people’s homes or workplaces, and natural or technological disasters. For people whose health is already compromised, exposure to negative environmental issues can add to or amplify their problems.65 Community Assets The county has many assets and resources to address issues related to the climate and natural environment. Some examples include: • Alameda County Department of Environmental Health • Alameda County Office of Sustainability • Bay Area Climate Adaptation Network (BayCAN) • Bay Area Air Quality Management District • City of San Leandro: Hub Network and other cities' climate resilience hubs • East Bay Regional Park District and various cities' departments of parks and recreation For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 95 Health Impacts Poor Air Quality. CHA participants discussed how the built environment affects air quality. They talked about how transportation-related pollution contributes to health issues such as cardiovascular diseases and cancer. Indicators of air quality were poor in Alameda County.66 • The county had a notably worse rate of particulate matter (PM2.5, 9.4 micrograms per cubic meter of air) versus California’s overall rate (7.1). • Alameda County’s diesel air pollution (0.33 kilograms per day) was also higher than the statewide measure (0.22 kg/day). • Its overall traffic volume statistic was also greater than the state’s (1,791 vehicles per meter of road versus 1,391 statewide). Figure 17. Diesel air pollution is higher near major arteries and in industrial areas. Note: Although these latest diesel particulate matter data are from 2016, the Healthy Places Index is the standard relied upon by HCAI in determining communities that are vulnerable to air pollution. Source: Public Health Alliance, Healthy Places Index. Retrieved from https://www.healthyplacesindex.org/ Alameda County Public Health Department • 2025–2027 CHA 96 Environmental Injustice. Participants in the CHA also raised concerns about industrial pollution and connected it with historical housing segregation. They cited redlining and historical placement of communities near heavy industry, freeways, and landfills as ongoing examples of environmental injustice. Participants also voiced their concerns about climate change. When discussing the climate, they frequently mentioned wildfires, flooding, droughts, and extreme heat as significant concerns. Participants explained how these events can lead to displacement, homelessness, and increased stress on already vulnerable populations. They noted that structural racism and economic inequities make these vulnerabilities more severe. Participants also discussed environmental injustice in relation to climate change. Quite a number highlighted the unequal effect that climate change has on low-income and marginalized communities due to inadequate housing, lack of cooling centers, and economic constraints. They noted that low- income communities and communities of color are more affected by extreme weather and environmental hazards and often have fewer resources to cope with their impact. “Housing segregation that happens in the Bay Area …pretty much tracks with the… proximity to industrial pollution, freeway pollution, soil and air and water contamination. These things usually align with housing segregation and structural racism.” —Key Informant Interviewee “What we’re experiencing, this heat, these fires are bringing us illnesses too ...all of this is affecting us.” —Spanish-Speaking Community Member Focus Group Participant “It’s the folks who live in places where cranking up the AC isn’t a viable option for monetary reasons. It’s people who are living in housing that has its own health issues.” —Key Informant Interviewee all the drought, the flooding… because of climate change, and how that is going to impact some of our lowest income, most marginalized communities the most. …With the increase of wildfires, especially your lower-income folks… you have a fire and then you’re displaced, you can’t pay; it can all turn into more devastation.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 97 Heat Risk. One health expert participant tied increasing asthma rates with poor air quality and an increasing number of days of extreme heat. In 2025, Alameda County was expected to experience 7 “hot” days (days when the temperature feels as though it is over 88 °F). This number is expected to double, to 14 days, over the next 30 years.67 Wildfire Risk. Some CHA participants mentioned they have been affected by wildfire smoke. Alameda County is at major risk of wildfire and has had 10 wildfires in the past 35- plus years. These include the SCU Lightening Complex fire of 2020, which burned nearly 1,650 square miles of land and affected more than 1,400 buildings. Nearly 50% of all properties in Alameda County are at some risk of being affected by wildfire in the next 30 years.68 Figure 18. More properties in eastern Alameda County are at high risk from wildfire than in other parts of the county. Source: First Street, a public benefit corporation connecting climate risk to financial risk via advanced climate science. (2024). Properties at risk of being affected by wildfire over the next 30 years. Retrieved from https://firststreet.org/county/alameda-county-ca/6001_fsid/fire ◉ Minimal ◉ Minor ◉ Moderate ◉ Major ◉ Severe ◉ Extreme Alameda County Public Health Department • 2025–2027 CHA 98 Need For Systemic Change. Regarding climate change, participants expressed feeling limited in their ability to make meaningful changes at the local level. They noted that individual actions are important but that only broader, societal changes can effectively address its root causes. For data about lead contamination, see the subsection on Social Determinants of Health: Built Environment, Including Unintended Injuries in this Social Determinants of Health section. How does the community suggest these issues are addressed? • Work with hospitals, community-based organizations, government, and nonprofits to develop climate strategies, environmental justice organizations to develop climate strategies and adopt policies integrating health equity with climate action. • Increase resource allocation toward climate adaptation measures, both at the individual and systemic level (e.g., clean mobility initiatives, addressing environmental disasters, etc.). • Direct investment in health infrastructure: workforce development, living wage jobs, access to healthy food, wraparound services. “Depression and anxiety are widespread and exacerbated by global climate change.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 99 Social Determinants of Health: Racism/Discrimination What is the issue? Research has shown that racism and discrimination, both structural and interpersonal, are a fundamental cause of health inequities, health disparities, and disease in the U.S.69 Their impact on Americans’ health is as severe as it is extensive. Throughout the country and locally, racial and ethnic minority populations continue to experience higher rates of poor health and disease, especially compared to their White counterparts.70 Other populations, such as individuals with disabilities or those identifying within LGBTQ+ communities, also experience varying degrees and forms of discrimination. This assessment considers systemic racism and discrimination as a root cause of health inequities, which are detailed in the other health need descriptions. Community Assets Many of the agencies in Alameda County that address the other health needs also address racism/discrimination. Some agencies specifically address it, such as: • Alameda County District Attorney Accountability Table • Ella Baker Center for Human Rights • NAACP chapters in Hayward and Oakland • Showing Up for Racial Justice Bay Area For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 100 Health Impacts Affects BIPOC Health and Well-Being. More than 2 in 5 key informants and focus groups called out structural racism and discrimination as a community priority to be addressed. Participants described structural racism as a continuous and pervasive force that takes different forms. These forms may include the built environment (e.g., diesel truck corridors routed through Black neighborhoods) and over- policing of Black and Brown communities such as Fruitvale and East Oakland. People discussed how discrimination and racism affect health, saying that structural racism has a negative effect on both physical and mental health. Speaking about mental health specifically, they often mentioned how the stress and anxiety of living under systemic racism contributes to poor mental health outcomes in affected communities. Affects Other Groups’ Health and Well- Being. Participants connected bias within health care systems to inadequate care. They said inferior care directly results in poorer health outcomes for marginalized groups. Such groups include people of color (participants specifically mentioned people who identify as African American/Black or Hispanic/ Latino/a/x/e), people with severe mental health issues, and people who identify as LGBTQ+. CHA participants often mentioned that people who speak limited English face more challenges when trying to access quality health care services. They highlighted poor health outcomes among these groups, such as higher rates of chronic diseases (e.g., diabetes and hypertension), higher infant and maternal death rates, and shorter life expectancy. “Incidence of diabetes and hypertension are higher in Black and Brown communities. Some of that is stressors, and some is economic, and some is carrying racism as a stress in [our] bodies.” — Key Informant Interviewee “Structural racism plays out near constantly, and it’s pervasive...people of color experience a near-constant hypervigilance around our race.” — Key Informant Interviewee “There is still a lot of discrimination; sometimes people are treated differently if they are Latina. In a hospital, they are not treated the same as White people. There is no cultural competency since there is discrimination. …[Providers] don’t know the language, they don’t know the culture.” — Spanish-Speaking Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 101 Participants also reported discrimination affecting multiple marginalized groups, including LGBTQ+ people, low-income individuals, and people with disabilities. Several described neglectful living conditions and landlord retaliation against immigrants, limited- English-speaking and BIPOC communities, complicating housing access. Hate crimes have risen sharply against LGBTQ+ people and African Americans. Reports involving Asian Americans surged in 2021 amid anti-Asian rhetoric during the COVID-19 pandemic and, while declining, remain above pre-pandemic levels. Figure 41. Rates of anti-LGBTQ+ and anti-Black hate crimes rose in the county. Alameda County Anti-LGBT Hate Crimes Reported by Law Enforcement (2004–2023) Source: California Department of Justice, 2004–2023. Alameda County Trends in Hate Crimes Reported to Law Enforcement, by Targeted Race and Ethnicity (2019–2023) Source: California Department of Justice, 2019–2023. 16 22 58 0 10 20 30 40 50 60 70 Re p o r t e d 0 10 20 30 40 50 60 70 2019 2020 2021 2022 2023 Re p o r t e d Anti-Black or African American Anti-Hispanic or Latino Anti-Asian Anti-White Alameda County Public Health Department • 2025–2027 CHA 102 People living with disabilities described having many different negative experiences with discrimination. These included: • Being mocked by nurses for needing to use accessible restrooms. • Being told they could not participate in a program because it could not accommodate their disability. • Not being seen as a competitive candidate for jobs they qualified for. • Being ignored or served last in medical offices, restaurants, and other venues. Affects Socioeconomic Outcomes. CHA participants said that discrimination restricts educational and employment opportunities for those who are affected. This includes people with disabilities, people of color (especially people who identify as Hispanic/ Latino/a/x/e or African American/Black), people who speak limited English, people who are low-income, and people who belong to other vulnerable populations. Participants described how economic barriers that disproportionately affect vulnerable communities combine with structural racism to have a greater negative impact. Some participants pointed to a lack of racial/ethnic representation and inclusivity in hiring and career advancement as a significant issue. Some participants discussed the digital divide as a modern manifestation of structural racism. These restricted opportunities keep people in cycles of poverty and limit their ability to achieve higher education and incomes. Affects Intersectional Populations. Multiple participants noted that discrimination often “If you [have] just enough factors to end up in the extremely low-income category, then these other factors [race, sexual orientation] make sure it’s multiplied.” — Key Informant Interviewee “Employment ...is often still not available. I mean, legally, it is. But you're not being sought after for positions and not competing. ...Employment, which is a way for people to thrive economically as well as emotionally, is often not available to people who are disabled.” — Key Informant Interviewee “I’ve had people actually floor it and come screeching to a halt right up next to me because I wasn’t crossing the street fast enough in my wheelchair.” —Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 103 intersects across race/ethnicity, disability, language, economic status, and sexual orientation. When it does, it multiplies the challenges an individual may face. For example, youth expressed concern about the forms of discrimination they experience from students at school. Effect of Historical Policies. Some CHA participants emphasized the historical roots of structural racism. This includes redlining (see Figure 42, next page) and lack of investment in communities of color, dynamics that continue to shape living conditions in affected communities. Several participants pointed out that these unjust historical policies have created long-lasting inequities between neighborhoods. This has led to residents having limited access to affordable housing, healthy food, green spaces, and other resources. Others spoke to economic barriers that disproportionately affect communities of color. A few stated specifically that structural racism is embedded in the criminal justice system. They explained that this has led to higher incarceration rates for people of color. Increased incarceration disrupts family structures and contributes to cycles of poverty and trauma. Finally, participants indicated that systemic change across multiple areas—housing, health care, education, criminal justice, and employment—is necessary to undo the causes and effects of structural racism and discrimination. Figure 43 and Figure 44 on the next page illustrate the effects of structural racism and related factors on Alameda County residents’ health.71 “Another thing I wish would not be present at school is the homophobia, the transphobia, the racism, and all of that hate. There’s so much promotion of ‘this is a safe space or inclusive.’ But then I have walked across campus and heard one of my friends be called [derogatory term for sexual orientation] five times. And that’s not something anyone should have to experience.” — Youth Participant, Eastern Alameda County Needs Assessment “We are at a disadvantage because of the color of our skin. Where we come from, the zip code we put down on the application, everything. Employers can say they don't look at it, but they do.” —Community Member Focus Group Participant “For me, [being] Black, it’s always discrimination. Discrimination is alive.” —Community Member Focus Group Participant Alameda County Public Health Department • 2025–2027 CHA 104 Figure 42. Alameda County map from 1937 showing redlining of BIPOC neighborhoods. Source: Nelson, R.K. et al. (2023). Mapping Inequality: Redlining in New Deal America. Figure 43. There are concentrated inequities in life expectancy by race and ethnicity. Alameda County* Life Expectancy, by Race/Ethnicity Note: *American Indian / Alaska Native data are provided for California to generate more stable estimates due to the small population size in Alameda County. Statewide all-races life expectancy for 2022–2023 is 81.1 years. Source: CAPE analysis of Alameda County & California vital statistics files, 2018–2023. 87.2 82.682.281.978.7 76.4 72.5 65 70 75 80 85 90 2018-2019 2020-2021 2022-2023 Asian All Races Hispanic/Latino/a/x/e White American Indian/Alaska Native* Pacific Islander 14.7 year gap 13.2 year gap Alameda County Public Health Department • 2025–2027 CHA 105 Figure 44. Even with neighborhood poverty levels taken into account, African American/Black and Pacific Islander populations still have the highest mortality rates. Alameda County Mortality Rate per 100,000 People, by Neighborhood Income and Race/Ethnicity (2019–2023 and 2016-2023) Source: ACPHD CAPE, with data from 2019–2023, and data from 2016–2023 for smaller populations (American Indian / Alaska Native and Pacific Islander). How does the community suggest these issues are addressed? • Advance racial equity through representation (hiring, valuing, fairly compensating people with lived experience, advocating for workforce diversity initiatives), and ensure care providers and service staff reflect cultural backgrounds of communities. • Address structural racism by targeting investment, addressing discriminatory practices, supporting reparations. • Advocate for and support advocacy campaigns of programs that support communities of color—especially people who identify as African Americans/Black—about existing supportive programs (e.g., Healthy Black Families, Black Infant Health), and partner with these organizations to improve access and advocacy. “Every single topic we discussed is a result of structural racism. Everything from education, housing and homelessness, the health outcomes, you name it, it’s tied to it. And I think until we address it head on and people are not afraid to call it out, we’re going stay in the same situation we are in.” — Key Informant Interviewee 0 300 600 900 1,200 1,500 1,800 <5.0%5.0-9.9%10.0-19.9%20.0%+ Ag e - Neighborhood Poverty Rate Pacific Islander African American/Black American Indian/Alaska NativeAll Races White Least poverty Highest poverty Alameda County Public Health Department • 2025–2027 CHA 106 Identified Health Need: Behavioral Health Alameda County Public Health Department • 2025–2027 CHA 107 3. Behavioral Health What is the issue? Behavioral health refers to both mental health and substance use. Mental health is defined as social, emotional, and psychological well-being. It plays a key role in a person’s overall wellness, ability to have and maintain healthy relationships, and function in society.72 The use of substances such as alcohol, marijuana, and other legal or illegal drugs affects not only the individuals who use them, but also their families and communities. Healthiest Aspects of Communities. When ACPHD and its partners asked CHA participants to describe the healthiest parts of their communities, they described emotional connections—such as love, care among families, and authentic self-expression. Participants understood these things as foundational to the community’s overall health. They also saw active parental and community involvement in schools and local organizations as a protective factor (i.e., something that acts as a buffer against negative outcomes) for mental health. They viewed such involvement as an important network of care and engagement for both youth and adults. As described in the section on Social Determinants of Health, many participants highlighted strong community support and unity as a community asset. They noted that people come together and help each other in times of need, and this fosters a sense of belonging and emotional well-being. Several emphasized the resilience of community members in facing hardship, such as discrimination and other social challenges. Participants saw this strength as having a positive effect on collective mental health. “Societal views have changed. …Before, it was really a negative if anyone sought out a therapist. Now… it’s becoming a positive thing to have somebody to talk to.” —Key Informant Interviewee “The connections, the love—that they care about each other, that even though there’s [tension]… we can work through some of that because parents and guardians care about the kids and want what’s best for them.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 108 Built Environment and Mental Health. Participants reported valuing environments where people feel safe and secure in their homes and neighborhoods. They directly linked safety to better mental health outcomes. Some participants spoke about the importance of affordable housing that has intentional design and access to amenities. They described how this creates a stable environment that supports mental health. They also mentioned how having access to green spaces, walkable environments, and opportunities for physical activity is an asset and supports physical and mental well-being. Access to Resources and Providers. Participants recognized the efforts of strong nonprofit sectors, grassroots organizations, and mutual aid groups in reducing stressors related to basic needs. They saw access to mental and behavioral health providers with lived experience as a positive step toward breaking down barriers to mental and behavioral health care. Lastly, some noted reduced stigma around seeking mental health care and believe that this has had a positive effect. Community Assets The county has many assets and resources to address behavioral and mental health issues. Some examples include: Integrated Mental Health and Substance Use Services: • Alameda County Behavioral Health Care Services • Axis Community Health Behavioral Health Services • Cronin House and other residential treatment centers Mental Health: • Alameda Health System John George Psychiatric Hospital • Axis Bridge Mental Health Urgent Care, Crisis Support Services of Alameda, and others providing mental health crisis care • Hively Mental Health, La Familia Counseling Services, and other service providers • National Alliance on Mental Illness (NAMI) local chapters • Afghan Coalition, Boldly Me, and other nonprofits working with specific populations • Various cities' youth and family services departments Substance Use: • Alameda County Medical Center Substance Abuse Program • Horizon Treatment Services' Project Eden, and other outpatient treatment options • Second Chance Centers, Cherry Hill Detox, and other residential treatment sites For a detailed list, please see Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 109 Challenges: Behavioral Health Although community members across the county celebrated the positive elements described above, they also faced many mental and behavioral health challenges. Health Impacts Mental Health Worsening. Across key informant interviews and focus groups, participants named behavioral health, including mental health and substance use, as one of the highest-priority needs. Most identified mental health as a top concern. They highlighted issues such as anxiety, depression, trauma, loneliness, grief, and social isolation. Some felt the COVID-19 pandemic and other stressors had exacerbated mental health challenges and substance use, causing it to increase in severity among those already struggling and introducing new cases. Affects All People; Crisis Among Youth. Participants described the links among food insecurity, housing instability, violence, and mental health issues such as hopelessness. A number noted that trauma, including the experiences of refugees, generational trauma, and structural racism, can play a large role in worsening mental health issues. Many identified a significant mental health crisis among youth. A greater proportion of children in Alameda County are hospitalized for mental diseases and disorders than children in California overall (see Figure 46, next page). Others felt there is a growing crisis among people of all ages, including children, youth, adults, and older adults. In 2022–2023, suicide was among the top 5 causes of death for adults aged 18–44 in Alameda County. “I’m mostly alone, I don’t really have anyone to talk to. It’s hard to find friends or … anyone to discuss anything with outside school.” —Youth Participant, Eastern Alameda County Needs Assessment “A lot of our youth and a lot of underserved folks, mostly Black and Brown communities, got hit very hard with COVID, not just getting COVID but a lot of death. That adds to the mental crisis that our youth are experiencing.” —Key Informant Interviewee “We work really closely with Afghans. I think being a refugee, we have focused a lot on mental health … And the trauma of being a refugee and coming from a war.” — Key Informant Interviewee “Young people are in a mental health crisis. They are dealing with skyrocketing rates of anxiety and depression and loneliness. There are Black and Brown kids living in Oakland, where the impact of institutional racism has affected how they’ve grown up.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 110 Figure 45. There are inequities by sexual orientation in youth suicidal ideation. Percentage of Alameda County High School Students That Seriously Considered Suicide Within the Past Year (2021–2023) Source: CAPE analysis of California Healthy Kids Survey (CHKS), 2021–2023. Figure 46. The top reason for child hospitalizations is mental diseases and disorders. Child Hospitalizations, Percent by Primary Diagnosis (2020) Source: California Department of Health Care Access and Information custom tabulation, 2020. As cited in KidsData.org. 2% 3% 3% 4% 5% California, 17% 2% 3% 3% 3% 6% Alameda County, 21% Metabolic/Nutritional Disorders Traumatic Injuries Fractures Seizures/Headaches Asthma/Bronchitis Mental Diseases and Disorders 45% 30% 9% 0% 10% 20% 30% 40% 50% Transgender Lesbian, Gay, Bisexual (Cisgender)Straight, Cisgender 5x Alameda County Public Health Department • 2025–2027 CHA 111 “If I am mentally well, I can help my children if they are going through some stress or something. But if I’m not mentally well, I cannot help.” —Community Member Focus Group Participant “We have kids who have self-harming behaviors that they’re undergoing. Could be cutting or could be eating disorders or other kinds of things as examples, but just kids with a lot of anxiety and depression in general.” —Key Information Interviewee Alameda County Public Health Department • 2025–2027 CHA 112 Barriers to Access. Participants frequently discussed the limited availability of mental health practitioners and related services. They described barriers such as long wait times for appointments, inadequate insurance coverage, and high costs of services. They also highlighted how stigma and stereotyping posed a commonplace barrier to seeking help. “There is not much access to mental health, appointments take very, very long [to get], and an appointment cannot be arranged when a person is already in crisis.” —Spanish-Speaking Community Focus Group Participant “There’s a crisis when it comes to mental health providers. We don’t have enough, and we don’t have enough that speak non-English languages or...have the cultural sort of understandings and competence for some of these communities.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 113 Concerns About Substance Use. Many participants emphasized the strong connection between mental health and substance use. They often recognized substance use as a coping mechanism for unaddressed mental health issues. Substance use, particularly among youth but also among adults, was a major concern for participants. Substance use treatment experts who participated in the CHA noted an increase in substance use disorders overall and emphasized that fentanyl and synthetic drugs are especially dangerous. Unintentional overdose was the top cause of death for adults aged 18–44 in Alameda County in 2022–2023. For adults aged 45–64, it was among the top 3 causes of death. Some treatment experts noted that opioid use rates may be similar across income strata but that such use is often kept quiet in affluent communities. Table 1. Across a recent five-year period, the top three leading causes of mortality in Alameda County for adults ages 18–64 included unintentional overdose. Rank <1 1-17 18-29 30-44 45-64 65-74 75+ All Ages 1 Perinatal conditions Homicide Unintentional drug overdose drug overdose Cancer Cancer Heart disease Cancer 2 anomalies All other diseases Homicide Heart disease Heart disease Heart disease Cancer Heart disease 61 deaths 34 227 261 1,689 2,008 5,481 10,504 3 All other diseases vehicle Motor vehicle crash Cancer drug overdose Stroke Stroke Stroke 24 deaths 29 153 255 740 569 2,913 3,956 Source: Alameda County vital statistics data, 2020–2024. “Danville, we’re a more affluent community, so a lot of our substance use and abuse is …not necessarily out in the open. So we see it in our clients,… but it’s not as widely spoken about, particularly things like fentanyl or opiate use. It’s more hidden in this community.” —Substance Use Treatment Expert, Focus Group Participant “I think health care professionals, by and large, do not understand the issue of addiction. [They] often come from religious traditions that suggest that substance use is a moral failure.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 114 Differences Among Various Populations. Participants voiced concern about mental health and substance use among youth, particularly high school and college students. They also expressed concern for substance use among unhoused individuals. Participants identified them as particularly susceptible to a combination of mental illnesses, substance use disorders, and other vulnerabilities that can negatively affect mental well-being. They also noted that people of color are especially vulnerable. Some participants mentioned that men are more likely to have substance use issues than women. Inequities exist among the county’s subpopulations in relation to mental health. For example, the county’s young adults and adults who identify as bisexual have significantly higher rates of likely serious psychological distress (35% and 58%, respectively) compared to all adults in the county (17%). Data by race show that the county’s Asian community members have significantly lower proportions of adults with likely serious psychological distress (10%) compared to adults of other races and ethnicities in the county. See more related to Social Determinants of Health: Health Care Access and Quality, Social Determinants of Health: Economic Stability, and Social Determinants of Health: Housing and the Unhoused in their respective descriptions in the section on Social Determinants of Health. “[I] imagine that’s why there are so many homeless people or people who live on the street: because of mental health problems, because their families practically can’t cope with them anymore, because they don’t have the resources for insurance to take care of them.” —Community Member Focus Group Participant “Alcohol is a coping mechanism for a lot of men in our community [who] don’t access resources, don’t talk about the …feelings they’re experiencing. …I think alcoholism is socially accepted, but problematic drinking behaviors—I think there’s a lot of it and the domestic violence that goes along with it.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 115 How does the community suggest these issues are addressed? • Use telehealth, street-level outreach, client-centered service design. • Center community-centered approaches like promotoras, peer educators, community health workers, including group therapies and peer support models (community gatherings, life skills workshops, employment programs). • Address stigma around mental illness and substance use. “I work a lot with youth... I have personally a really high concern for the lack of awareness and education surrounding substance use, but in particular, the fentanyl issue we see out there.” “I work in adult substance use [treatment;] it is astonishing to me how little knowledge is out there. We’ll do an [educational] group about alcohol. We’ll do a group about methamphetamines. And there does not seem to be an awareness of substances at all, really, and their impact on your body and your health.” —Substance Use Experts, Focus Group Participants Alameda County Public Health Department • 2025–2027 CHA 116 Identified Health Need: Communicable Diseases Alameda County Public Health Department • 2025–2027 CHA 117 4. Communicable Diseases Infectious diseases are caused by germs, such as viruses and bacteria, that can infect the body. These germs are spread through direct or indirect physical contact with bodily fluids like saliva, mucus, or blood. Various forms of protection from communicable diseases include hygiene, vaccination, and protective barriers such as condoms (for STIs) or face masks (for respiratory infections). At a more basic level, sanitation (effective sewer systems) and a clean water supply are key to preventing the spread of infectious diseases. Access to Clean Environment and Accurate Information. When ACPHD and its partners asked CHA participants to name the healthiest parts of their communities, some highlighted the importance of clean surroundings for community health. Others emphasized the need for access to clean water for health and hygiene. Some participants were concerned about community members who do not have access to clean water, including people who are unhoused. They were also concerned about the lack of accurate, publicly available information and education on the frequency and treatment of communicable diseases. On the next pages, some of the issues affecting people in Alameda County are described. Community Assets The county has many assets and resources to address communicable diseases, including: • Alameda County Public Health Department, Division of Communicable Disease Control & Prevention • Local hospitals, Federally Qualified Health Centers and other health clinics • East Bay Getting to Zero • Hep B Free Alameda County Collaborative • HIV Education and Prevention Project of Alameda County • I Know • Immunization Partnership of Alameda County (IPAC) • Long Covid Families • STI testing clinics For a detailed list, please see Attachment 8: Community Assets and Resources. “There are folks from our community who want to collaborate and give folks a very basic need in order to survive because it’s not just food, it’s clean water.” —Key Informant Interviewee Alameda County Public Health Department • 2025–2027 CHA 118 Challenges: Communicable Diseases Communicable Diseases: Sexually Transmitted Infections What is the issue? Sexual health depends on people having access to complete and factual information about sex and sexuality. It requires that people have access to sexual health care and know the risks and consequences of unprotected sex. These include sexually transmitted infections (STIs). An environment that supports sexual health enables this access and knowledge. STIs are caused by germs that are mainly passed through direct sexual contact (e.g., human papilloma virus, or HPV, is transmitted this way). Some STIs, like herpes or HIV/AIDS, are also blood-borne. All STIs can be treated with medication, but not all can be cured. Protective barriers like condoms are the primary means of prevention, but vaccination is a strong deterrent against some STIs, notably HPV and hepatitis B.73 Health Impacts Vulnerable Populations. Incidence rates of chlamydia and gonorrhea among Alameda County youth aged 15–19 are much higher than the rates of these STIs statewide. Some CHA participants expressed concern over the rising rates of STIs like syphilis and chlamydia, especially among young people. Separately, one health expert linked damage to the body from heavy substance use to an increased risk of STIs. Figure 47. Chlamydia and gonorrhea rates for youth in Alameda County are higher than California rates. Sexually Transmitted Infection Rates per 100,000 Youth Aged 15–19 (2020) Source: California Department of Public Health. 2020. Rates per 100,000 population. 572.6 648.2 520 560 600 640 680 CA AC Chlamydia 130.8 159.0 0 30 60 90 120 150 180 CA AC Gonorrhea Alameda County Public Health Department • 2025–2027 CHA 119 Communication Issues. CHA participants were concerned about limited public/ community education on STIs. One participant pointed to health providers’ and public health departments’ current messages about sexual health. They noted that such messages often don’t reach individuals who do not identify strictly as a particular sexual orientation but who engage in high-risk behaviors. This gap in messaging, the participant though, may be linked to a lack of awareness and an absence of preventive care measures in this group. Other Factors. The Centers for Disease Control and Prevention suggests that various social factors affect individuals’ ability to “stay sexually healthy.”74 These include: • Income inequality • Poverty and/or lack of employment • Lower levels of education • Distrust of the health care system due to shame, stigma, experience or fear of discrimination. “You don’t see a lot of information on HIV and AIDS that’s publicly out there anymore. People are just not as aware of it still being an epidemic. And it is. It’s still an active epidemic.” —Key Informant Interviewee “There’s a whole group of folks just kind of roaming about, who it doesn’t even cross their mind that they’re at risk for certain [STIs] because they don’t see themselves fitting into the [risk] category.” —Community Member Focus Group Participant “You know, when you combine sexuality and substance use, the chances of exposure increase, and the chances of conversion in the case of exposure increase because substance use affects the immune system.” —Key Informant Interviewee “From my personal observation, STDs are more serious now compared to before. [I believe] the increasing acceptance of different sexual orientations has contributed to the spread of STDs. For older people, it doesn’t seem to be an issue. But … it affects our younger generation.” —Khmer-Speaking Community Alameda County Public Health Department • 2025–2027 CHA 120 Communicable Diseases: Respiratory Infections What is the issue? Respiratory infections are diseases are caused by germs that can infect the nose, throat, lungs, and other parts of the respiratory system. The germs are spread from an infected person’s nose or mouth through small airborne particles of mucus and saliva.75 Respiratory infections include many vaccine-preventable diseases (VPDs), infections that can be prevented or significantly reduced in severity through vaccination. Respiratory VPDs include coronavirus (COVID-19), tuberculosis, pertussis (whooping cough), and influenza. Lack of vaccination (also called immunization) creates greater health risks for individuals, their families, and their communities, up to and including death. The American Lung Association reviewed the CDC’s data on COVID-19. It found that in 2023, people who were unvaccinated were 6 times more likely to require hospitalization and 12 times more likely to die from COVID than individuals who were fully vaccinated and boosted.76 Long-term effects from COVID-19 infection (called long COVID) include chronic tiredness, memory issues (“brain fog”), fast or irregular heartbeat, and problems with taste or smell.77 Other respiratory VPDs have similar disparities between those who are immunized against them and those who are not. Getting vaccinated is one of the best ways to protect against contagious and sometimes deadly diseases like flu, COVID-19, pneumonia, and whooping cough. Health Impacts Relatively High Case Rates. Chronic lower respiratory diseases are among the top 10 causes of death in Alameda County. The county’s annual tuberculosis (TB) incidence rate is higher than the state’s (although it is trending downward). During winter 2024, the county, and the rest of the U.S., saw a huge increase in whooping cough cases, mostly among youth. Whooping cough is cyclical in nature, with cases peaking every 3 to 5 years. When more community members are vaccinated, cases tend to be lower overall. Disparities Exist. Although CHA participants rarely prioritized respiratory infections alone, a number highlighted the significant impact COVID-19 has had on their communities. They mentioned severe illness, long-term symptoms like loss of smell, and ongoing health issues such as kidney problems. Pacific Islanders in the county experienced higher COVID mortality rates than their peers (see Figure 48, next page). Some Hispanic/Latino/a/x/e community members discussed the role COVID vaccine misinformation and distrust in health care systems had in differences among COVID mortality rates. Alameda County Public Health Department • 2025–2027 CHA 121 Some CHA participants reported their perception that certain respiratory diseases, such as influenza, have been worse in recent years. While overall deaths from the flu in Alameda County have been trending down over time, disparities exist in vaccination rates (see Figure 49). Figure 48. Due to COVID-19, people died at higher rates in 2020–2021, but racial/ethnic disparities were still seen. Alameda County COVID-19 Mortality Rate per 100,000 People, by Race and Ethnicity (2021–2023) Source: Alameda County Public Health Department, 2021. Rates per 100,000 population. Figure 49. Older adults who are Black or Latino/a/x/e are the least likely of all ethnic groups to get a flu shot. Alameda County Influenza Vaccinations Among Older Adults, Percentages (2022) Source: Centers for Medicare and Medicaid. 2022. 54%54%45%41% 31% California, 46% 0% 25% 50% 75% White Asian/Pacific Islander American Indian/ Alaskan Native Hispanic/ Latino/a/x/e African American/ Black 79.3 60.9 45.8 43.2 18.6 17.9 24.7 0 20 40 60 80 100 American Indian/ Alaska Native (CA rate) Pacific Islander African American/ Black Hispanic/ Latino/a/x/e White Asian All Races Ag e - 10 0 , 0 0 0 P e o p l e Alameda County Public Health Department • 2025–2027 CHA 122 How does the community suggest these issues are addressed? See suggested solutions for all communicable diseases at the end of this health need category’s section. “One thing that we have noticed …in the spaces where we work is misinformation. Many people do not receive true or valid information, and sometimes that stops them from continuing to sign up or taking the step to go and investigate. Sometimes they are misinformed, like their neighbor said, ‘No, don’t get the vaccine, it has a baby fetus and everything [in it].’ ” “We also work with Mam families, and there’s a lack of trust because they have been deceived, because they’ve been victims not only in their own country, but also here, and the abuse and discrimination and all of that make them distrustful and isolate themselves, whether they like it or not.” —Discussion among Spanish-Speaking Community Leaders, Community Focus Group Participants Alameda County Public Health Department • 2025–2027 CHA 123 Communicable Diseases: Vaccine-Preventable Diseases What is the issue? Vaccine-preventable diseases (VPDs) that are not respiratory or sexually transmitted include measles, polio, hepatitis A and B, chicken pox, and shingles. Vaccines, also called immunizations, are meant to be administered on a schedule. For example, the shingles vaccine is administered in two doses, 6 months apart, for people over age 50.78 Many vaccines are scheduled for young children. This is to protect them from VPDs like measles or polio, which can be life-threatening to them. It is also to contribute to “herd immunity.” This term refers to enough people being vaccinated in a community that it prevents the spread of infectious diseases within it.79 Structural inequities contribute to immunization barriers. For example, National Immunization Survey data has shown racial/ethnic disparities in child immunization rates in California and nationwide. It has also indicated that children without health insurance coverage have especially low rates of immunization coverage.80 Continued support for vaccination programs is key to addressing these disparities. Health Impacts Barriers to Vaccination. Maintaining high rates of childhood immunization is essential to ensuring population health and health equity. This is especially the case in the current context of the increasing spread of measles and other vaccine-preventable diseases. Participants identified distrust within communities and misinformation as barriers to vaccination. People said that rumors and false information (e.g., about vaccine ingredients) can discourage parents from vaccinating their children. Youth who participated in the CHA also spoke to their ability to get vaccinated. Figure 50 depicts trends in the percentage of kindergarteners fully immunized at school entry over time in Alameda County and in California. State policies eliminated nonmedical vaccine exemptions in 2014. Such policies were associated with an increase in immunization rates across those states, which helps protect the people who live there. “I [wasn’t able to] schedule me a doctor’s appointment [for a vaccination], just a routine check-up. Because at the time I was still under 18. …So I feel, instead of focusing on the parent’s consent [when teens are] trying to get some type of health care, we can focus a little bit more on the person that’s [trying to] get …the treatment. They should focus the consent on them more than the parents.” —Youth Community Member Focus Group Participant, speaking about minor consent Alameda County Public Health Department • 2025–2027 CHA 124 Figure 50. Most children in Alameda County and in California are now fully immunized at the time they start elementary school, due in part to a change in state policy. Kindergarteners Fully Immunized at School Entry, Trends Over Time in Alameda versus California Source: Alameda County Public Health Department’s Department of Communicable Disease Prevention and Control In Alameda County, older adult immunizations for pneumonia have been trending up post- pandemic. However, rates of vaccination for pneumonia are still quite low (11% in 2023). Flu vaccinations among Medicare recipients appear to have remained above 50% since the pandemic (53% in 2023). Structural Inequities. Alameda County has high immunization rates overall compared to California and the entire U.S. Yet structural inequities, such as economic instability, drive barriers to immunization. Continued commitment to immunization programs is necessary toa close these gaps. This is especially true for communities affected by structural inequities and given potential changes in coverage through programs like Medicaid. 88.6% 95.9%96.5% 90.3% 93.6% 80% 85% 90% 95% 100% California Alameda County CA SB277 eliminated non- medical exemptions from school immunization requirement Alameda County Public Health Department • 2025–2027 CHA 125 How does the community suggest communicable diseases are addressed? • To address communicable diseases, bring health services to where people are (pop up vaccination clinics, mobile testing, community health centers, free/low cost STD testing/vaccines/prevention screenings). • Expand comprehensive, inclusive, culturally responsive sexual education, including robust, visible, stigma-free education on sexual and communicable disease prevent. • Ensure providers are trained to offer sex-positive, age-appropriate, culturally relevant framework (in schools and communities) and include early prevention efforts. Alameda County Public Health Department • 2025–2027 CHA 126 6. Community Comments Alameda County Public Health Department • 2025–2027 CHA 127 Community Comments The research team of Alameda County Public Health Department (ACPHD), Actionable Insights, and Jones Psychological Services (JPS) facilitated community forums around Alameda County. This phase of the research was intended to validate the assessment findings with the community. It was also meant to create room for additional feedback from initial focus groups that may have been missed. ACPHD conducted six 2-hour sessions (see Table 2). The sessions included a presentation of the CHA methods and findings for the identified health needs. Participants received handouts with health need summaries. These were provided in English, Spanish, Chinese, and Vietnamese. Live interpretation was also provided in these languages. Following the presentation, the team facilitated small group discussions (described further, below). Attendees were provided with a meal, childcare, and a $50 gift card at the end of each session. Table 2. Community Engagement Sessions Location Host Date (2025) Number of Community San Leandro ACPHD June 3 32 Oakland Serenity House June 12 30 Dublin Dublin Library June 17 8 Countywide (virtual) -- June 26 29 Fremont Fremont Family Resource Center * Sessions were also attended by community partner staff and other ACPHD staff. Community Feedback Before the presentation, staff provided participants with worksheets to track their reactions and write questions about the information presented to them (see Attachment 7: Qualitative Research Materials). Worksheets and discussions focused on the following questions for each of the health needs: • What confirms your experience? • What community input or concerns stood out for you? Why? • What surprised you, or what is different from your experience? • What are you still wondering? Alameda County Public Health Department • 2025–2027 CHA 128 What Resonated and What Was Surprising (What Stood Out) ACPHD staff scribed these sessions. Actionable Insights analyzed the worksheets and staff notes. Overall, the data confirmed the participants’ lived experiences. Based on the worksheets that some participants filled out, there was no sense that the data presented were different from what participants know or experience. The most common things that participants said resonated were: • health care access issues including long appointment times, a lack of close facilities and specialists, and language barriers that make even scheduling appointments difficult • health care quality barriers such as lack of attention from doctors • mental health issues including depression, anxiety, isolation, and adverse child experiences (ACES) • family or personal experiences with drug use disorders • lack of economic stability and its negative impact on mental health • personal experiences of homelessness or observations about the increase in seeing people living on the street • violence in their intimate partnerships and their neighborhoods (and the connection to poor mental health) • Chinese and Vietnamese elder adults attributing the relative healthy outcomes among the Asian community to their preparedness (e.g., high vaccination rates), use of herbal remedies and acupuncture, and their belonging to tight-knit communities Very few people commented on the qualitative feedback presented (e.g., from focus groups). However, some statistical data surprised participants, including: • motor vehicle and pedestrian mortality • mental health emergency department visits among children • sexually transmitted infection rates The most commonly expressed surprise was about racial inequities in the data. Several people said they did not know about racial inequities in areas such as COVID mortality, poverty, and life expectancy. Many comments from participants expressed empathy for people from groups who experience worse health outcomes (i.e., people from the Black and Pacific Islander populations). Alameda County Public Health Department • 2025–2027 CHA 129 “Nothing surprised me [about the CHA] aside from the fact that we have so many people experiencing these things and no change coming forward.” —Community Engagement Session Participant “I was surprised to see such racial disparities in terms of COVID mortality rates.” —Community Engagement Session Participant “Why is there such a stigma around those who have mental health issues, and how do we get away from the stigma and get to making sure those who are [in] need of services [are] able to receive them at little to no cost?” —Community Engagement Session Participant “I have to go all the way to Hayward to see a doctor for my knee. There are specialists in Oakland, why can’t I see them?” —Community Engagement Session Participant “Can Alameda County help bring education to our communities?” —Community Engagement Session Participant Alameda County Public Health Department • 2025–2027 CHA 130 What People Are Wondering About Participants’ responses to this question usually included recommendations for action or expressed the sense that these needs are the “same old story.” People voiced that they want to know how ACPHD can help with these problems. Multiple participants used this opportunity to list their suggestions for action. These are described below. Action-Oriented Feedback Participants want more information on matters that affect their health. They most often found information lacking for mental health. Others mentioned wanting information on medications and their side effects, including substance use disorders and the effects of drugs; Medi-Cal qualification information; and English as a Second Language (ESL) classes. Recommendations/requests for ACPHD around sharing information and effective program delivery included: • Build trust with the community. Some participants said they’ve received misinformation from other sources, and others indicated that many people are vulnerable to scams. • Broadcast information to specific communities. • Help community members understand the resources ACPHD is providing, rather than just list them. This will help people better use them. • Provide information in non-English languages, especially about mental health. • Make bilingual staff available (Chinese was mentioned) so that community members can schedule appointments over the phone. • Provide services in languages other than English or provide interpreters Solutions External to Public Health • Use schools to engage youth about mental/behavioral health and safe sex. • Offer substance use disorder rehabilitation. Some participants said the state should have a drug rehabilitation model and that insurance should cover it. • Build more affordable housing. • Provide financial literacy education and training for careers. • Improve cleanliness of neighborhoods (e.g., more frequent trash pickup). Some believe this can help reduce community violence. Alameda County Public Health Department • 2025–2027 CHA 131 Summary of Community Engagement Sessions The identified health needs resonated with the 148 residents who attended the public forums. Forum participants were highly engaged and eager to understand how Alameda County Health’s Public Health Department and others can improve health. They offered specific action steps that they want to see the department take. They were most concerned and surprised about health inequity, and most of their suggestions focused on the need for health education. These suggestions will be taken into account during the Community Health Improvement Plan process. Alameda County Public Health Department • 2025–2027 CHA 132 7. Community Resources Alameda County Public Health Department • 2025–2027 CHA 133 Community Partners and Resources Alameda County has a strong history of community activism and leadership. The county is a tapestry of diverse residents, organizations, faith-based organizations, businesses, and institutions representing the rich, intersecting identities of the region. ACPHD wants to highlight all of the partners that contributed to CHA. The partners listed below represent just a fraction of the network of community-based organizations delivering culturally affirming care, lifting up the needs of communities most impacted by health inequities, and building trust with them. Their partnership is key to removing health inequities and improving community health for all Alameda County residents. Strength of Community Partnerships • Alameda County Probation • Allen Temple Arms • Asian Health Services • E. C. Reems Community Services • Eden Youth & Family Center • El Timpano • EmbraceHer • Family Health Services • Fremont Family Resource Center • Hayward YMCA • Helping Hands East • Korean Community Center • La Familia • LGBTQ Center / Gay Bi Trans Men of Color Roundtable • REACH • Regional Center of the East Bay / Disability Council • Regional Pacific Islander Task Force • Roots Health Center • Rotary District 5170, Area 5 • Tri-Valley Non-Profit Alliance • Vision y Compromiso Community Resources Various hospitals and clinics, other community-based organizations, government departments/ agencies, and other resources in Alameda County are engaged in addressing the community health needs and challenges identified by this assessment. Community health and services providers who participated in key informant interviews and focus groups were asked to review the resources list from partner hospitals’ 2022 assessments as it related to their area of expertise and provide updates. This feedback was consolidated by Actionable Insights. The updated assets list is provided in Attachment 8: Community Assets and Resources. Alameda County Public Health Department • 2025–2027 CHA 134 8. Conclusion Alameda County Public Health Department • 2025–2027 CHA 135 Conclusion The Alameda County Public Health Department worked with local partners, combining expertise, guidance, and resources to conduct the 2025–2027 Community Health Assessment. By gathering secondary data and conducting new primary research with local hospitals, ACPHD gained a shared understanding of how health indicator data for Alameda County compared to state benchmarks and learned about the community’s perception of health needs and challenges. This extensive base of information informed the identified health needs. How can ACPHD address these inequities? Support policies and programs that promote economic, food, and housing security, access to health care, and educational attainment to reduce health inequities Support programs and funding for populations specifically affected by concentrated inequities alongside programs that serve everyone Continue to improve language access for all programs and services Continue to expand and invest in culturally affirming programs and services One of the major conclusions of this report is that African American/Black and Pacific Islander people in Alameda County are disproportionately affected by all leading causes of death, especially at younger ages. Alameda County Public Health Department • 2025–2027 CHA 136 Support disaggregated data collection (by race & ethnicity, sexual orientation/gender identity, age, and disability status) to better identify and meet people’s different needs Continue to address inequities that may be rendered less visible as data availability changes due to policy (i.e., measurement by sexual orientation and gender identity) The other major conclusions of this report are: ACPHD will collaborate with the community and other agency departments to develop a Community Health Improvement Plan (CHIP); see Figure 51, following page. Through implementing the CHIP, ACPHD and its community and agency partners can work collectively to address the community’s health needs and close the health equity gap. Social determinants of health, the conditions that shape people’s everyday environments, are of great concern to the community. Community members, regardless of race/ ethnicity, sexual orientation/gender identity, age, disability status, or neighborhood, report experiencing behavioral health challenges. Alameda County Public Health Department • 2025–2027 CHA 137 Figure 51. Next Steps Next steps for ACPHD: • Make final 2025–2027 CHA report publicly available on ACPHD’s website and submit the report to the Public Health Accreditation Board in 2026. • Convene community partners and other Alameda County Health departments to review the CHA results and begin working on the CHIP. • Using the CHA results, develop a CHIP in collaboration with the community and other agency departments, to be published in 2027. • Monitor progress of the CHIP and share regular updates with the community. Approve CHA Convene CHIP partners Identify/ develop CHIP strategies Adopt and implement CHIP Alameda County Public Health Department • 2025–2027 CHA 138 9. Attachments Alameda County Public Health Department • 2025–2027 CHA 139 Attachments 1. List of Community Partner Organizations 2. Definitions 3. Primary/Secondary Qualitative Data Collection (Community Input) 4. Statistical Data Collection and Community Health Charts 5. Secondary Reports and Presentations Consulted 6. Secondary Data Indicator Index 7. Qualitative Research Materials 8. Community Assets and Resources 9. PHAB Checklist 10. Endnotes Alameda County Public Health Department • 2025–2027 CHA 140 Attachment 1: List of Community Partner Organizations The Alameda County Public Health Department is especially grateful to the following community-based organizations for their partnership in recruiting participants and providing space as hosts for ACPHD’s focus groups with community members. • Alameda County Probation • Allen Temple Arms • Asian Health Services • E. C. Reems Community Services • Eden Youth & Family Center • El Timpano • EmbraceHer • Family Health Services • Fremont Family Resource Center • Hayward YMCA • Helping Hands East • Korean Community Center • La Familia • LGBTQ Center / Gay Bi Trans Men of Color Roundtable • REACH • Regional Center of the East Bay / Disability Council • Regional Pacific Islander Task Force • Roots Health Center • Rotary District 5170, Area 5 • Tri-Valley Non-Profit Alliance • Vision y Compromiso Alameda County Public Health Department • 2025–2027 CHA 141 Attachment 2: Definitions The definitions below relate to the criteria used by ACPHD to identify the health needs for this CHA report. Health indicator: A characteristic of an individual, a population, or an environment that can be measured (directly or indirectly) and used to describe one or more aspects of the health of an individual or population. Health need: A poor health outcome and its associated risk(s), or a risk that may lead to a poor health outcome. Health outcome: A snapshot of a disease/health event in a community that can be described in terms of both morbidity (illness or quality of life) and mortality (death). Health risk: A behavioral, social, environmental, economic, or clinical care factor that impacts health. May be a social determinant of health. Alameda County Public Health Department • 2025–2027 CHA 142 Attachment 3: Primary/Secondary Qualitative Data Collection ACPHD and its partners collected qualitative data to better understand certain topics and subpopulations that are not well understood through the statistical data.81 They also relied on qualitative data to fill previously identified information gaps for which statistical data remain unavailable. • These are three of the strategies used for collecting community input for this CHA: • key informant interviews with health experts and community service providers • focus groups with professionals who represent and/or serve the community • focus groups with community members Primary research was conducted by ACPHD and its partners through 36 focus groups. • In generating primary research protocols, ACPHD and its partners consulted and built upon prior assessments to focus and refine the protocol questions and topics. • ACPHD included in this CHA as secondary qualitative data transcripts of 36 interviews conducted by Kaiser Foundation Hospitals (Fremont, Oakland, San Leandro) and Sutter Health Medical Centers (Alta Bates Summit and Eden). This CHA also includes 12 interviews conducted by John Muir Health, St. Rose Hospital, Stanford Heath Care Tri-Valley, UCSF Benioff Children’s Hospitals, and Washington Health. While discussion questions were the same, participants were different across sessions and enhanced community input collected by ACPHD. • Both primary and secondary interviews and focus groups were recorded, and, if needed, translated, and transcribed into English. Alameda County Public Health Department • 2025–2027 CHA 143 • The CHA included individuals who represent the following vulnerable populations:  people with disabilities  people who identify as Black/African American, Hispanic/Latino/a/x/e, American Indian/Alaskan Native, or Pacific Islander  people whose primary language is not English, including people who speak Khmer (Cambodian), Korean, Mam, Mandarin, Spanish, Tagalog, or Vietnamese  people who identify as LGBTQ+  people with low incomes  people who are unhoused  people from communities with inadequate access to clean air and safe drinking water  people who are medically underserved • experts, and representatives of various organizations and sectors informed the 2025–2027 CHA. The latter representatives either work directly in the health field or in a community-based organization that focuses on improving health and quality-of-life conditions by serving those of vulnerable populations. CHA/CHNA Interviews and Focus Groups Community members, leaders, local health experts and service providers participated in interviews and focus groups. Some interviews and focus groups gathered local information on a certain topic, such as substance use, and some were held with vulnerable populations, such as unhoused individuals. • From April to September of 2024, 48 key informant interviews were held with a total of 69 health experts/service providers from various organizations in Alameda County. Interviews were conducted virtually via Zoom for about 1 hour. Alameda County Public Health Department • 2025–2027 CHA 144 • Before each interview, people were asked to complete a short online survey:  They were asked to identify what they felt were the most-pressing health needs among the people they serve. Interviewees could choose up to five needs from the list presented to them, which had been identified in their county in 2022. Alternatively, they could submit needs that were not on the 2022 list.  The survey also explained to interviewees how their data would be used and asked them to consent to participate and be recorded.82  Finally, they were offered the option to be listed in the report, and they were asked, but not required, to provide basic demographic information. • interviewees prioritized in the online pre-survey: 1. How do you see this need playing out; what do you think creates these issues here? 2. Which populations or geographic areas in the community are affected more than others? 3. How has this community need changed in the past few years? 4. What are the biggest challenges to addressing this need? 5. What is needed in the community (including models / best practices / key resources) to better address this need? • Across Alameda County, 36 focus groups were conducted with almost 100 health experts/service providers and over 370 community members/leaders between June 2024 and April 2025. • Focus group participants also provided responses to a pre-survey,83 discussions centered on the needs that had received the most votes from prospective participants in the pre-survey. The questions were identical to those asked of key informants, but language was modified appropriately for each audience. See next page for a list of focus group and interview details. See Attachment 7: Qualitative Research Materials for protocols used. Alameda County Public Health Department • 2025–2027 CHA 145 Community Leaders, Representatives, and Members Consulted The list below contains the names of leaders, representatives, and members who were consulted for their expertise in the community. Leaders were identified based on their professional expertise and knowledge of vulnerable populations. Collection Method People Represented Represented Was Gathered Secondary Partnership Nurse Manager, Alameda County Public Health health underserved County Secondary Aging & Family Services, City of Fremont adults County, Fremont Secondary Director, Tri-Valley Haven communities Secondary Programs Director, YOUTH ALIVE! communities County Secondary with inadequate access to clean air and safe drinking water Alameda County Alameda County Public Health Department • 2025–2027 CHA 146 Collection Method People Represented Represented Was Gathered Secondary Health Director, Alameda County Public Health Department medically underserved, BIPOC County Secondary Director, Alameda County Public Health Department medically underserved, BIPOC County Secondary Officer, The Alliance For Community Wellness underserved County Secondary Systems Manager, Health Equity Division, Behavioral Health Department, Alameda County Health BIPOC, medically underserved County Secondary Integrated Care, Psychiatrist, Alameda County Health Care for the Homeless substance use disorder unhoused, medically underserved County Secondary County Health Care for the Homeless substance use disorder unhoused, medically underserved County Alameda County Public Health Department • 2025–2027 CHA 147 Collection Method People Represented Represented Was Gathered Secondary Director, Policies and Programs, Bay Area, Bay Area Regional Health Inequities Initiative (BARHII) sustainability BIPOC, medically underserved, people with inadequate access to clean air and safe drinking water County Secondary Alameda County Secondary with inadequate access to clean air and safe drinking water Alameda County, Tri- Valley Secondary unhoused, medically underserved Alameda County Secondary Secondary Development Corporation unhoused County 6/6/2024 Alameda County Public Health Department • 2025–2027 CHA 148 Collection Method People Represented Represented Was Gathered Housing Project/Bay Area Community Services (BACS) Secondary Alameda County Secondary Center/Tiburcio Vasquez Medical Center health care BIPOC, medically underserved Southern Alameda County Secondary employment Alameda County Secondary County Secondary behavioral health, Native American population population, medically underserved Alameda County Alameda County Public Health Department • 2025–2027 CHA 149 Collection Method People Represented Represented Was Gathered Secondary behavioral health underserved County Secondary employment, justice-involved population justice-involved population Southern Alameda County Secondary Alameda County Secondary Clinic Consortium/Alameda Health Consortium/La Clinica de la Raza health care BIPOC, medically underserved County Secondary Services, Inc. employment County Secondary Food Bank Central Alameda County Alameda County Public Health Department • 2025–2027 CHA 150 Collection Method People Represented Represented Was Gathered Secondary health care, Asian population medically underserved County Secondary American/ Pacific Islander older adults adults, Asian population, Pacific Islander population, medically underserved County Secondary unhoused Central Alameda County Secondary Fremont Family Resource Center Alameda County Alameda County Secondary education children Alameda County Secondary employment Alameda County Alameda County Public Health Department • 2025–2027 CHA 151 Collection Method People Represented Represented Was Gathered Secondary Development Center employment, youth Alameda County Secondary Alameda County Secondary youth adults, transition aged youth Alameda County Secondary Coalition & Day Break Adult Day Center health care, older adults adults, medically underserved County Secondary health care medically underserved Alameda County Secondary population, peaceful communities Alameda County Secondary Growth behavioral health underserved County Alameda County Public Health Department • 2025–2027 CHA 152 Collection Method People Represented Represented Was Gathered Secondary health care underserved, BIPOC Alameda County Secondary education children Alameda County Secondary School District education children Secondary Latino/a/x /e population, peaceful communities Hispanic/ Latino/a/x/e population Alameda County Secondary with inadequate access to clean air and safe drinking water County Secondary Alameda County Alameda County Public Health Department • 2025–2027 CHA 153 Collection Method People Represented Represented Was Gathered Secondary Community Health access, Tri- Valley community underserved, Tri- Valley residents Secondary Superintendent, Pleasanton Unified School District children, education, Tri- Valley community Valley residents Secondary Chief Executive Officer, City Serve of the Tri-Valley Tri-Valley community Valley residents Secondary Superintendent, Dublin Unified School District children, education, Tri- Valley community Valley residents Group- Secondary clinics underserved, low- income County Alameda County Public Health Department • 2025–2027 CHA 154 Collection Method People Represented Represented Was Gathered Officer, Axis Community Health Manager, Bay Area Community Health Assistant Promotores Program, City of Newark Worker; Job position: Program Supervisor, La Familia Counseling Services Medical Operations, Native American Health Center Director, Order of Malta Clinic Alameda County Public Health Department • 2025–2027 CHA 155 Collection Method People Represented Represented Was Gathered Clinical Services Manager, Roots Community Health Medical Site Manager, San Antonio Neighborhood Health Center Specialist, Tiburcio Vasquez Health Center Group- Secondary addiction underserved County Substance Use Disorder / Medication Assisted Treatment Program Supervisor, Bay Area Community Health Family Services Alameda County Public Health Department • 2025–2027 CHA 156 Collection Method People Represented Represented Was Gathered Clinical Director, Discovery Counseling Center of the San Ramon Valley HAART Hayward Director, Haller's Pharmacy and Medical Supply Manager, Horizons Family Counseling Supervisor - Adult Outpatient Substance Use, La Familia Director, National Coalition Against Prescription Drug Abuse Alameda County Public Health Department • 2025–2027 CHA 157 Collection Method People Represented Represented Was Gathered Group- Secondary County Berkeley Zen Center Church United Methodist Church of Fremont GraceWay Church Community Outreach Coordinator, Gurdwara Sahib Fremont Senior Rabbi, Temple Sinai Alameda County Public Health Department • 2025–2027 CHA 158 Collection Method People Represented Represented Was Gathered Group- Secondary County Services Director, City of Fremont Chief Executive Officer, City Serve of the Tri-Valley Agency for Children Youth & Family Services Officer, Hively Open Heart Kitchen Alameda County Public Health Department • 2025–2027 CHA 159 Collection Method People Represented Represented Was Gathered Executive Officer, Seneca Family of Agencies Haven Unified School District Group Center, service providers southern Alameda County residents of southern Alameda County Alameda County Group Center, Tri-City Afghan refugee service providers community Farsi-speaking Alameda County Group Alliance Tri-Valley area Valley residents Group- Secondary development adults County Alameda County Public Health Department • 2025–2027 CHA 160 Collection Method People Represented Represented Was Gathered Alameda County Health Care for the Homeless President of Instruction, College of Alameda High School Eden Area Regional Occupational Program Executive Officer, Health Career Connection Registered Nursing Program, Ohlone College Tri-Valley Career Center Alameda County Public Health Department • 2025–2027 CHA 161 Collection Method People Represented Represented Was Gathered Programs Manager, UC San Francisco Group infant health people Alameda County Group community health workers & domestic workers access, Spanish- speaking medically underserved, Spanish-speaking population County Group Center unhoused, medically underserved Alameda County Group community population County Group community, older adults older adults County Alameda County Public Health Department • 2025–2027 CHA 162 Collection Method People Represented Represented Was Gathered Group speaking community, older adults population, older adults Alameda County Group speaking community speaking population County Group community County Group Spanish- speaking community population County Group speaking community, Hispanic/ Latino/a/x/e community, parents population, Hispanic/ Latino/a/x/e population, parents of children/teens Alameda County Group East Bay / Disability Council community underserved, people with disabilities, County Alameda County Public Health Department • 2025–2027 CHA 163 Collection Method People Represented Represented Was Gathered people with disabilities Group East Bay / Disability Council community, Spanish- speaking community population, people with disabilities, people caring for people with disabilities, medically underserved County Group speaking community, Cambodian community population, Cambodian population County Group Center Korean- speaking community Korean-speaking population, Korean population County Group Trans Men of Color Roundtable, service providers and community members community underserved, LGBTQ+ community Alameda County Alameda County Public Health Department • 2025–2027 CHA 164 Collection Method People Represented Represented Was Gathered Group community, Vietnamese- speaking community disabilities, people caring for people with disabilities, medically underserved, Vietnamese- speaking population Central Alameda County Group speaking community, Filipino/a/x community population, Filipino/a/x population Alameda County Group Hispanic/ Latino/a/x/e community, Cherryland community population, Hispanic/ Latino/a/x/e population, parents of children/teens Alameda County, Cherryland Group Center speaking community, Hispanic/ Latino/a/x/e population, Hispanic/ Latino/a/x/e County Alameda County Public Health Department • 2025–2027 CHA 165 Collection Method People Represented Represented Was Gathered parents of children/teens Group involved community population County Group Community Services American/ Caribbean community American/ Caribbean population County Group Center Chinese community, Chinese- speaking community Chinese population, Mandarin-speaking population Alameda County Group 5 Asian community, Tri- Valley residents community, Tri- Valley residents Group American community, 40x40 zone residents of Oakland’s 40x40 zone 40x40 zone Alameda County Public Health Department • 2025–2027 CHA 166 Collection Method People Represented Represented Was Gathered Group speaking community, 40x40 zone population, residents of Oakland’s 40x40 zone 40x40 zone Group Center community youth County Group Northern Alameda County Group Task Force population population Northern Alameda County Alameda County Public Health Department • 2025–2027 CHA 167 Attachment 4: Statistical Data Collection and Community Health Charts Secondary Statistical Data Collection ACPHD and its consultant, Actionable Insights, (collectively, “the team”) analyzed over 350 quantitative health indicators from many different sources to assist with understanding health needs in Alameda County and assessing community priorities. The team gathered statistical data from the Alameda County Public Health Department’s Community Assessment, Planning, and Evaluation unit (AC CAPE). The team also gathered statistical data from existing sources using County Health Rankings & Roadmaps, a public dataset supported by the Robert Wood Johnson Foundation and developed by the University of Wisconsin Population Health Institute.85 The team collected supplementary data from other online sources such as the U.S. Census Bureau, KidsData.org, and the California Department of Public Health. The team used subcounty data when it was available and a variety of reports and presentations (see Attachment 5: Secondary Reports and Presentations Consulted). Local quantitative data were compared to state benchmarks (California averages and rates) to help determine the severity of a health issue and to identify disparities. The team asked: • How do these indicators perform against accepted benchmarks? • What are the inequitable outcomes and conditions for community members? AC CAPE provided 2019–2023 mortality rates overall and by race/ethnicity for requested causes. However, many public health departments face difficulty in providing comparable California rates. This is because the specific diagnoses codes used in some published California mortality rates are not always available. In some cases, Actionable Insights used California mortality benchmarks provided by another county’s public health department. Actionable Insights also used ACPHD’s 2024 report, Examining Increases in Mortality and Disparities from 2018–2019 to 2020–2021, to gather rates that are comparable to California. AC CAPE also provided rates for birth outcomes, emergency department visits, and hospitalization discharges (all by race/ethnicity). Again, in some cases Actionable Insights used corresponding California benchmarks provided by another county’s health department. When benchmarks were missing for emergency department visit and hospitalization rates, Actionable Insights followed the guidance provided by AC CAPE to give priority to the top preventable reasons for emergency department visits and hospitalizations (e.g., drug overdoses, asthma) in assessing the statistical data. Alameda County Public Health Department • 2025–2027 CHA 168 Note that for the purposes of this assessment, “community health” was not limited to traditional health measures. The team considered indicators relating to the quality of life (e.g., access to health care, affordable housing, food security, education, and employment) and to the physical, environmental, and social factors that influence the health of the county’s residents. This broader definition reflects the understanding that many factors affect community health and that community health cannot be adequately understood without considering trends outside the realm of health care. A Further Look The charts and figures in this attachment provide a further look at the statistical data provided by AC CAPE. Source: Decennial census 2000, 2020; CA DOF projections file P-3 vintage 2023 (2024.3.8) Alameda County Public Health Department • 2025–2027 CHA 169 Alameda County Public Health Department • 2025–2027 CHA 170 Alameda County Public Health Department • 2025–2027 CHA 171 Percent of People Living At or Below Federal Poverty Level Alameda County Public Health Department • 2025–2027 CHA 172 Alameda County Public Health Department • 2025–2027 CHA 173 Alameda County Public Health Department • 2025–2027 CHA 174 Percent of younger children (aged 0-6) in households Alameda County Public Health Department • 2025–2027 CHA 175 Alameda County Public Health Department • 2025–2027 CHA 176 Alameda County Public Health Department • 2025–2027 CHA 177 Percent of Older Adults (Aged 65+) in Households Alameda County Public Health Department • 2025–2027 CHA 178 Alameda County Public Health Department • 2025–2027 CHA 179 Alameda County Public Health Department • 2025–2027 CHA 180 Alameda County Public Health Department • 2025–2027 CHA 181 Alameda County Selected Site-Specific Cancer Incidence Rates per 100,000 Population, by Race and Ethnicity Cancer Site All Races White Hispanic/ Latino/a/x/e Pacific Islander American/ Black 65.5 73.7 48.8 58.9 69.4 32.6 33.6 30.1 28.2 41.2 12.6 12.8 16.3 7.8 19.2 9.8 7.3 14.2 11.0 11.0 38.5 39.6 27.6 34.1 54.9 18.4 21.1 18.8 14.6 16.0 19.2 40.6 5.2 1.0 1.2 12.1 12.6 12.3 9.7 15.8 43.4 45.9 37.4 25.7 68.1 10.3 11.2 9.3 11.3 4.9 14.6 20.0 11.4 8.1 11.7 14.3 15.4 14.2 12.1 16.8 Note: Blue text denotes rates higher than the county average. Source: California Health Maps, 2012–2021. According to California Department of Public Health guidelines, cancer incidence rates cannot be reported if based on <15 cancer cases and/or a population of <10,000 to ensure confidentiality and stable statistical rates. Alameda County Public Health Department • 2025–2027 CHA 182 Information Gaps and Limitations In this CHA cycle, the study team had access to more statistical data than ever before. This was due in part to local public health departments’ efforts to make their data readily accessible to the public, and their partnership in working with us to obtain that information in a format that was easy to use. However, there are some limitations to the data, which affect the ability to fully assess some health issues that were identified as community needs during the 2025 CHA process: 1. Differing local measures. Overall, the study team was challenged with comparing local emergency department visit rates and hospitalization rates to readily available California benchmarks due to differing local measures. However, ACPHD is working on these issues for future assessments. 2. Cognitive decline data. In this assessment, the team was able to access Alzheimer's disease (AD)/dementia mortality rates, but not data on the prevalence of cognitive decline. While California is among the 10 states with the highest prevalence of AD/dementia (12%), there is no indication that prevalence in Alameda County is higher than in the state overall. Although the Alzheimer's Association recently studied prevalence in certain counties, it only published data on the five with the highest prevalence, none of which are Alameda County. 3. Childhood diabetes and prediabetes prevalence. Because childhood obesity has been a topic of concern previously, ACPHD and the hospitals continue to seek data about childhood diabetes as well, but current local data are not available. 4. Oral health data. The team also lacked sufficient data pertaining to oral health, including the number of dentists per capita who accept Denti-Cal, and data on prevalence of recent dental visits was irregular due to the recency of the pandemic. 5. Emerging or difficult-to-measure topics. Lastly, some indicators are difficult to measure or are just emerging. For example, statistical information related to adult marijuana use is scarce. Additionally, health-related data are rarely broken out by income/socioeconomic status, limiting the team’s ability to understand disparities by income level. Alameda County Public Health Department • 2025–2027 CHA 183 Attachment 5: Secondary Reports and Presentations Consulted The assessment team consulted the reports and presentations listed below to further understand the community health needs. • Alameda County 2024 Point-in-Time Count Tableau Dashboard, 2024, Alameda County Public Health Department • Alameda County Healthy Brain Initiative: Preliminary Community Needs Assessment, 2024, Alameda County Public Health Department • Eastern Alameda County Human Services Needs Assessment, 2024, John Snow, Inc. • Examining Increases in Mortality and Disparities from 2018-2019 to 2020-2021, 2024, Alameda County Public Health Department • Maternal, Paternal, Child, & Adolescent Health (MPCAH), 2024, Alameda County Public Health Department • Promoting Peaceful Families and Communities: Maintaining Progress in Reducing Gun Violence in Alameda County, 2025, Alameda County Public Health Department Alameda County Public Health Department • 2025–2027 CHA 184 Attachment 6: Secondary Data Indicators Index This list is categorized. It begins with general health, and follows by alphabetical health topic. Note that measures of violence are found under “Peaceful Communities.” Category Indicator Description Source Year(s) LIFE/MORTALITY Statistical Master Files; California Dept. of Finance, Population Estimates and Projections; CDC WONDER Online Database, Underlying LIFE/MORTALITY English-speaking) Households speaking households U.S. Census Bureau American Community Survey public use LIFE/MORTALITY to live Mortality Files, as cited by County Health LIFE/MORTALITY County 100,000, by age, race/ethnicity Alameda County: Examining Increases in Mortality and Disparities from 2018-2019 to LIFE/MORTALITY who reported speaking English less than Community Survey, 5-year estimates Alameda County Public Health Department • 2025–2027 CHA 185 Category Indicator Description Source Year(s) LIFE/MORTALITY American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, Child Hospitalization among children ages 0-17 for the 11 most common primary diagnoses, excluding Information custom tabulation, as cited on KidsData.org Children Ages 0-4 Ages 0-4 the California Dept. of Health Care Access Children Ages 5-17 Ages 5-17 the California Dept. of Health Care Access Asthma California Health Interview Survey, as cited Alameda County Public Health Department • 2025–2027 CHA 186 Category Indicator Description Source Year(s) HEALTH disease and cirrhosis, and drug/alcohol poisoning. Age-Adjusted Rate per 100,000 Population. Regex Code(s): K70[0-4]|K7[3- CAPE Unit HEALTH: ATOD86 involvement Administration, Fatality Analysis Reporting HEALTH: ATOD ED Visits and Hospitalizations, Regex Code(s): F1[0-6,8-9] CAPE Unit HEALTH: ATOD Involving Any Opioid Deaths, Regex Code(s): T40[0-4,6] CAPE Unit HEALTH: ATOD and Hospitalizations, Alameda Regex Code(s): T40[0-9]..(A|$|\b) CAPE Unit HEALTH: ATOD Visits and Hospitalizations, Alameda Regex Code(s): ((T40[0-4].|T406[09])[1-CAPE Unit HEALTH: ATOD & Dependence Deaths, Alameda Regex Code(s): F1 CAPE Unit HEALTH: ATOD More Times in Their Lifetimes (7th Graders, 9th th (CHKS) & Biennial State CHKS. California Alameda County Public Health Department • 2025–2027 CHA 187 Category Indicator Description Source Year(s) HEALTH: ATOD Previous Month (7th Graders, 9th Graders, 11th (CHKS) & Biennial State CHKS. California HEALTH: ATOD the Previous Month (7th Graders, 9th Graders, th (CHKS) & Biennial State CHKS. California HEALTH: MH87 (prevalence) Alameda County Human Services Needs HEALTH: MH Experiences experiences gram, tabulation of data from the CA Behavioral Risk Factor Surveillance System and American Community Survey, as cited by HEALTH: MH Childhood Experiences 2017 childhood experiences gram, tabulation of data from the California Behavioral Risk Factor Surveillance System, as cited by HEALTH: MH Experiences Adverse Experiences (Parent Reported) National Survey of Children's Health and the American Community Survey, as cited by HEALTH: MH days of poor mental health per month (age-System HEALTH: MH Areas within counties Services, Health Resources and Services Alameda County Public Health Department • 2025–2027 CHA 188 Category Indicator Description Source Year(s) HEALTH: MH (prevalence) Alameda County Human Services Needs HEALTH: MH Psychologists Staff Assignment and Course Data & HEALTH: MH Workers Staff Assignment and Course Data & HEALTH: MH Hospitalizations, Alameda County Regex Code(s): ((T3[6,7,9]9| T414|T427|T4[3,5,7,9]9)2.|(?!(T3[6,7,9]9|T414|T427|T4[3,5,7,9]9))(T3[6-9]|T4[0-9]|T50)..2|((T5[1-4,6-9]| T6[0-3,5])9|(T58|T61)[01]|T64[08])2.|(?!((T5[1-4,6-9]|T6[0-3,5])9|(T58|T61)[01]|T64[0,8]))(T5[1-9]|T6[0-5])..2|(X7[1-9]|X8[0- CAPE Unit HEALTH: MH Hospitalizations, Alameda County Regex Code(s): F2[0-9]|F30[1-3,8-9]|F31[0-6]| F317[0-1,3,5,7] |F31[8-9]|F32[2-4]|F32[8- 9]|F33[1-3]|F334[0-1]|F33[8- 9]|F34|F39|F400|F4[1-2]|F431 |F4[4-5]|F48[1- CAPE Unit HEALTH: MH Hospitalizations population. ICD-10 Codes: F2[0-9]|F30[1-3,8-9]| F31[0-6]| F317[0-1,3,5,7]| F31[8-9]| F32[2-4]| F32[8-9]| F33[1-3]| F334[0-1]| F33[8-9]| F34| F39| F400| F4[1-2]| F431| F4[4-5]| F48[1-2]| Access and Information (HCAI), Patient Discharge Data HEALTH: MH Drug and Alcohol ED Visits and Regex Code(s): F1[01,3-6,89][129][4-5]|F1[0,2-CAPE Unit Alameda County Public Health Department • 2025–2027 CHA 189 Category Indicator Description Source Year(s) HEALTH: MH Drug and Alcohol ED Visits and Hospitalizations population. ICD-10 Codes: F101[4-5]|F10180| F102[4-5] |F10280|F109[4-5]|F10980|F111[4-5]|F112[4-5]|F119[4-4],|F12150| F12180|F1225| F12280|F1295| F12980|F131[4-5]|F13180|F132[4-5]|F13280|F139[4-5]|F13980 |F141[4-5]| F14180| F142[4-5]|F14280|F149[4-5]| F14980|F151[4-5]| F15180|F152[4-5]|F15280|F159[4-5]|F15980|F161[4-5]|F16180|F162[4-5] |F16280 |F169[4-5]| F16980| F181[4-5]| F18180|F182[4-5]| F18280|F189[4-5]|F18980|F191[4-5]|F19180|F192[4-5]| F19280| F199[4- Access and Information (HCAI), Patient Discharge Data HEALTH: MH Feelings in the Previous (Year 7th Graders, 9th th (CHKS) & Biennial State CHKS. California HEALTH: MH Previous Year Attempting Suicide in the Previous Year (9th th (CHKS) & Biennial State CHKS. California HEALTH: MH Relationships with Adults at School Relationships with Adults at School (7th th th (CHKS) & Biennial State CHKS. California ENVIRONMENT blood lead levels among those tested. Moderate: 4.5-9.49 mcg/dL Very high: at least 9.5 mcg/dL Lead Poisoning Prevention Branch, California Blood Lead Data & California's Progress in Preventing and Man ENVIRONMENT high blood lead levels among those tested. Moderate: 4.5-9.49 mcg/dL Lead Poisoning Prevention Branch, California Blood Lead Data & Alameda County Public Health Department • 2025–2027 CHA 190 Category Indicator Description Source Year(s) ENVIRONMENT assault and unintentional injuries) per 100,000 Mortality Files, as cited in Community UNINTENDED pedestrian, and vehicle) per 100 vehicle miles and Association of Bay Area Governments, UNINTENDED Regex Code(s): W6[5-9]|W7[0-4]|X71|X92|Y21 CAPE Unit UNINTENDED INJURIES Hospitalizations, Alameda County Regex Code(s): (T751..| W16[49]1.| (?!W16[49]) W16..1|W22041| (V9[02]| W6[5-9]| CAPE Unit UNINTENDED 100,000 population Mortality Files UNINTENDED and Hospitalizations, Alameda Regex Code(s): ((V0[2-CAPE Unit UNINTENDED INJURIES Alameda County Regex Code(s): V0[2-4][1,9]|V092|V1[2-4][3- 9]|V19[4-6]|V2[0-8][3-9]|V29[4-9]|V[3-7][0-9][4- 9]|V80[3-5]|V811|V821|V8[3-6][0-3]|V87[0- CAPE Unit UNINTENDED INJURIES and Hospitalizations Regex Code(s): ((V0[2-4][19]|V09[23]|V1[2-4][3-5,9]|V19[4-69]|V2[0-8][3-5,9]|V29[4-9]|V[3-7].[4-9]|V8[3-6][0-3]|V80[3-5]|V8[12]1|V87[0-8]|V892|X810|Y020)..|(X82|Y03|Y32)...)(A|$|\b CAPE Unit UNINTENDED Regex Code(s): V0[2-4][1,9]|V092 CAPE Unit Alameda County Public Health Department • 2025–2027 CHA 191 Category Indicator Description Source Year(s) UNINTENDED children Ages 0-17 for Poisoning Ages 0-17 for Poisoning Information custom tabulation UNINTENDED children Ages 0-17 for Traumatic Ages 0-17 for Traumatic Injuries Information custom tabulation UNINTENDED Among Leading Causes of Death Death Statistics File. UNINTENDED County Regex Code(s): V|W|X[0-5]|Y85|Y86 CAPE Unit UNINTENDED INJURIES Hospitalizations, Alameda County Regex Code(s): (T1[5-9]...|(T3[679]9|T414|T427| T4[3579]9)1.| (?!(T3[679]9|T414 |T427|T4[3579]9)) (T3[6-9]|T4[0-9]|T50)..1|((T5[1-46-9]|T6[0-35])9|(T58|T61)[01]|T64[08])1.|(?!( (T5[1-46-9]|T6[0-35])9|(T58|T61)[01]|T64[08]))(T5[1-9]|T6[0-5])..1|(V|W)\d....|X[0-5]....|T71..1|T712[019].| CAPE Unit Ages 0-19 Epidemiology, and End Results (SEER) Program Research Data; U.S. Cancer Statistics Working Group, U.S. Cancer Alameda County Public Health Department • 2025–2027 CHA 192 Category Indicator Description Source Year(s) ages 65-74 that received an annual Mapping Medicare Disparities Tool CONDITIONS ED Visits and Hospitalizations, Regex Code(s): J4[0-7] CAPE Unit NATURAL ENV matter in micrograms per cubic meter Network Alameda County Public Health Department • 2025–2027 CHA 193 Category Indicator Description Source Year(s) NATURAL ENV considered to be “Unhealthy” or “Unhealthy for Sensitive Groups,” based on the U.S. Environmental Protection Agency’s Air Quality Index (AQI), for both today and 30 years in the NATURAL ENV alone, the percentage that commute more Community Survey, 5-year estimates NATURAL ENV contaminants and 2 types of water quality violations found during drinking water sample testing. California Environmental Protection Agency (CalEPA) and is included in the (CalEPA) NATURAL ENV drinking water violations. 'Yes' indicates the presence of a violation, 'No' indicates no System NATURAL ENV annually for 2050 and 2085. Extreme heat Climate Effects (CalBRACE) NATURAL ENV severe) by type (residential, commercial, NATURAL ENV NATURAL ENV Screening and Mapping Tool, as cited by Alameda County Public Health Department • 2025–2027 CHA 194 Category Indicator Description Source Year(s) DISEASES Immunizations Immunizations Immunization Branch, Reporting Data for Kindergarten and 7th Gra DISEASES: CAPE Unit DISEASES: Hospitalizations, Alameda County Regex Code(s): U071 CAPE Unit DISEASES: enrollees that had an annual flu vaccination. Medicare Disparities Tool DISEASES: Leading Causes of Death Health, Death Statistics File. DISEASES: Population, and Rank Tuberculosis Control Branch DISEASES: Population, and Rank Tuberculosis Control Branch OBESITY Consumption, Children Ages 12-17 Servings of Fruits and Vegetables in the California Health Interview Survey OBESITY Consumption, Children Ages 2-11 Servings of Fruits and Vegetables in the California Health Interview Survey Alameda County Public Health Department • 2025–2027 CHA 195 Category Indicator Description Source Year(s) Preschoolers Ages 3-5 in a Childcare Ages 3-5 in a Childcare Center Network, California Child Care Portfolio children as a percent of median household Income and Poverty Estimates 2021 Parental Employment Employment U.S. Census Bureau American Community Price Lunch schools that are eligible for free or reduced-cited by County Health Rankings Poverty Estimates, as cited by County median earnings for all full-time, year-round Community Survey, 5-year estimates, as percentile to income at the 20th percentile Community Survey, 5-year estimates, as Licensed Childcare is Available Whom Licensed Childcare is Available Network, California Child Care Portfolio; U.S. Census Bureau, American Community county earn more and half of households earn Poverty Estimates, as cited by Community Alameda County Public Health Department • 2025–2027 CHA 196 Category Indicator Description Source Year(s) Poverty, Alameda County level, by ZIP Code. Excludes people living in group quarters. Community Survey, 5-year estimates provided by Alameda County Public Health Department, CAPE Unit via personal based on the cost of housing, childcare, food, health care, transportation, taxes and other Measure Interactive Data Dashboard. https://unitedwaysca.org/realcost Employed and Not in School, by Race provided by Alameda County Public Health Department, CAPE Unit via personal and Special Student Populations. of students who graduated from high school within five years with a regular high school diploma divided by the number of students who form the final four-year adjusted cohort from the preceding year, plus any new students who transfer to and graduate from the selected entity-level during the five-year cohort outcome period. Special populations include youth who are homeless, English learners, have disabilities, immigrant, in the foster system, and socioeconomically Provided by Alameda County Public Health Department, CAPE Unit via personal correspondence September 3, 2025. 2023–2024 ECON: EDUC High School Graduates Completing College Preparatory Courses Preparatory Courses Adjusted Cohort Alameda County Public Health Department • 2025–2027 CHA 197 Category Indicator Description Source Year(s) Counselors Staff Assignment and Course Data & graders on English Language Arts Data Archive and required spending per pupil among public school districts. Required spending is an estimate of dollars needed to achieve U.S. School of Education and Human Development, and the Rutgers University Graduate School of Education: School race and ethnicity groups are unevenly distributed across schools when compared with the racial and ethnic composition of the local population. Index 0 to 1; 0=school composition that approximates race and ethnicity distributions in the student populations within the county;1=more Standards Level CAASPP Standard in English Language Test Results for California's Assessments School Dropouts by Race and Gender & Adjusted Alameda County Public Health Department • 2025–2027 CHA 198 Category Indicator Description Source Year(s) Meaningful Participation at School Participation at School (7th Graders, 9th th (CHKS) & Biennial State CHKS. California Connectedness Connectedness (7th Graders, 9th Graders, 11th (CHKS) & Biennial State CHKS. California ACCESS & QUAL91 Households Speaking Households U.S. Census Bureau American Community Survey public use microdata, as cited on ACCESS & QUAL Coverage Coverage U.S. Census Bureau American Community ACCESS & QUAL Primary Care within county Services, Health Resources and Services ACCESS & QUAL Code Residents is More or Less than 20% of the Kaiser Permanente Community Health Data ACCESS & QUAL Population Medi-Cal (Medicaid) managed care Personal correspondence, September 3, ACCESS & QUAL (Medicaid), by age, race/ethnicity Personal correspondence, September 3, ACCESS & QUAL Mothers Cal (Medicaid) Personal correspondence, September 3, ACCESS & QUAL sensitive conditions per 100,000 Medicare Mapping Medicare Disparities Tool, as cited Alameda County Public Health Department • 2025–2027 CHA 199 Category Indicator Description Source Year(s) ACCESS & QUAL Speech/Language/Hearing Speech/Language/Hearing Specialists Assignment and Course Data & DataQuest ACCESS & QUAL Staff Assignment and Course Data & ACCESS: MAT92/ Hospital Breastfeeding Initiation Data, as ACCESS: MAT/ Exclusively Hospital Breastfeeding Initiation Data, as ACCESS: MAT/ Prenatal Care in the First Trimester California Vital Data (Cal-ViDa) Query Tool ACCESS: MAT/ Discrimination in Health Care Child, and Adolescent Health (MPCAH) Needs Assessment ACCESS: MAT/ 1,000 live births Mortality Files, as cited in KidsData.org ACCESS: MAT/ 1,000 live births CAPE Unit ACCESS: MAT/ (< 2,500 grams) Natality files, as cited by County Health ACCESS: MAT/ County death is a death while pregnant or within one California Pregnancy Mortality Surveillance Alameda County Public Health Department • 2025–2027 CHA 200 Category Indicator Description Source Year(s) – from any cause related to or aggravated by the pregnancy or its management, but not ACCESS: MAT/ (per 10,000 labor hospitalizations) hospitalizations among females, aged 12 to California Pregnancy Mortality Surveillance ACCESS: MAT/ County (< 2,500 grams) CAPE Unit ACCESS: MAT/ County estimated gestational age < 37 weeks, CAPE Unit ACCESS: MAT/ Health Child, and Adolescent Health (MPCAH) Needs Assessment ACCESS: MAT/ Child, and Adolescent Health (MPCAH) Needs Assessment ACCESS: MAT/ INFANT HEALTH with Special Health Care Needs Child, and Adolescent Health (MPCAH) population Needs Assessment ACCESS: MAT/ Child, and Adolescent Health (MPCAH) Needs Assessment ACCESS: MAT/ Health Child, and Adolescent Health (MPCAH) Needs Assessment ACCESS: MAT/ Health Child, and Adolescent Health (MPCAH) Needs Assessment ACCESS: MAT/ ages 15-19 CAPE Unit Alameda County Public Health Department • 2025–2027 CHA 201 Category Indicator Description Source Year(s) ACCESS: ORAL insurance AskCHIS Dashboard. ACCESS: ORAL HEALTH Services, Health Resources & Services Administration, Area Health Resource File/National Provider Identifier ACCESS: ORAL Dental Health within County Services, Health Resources and Services STROKE and Hospitalizations, Alameda Regex Code(s): I2[1-2] CAPE Unit STROKE Hypertensive Renal Disease Among Health, Death Statistics File. Alameda County Public Health Department • 2025–2027 CHA 202 Category Indicator Description Source Year(s) STROKE High Blood Pressure Interactive Atlas of Heart Disease and STROKE Alameda County that occurs when blood flow to the brain is blocked. This prevents brain tissue from getting oxygen and nutrients, which can lead to brain cell death. Ischemic strokes are the most common type of stroke. Age-Adjusted Rate per 100,000 Population. Regex Code(s): CAPE Unit Alameda County Public Health Department • 2025–2027 CHA 203 Category Indicator Description Source Year(s) UNHOUSED Households Households U.S. Census Bureau American Community Survey public use UNHOUSED sheltered and unsheltered, with demographics (e.g. race and age.) Survey Executive Summaries, 2022 and 2024 2024 UNHOUSED Community Survey, 5-year estimates, as UNHOUSED Children Ages 0-17 (multiple counties and California) Development, Point-In-Time UNHOUSED Youth 18-24 (multiple counties and California) Development, Point-In-Time Estimates of Homelessness in the U.S., as cited in UNHOUSED Homeless Children Children Ages 0-17 (multiple counties and California) Development, Point-In-Time Estimates of Homelessness in the U.S., as cited in UNHOUSED Homeless Youth Youth Ages 18-24 (multiple counties and California) Development, Point-In- Time Estimates of Homelessness in the U.S., as cited in UNHOUSED including severely rent-burdened (by race, UNHOUSED housing problems: overcrowding, high housing costs, lack of kitchen facilities, or Development, Comprehensive Housing Affordability Strategy (CHAS) data Alameda County Public Health Department • 2025–2027 CHA 204 Category Indicator Description Source Year(s) UNHOUSED Some Point during the School Year Point during the School Year Coordinated School Health and Safety COMMUNITIES 100,000 population. Mortality Files, as cited by County Health Rankings, as cited by County Health COMMUNITIES Hospitalizations, Alameda County Regex Code(s): ((T3[679]9|T414|T427|T4[3579]9)3.|(?!(T3[679 ]9|T414|T427|T4[3579]9))(T3[6-9]|T4[0- 9]|T50)..3|((T5[1-46-9]|T6[0- 35])9|(T58|T61)[01]|T64[08])3.|(?!((T5[1-46- 9]|T6[0-35])9|(T58|T61)[01]|T64[08]))(T5[1- 9]|T6[0-5])..3|T71..3|(X9[2-9]|Y0[0- CAPE Unit COMMUNITIES experienced abuse or neglect in cases per 1,000 children. Rates are based on children CCWIP Reports. University of California at Berkeley & California Dept. of Social COMMUNITIES Assistance among Adults Ages 18-69 Statistics Center, Domestic Violence- COMMUNITIES Ages 10-17 Arrests; California Dept. of Finance, COMMUNITIES population Mortality Files, as cited by County Health COMMUNITIES Hospitalizations, Alameda County Regex Code(s): ((W3[23][01]|(X74|X95|Y24)[89]|Y384)..|((X7|Y2)[23]|X9[34])...|W34[01][09].|Y350[0- CAPE Unit Alameda County Public Health Department • 2025–2027 CHA 205 Category Indicator Description Source Year(s) COMMUNITIES Children Ages 0-17 Entering Foster Care CCWIP Reports. University of CA at Berkeley COMMUNITIES CCWIP Reports. University of CA at Berkeley COMMUNITIES Court Case Counts, as cited by Community COMMUNITIES Members (7th Graders, 9th Graders, 11th (CHKS) & Biennial State CHKS. California COMMUNITIES School Previous Year (7th Graders, 9th Graders, 11th (CHKS) & Biennial State CHKS. California COMMUNITIES School because of Race/Ethnicity or National Origin school in the previous year on the basis of their race/ethnicity or national origin, by race/ethnicity and number of occasions (7th th th (CHKS) & Biennial State CHKS. California Dept. of Education COMMUNITIES Previous Year (7th Graders, 9th Graders, 11th (CHKS) & Biennial State CHKS. California COMMUNITIES School School on 4 or More Occasions in the Previous Year (7th Graders, 9th Graders, 11th (CHKS) & Biennial State CHKS. California Dept. of Education COMMUNITIES School Graders, 9th Graders, 11th Graders) (CHKS) & Biennial State CHKS. California COMMUNITIES DISCRIMINATION to live Mortality Files, as cited by County Health Alameda County Public Health Department • 2025–2027 CHA 206 Category Indicator Description Source Year(s) DISCRIMINATION 100,000 population (age-adjusted) Mortality Files, as cited by County Health DISCRIMINATION indicate greater residential segregation Community Survey, 5-year estimates TRANSMITTED INFECTIONS per 100,000 population Hepatitis, STD, and TB Prevention California Dept. of Public Health, Sexually Transmitted Diseases Control Branch custom tabulation; Centers for Disease Control and Prevention, TRANSMITTED 19 per 100,000 population ages 10-19 Hepatitis, STD, and TB Prevention TRANSMITTED INFECTIONS 19 Transmitted Diseases Control Branch custom tabulation; Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance; U.S. Census Bureau, National Population by Characteristics & National Transmitted Diseases Control Branch custom tabulation; Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance. TRANSMITTED due to Human Immunodeficiency Virus. Regex CAPE Unit TRANSMITTED Hospitalizations, Alameda County due to Human Immunodeficiency Virus. Regex CAPE Unit TRANSMITTED INFECTIONS living with a diagnosis of human immunodeficiency virus (HIV) infection per Hepatitis, STD, and TB Prevention Alameda County Public Health Department • 2025–2027 CHA 207 Attachment 7: Qualitative Research Materials English-language pre-surveys and qualitative protocols are included on the following pages of this attachment. For pre-surveys and protocols in other languages, please contact Actionable Insights, LLC (inquiries@ActionableLLC.com). Alameda County Public Health Department • 2025–2027 CHA 208 Alameda County Public Health Department • 2025–2027 CHA 209 Alameda County Public Health Department • 2025–2027 CHA 210 Alameda County Public Health Department • 2025–2027 CHA 211 Alameda County Public Health Department • 2025–2027 CHA 212 Alameda County Public Health Department • 2025–2027 CHA 213 Alameda County Public Health Department • 2025–2027 CHA 214 Alameda County Public Health Department • 2025–2027 CHA 215 Alameda County Public Health Department • 2025–2027 CHA 216 Alameda County Public Health Department • 2025–2027 CHA 217 Alameda County Public Health Department • 2025–2027 CHA 218 Alameda County Public Health Department • 2025–2027 CHA 219 Alameda County Public Health Department • 2025–2027 CHA 220 Alameda County Public Health Department • 2025–2027 CHA 221 Alameda County Public Health Department • 2025–2027 CHA 222 CHA/CHNA KII Protocol - Professionals (60 min.) PREP ● Schedule call, send background, needs, consent, and demographics survey and main topics from page 2 [minimum: 1 week ahead of time]. [Insert QR code for survey] ● 48 hours before: ○ Review the individual’s background on LinkedIn and/or their organization’s website; review their survey response (health needs they identified). ○ Send reminder email; remind them of their survey response (most pressing needs among those they serve) and the main questions. ■ If they didn’t respond to the survey, include the link and ask them to respond ASAP before the interview. INTRODUCTION (5 MIN.) [Start recording from the beginning of the session.] ● WELCOME: Thank you for agreeing to do this interview today. My name is [NAME] with Actionable Insights. I will be conducting the interview today on behalf of local health care organizations as part of the Community Health Needs Assessment process for them in [ ____ County or Counties]. ● [If they didn’t submit survey: In order to go ahead, we’ll need you to take the survey we sent you. Here’s the link; I’ll wait while you complete it [place in Zoom chat] ● What the project is about: ○ Local nonprofit hospitals are conducting a Community Health Needs Assessment. It is a systematic examination of health indicators in [ ____ County or Counties] that will be used to identify key problems and assets in a community and develop strategies to address community health needs. You are an important contributor to this assessment because of your knowledge of the needs in the community you serve or represent. The hospitals greatly value your input. ○ A CHNA is required of all non-profit hospitals in the U.S. every three years. The report based on this assessment will be a snapshot in time; this report will be published next year (in 2025) and consulted through 2028. ● We expect this interview to last no longer than 1 hour; does that still work for you? ● Today’s main topics: ○ Better understand the needs you identified as most pressing in your area ○ Which populations are experiencing inequities related to the needs ○ How things may have changed in the past few years (trends) ○ The biggest challenges you see in addressing the needs ○ Key resources and any models or best practices you know of for addressing the needs ○ Other areas of concern ○ [If not one of the needs identified:] Your expertise as it relates to the community’s needs Alameda County Public Health Department • 2025–2027 CHA 223 ● What we’ll do with the information you tell us today: ○ Will record so that we can get the most accurate record possible ○ Will not share the audio itself; transcript will go to the health care organizations and their consultants, like me. ○ Hospitals will make decisions about which needs they can best address ○ We can keep anything confidential; just let me know any time. ○ The information you provide today will not be reported in a way that would identify you. [Next part depends on their survey response:] We plan to name you/your organization in the report where we list all the health experts/service providers we consulted, but will not attach your name to any quotes we might use. ● Do you have any questions before we get started? [If we don’t have the answer, commit to finding it and sending later via email.] Kick on Zoom recording! HEALTH NEEDS DISCUSSION (35 MIN.) Could you please pronounce your name and share your preferred pronoun? OK, [name], before we get down to the issues you identified, I’d like to ask you: 1. What are the healthiest characteristics of this community? [Prompt if needed: For example, a strong transportation system, an active arts and culture sector, safe and accessible spaces for physical activity] a. What strengths in the community amplify or support these healthy characteristics? Thank you. Now, you identified [read list from survey] as the biggest health issues or conditions your community struggles with. For each of these needs, I’ll ask you six things [read only bold text to introduce this section]: 1. Please briefly describe how you see the need playing out. What does it look like among the people you serve or represent? 2. What do you think creates these issues? [Prompts for barriers if they are having trouble thinking of any: Income/economic issues, language, culture/stigma, lack of awareness/education, Alameda County Public Health Department • 2025–2027 CHA 224 policies/laws, budget cuts, lack of community resources, geographic location, transportation, housing, addiction, stress, being victims of abuse/bullying/crime] 3. This may overlap the previous question, but are there certain people or geographic areas that have been affected by the issues we’ve been talking about more than others? If so, in what ways? In other words, which specific groups of the population, if any, should the hospitals focus on to reduce disparities and inequities related to race or other factors? [Prompts for populations if they are having trouble thinking of any: income/education level, housing status, language, immigration status, age, ethnicity, sexual orientation, gender identity, disability status, geographic location; intersectionality of any of these] 4. Next, how things may have changed in the last few years (since we know that the data always lag what is happening now)? What emerging trends or areas of concern have you seen since 2021? How has COVID recovery influenced the characteristics of these needs? 5. What are one or two of the biggest challenges to addressing the need? 6. [1st time through only: As you know, the hospitals will make decisions about which needs they can best address, and develop strategies to address them.] What do you feel is needed to better address this need, including any models, best practices, or key community resources for addressing the need? In other words, what are effective strategies to reduce health disparities and inequities in your community? [Prompts if needed: Is there work underway that is promising? Who is doing that work? Are there any best practices you have observed within your health system or organization, in our county agencies, national practices you’ve heard about, or practices you’ve read about in literature?] Probes: How would you like to see health care organizations like these hospitals address these needs? Who are the individuals or organizations that are important in connecting the sub-groups most affected by disparities to community resources that support this need? OK, let’s get started. For [name first need], [start at Q1; address all six questions, then go back to Q1-6 with second need, again with third need, then go on to the questions below.] Only if their expertise was not related to one or more of the needs chosen: FURTHER DISCUSSION: THEIR EXPERTISE (5-10 min.) You were invited to share your expertise/experience about [topic, e.g., substance use disorder, maternal health, or homelessness]. Let’s talk a little about that; how does it relate to the community’s health needs? [Probe: What services does your organization provide to help meet those needs?] Alameda County Public Health Department • 2025–2027 CHA 225 Only if structural inequities were not already discussed: FURTHER DISCUSSION: STRUCTURAL INEQUITIES (5-10 min.) I know you didn’t identify structural inequities as a specific need; would you mind... ● Speaking to any particularly detrimental structural inequities that are affecting the people you serve? How do those structural inequities show up? ● Identifying any equity initiatives or strategies you know of, which have momentum – that is, they seem to be making a positive impact? ADDITIONAL COMMENTS (time permitting) We have a few minutes left; is there anything else you would like to add regarding community health needs that we haven’t already discussed? Any recent reports we should consult? Any other thoughts or comments we can convey to the hospitals? REQUEST FOR ASSISTANCE WITH ASSETS LIST (2 min.) The IRS requires that we get feedback from the community on potential resources available to address these health needs. We are compiling a list of resources by health need later this spring, which will be based on 2-1-1’s list. Would you be willing to review a list at that time, related to your area of expertise, and give us feedback? [Pause] For example, we may ask whether the resources seem sufficient or if there are gaps; or if there are resources available that we have missed. [Make a note as to whether they agree or not.] CLOSING (1 min.) You can look for the hospitals' CHNA reports to be made publicly available on their individual websites in the second half of 2025. If anything occurs to you later that you would like to add to this interview, please feel free to send me an email. Thank you so much for contributing your expertise and experience to the CHNA. Alameda County Public Health Department • 2025–2027 CHA 226 CHA/CHNA FG Protocol - Professionals (90 min.) PREP ● Schedule group of 8-10 participants. ● Ahead of time [minimum: 1 week ahead of time], send participants: ○ Pre-focus group consent/demographics & health needs survey [INSERT LINK] [depending on group] and QR code for survey: [insert QR CODE] ○ FG date, time, and Zoom login information ○ Advise that the session will be recorded ● Prepare: ○ Slide of agenda/questions ○ Review pre-survey responses + create slide of top needs ● 48 hours before: ○ Send reminder email. ■ If they didn’t respond to the survey, include the link and ask them to respond ASAP before the interview. INTRODUCTION (10 MIN.) ● Hello everyone. Thank you for agreeing to participate in this focus group today. Today we are hosting a discussion about health here in [ ____ County or Counties]. This session will run until [time] (one hour). ● My name is ____ and I’m with [organization name and description, e.g., “a local consulting firm”]. My colleague will also introduce [her/him/their]self. [Pause for their introduction.] We are doing this focus group on behalf of local health care organizations as part of the Community Health Needs Assessment process for them in [COUNTY OR COUNTIES]. When we start our discussion in a few minutes, we will ask you to say your first name and your pronouns before speaking. ● What the project is about: ○ Local nonprofit hospitals are conducting a Community Health Needs Assessment. It is a systematic examination of health indicators in [COUNTY or COUNTIES] that will be used to identify key problems and assets in a community and develop strategies to address community health needs. You are an important contributor to this assessment because of your knowledge of the needs in the community you serve or represent. The hospitals greatly value your input. ○ A CHNA is required of all non-profit hospitals in the U.S. every three years. The report based on this assessment will be a snapshot in time; this report will be published next year (in 2025) and consulted through 2028. ● Today’s main topics: show slide or point to agenda ○ Better understand the needs you identified as most pressing in your area Alameda County Public Health Department • 2025–2027 CHA 227 ○ Which populations are experiencing inequities related to the needs ○ How things may have changed in the past few years (trends) ○ The biggest challenges you see in addressing the needs ○ Key resources and any models or best practices you know of for addressing the needs ● Confidentiality: ○ Like you saw in the survey, we asked everyone if it was OK to record this discussion, and you all said yes. We are recording so that we can make sure to take down your words as accurately as possible. ○ We will only use first names here. (If you want to use a pseudonym, that’s OK too!) ○ We can keep anything confidential; just let me know any time and we can delete it from the recording. ● What we’ll do with the information you tell us today: ○ Hospitals will make decisions about which needs they can best address ○ The information you provide today will not be reported in a way that would identify you. We plan to name you/your organization in the report where we list all the health experts/service providers we consulted unless you told us in the pre-survey that you didn’t want us to be included, or only wanted your organization to be listed. We will not attach your name to any quotes we might use. ○ When we are finished with all of the focus groups, we will read all of the transcripts and summarize the things we learn. We will also use some quotes so that the hospitals can read your own words. We will not use your name when we give them those quotes. ○ If for any reason you are deciding that you do not want to participate, it is OK to leave the meeting now. No hard feelings! ● Guidelines: ○ We know you have other things to do and we really appreciate you taking the time out of your day to be here. It is my job to move us along to keep us on time. I may interrupt you; I don’t mean any disrespect, but it is important to get to all of the questions so we can finish on time. ○ We understand that you may have other things going on your end; we ask that you do the best you can to stay present, and let us know through the chat if you absolutely need to step away. ○ It’s OK to disagree, but please be respectful. We want to hear from everyone. Really want your personal opinions and thoughts, even – especially! – if they aren’t the same as everyone else’s. ● Do you have any questions before we get started? [If we don’t have the answer, commit to finding it and sending later via email.] Alameda County Public Health Department • 2025–2027 CHA 228 Kick on Zoom recording! HEALTH NEEDS DISCUSSION (35 MIN.) OK, you identified [read list from survey on PPT slide] as the biggest health issues or conditions your community struggles with. For each of these needs, I’ll ask this group six things [read only bold text to introduce this section]: 1. Briefly describe how you see the need playing out. What does it look like among the people you serve or represent? Remember, please say your name and your pronouns before speaking. 2. What do you think creates these issues? [Prompts for barriers if they are having trouble thinking of any: Income/economic issues, language, culture/stigma, lack of awareness/education, policies/laws, budget cuts, lack of community resources, geographic location, transportation, housing, addiction, stress, being victims of abuse/bullying/crime] 3. This may overlap the previous question, but are there certain people or geographic areas that have been affected by the issues we’ve been talking about more than others? If so, in what ways? In other words, which specific groups of the population, if any, should the hospitals focus on to reduce disparities and inequities related to race or other factors? [Prompts for populations if they are having trouble thinking of any: income/ed level, housing status, language, immigration status, age, ethnicity, sexual orientation, gender ID, disability status, geographic location; intersectionality of any of these] 4. Next, how things may have changed in the last few years (since we know that the data always lag what is happening now)? What emerging trends or areas of concern have you seen since 2021? How has the COVID recovery influenced the characteristics of these needs? 5. What are one or two of the biggest challenges to addressing the need? 6. What do you feel is needed to better address this need, including any models, best practices, or key community resources for addressing the need? [Prompts if needed: Is there work underway that is promising? Who is doing that work? Are there any best practices you have observed within your health system or organization, in our county agencies, national practices you’ve heard about, or practices you’ve read about in literature?] [Probe: How would you like to see health care organizations like these hospitals address these needs?] Alameda County Public Health Department • 2025–2027 CHA 229 a. What are effective strategies to reduce health disparities and inequities in your community? [Probe: Who are the individuals or organizations that are important in connecting the sub- groups most affected by disparities to community resources that support this need?] OK, let’s get started. For [name first need], [start at Q1; address all six questions, then go back to Q1-6 with second need, again with third need, then go on to the questions below.] Only if their expertise was not related to one or more of the needs chosen: FURTHER DISCUSSION: THEIR EXPERTISE (5-10 min.) You were invited to share your expertise/experience about [topic, e.g., substance use disorder, maternal health, or homelessness]. Let’s talk a little about that; how does it relate to the community’s health needs? [Probe: What services do your organizations provide to help meet those needs?] Only if structural inequities were not already discussed: FURTHER DISCUSSION: STRUCTURAL INEQUITIES (5-10 min.) I know the group didn’t prioritize structural inequities as a specific need; would you mind... ● Speaking to any particularly detrimental structural inequities that are affecting the people you serve? How do those structural inequities show up? ● Identifying any equity initiatives or strategies you know of, which have momentum – that is, they seem to be making a positive impact? ADDITIONAL COMMENTS (time permitting) We have a few minutes left; is there anything else you would like to add regarding community health needs that we haven’t already discussed? Any recent reports we should consult? Any other thoughts or comments we can convey to the hospitals? REQUEST FOR ASSISTANCE WITH ASSETS LIST (2 min.) The IRS requires that we get feedback from the community on potential resources available to address these health needs. We are compiling a list of resources by health need later this spring, which will be based on 2-1-1’s list. Would you be willing to review a list at that time, related to your area of expertise, and give us feedback? [Pause] For example, we may ask whether the resources seem sufficient or if there are gaps; or if there are resources available that we have missed. [Launch Zoom poll.] Alameda County Public Health Department • 2025–2027 CHA 230 CLOSING (1 min.) You can look for the hospitals' CHNA reports to be made publicly available on their individual websites in the second half of 2025. If anything occurs to you later that you would like to add, please feel free to send me [or my colleague] an email. Thank you so much for contributing your expertise and experience to the CHNA. Alameda County Public Health Department • 2025–2027 CHA 231 CHA/CHNA FG Protocol - Community Members (90 min.) PREP ● Work with host to schedule group of 8-10 participants. If needed, create recruitment email/flier for host. Ahead of time, have host send participants: ○ Pre-focus group consent/demographics & health needs survey [INSERT LINK] [depending on group] QR code for survey: [insert QR CODE] ○ FG date, time, and location [or Zoom login information] ○ Advise that the session will be recorded ● Prepare: ○ PDF [or flipchart] of agenda/questions ○ PDF [or flipchart] of prior cycle health needs list (including definition of health care access) [if no pre-survey] ○ Review pre-survey responses [depending on group] + create slide of top needs ○ If in person: consent + demographics survey & health needs paper survey [if no pre-survey] ○ If virtual: consent language & Zoom poll of health needs [if no pre-survey] INTRODUCTION (10 MIN.) [Start recording from the beginning of the session.] ● Hello everyone. Thank you for agreeing to participate in this focus group today. Today we are hosting a discussion about health here in [ ____ County or Counties]. This session will run until [time] (90 minutes). ● My name is ____ and I’m with [organization name and description, e.g., “a local consulting firm”]. My colleague will also introduce [her/him/their]self. [Pause for their introduction.] We are doing this focus group for local hospitals, including [list names of participating hospitals in the area]. When we start our discussion in a few minutes, we will call on you and ask you to say your name and your pronouns before speaking. ● Purpose: ○ You are here today to let nonprofit hospitals [if applicable: and the health department] know what the biggest health needs are in your community. These can include health conditions and the things that make those conditions better or worse. ○ This is called the Community Health Needs Assessment (CHNA), which is required every three years by the IRS, so it is an official, public report. ○ Hospitals will look at the numbers (statistics) and at what you say, to plan how they will use their resources to improve health and wellness in your county. So your thoughts are really important to them. ● Today’s questions: show slide or point to agenda ○ What are the needs? ■ Which groups of people are doing better or worse when it comes to the needs? Alameda County Public Health Department • 2025–2027 CHA 232 ■ What can hospitals/health systems do to improve health in the community? ○ Lastly, we will get your perspective about equity and cultural competence when it comes to health care. ● Confidentiality: ○ Like you saw in the survey, we asked everyone if it was OK to record this discussion, and you all said yes. We are recording so that we can make sure to get your words right. ○ We will only use first names here -- you will be anonymous. (If you want to use a fake name, that’s OK too!) ○ Will not share the audio [and video, if on Zoom]; just the transcript will go to the health care organizations and their consultants [if applicable: like me]. ○ When we are finished with all of the focus groups, [we or the consultants] will read all of the transcripts and summarize the things [we/they] learn. [We/They] will also use some quotes so that the hospitals can read your own words. [We/They] will not use your name when [we/they] give them those quotes. ○ If for any reason you are deciding that you do not want to participate, it is OK to leave the meeting now. No hard feelings! ● Guidelines: ○ We know you have other things to do and we really appreciate you taking the time out of your day to be here. It is my job to move us along to keep us on time. I may interrupt you; I don’t mean any disrespect, but it is important to get to all of the questions so we can finish on time. ○ We understand that you may have other things going on [on your end]; we ask that you do the best you can to stay present, and let us know [through the chat] if you absolutely need to step away. ○ If no pre-survey: You have a choice of a $50 credit to Amazon or [XYZ]. Please [mark your choice on the sign-in sheet or chat your email address to my colleague [name] now, along with your choice]. If you don’t tell [him/her/them] which one you prefer, we’ll [give or send] you an Amazon credit. ○ It’s OK to disagree, but please be respectful. We want to hear from everyone. Really want your personal opinions and thoughts, even – especially! – if they aren’t the same as everyone else’s. ● Any questions before we begin? [If we don’t have the answer, commit to finding it and sending later via email.] HEALTH NEEDS DISCUSSION (50-60 MIN.) If no pre-survey: Here’s a list of health needs in your area from 2022. [show slide or point to flip chart list] You’ll see that there are regular physical health conditions, like cancer, and other kinds of needs, like a healthy climate, and housing. We’re going to read the needs, then take a poll for you to choose the five you think are the most important, or Alameda County Public Health Department • 2025–2027 CHA 233 pressing, in your community. [Read off needs, then: launch zoom poll or give five sticky dots to each person in the room. Give people a few minutes to complete.] If collected by pre-survey, start here: As a group, you identified [read list] as the most important needs in your community -- these are the needs that got the most votes in the pre-survey. For each of these needs, I’ll ask you three things [read only bold text in Q1-3 on the next page to introduce this section]. But before we get down to the needs you all chose, I’d like to ask you to share: What is one thing that you are proud of about your community? How might that relate to the overall health of your community? [Prompt if needed: For example, maybe your community is a place where the people are welcoming to everyone, which could mean people feel safe living there; or maybe there are lots of ways to enjoy nature here, which could mean it’s easy for people to be physically active; or there are good services for people who are in need, which could mean people generally have their basic needs taken care of.] After each participant who wants to share has done so: OK, let’s move on to talk about the needs you chose. 1. [If on Zoom, facilitators call on participants one by one.] “Please say your first name, and then describe what the need looks like in your community, including what might get in the way for people to [live healthier lives / have better outcomes: use "have better outcomes" language if need is homelessness, economic stability, violence/safety, or transportation; use "live healthier lives" for all other needs]. You can choose to pass if you didn’t vote for the need and don’t have anything to say about it.” [Prompts for barriers if they are having trouble thinking of any: Income/economic issues, language, culture/stigma, lack of awareness/education, policies/laws, budget cuts, lack of community resources, geographic location, transportation, housing, addiction, stress, being victims of abuse/bullying/crime, poor access to resources] 2. This may overlap the previous question, but I’ll ask you to identify what groups of people are better or worse off than others for that need and explain how or why. [Prompts for populations if they are having trouble thinking of any: income/education level, housing status, language, immigration status, age, ethnicity [get specific], sexual orientation, gender identity, disability status, geographic location] 3. Finally, I’ll ask you to describe, for that issue, what you think is most needed to help your community become healthier / improve everyone’s lives [use "improve lives" language if need is homelessness, economic stability, violence/safety, or transportation; use "help become healthier" for all other needs]. a. What is working already, that could be continued or expanded? i. What would make it easier for people to access these resources? Alameda County Public Health Department • 2025–2027 CHA 234 b. Formal resources like government agencies and community organizations can help [pause]; so can informal resources like community elders, faith leaders, teachers, and coaches [pause]. They can support good programs that are already happening. Or they can help bring services to your community, that aren’t here already. c. Thinking of all these organizations and people in your community, which ones do you think could best help when it comes to this need? d. If you could choose a program, service, or other strategy that’s not already here in your community, that you think could help, what would it be? [Probe if necessary: How could it help?] OK, let’s get started. For [name first need], [start at Q1; address all three questions, then go back to Q1-3 with second need, then again with third, then go on to the questions below.] YOUR PERCEPTION OF EQUITY ISSUES (20-25 min.) You have probably heard the words “cultural competence” before; they mean being able to understand the values and beliefs of people who are different from yourself, so you can communicate with them respectfully. 1. We’ve heard that not all providers know how to care for people in a culturally competent and respectful way. What do you think those providers are missing? What do you think they need to learn? As you probably know, people have been talking about issues of equity now more than ever. “Equity” means fairness and unbiased treatment. When it comes to health care, we’d like to ask about your opinion on equity and cultural competence: 2. What do you think gets in the way of everyone having the same access to health care? 3. What do you think gets in the way of everyone getting the same quality of health care? 4. What can hospitals and health systems do to best address equity for you and the people in your community? OTHER COMMENTS (time permitting) Are there any other thoughts or information you would like to share that we have not already talked about? CLOSING (1 min.) Alameda County Public Health Department • 2025–2027 CHA 235 Thank you for contributing your opinions and experience to the CHNA. The hospitals’ CHNA reports will be available on their websites in the second half of 2025. After the assessment, they will be working on their plan for how they will use their resources to improve health and wellness in your county, and those plans will be available in late 2025 or early 2026. You can contact us if you want any more information about the assessment. If anything occurs to you later that you would like to add, please feel free to send us an email. Alameda County Public Health Department • 2025–2027 CHA 236 Alameda County Public Health Department • 2025–2027 CHA 237 Alameda County Public Health Department • 2025–2027 CHA 238 Alameda County Public Health Department • 2025–2027 CHA 239 Attachment 8: Community Assets and Resources Health Care Facilities and Agencies The following health care facilities are available in Alameda County. HOSPITALS • Alameda Health System, Alameda Hospital • Alameda Health System, Fairmont Hospital • Alameda Health System, Wilma Chan Highland Hospital • Alameda Health System, John George Psychiatric Hospital • Alameda Health System, San Leandro Hospital • Kaiser Foundation Hospital–Fremont • Kaiser Foundation Hospital–Oakland • Kaiser Foundation Hospital–San Leandro • Stanford Health Care Tri-Valley • Sutter Health Alta Bates Summit Medical Center • Sutter Health Eden Medical Center • UCSF Benioff Children’s Hospital Oakland • Washington Health FEDERALLY QUALIFIED HEALTH CENTERS • Asian Health Services (multiple sites) • Axis Community Health (multiple sites in the Tri-Valley) • Bay Area Community Health (multiple sites and Mobile Clinics) • Baywell Health • Brighter Beginnings • Davis Street Community Center • La Clínica (multiple locations) • LifeLong Medical Care (multiple locations) • Native American Health Center • Tiburcio Vásquez Health Center (multiple sites) OTHER HEALTH CLINICS • Alameda Health System:  Creedon Advanced Wound Care Alameda County Public Health Department • 2025–2027 CHA 240  Eastmont Wellness  Fairmont Rehabilitation and Wellness  Hayward Wellness  Highland Wellness  Marina Wellness & Surgical Associates  Newark Wellness  Park Bridge Rehabilitation and Wellness  South Shore Rehabilitation and Wellness • Ashland Free Medical Clinic • Center for Elder Independence • Fremont Hospital mental health clinic • Kindred long-term acute care and specialized rehabilitation facility • Order of Malta Clinic • Roots Community Health Center • Sutter Health Palo Alto Medical Foundation, Fremont Center • Washington Township Medical Foundation (multiple sites) OTHER ORGANIZATIONS • Alameda County Health Care Services: HealthPAC • Alameda County Social Services Agency • Assistance League of the Amador Valley • East Bay Agency for Children • Eden I & R, Inc. • Family Resource Center, Fremont • George Mark Children’s House • Operation Access • Rubicon Programs Wellness Services • Union City Family Center • Washington Women’s Center Alameda County Public Health Department • 2025–2027 CHA 241 Assets and Resources by Identified Health Need/Challenge The following tables provide the names, summary descriptions, and websites for various health care assets and resources available in Alameda County to address identified health needs. The sets of tables follow the same order as the health needs and challenges are listed in the main body of the report. CHRONIC CONDITIONS Asthma Resource Name Summary Description Website Area Alameda County Public Health: Asthma Start Program Works with families of children with asthma by providing in- home case management services, education and support, and developing an action plan to assist families in controlling their children’s asthma. https://acphd.org/asthm a/ AC Breathe California Promotes lung health through education, advocacy, and support. https://lungsrus.org/ala meda-county/ AC Regional Asthma Management & Prevention (RAMP) Advocates for policy and systems changes targeting the root causes of asthma disparities. https://rampasthma.org/ AC Cancer Resource Name Summary Description Website Area American Cancer Society Aims to freeing the world from cancer by funding and conducting research, sharing expert information, supporting patients, and spreading the word about prevention. https://www.cancer.org/ AC CancerCare Professional oncology social workers provide free emotional and practical support for people with cancer, caregivers, loved ones and the bereaved. https://www.cancercare. org/ AC Alameda County Public Health Department • 2025–2027 CHA 242 Resource Name Summary Description Website Area Every Woman Counts Run by the California Department of Health Care Services, provides free breast and cervical cancer screening and diagnostic services to California’s underserved populations. https://www.dhcs.ca.gov /services/Cancer/ewc/P ages/default.aspx AC HERS Breast Cancer Foundation Supports all individuals healing from breast cancer by providing post-surgical products and services regardless of financial status. https://hersbreastcancer foundation.org/ South, Mid, TV The Leukemia and Lymphoma Society Strives to find a cure for leukemia, lymphoma, Hodgkin’s disease and myeloma, and to improve the quality of life of patients and their families. https://www.lls.org/ AC Tobacco Control Coalition of Alameda County Grassroots coalition of educators, professionals, and community members that works to prevent, reduce, and limit tobacco use in Alameda County through education, advocacy, and policy. https://tobaccofreealam edacounty.org/ AC Women’s Cancer Resource Center Helps women with cancer improve their quality of life through education, practical assistance, and support services. https://www.wcrc.org/ AC Cognitive Decline Resource Name Summary Description Website Area Age-Friendly Alameda County Website provides access to local services, information about current programmatic and policy efforts to support older adults in the county, and resources to learn more about public policy and ways be heard. https://agefriendly.acgov .org/index.page AC Alameda County Public Health Department • 2025–2027 CHA 243 Resource Name Summary Description Website Area Alameda County Adult & Senior Services Central repository for links to resources and services for older adults, including hotline for elder abuse. https://www.acgov.org/a dults/adults.htm AC Alameda County Social Services Agency, Area Agency on Aging Provides Adult Day Care, Family Caregiver Support programs, Food and Nutrition programs, Legal Assistance, Senior Information and Assistance, Long Term Care Ombudsman Services, Senior Center Services and Visiting. https://www.alamedaco untysocialservices.org/o ur-services/Seniors-and- Disabled/Area-Agency- on-Aging/Area-agency- on-aging AC Alameda County Social Services Agency, Department of Adult & Aging Services Coordinated service delivery system that protects, supports, and advocates for an aging population. https://socialservices.al amedacountyca.gov/our- services/Seniors-and- Disabled/Seniors-and- Disabled AC Alameda County Social Services Agency, In- Home Supportive Services Program Provides assistance to older adults and individuals with disabilities, who without this care, would be unable to remain safely in their home. https://socialservices.al amedacountyca.gov/our- services/Seniors-and- Disabled/IHSS/In-Home- Supportive-Services AC Alzheimer’s Association (Northern California & Northern Nevada chapter) Offer support to anyone facing Alzheimer’s, advocates for the needs and rights of those facing dementia, and advances critical research, to work toward methods of treatment, prevention, and ultimately, a cure. https://www.alz.org/ https://www.alz.org/norc al AC Alzheimer’s Services of the East Bay Provides services for individuals with dementia, as well as for their families, including Adult Day Care, Family Support, and Education & Community Outreach Services. https://aseb.org AC Alameda County Public Health Department • 2025–2027 CHA 244 Resource Name Summary Description Website Area Bay Area Caregiver Resource Center Provides services to family caregivers of adults with physical and cognitive impairments, such as Parkinson’s, stroke, Alzheimer’s and other types of dementia. Services include assessment, care planning, direct care skills, wellness programs, respite services, and legal/financial consultation vouchers. https://www.caregiver.or g/ AC Various cities’ Aging & Family Services agencies Advocate for and provide assistance to older adults and individuals with disabilities. AC Diabetes and Obesity See Social Determinants of Health, Economic Security: Food Security for free food resources. Resource Name Summary Description Website Area Alameda County Women, Infants, and Children (WIC) Promotes healthy eating via nutrition advice, help with breastfeeding, referrals to services, and special checks to buy healthy food items. http://www.acphd.org/wi c.aspx AC Alameda County Public Health Department – Nutrition Services Promotes and supports healthy eating and physical activity. https://acphd.org/nutriti on-services/programs/ AC Alameda County Social Services Agency Provides benefits programs through cash assistance and CalFresh (“food stamps”), CalWORKs (assistance for families with children), General Assistance, and Medi-Cal Health Insurance. https://socialservices.al amedacountyca.gov/our- services/Health-and- Food/index AC Alameda County Public Health Department • 2025–2027 CHA 245 Resource Name Summary Description Website Area American Diabetes Association Educates people about ways to live healthier lives and support friends and loved ones living with diabetes. https://diabetes.org/loca l/northern-california AC California State University, East Bay, Hayward Promise Neighborhood Through collaborative partnership, offers over 35 programs that serve residents, families, children, and students in the Hayward area to ensure educational success and a safe, healthy, thriving community http://www.csueastbay. edu/haywardpromise Mid Centro de Servicios Offers weekly food distribution to the hungry. https://centrouc.org/ South East Bay Regional Park District Conserves open space resources and provide outdoor recreational opportunities for present and future generations. https://www.ebparks.org / AC Fremont Family Resource Center Combines the best efforts of multiple social services programs, including food assistance and referrals to older adult services https://www.fremont.gov /government/department s/human- services/fremont-family- resource-center South Senior Support Program of the Tri-Valley Provides programming and referrals for older adults, including case management, 1:1 counseling and emotional support, and wellness education (e.g., nutrition, fitness). https://seniorservicesco alition.org/senior- support-program-of-the- tri-valley/ TV Solid Rock Community Services, Newark Provides resources, food, health/wellness and family reunification services to improve the quality of life for families in Alameda County to ensure basic needs are met. https://solidrockcommu nityservices.org/ South Union City Family Center Provides multiple supports including food distribution and partners with mobile health clinic. https://www.unioncityfa milycenter.org/ South Alameda County Public Health Department • 2025–2027 CHA 246 Resource Name Summary Description Website Area Viola Blythe Community Service Center of Newark Distributes emergency food and clothing, makes referrals to other social services agencies. https://www.violablythe. org/ South Various cities’ Parks and Recreation Departments Promote healthy living by providing accessible, free, or low-cost opportunities for physical activity. AC Heart Disease and Stroke See Economic Security: Food Security for free food resources. Resource Name Summary Description Website Area Alameda County Public Health Department – Nutrition Services Promotes and supports healthy eating and physical activity. https://acphd.org/nutriti on-services/programs/ AC Alameda County Social Services Agency Provides benefits programs through cash assistance and CalFresh (“food stamps”), CalWORKs (assistance for families with children), General Assistance, and Medi-Cal Health Insurance. https://socialservices.al amedacountyca.gov/our- services/Health-and- Food/index AC American Heart Association Strives to prevent and cure heart disease. https://www.heart.org/e n/affiliates/california/nor thern-california AC American Stroke Association Resource for evidence-based information on stroke, post- stroke recovery, and caregiver info. https://www.stroke.org/e n/ AC California State University, East Bay, Hayward Promise Neighborhood Through collaborative partnership, offers over 35 programs that serve residents, families, children, and students in the Hayward area to ensure educational success and a safe, healthy, thriving community. http://www.csueastbay. edu/haywardpromise Mid Alameda County Public Health Department • 2025–2027 CHA 247 Resource Name Summary Description Website Area Centro de Servicios Offers weekly food distribution to the hungry. https://centrouc.org/ South East Bay Regional Park District Conserves open space resources and provides outdoor recreational opportunities for present and future generations. https://www.ebparks.org / AC Fremont Family Resource Center Combines the best efforts of multiple social services programs, including food assistance and referrals to older adult services. https://www.fremont.gov /government/department s/human- services/fremont-family- resource-center South Senior Support Program of the Tri-Valley Provides programming and referrals for older adults, including case management, 1:1 counseling and emotional support, and wellness education (e.g., nutrition, fitness). https://seniorservicesco alition.org/senior- support-program-of-the- tri-valley/ TV Solid Rock Community Services, Newark Provides resources, food, health/ wellness and family reunification services to improve the quality of life for families in Alameda County to ensure basic needs are met. https://solidrockcommu nityservices.org/ South Union City Family Center Provides multiple supports including food distribution and partners with mobile health clinic. https://www.unioncityfa milycenter.org/ South Viola Blythe Community Service Center of Newark Distributes emergency food and clothing, makes referrals to other social services agencies. https://www.violablythe. org/ South Various cities’ Parks and Recreation Departments Promote healthy living by providing accessible, free, or low-cost opportunities for physical activity. AC Alameda County Public Health Department • 2025–2027 CHA 248 Heart Disease and Stroke, Healthy Lifestyles: Senior Centers in Alameda County Name Location Website Age Well Center at South Fremont Fremont https://www.fremont.gov/governmen t/departments/human-services/age- well-centers Age Well Center at Lake Elizabeth Fremont https://www.fremont.gov/governmen t/departments/human-services/age- well-centers Alameda Mastick Senior Center Alameda https://www.alamedaca.gov/Depart ments/Recreation-Parks/Mastick- Senior-Center Albany Senior Center Albany https://www.albanyca.org/recreation /senior-center City of Dublin Senior Center Dublin https://www.dublin.ca.gov/1053/Seni or-Center City of Union City Union City https://www.unioncity.org/289/Ralph -and-Mary-Ruggieri-Senior-Center Downtown Oakland Senior Center Oakland https://www.oaklandca.gov/topics/d owntown-oakland-senior-center East Bay Korean Senior Citizen Center Oakland https://eastbaykoreanamericansenio rcenter.org/index.html East Oakland Senior Center Oakland https://www.oaklandca.gov/topics/e ast-oakland-senior-center Emeryville Senior Center Emeryville https://www.emeryville.org/Recreati on/50-Adults-Services Fruitvale-San Antonio Senior Center Oakland https://unitycouncil.org/program/sen ior-center/ Hayward Area Senior Center Hayward https://www.haywardrec.org/Facilitie s/Facility/Details/Hayward-Area- Senior-Center-93 Judge Henry Ramsey Jr. South Berkeley Senior Center Berkeley https://berkeleyca.gov/community- recreation/seniors/senior- centers/judge-henry-ramsey-jr- south-berkeley-senior-center Kenneth C. Aitken Senior Center Castro Valley https://haywardrec.org/facilities/facil ity/details/Kenneth-C-Aitken-Senior- Community-Center-89 Alameda County Public Health Department • 2025–2027 CHA 249 Name Location Website LARPD Senior Services Center Livermore https://www.larpd.org/senior- services North Berkeley Senior Center Berkeley https://berkeleyca.gov/community- recreation/seniors/senior- centers/north-berkeley-senior-center North Oakland Senior Center Oakland https://www.oaklandca.gov/topics/n orth-oakland-senior-center Pleasanton Senior Center Pleasanton https://www.cityofpleasantonca.gov/ your-community/recreation/senior- services/ San Leandro Senior Community Center San Leandro https://www.sanleandro.org/517/Sen ior-Services West Oakland Senior Center Oakland https://www.oaklandca.gov/topics/w est-oakland-senior-center Alameda County Public Health Department • 2025–2027 CHA 250 SOCIAL DETERMINANTS OF HEALTH Health Care Access and Quality See also Health Care Facilities and Agencies listed on the second page of this attachment. Resource Name Summary Description Website Area Alameda County Health Care for the Homeless Increases access to quality health care for homeless individuals through free health centers and mobile clinics that provide primary care, substance abuse treatment, and other services. https://www.achch .org/ AC Alameda County Health Care Services, School Health Services Provides school districts an array of school-based, school-linked health and wellness services for youth and families, and partner with school districts to build school-based health and wellness systems. https://achealthys chools.org/ AC Alameda County Public Health: Family Health Services Black Infant Health Program Helps reduce stress, build resilience, promote healthy behaviors, and increase social support among pregnant and mothering Black women, and build a community that stands up against the injustices towards African-American women and their birthing experiences. https://acphd.org/ programs-and- services/black- infant-health/ AC Bay Area Legal Aid Improves access to the civil justice system through legal assistance for low- income individuals. https://baylegal.or g/ AC Baywell Health Parent organization of West Oakland Health Center, FQHC with multiple locations that offers medical and dental care as well as behavioral health and other services. https://baywellheal th.org/ North California Department of Health Care Services Helps low-income and disabled people get access to affordable, integrated, high- quality health care, including medical, dental, https://www.dhcs. ca.gov/ AC Alameda County Public Health Department • 2025–2027 CHA 251 Resource Name Summary Description Website Area term care. Center for Healthy Schools and Communities Provides integrated health and wellness services (medical, dental, behavioral health, health education, and youth development) in 29 school health centers throughout Alameda County. https://achealthys chools.org/project s AC DayBreak Adult Care Assists Alameda County seniors with accessing and navigating their care needs. www.daybreakac.o rg AC Eden I&R, Inc. Connects individuals in need with human services agencies. http://edenir.org/ Mid George Mark Children’s Home Provides pediatric nursing and other support services to children with complex medical conditions. https://georgemark .org/ Mid Jewish Family and Community Services East Bay Promotes the well-being of individuals and families of all ages, races, and religions with essential mental health and social services at every stage of life. https://jfcs- eastbay.org/ AC Operation Access Enables Bay Area health care providers to donate surgical and specialty care to people in need. https://www.opera tionaccess.org/ AC Ronald McDonald Care Mobile Dental Clinic Provides pediatric health services for underserved populations through health education and treatment and referral services. https://rmhcbayare a.org/what-we- do/ronald- mcdonald-care- mobile/ AC United Seniors of Oakland and Alameda County Offers programs for older adults to educate, mobilize and enable seniors and their supporters to address the issues that affect their quality of life. https://www.usoac .org/ AC / North Alameda County Public Health Department • 2025–2027 CHA 252 Access: Transportation Resource Name Summary Description Website Area Alameda Alliance For Health Medi- Cal Transportation Benefit Transportation services offered via the Alliance’s transportation provider, ModivCare. There is no cost when transportation is authorized by the Alliance. https://alamedaalli ance.org/members /medi-cal/benefits- and-covered- services/ AC Alameda–Contra Costa Transit District (AC Transit) Provides regional bus service. http://www.actrans it.org/ AC Bay Area Rapid Transit (BART) Provides elevated and subway rail travel across Bay Area counties. https://www.bart.g ov/ AC Bay Wheels Offers an affordable, accessible mode of transportation via a bicycle-sharing service (operated by Lyft), with discounted memberships for low-income individuals. https://www.lyft.co m/bikes/bay- wheels AC Bike East Bay Promotes a healthy, sustainable community by making cycling safe, fun and accessible. https://bikeeastbay .org/ AC Eden I&R, Inc. Serves as a centralized source of health, housing, and human services information http://edenir.org/ Mid Paratransit Provides public transit service for people who are unable to use regular buses or trains because of a disability or a disabling health Condition. https://www.eastb ayparatransit.org/ AC Ride-On Tri-City! Provides a number of transportation and mobility support services for seniors and people with disabilities residing in Fremont, Newark, and Union City. https://www.fremo nt.gov/government/ departments/huma n- services/transporta tion-mobility South Alameda County Public Health Department • 2025–2027 CHA 253 Resource Name Summary Description Website Area Union City Transit Local, city-run bus system. https://www.union city.org/170/Union- City-Transit South Economic Stability See Food Security sub-section for free food resources. Resource Name Summary Description Website Area Abode Services: Project Independence Provides young adults leaving the foster care system with supportive housing and services aimed at helping them achieve self-sufficiency and stability in their lives, including case management, education and vocational training, employment placement, and financial literacy training. https://abode.org/servic es AC Alameda County Social Services Agency Provides benefits programs through cash assistance and CalFresh (“food stamps”), CalWORKs (assistance for families with children), General Assistance, and Medi-Cal Health Insurance. https://www.alamedaso cialservices.org AC America Works Provides work readiness training, vocational training, career placement, career advancement, and employment retention services. Serves individuals in both San Francisco and Alameda County. https://americaworks.co m/ AC Bay Area Legal Aid Increases access to the civil justice system through legal assistance for low-income individuals. https://baylegal.org/ Legal advice line: 1-800- 551-5554 AC Alameda County Public Health Department • 2025–2027 CHA 254 Resource Name Summary Description Website Area Berkeley City College CalWORKs Program Provides academic support for CalWORKs participants to succeed in both their educational and employment goals, including childcare assistance and work-study opportunities. https://www.berkeleycity college.edu/calworks/ North Building Opportunities for Self-Sufficiency Operates programs and services designed to empower homeless, poor, and disabled individuals to become self-sufficient. https://self- sufficiency.org/ AC California State University, East Bay, Hayward Promise Neighborhood Through collaborative partnership, offers over 35 programs that serve residents, families, children, and students in the Hayward area to ensure educational success and a safe, healthy, thriving community. http://www.csueastbay. edu/haywardpromise Mid Centro de Servicios Weekly food distribution to the hungry, community thrift store, assistance for veterans, job placement assistance. https://centrouc.org/ South Citizens for Better Community Student internship program; business networking for Chinese community. https://www.cbcsfbay.or g/ South Clausen House Provides housing, wellness programs, and advocacy for developmentally disabled adults in Oakland and the surrounding East Bay area. https://clausenhouse.or g/ North Community Resources for Independent Living Focuses on providing disabled individuals with peer-based resources and advocacy to improve their lives and their ability to navigate their environment. http://www.crilhayward. org/ AC DeafPlus Integrated adult day program that serves deaf adults with https://deafplus.us/ South Alameda County Public Health Department • 2025–2027 CHA 255 Resource Name Summary Description Website Area employment and education. Davis Street Community Center Provide programs and services encompassing: primary care (including medical, dental, pediatric, behavioral health and women’s health services), child care, programs for adults living with developmental disabilities, free food and clothing, housing information, utility assistance and more. https://www.davisstreet. org Mid East Bay Asian Local Development Corporation EBALDC assists families and individuals to stabilize their financial situations and develop asset-building tools as part of its work with and for the diverse populations of the East Bay to build healthy, vibrant, and safe neighborhoods through community development. https://ebaldc.org/ AC East Bay Community Foundation Supports entrepreneurs of color through community-controlled and democratically governed loan fund for businesses with a strong social mission; funds economic justice nonprofits and impact investing. https://www.ebcf.org/ AC East Bay Community Law Center Addresses the underlying causes of poverty and economic and racial inequality to improve opportunities in economic security, education, health and welfare, housing, and immigration. https://ebclc.org/ AC East Bay Works Partners with job centers, economic developers, support service providers, and educational entities to provide http://www.eastbaywork s.com/ AC Alameda County Public Health Department • 2025–2027 CHA 256 Resource Name Summary Description Website Area youth ages 16–24 at no cost. East Oakland Collective Supports various programs including lending circles and financial literacy education. https://www.eastoaklan dcollective.com/ North East Oakland Youth Development Center Develops the social and leadership capacities of youth and young adults ages 6–24 so that they are prepared for employment, higher education, and leadership roles. http://eoydc.org/ North Eden I&R, Inc. Serves as a centralized source of health, housing, and human services information. http://edenir.org/ Mid First Place for Youth Supports youth, particularly those in foster care, in developing self- sufficiency and a sense of purpose by offering housing and case-management services. https://www.firstplacefor youth.org AC Give Teens 20 / Nav Z Website with self-sufficiency resources for teens. https://gt20.org/ AC Hidden Genius Project Focuses on increasing diversity in the workforce and transforming communities by mentoring black male youth in technology creation, entrepreneurship, and leadership skills. https://www.hiddengeni usproject.org/ AC Hively Provides help with affordable child care options and offers basic children’s necessities (clothing, shoes, diapers, wipes) to families in need. https://behively.org North, TV The Hub Family Resource Center Assistance with obtaining Medi- Cal, Cal Fresh (food stamps), health insurance, CalWORKs, job search, child support https://www.husd.us/de partments/sfs/student- and-parent-support- programs/the-hub Mid Alameda County Public Health Department • 2025–2027 CHA 257 Resource Name Summary Description Website Area Family Leave, etc. Lao Family Community Development Extensive menu of quality specialized jobs and career and employment programs. https://lfcd.org/ North Narika Seed Program Job training program to foster economic independence and self-reliance among survivors of domestic violence and new immigrant populations that are particularly vulnerable to abuse and exploitation. https://www.narika.org/s eed-program-1 AC One-Stop Career Center (EDD) Offers free help to job seekers, including employment and training assistance, and serves a range of specialized clients including veterans, youth, laid- off workers, and employers. https://www.careeronest op.org/LocalHelp/Americ anJobCenters/find- american-job- centers.aspx multi Rising Sun Center for Opportunity Provides green training, employment, and residential energy-efficiency services. https://risingsunopp.org AC Rubicon Programs Equips East Bay residents with resources to break the cycle of poverty. http://rubiconprograms. org/ AC Solid Rock Community Services Solid Rock Community Services provides resources, food, health/wellness and family reunification services to improve the quality of life for families in Alameda County to ensure basic needs are met. https://solidrockcommu nityservices.org/ South Tri-Valley Haven Offers services to survivors of domestic violence, sexual assault and homelessness, including financial assistance for survivors. https://trivalleyhaven.org / TV Tri-Valley Seek and Save Providing for utilities, rent, groceries, clothing, and other https://www.trivalleysee kandsave.org/ TV Alameda County Public Health Department • 2025–2027 CHA 258 Resource Name Summary Description Website Area case basis. United Way: SparkPoint Centers Centers assist families and individuals with financial stability, employment and skills training, and more. Locations in Alameda County include Fremont, Hayward, Oakland, and Union City. https://uwba.org/what- we-do/sparkpoint- program/ AC Unity Council Helps families and individuals build wealth and assets through sustainable economic, social, and neighborhood development programs. https://unitycouncil.org/ AC Youth Spirit Artworks Engages homeless and low- income individuals in artistic jobs and training to help them develop skills, experience, and self-confidence. http://youthspiritartwork s.org/ AC Various cities’ Human Services Departments Agencies may foster employment by offering job readiness training, career counseling, resume building, and interview preparation to help residents find work; and may promote economic independence and reduce poverty by partnering with agencies to provide job placement, vocational training, and support services such as childcare and transportation for eligible individuals. AC Alameda County Public Health Department • 2025–2027 CHA 259 Economic Stability: Education Also see overall Economic Stability for resources. Resource Name Summary Description Website Area Alameda County Early Head Start and Head Start Provides child development and family support services to facilitate children’s health and education. https://www.alamedafs. org/early-childhood-and- family-support AC Alameda County Library Offers family literacy days and free 1:1 learning for reading, writing, and speaking English better. https://aclibrary.org/ AC Alameda County Office of Education Oversees school districts' budgets and educational plans, serves as a school district, and provides programs to the county’s most vulnerable students. Also provides training and support services for educators. https://www.acoe.org/ AC Alameda County Tri-City Children and Youth Service Trains current graduate students in counseling and social work. https://www.acbhcs.org/ plan- administration/intern- and-trainee-programs- acbh-tri-city-children- and-youth-services/ South Berkeley City College Community college that provides instruction, student support and learning resources which enable students to earn associate degrees and certificates, and to attain college competency, careers, transfer, and skills for lifelong success. https://www.berkeleycity college.edu/ North Boys and Girls Clubs of San Leandro Provides a variety of recreational programs for children and youth, also after-school kinder care in elementary schools. http://bgcsl.org/ Mid Alameda County Public Health Department • 2025–2027 CHA 260 Resource Name Summary Description Website Area Brighter Beginnings: Family Partnership Program Home visiting program designed to help families in CalWORKs who have infants and children under 3 years old participate. https://www.brighter- beginnings.org/programs /parenting-and-child- development/family- partnership-program/ AC Center for Early Childhood Connections Social groups for parents and children, parent coaching and mentorship, assessments for 0- 5, educational and non-clinical services for 0-8 and their caregivers. http://www.thececc.org North Chabot College Community college that offers educational programs and experiences for students to succeed in their education, progress in the workplace, and engage in the civic and cultural life of the community. https://www.chabotcolle ge.edu/about/ Mid College of Alameda Community college that provides comprehensive and flexible programs and resources that empower students to achieve their goals. https://alameda.edu/ North Castro Valley Education Foundation CVEF provides resources and programs that support academic opportunities in Castro Valley Unified School District. https://www.cvef.org/ Mid California State University, East Bay, Hayward Promise Neighborhood Through collaborative partnership, offers over 35 programs that serve residents, families, children, and students in the Hayward area to ensure educational success and a safe, healthy, thriving community. http://www.csueastbay. edu/haywardpromise Mid Catholic Charities of the East Bay Offers services to aid youth, children, and families facing difficulties with immigration, eviction, literacy, or surviving traumatic violence. https://www.cceb.org/ AC Alameda County Public Health Department • 2025–2027 CHA 261 Resource Name Summary Description Website Area Community Child Care Council (4C’s) of Alameda County Strengthens children and families by helping parents find and pay for affordable child care. https://www.4c- alameda.org AC DayBreak Adult Care Provides education, training, and support for family caregivers. www.daybreakac.org AC Eden Area ROP Provides Career Technical Education (CTE) to high school students in CVUSD, HUSD, SLUSD, and SLzUSD. Provides CTE for Adults throughout Bay Area. https://www.edenrop.org / Mid Davis Street Community Center Supports children and families through State Subsidized Alternative Payment Program (APP) and child development centers. https://www.davisstreet. org AC Eden Youth and Family Center Provides services to promote the health and socioeconomic well-being of children, youth, and families. http://www.eyfconline.or g/ Mid First 5 Alameda Provide funding and programming for childcare and learning (e.g., parenting classes, childcare provider training), as well as advocacy and partnership. https://first5alameda.org / AC Fremont Education Foundation Provides grants to classroom teachers, music education, and other efforts in Fremont Unified School District. https://www.fremont- education.org/ South Fremont Family Resource Center Combines the best efforts of multiple social services programs, including educational events and child care information and subsidies. https://www.fremont.gov /government/department s/human- services/fremont-family- resource-center South Alameda County Public Health Department • 2025–2027 CHA 262 Resource Name Summary Description Website Area Friends of Children with Special Needs Provides information and assistance to children with special needs, adults with special needs, and their communities. https://fcsn1996.org/ South Give Teens 20 / NavZ Website with self-sufficiency resources for teens, including information on funding for college. https://gt20.org/ AC Hidden Genius Project Focuses on increasing diversity in the workforce and transforming communities by mentoring black male youth in technology creation, entrepreneurship, and leadership skills. http://www.hiddengeniu sproject.org/ Hively Provides education and training to child care providers and helps families find and pay for child care that promotes early childhood development and learning. https://behively.org/ AC Laney College Community college that provides certificates, degrees, transfer pathways, career education, and lifelong learning opportunities. https://laney.edu/ North Las Positas College Community college that offers curriculum for students seeking career preparation, transfer to a four-year college or university, or personal enrichment. https://laspositascollege .edu/ TV Merritt College Community college that provides rigorous and engaging in-person and remote learning experiences that support students’ desired academic and personal achievements. https://www.merritt.edu/ North Alameda County Public Health Department • 2025–2027 CHA 263 Resource Name Summary Description Website Area Mission Valley ROP Provides career training for successful business, medical, and technical careers. https://www.mvrop.org/ South New Haven Schools Foundation Administers an annual grant program that provides funding for innovative classroom and enrichment programs in the New Haven School District. https://nhsfoundation.or g/ South Newark Education Foundation Supports major initiatives and programs in Science, Technology, and the Arts for the Newark Unified School District. https://newarkeducation alfoundation.org/ South Ohlone Community College Community college that provides excellent instruction and support services, awards associate degrees and certificates, and promotes university transfer. https://www.ohlone.edu/ South San Leandro Education Foundation Funds positive youth development activities in the San Leandro community. https://www.sledfund.or g/ Mid Tri-Valley ROP Offers high school students in the Tri-Valley hands-on career- technical education classes that explore careers and/or college majors and develop job skills and a robust Middle College High School Program. https://www.tvrop.org/ TV Union City Family Center Bilingual story time, kinder readiness programs for families with children ages 0-5 who reside in Union City and New Haven Unified School District boundaries. http://www.unioncityfam ilycenter.org South Alameda County Public Health Department • 2025–2027 CHA 264 School Districts in Alameda County School District Location Website Alameda USD Alameda https://www.alamedaunified.org Albany USD Albany https://www.ausdk12.org/ Berkeley USD Berkeley https://www.berkeleyschools.net/ Castro Valley USD Castro Valley https://www.cv.k12.ca.us/ Dublin USD Dublin https://www.dublin.k12.ca.us/ Emeryville USD Emeryville https://emeryusd.k12.ca.us/ Fremont USD Fremont https://fremontunified.org/ Hayward USD Hayward https://www.husd.us/ Livermore Valley Joint USD Livermore https://www.livermoreschools.org/ Newark USD Newark https://www.newarkunified.org/ New Haven USD Union City https://mynhusd.org/ San Leandro USD San Leandro https://www.sanleandro.k12.ca.us/ San Lorenzo USD San Lorenzo https://www.slzusd.org/ Oakland USD Oakland https://www.ousd.org/ Piedmont USD Piedmont http://www.piedmont.k12.ca.us/ Pleasanton USD Pleasanton https://www.pleasantonusd.net/ Alameda County Public Health Department • 2025–2027 CHA 265 Economic Stability: Food Security Also see overall Economic Stability for resources. Resource Name Summary Description Website Area 18 Reasons Empowers community members with the confidence to buy, cook, and eat good food every day. https://18reasons.o rg/ AC Acta Non Verba Provides urban farming opportunities for children, youth, and families in East Oakland to deepen their understanding of nutrition, food production, and healthy living, and strengthen their ties to the community. https://anvfarm.org / North Alameda County Community Food Bank Pursues a hunger-free community by conducting food distribution services, CalFresh outreach, youth and student nutrition programs, and mobile produce stands at health-delivery centers. https://www.accfb. org/ AC Alameda County Food Resources Lists community groups providing food assistance. https://www.needh elppayingbills.com/ html/alameda_cou nty_food_banks.ht ml AC Alameda County Deputy Sheriffs’ Activities League Collaborates with Alameda County adults and youth on initiatives to reduce crime and improve community health. https://www.acdsal .org/ AC Alameda County Public Health Department Offers community-based activities that engage residents and local partners in the planning, evaluation, and implementation of health activities. http://www.acphd. org/ AC Alameda County Public Health Department – Nutrition Services Promotes and supports healthy eating and physical activity. https://acphd.org/n utrition-services/ AC Alameda County Public Health Department • 2025–2027 CHA 266 Resource Name Summary Description Website Area Alameda County Social Services Agency Provides benefits programs through cash assistance and CalFresh (“food stamps”), CalWORKs (assistance for families with children), General Assistance, and Medi-Cal Health Insurance. https://www.alame dasocialservices.or g AC Alameda County Women, Infants, and Children (WIC) Promotes healthy eating via nutrition advice, help with breastfeeding, referrals to services, and special checks to buy healthy food items. http://www.acphd. org/wic.aspx AC Axis Community Health WIC Program Provides eligible women and children with programming that supports better nutrition, offers supplemental food, and makes referrals to health care and other community services. https://axishealth.o rg/wic/ TV Catholic Charities of the East Bay Offers services to aid youth, children, and families facing difficulties with immigration, eviction, literacy, or surviving traumatic violence. https://www.cceb.o rg/ AC Daily Bowl Recovers excess food that would otherwise go to waste and delivers it to Bay Area agencies that feed families who are hungry. https://dailybowl.or g/ AC Davis Street Community Center Provides emergency food, clothing, utility assistance and housing support. https://www.daviss treet.org AC First 5 Alameda County Provide funding, programming, advocacy, and partnership to support children aged 0-5 and their families, including ensuring basic resources such as food. https://first5alame da.org/ AC Fremont Family Resource Center Combines the best efforts of multiple social services programs, including food assistance. https://www.fremo nt.gov/government/ departments/huma n-services/fremont- family-resource- center South Alameda County Public Health Department • 2025–2027 CHA 267 Resource Name Summary Description Website Area Fresh Approach Improves healthy food access in the community through farmers markets, community gardens, and cooking and nutrition classes. https://www.fresha pproach.org/ AC Mandela MarketPlace Builds health, wealth, and assets in low- income communities by creating local food enterprises. https://www.mand elapartners.org/ AC Meals on Wheels of Alameda County Delivers nutritious meals to, and performs wellness checks on, frail and/or homebound seniors. https://www.feedin gseniors.org/ AC Open Heart Kitchen Provides equitably access to nutritious food today, while building a food secure tomorrow. Community meals, senior center meals, pop-up pantries, and Open Heart Food Bank. https://www.openh eartkitchen.org/ TV Senior Support Program of the Tri- Valley Provides programming and referrals for older adults, including case management, 1:1 counseling and emotional support, and wellness education (e.g., nutrition, fitness). https://seniorservic escoalition.org/seni or-support- program-of-the-tri- valley/ TV Solid Rock Community Services Solid Rock Community Services provides resources, food, health/wellness and family reunification services to improve the quality of life for families in Alameda County to ensure basic needs are met. https://solidrockco mmunityservices.or g/ South South Hayward Parish Emergency Food Pantry Food pantry serves thousands of pounds of food per month. https://www.south haywardparish.org/ food-pantry Mid/ South Spectrum Community Services: Meals on Wheels, Senior Meals Meals on Wheels offers healthy, home-delivered meals for seniors who are unable to prepare their own food and have difficulty with mobility; Senior Meals distributes freshly prepared, nutritious meals https://www.spectr umcs.org/senior- services AC Alameda County Public Health Department • 2025–2027 CHA 268 Resource Name Summary Description Website Area can pick them up. The East Oakland Collective Supports various programs including food distribution. https://www.eastoa klandcollective.co m/ North Tri-City Volunteers Food Bank & Thrift Store Provides food assistance to the residents of Alameda County; largest client-direct food bank in the area, with marketplace, mobile pantry, and bag lunch program. https://tcvfoodbank .org/ South Tri-Valley Haven for Women: Food Pantry Provides free groceries, fresh fruit and veggies to low-income Tri- Valley residents. https://trivalleyhave n.org/food-pantry/ TV Tri-Valley Seek and Save Providing for groceries and other living essentials on a case-by-case basis. https://www.trivalle yseekandsave.org/ TV United Way: SparkPoint Centers Centers assist families and individuals with financial stability, food security, and more. Locations in Alameda County include Fremont, Hayward, Oakland, and Union City. https://uwba.org/w hat-we- do/sparkpoint- program/ AC Union City Family Center Provides multiple supports including food distribution. https://www.unionc ityfamilycenter.org/ South Viola Blythe Community Service Center of Newark Distributes emergency food and clothing, makes referrals to other social services agencies. https://www.violabl ythe.org/ South Peaceful Communities Resource Name Summary Description Website Area A Safe Place Provides domestic violence shelter and services. https://www.asafeplace. org/ AC Afghan Coalition Supports and empowers Afghani refugee families, women, and youth to achieve health and wellness. https://www.afghancoali tion.org/ AC Alameda County Public Health Department • 2025–2027 CHA 269 Resource Name Summary Description Website Area Alameda County Court Appointed Special Advocates Promotes and supports quality volunteer advocates to speak for the best interests of abused and neglected children in the dependency court system. https://casaofalamedac ounty.org/ AC Alameda County Deputy Sheriffs’ Activities League Collaborates with residents on initiatives that reduce crime and improve community health. https://www.acdsal.org/ AC Alameda County District Attorney Accountability Table Coalition of Alameda County- based organizations that work together to advance public safety solutions. https://acaccountability. org AC Alameda County Family Justice Center Ensures the safety, healing, and self-empowerment of victims of interpersonal violence through supportive services related to counseling, trauma recovery, and resource referral. http://www.acfjc.org/ AC Alameda Family Services Offers programs to improve the emotional, psychological, and physical health of children, youth and families. https://www.alamedafs. org/ AC Alternatives in Action Offers school and community programs for youth. https://www.alternatives inaction.org/ AC Bananas Supports families and individuals with children by providing referrals to childcare, education around reimbursement for childcare, and workshops for parents. https://bananasbunch.or g/ AC Alameda Health System, Sexual Assault & Domestic Violence Program (SARRT) Extends 24/7 trauma-informed comprehensive support to survivors of sexual assault, domestic violence, and human trafficking, aged 14 and above, including their families. https://www.alamedahe althsystem.org/sarrt/ AC Berkeley Youth Alternatives Helps at-risk youth through programs that emphasize https://www.byaonline.o rg/ North Alameda County Public Health Department • 2025–2027 CHA 270 Resource Name Summary Description Website Area sufficiency. Boys and Girls Clubs Provide mentorship, programming (including sports, arts, wellness, and leadership), and safe places for young people. https://www.bgca.org/ Mid, North Building Futures Provides a continuum of care through residential programs, crisis lines, and case management to help county residents build a future free of violence and homelessness. http://www.bfwc.org/ AC Calico Center Works with law enforcement officers, child welfare workers, prosecutors, and other professionals to achieve justice for abused children by investigating abuse allegations and eliciting testimony from children. https://www.calicocente r.org/ AC Catholic Charities of the East Bay Offers services to aid youth, children, and families facing difficulties with immigration, eviction, literacy, or surviving traumatic violence. https://www.cceb.org/ AC Center for Human Development Facilitates the growth and strengthening of communities by providing services for at-risk youth, individuals, and families. http://chd- prevention.org/ AC Community Violence Solutions Works to end sexual assault and family violence by providing services to survivors of sexual assault or abuse and their families. https://cvsolutions.org/ AC Eden I&R, Inc. Serves as a centralized source of health, housing, and human services information. http://edenir.org/ Mid Alameda County Public Health Department • 2025–2027 CHA 271 Resource Name Summary Description Website Area Eden Youth and Family Center Provides services to promote the health and socioeconomic well-being of children, youth, and families. http://www.eyfconline.or g/ Mid Ella Baker Center for Human Rights Organizes to shift resources away from prisons and punishment towards opportunities that make our communities safe, healthy, and strong. https://ellabakercenter.o rg/ North Exonerated Nation Helps exonerated formerly incarcerated individuals transition to life outside prison. https://exoneratednation .org/ AC Family Support Services Assists families who face serious challenges in successfully caring for their children. https://fssba.org/ AC Family Violence Law Center Helps diverse communities in Alameda County heal from domestic violence and sexual assault, advocating for justice and healthy relationships. https://fvlc.org/ AC Fresh Lifelines for Youth Prevents juvenile crime and incarceration through legal education, leadership training, and one-on-one mentoring. https://flyprogram.org/ AC Girls, Inc. Runs programs designed to empower and inspire girls and young women. https://girlsinc.org/ AC Highland Hospital Sexual Assault Response and Recovery Team Provides comprehensive services to victims of domestic violence and sexual assault. https://www.alamedahe althsystem.org/sarrt/ AC Hively Hively helps families find and pay for child care, offers mental health support and provides https://behively.org/ AC Alameda County Public Health Department • 2025–2027 CHA 272 Resource Name Summary Description Website Area and abuse. Immigration Institute of the Bay Area Helps immigrants, refugees, and their families settle in the community by providing legal- aid services as well as education and community engagement opportunities. https://iibayarea.org/ AC KidPower International Provides resources and training to support education on safety, including bullying solutions, sexual assault prevention, child abuse prevention, self-defense, and online safety. https://www.kidpower.or g/ AC Koreatown Northgate (KONO) Ensures the district (Telegraph Avenue from 20th to 35th Streets in Oakland) is safe, clean, and promoted. https://www.koreatownn orthgate.org/ North Narika Helps domestic violence survivors with advocacy, support, and education. https://www.narika.org/ AC Oakland Unite! Targets the highest-risk community members and neighborhoods, with programs focused on interrupting violence as it occurs and preventing future violence. https://rootscommunityh ealth.org/oakland-unite- violence-prevention- navigation/ North OneChild Helps youth take action against sex trafficking through education, advocacy, mobilization, and survivor care and empowerment. https://www.onechild.ca / AC Project Avary Runs a program that meets the unique emotional needs of children with a parent in prison, starting at ages 8–11 and continuing for 10 years. http://www.projectavary. org/ AC REACH Ashland Youth Center Provides youth programs in the areas of arts, recreation, https://reachashland.org / Mid Alameda County Public Health Department • 2025–2027 CHA 273 Resource Name Summary Description Website Area and health and wellness. Reentry Success Center Supports formerly incarcerated individuals in transitioning back into the community. http://reentrysuccess.or g/ AC Restorative Pathways (formerly Ruby’s Place) Offers women, men, transgender people, and accompanied minors who have been affected by domestic violence or human trafficking with shelter, case management, therapy, and housing services. https://restorativepathw ays.org/ Mid Safe Alternatives to Violent Environments Supports victims of domestic violence through providing shelter, support and educational opportunities. https://save-dv.org/ 24-hour crisis line: (510) 794-6055 South STAND! for Families Free of Domestic Violence Strives to break the cycle of violence in families impacted by domestic violence and child abuse by providing services around therapy, crisis lines and educational opportunities. http://www.standffov.org / AC Tri-Valley Haven Offers services to survivors of domestic violence, sexual assault and homelessness, including restraining order assistance, counseling groups, financial assistance for survivors, groceries, and more. https://trivalleyhaven.org / TV Youth Alive! Works to prevent violence, and helps violently wounded people heal themselves and their community. http://www.youthalive.or g/ AC Youth Uprising Engages youth in East Oakland in leadership opportunities to drive the health and economic growth of the community. https://www.youthuprisi ng.org/ North Alameda County Public Health Department • 2025–2027 CHA 274 Housing and the Unhoused Resource Name Summary Description Website Area Abode Services Works with government, supporters, landlords, and clients to provide housing for people experiencing homelessness. https://www.abode services.org/ AC Alameda County Health Care for the Homeless Increases access to quality health care for homeless individuals through free health centers and mobile clinics that provide primary care, substance abuse treatment, and other services. https://www.achch .org/ AC Alameda County Housing and Community Development Leads the development of housing and programs to serve low- and moderate- income households, people experiencing homelessness, and disabled individuals. http://www.acgov. org/cda/hcd/ AC Alameda Point Collaborative Permanent supportive housing community for individuals experiencing homelessness, which aims to break the cycle of poverty by providing supportive services around education, employment, nutrition, and entrepreneurship. https://apcollabora tive.org/ North Bay Area Community Services Provides behavioral health and housing services for teens, adults, older adults, and their families across the Bay Area. https://www.bayar eacs.org/ AC Bay Area Legal Aid Increases access to the civil justice system through legal assistance for low-income people. https://baylegal.or g/ AC Building Futures Provides a continuum of care through residential programs, crisis lines, and case management to help county residents build a future free of violence and homelessness. http://www.bfwc.or g/ AC Alameda County Public Health Department • 2025–2027 CHA 275 Resource Name Summary Description Website Area Building Opportunities for Self-Sufficiency Operates a variety of programs and services targeted towards empowering homeless, poor and disabled individuals to be self- sufficient. https://self- sufficiency.org/ AC Catholic Charities of the East Bay Offers a wide variety of services to aid youth, children and families facing eviction including rent assistance and funds for housing deposits. https://www.cceb. org/housing- services/ AC CityServe of the Tri- Valley Provides counseling, mental health support, job training, and health services for individuals and families. https://cityserveca res.org/ TV Clausen House Provides housing, wellness programs, and advocacy for developmentally disabled adults in Oakland and the surrounding East Bay area. https://clausenhou se.org/ North DayBreak Adult Care Offers housing navigation and support for vulnerable seniors in Alameda County. www.daybreakac.o rg AC DeafPlus Integrated adult day program that serves deaf adults with disabilities, including support necessary to develop independent living skills. https://deafplus.us / South East Bay Asian Local Development Corporation Works with and for the diverse populations of the East Bay to build healthy, vibrant, and safe neighborhoods through community development. https://ebaldc.org/ AC East Bay Community Law Center Housing Program Defends low-income tenants in eviction lawsuits brought against them. https://ebclc.org/n eed- services/housing- services AC East Bay Housing Organizations Works through organized campaigns focused on policy or a http://ebho.org/loo king-for-housing/ AC Alameda County Public Health Department • 2025–2027 CHA 276 Resource Name Summary Description Website Area ongoing committees. Eden Council for Hope and Opportunity (ECHO) Housing Supports fair housing, tenant rights, and offers other services. https://www.echof airhousing.org/ Mid Eden Housing Creates and sustains affordable housing for very low, low and moderate-income families, seniors, veterans, people living with physical, mental, or developmental disabilities, and the formerly homeless. https://edenhousin g.org/ Mid Eden I&R, Inc. Serves as a centralized source of health, housing, and human services information. http://edenir.org/ Mid Everyone Home Supports collaborative projects to end homelessness. http://everyoneho me.org/ AC FESCO Provides low/extremely low- income homeless families with food, emergency, transitional, permanent housing, and supportive services. https://www.fescof amilyshelter.org/ AC First Place for Youth Supports youth, particularly those in foster care, in building self- sufficiency and a sense of purpose by offering housing and case management services. https://www.firstpl aceforyouth.org AC Goodness Village An affordable tiny home program that provides the Tri-Valley’s formerly unhoused neighbors a safe and supportive community to live independently, heal, and thrive. https://gvlivermore .org/ TV Homeless Action Center Makes it possible for people who are experiencing severe homelessness, poverty, or disability to access social safety http://homelessact ioncenter.org/ AC Alameda County Public Health Department • 2025–2027 CHA 277 Resource Name Summary Description Website Area representation. HOPE Project Mobile Health Clinic Homeless Outreach for People Empowerment Project is a mobile clinic that brings services to those in need. It provides health and social services to homeless people in five locations throughout southern and eastern Alameda County, in partnership between Abode Services and Bay Area Community Health. https://bach.health /homeless- programs TV/ South Lao Family Community Development Operates a range of housing for families, seniors, and adults in need. https://lfcd.org/ North MidPen Housing Nonprofit developer that owns and manages high-quality affordable housing for low-income families, seniors and people with special needs. https://www.midpe n-housing.org/ AC Open Heart Refuge 20-bed overnight shelter for unhoused folks and individuals experiencing crisis. Located at the Vineyard Resource Center in Livermore. Open 365 days a year. https://www.openh eartkitchen.org/ref uge TV Rebuilding Together East Bay Network Provides free rehabilitation and critical repairs to the homes of income qualified seniors, veterans, and people with disabilities. https://rtebn.org/ North Rubicon Programs Equips East Bay residents with resources to break the cycle of poverty. http://rubiconprogr ams.org/ AC Satellite Affordable Housing Associates (SAHA) Offers quality affordable homes and services that empower people and strengthen neighborhoods. https://www.sahah omes.org/ AC Shepherd's Gate Provides housing and job skill training for women in transition as well as programs for their children. https://shepherdsg ate.org/ TV Alameda County Public Health Department • 2025–2027 CHA 278 Resource Name Summary Description Website Area South County Homeless Project Offers emergency housing, including special needs housing, and various support services. https://www.self- sufficiency.org/sch p Mid, South South Hayward Parish Shelter guests receive a nightly foldable mat, sleeping bag, as well as a hot dinner and breakfast. https://www.south haywardparish.org/ shelter Mid The East Oakland Collective Supports various programs including advocacy for the rights of unhoused individuals, research on alternative housing models, and improvement of hygiene at encampments. https://www.easto aklandcollective.c om/ North Tri-Valley Haven Offers services for homeless individuals and families in severe economic need, including shelter, a food pantry, and transitional housing. https://trivalleyhav en.org/ TV Tri-Valley Seek and Save Provides permanent housing application assistance, occasional relocation funding. https://www.trivall eyseekandsave.org / TV United Way: SparkPoint Centers Centers assist families and individuals with financial stability, rental support, and more. Locations in Alameda County include Fremont, Hayward, Oakland, and Union City. https://uwba.org/w hat-we- do/sparkpoint- program/ AC Unity Council Helps families and individuals build wealth and assets through sustainable economic, social, and neighborhood development programs. https://unitycounci l.org/ AC Women's Daytime Drop-In Center Empowering women and children to move from the streets to a home by providing housing problem solving services and support, housing case management and referral services, and a transitional housing program. http://www.women sdropin.org North Alameda County Public Health Department • 2025–2027 CHA 279 Resource Name Summary Description Website Area Various cities’ Housing and Human Services Departments Provide various support for housing needs, which can include emergency shelter, rental assistance, housing navigation, and specialized aid for unhoused, veterans, older adults, and disabled individuals. AC Built Environment Resource Name Summary Description Website Area Alameda County Community Development Agency: Healthy Homes Dept., Lead Poisoning Prevention Program Provides grants for lead hazard removal and offers guidelines for lead poisoning prevention and risk reduction. https://www.achhd .org/leadpoisoning/ leadp.htm AC Alameda County Health, Emergency Medical Services: Injury Prevention Programs Operates and supports several programs designed to prevent injuries and emergencies from occurring among children and older adults. https://health.alam edacountyca.gov/p revention/ AC Alameda County Health, Environmental Health Department Protects and enhances the health and quality of life by ensuring food and recreational safety, reducing exposures to toxins and pests, protects the quality of water, air, the physical environment and more. https://deh.acgov. org/index.page AC Alameda County Public Health Department Works to reduce barriers to health in the built environment, including causes of asthma and other challenges. https://acphd.org/ AC Alameda County Public Works Agency Aims to provide safe, well- maintained and lasting public works infrastructure for the https://www.acpw a.org/index.page AC Alameda County Public Health Department • 2025–2027 CHA 280 Resource Name Summary Description Website Area areas. Alameda County Transportation Commission: Bicycle Safety Education Program Educates approximately 4,000 adults, teenagers and children annually in safe bicycle riding techniques. Encourages bicycle riders to ride their bicycles with greater control and awareness to enhance their travel safety. https://www.alame dactc.org/program s-projects/bicycle- and- pedestrian/bicycle- safety-education AC Child Passenger Safety Program Supports the standardization and quality- control course with content and instructors to ensure that information and materials being taught and disseminated are up-to-date, accurate, and consistent. https://www.in.gov /cji/traffic- safety/occupant- protection/children /child-passenger- safety/ AC City of Berkeley Department of Health Services Provides a wide array of services to monitor the health of the community, to prevent epidemics and the spread of disease, to protect against environmental hazards, to respond to disasters, and to encourage healthy behaviors. https://www.cityof berkeley.info/publi chealth/ North First 5 Alameda County Offers continuous prevention and early intervention programs that promote optimal health and development, narrow disparities and improve the lives of children ages 0–5 and their families. http://www.first5al ameda.org/ AC Safe Kids Alameda County Coalition implements evidence- based programs, such as car-seat checkups, safety workshops and sports clinics, that help parents and caregivers prevent childhood injuries. https://www.safeki ds.org/coalition/sa fe-kids-alameda- county AC Various cities’ Public Works agencies Address illegal dumping, storm drainage and sewer/wastewater systems maintenance, AC Alameda County Public Health Department • 2025–2027 CHA 281 Resource Name Summary Description Website Area capital contracts, etc. Various local water agencies Provide drinking water to community residents and monitor water quality. AC Climate/Natural Environment Resource Name Summary Description Website Area Alameda County Department of Environmental Health Ensures food and recreational safety, reduces exposures to toxics and pests, protects the quality of local water, air, and physical environment. https://deh.acgov. org/index.page AC Alameda County Office of Sustainability Leads implementation of county’s Climate Action Plan. https://www.acgov .org/sustain/ AC Asian Pacific Environmental Network Supports environmental justice movement with work focused on Asian immigrant and refugee communities. https://apen4ej.org / AC Bay Area Climate Adaptation Network (BayCAN) A collaborative network of local government staff and partnering organizations working to help the Bay Area respond effectively and equitably to the impacts of climate change on human health, infrastructure, and natural systems. https://www.bayca nadapt.org/ AC Bay Area Air Quality Management District Oversees and implements policies and regulations for the control of air pollution within the nine counties that surround San Francisco Bay. https://www.baaq md.gov/ AC City of San Leandro: Hub Network This network of sites – including places of worship, community centers, and neighborhoods – will center the most vulnerable https://www.sanle andro.org/1173/Hu b-Sites-in-San- Leandro Mid Alameda County Public Health Department • 2025–2027 CHA 282 Resource Name Summary Description Website Area and belonging, and climate mitigation and adaptation to be “ready for anything.” Climate Protection Planning Program Supports development and implementation of Comprehensive Climate Action Plan, a roadmap for meeting regional near- and long-term greenhouse gas (GHG) reduction targets by reducing GHG emissions and enhancing carbon sinks in the Bay Area. https://www.baaq md.gov/en/plans- and- climate/climate- planning/bay-area- regional-climate- action-planning- initiative AC Collective Resilience Supports the development of resilience hubs. https://collectivere siliencenow.org AC East Bay Regional Park District Conserves open space resources and provides outdoor recreational opportunities for present and future generations. https://www.ebpar ks.org/ AC Friends of Lincoln Square Park Supports the building of a community resilience center in Oakland’s Chinatown. https://www.friend soflincolnsquarepa rk.org/ North Local Clean Energy Alliance Membership organization to promote the development and democratization of local renewable energy resources. https://localcleane nergy.org/ AC Sierra Club Grassroots organization that supports efforts to appreciate and protect the environment and create a more sustainable future. https://www.sierra club.org/sfbay AC West Oakland Environmental Indicators Project Conducts participatory environmental research and engages in environmental justice advocacy. https://woeip.org/ North Various cities’ Environmental Services Divisions Agencies’ work may include managing core ecological and utility functions, including solid waste/recycling, wastewater treatment, stormwater management, and water AC Alameda County Public Health Department • 2025–2027 CHA 283 Resource Name Summary Description Website Area enforcing environmental regulations, managing hazardous waste, and leading climate action plans/sustainability initiatives. Racism/Discrimination Many of the agencies/organizations addressing the other health needs also address racism/discrimination. The agencies/organizations listed below specifically address it. Resource Name Summary Description Website Area Alameda County District Attorney Accountability Table Coalition of Alameda County- based organizations working together to advance public safety solutions. https://acaccounta bility.org AC Ella Baker Center for Human Rights Organizes to shift resources away from prisons and punishment towards opportunities that make our communities safe, healthy, and strong. https://ellabakerce nter.org/ North NAACP Hayward South Alameda County Seek the enactment and enforcement of federal, state and local laws securing civil rights, and inform the public of the adverse effects of racial discrimination. https://naacphayw ard.org/advocacy Mid, South NAACP Oakland Seek the enactment and enforcement of federal, state and local laws securing civil rights, and inform the public of the adverse effects of racial discrimination. https://www.naacp oakland.org/ North Showing Up for Racial Justice Bay Area Through community organizing, mobilizing, and education, SURJ moves white people to act as part of a multi-racial majority for justice. https://www.surjba yarea.org/ North Alameda County Public Health Department • 2025–2027 CHA 284 BEHAVIORAL HEALTH Resource Name Summary Description Website Area A Better Way Inc. Assessment/referral and parenting support and education through group classes, topic-specific trainings, and through peer-led support groups. https://www.abetterwayi nc.net/ AC Afghan Coalition Supports and empowers Afghani refugee families, women, and youth to achieve health and wellness. https://www.afghancoali tion.org/ AC Alameda County Behavioral Health Care Services Provides services to maximize the recovery, resilience and wellness of all eligible Alameda County residents who are developing or experiencing serious mental health, alcohol or drug concerns. http://www.acbhcs.org/ AC Alameda County Medical Center Substance Abuse Program Offers high quality treatment and prevention services for residents seeking recovery from drug and alcohol addictions. https://www.acbhcs.org/ substance-use- treatment/ AC Alameda County Social Services Agency Provides benefits programs through cash assistance and CalFresh (“food stamps”), CalWORKs (assistance for families with children), General Assistance, and Medi-Cal Health Insurance. https://www.alamedaso cialservices.org AC Alameda Health System Aims to extend care, wellness, and prevention to all members of the community. http://www.alamedaheal thsystem.org/ AC Alameda Health System John George Psychiatric Hospital Provides psychiatric emergency and acute care services to adults experiencing severe and disabling mental illnesses. https://www.alamedahe althsystem.org/locations /john-george-psychiatric- hospital/ AC Alameda County Public Health Department • 2025–2027 CHA 285 Resource Name Summary Description Website Area Al-Anon 12-step program for adult relatives and friends of alcoholics or someone coping with alcoholism. https://al-anon.org/ AC Alateen 12-step program for teen relatives and friends of alcoholics or someone coping with alcoholism. https://al-anon.org/for- members/group- resources/alateen AC Alcoholics Anonymous 12-step program for individuals who need help with alcohol addiction or excessive drinking. https://www.aa.org/ AC Asian Health Services - Specialty Mental Health Provide children and youth ages 0-8 (early childhood) and 5-21 (children & youth) living in Alameda County with social- emotional support through screening, assessment, education, early intervention, medication support, and individual and family therapy. http://www.asianhealths ervices.org AC Axis Bridge Mental Health Urgent Care Provides rapid access to mental health treatment to patients ages 5 and up. https://axishealth.org/axi s-bridge-mhuc/ TV Axis Community Health Behavioral Health Services Integrated behavioral health, providing mental health and substance use counseling for adults, teens, couples, families and children. https://axishealth.org/ib h/ TV Bay Area Community Services Provides behavioral health and housing services for teens, adults, older adults, and their families across the Bay Area. https://www.bayareacs. org AC Baywell Health Parent organization of West Oakland Health Center, FQHC with multiple locations that offers medical and dental care as well as behavioral health and other services. https://baywellhealth.org / North Alameda County Public Health Department • 2025–2027 CHA 286 Resource Name Summary Description Website Area Beats, Rhymes and Life Engages youth in Oakland to use hip-hop and self-expression as a form of therapy to facilitate healing. http://brl-inc.org/ North Boldly Me Helps people with differences due to birth conditions, medical treatments, injury, disease, and self-perception heal from emotional trauma. http://www.boldlyme.org / AC Building Futures Provides a continuum of care through residential programs, crisis lines, and case management to help county residents build a future free of violence and homelessness. http://www.bfwc.org/ AC California Smokers Helpline Free telephone program that helps smokers quit.. 1-800-BUTTS AC The Center for Early Childhood Connections Child and family therapy, assessments for 0-5, perinatal emotional support during infertility, pregnancy, adoption and postpartum. http://www.thececc.org North Cherry Hill Detox Sobering Unit assists those needing immediate sobering services for 23 hours or less; Detox Unit residential program serves men and women who are withdrawing from the effects of alcohol or drug use. https://www.horizonservi ces.org/cherry-hill/ Mid Chrysalis Residential treatment program for women age 18+ living with mental health and substance use disorders. https://www.horizonservi ces.org/chrysalis/ North City of Berkeley Department of Health Services Provides services to monitor the health of the community, prevent epidemics and the spread of disease, protect against environmental hazards, https://www.cityofberkel ey.info/publichealth/ North Alameda County Public Health Department • 2025–2027 CHA 287 Resource Name Summary Description Website Area behaviors. City of Union City Youth and Family Services Provides youth violence prevention and intervention services (ages 8-24). https://www.unioncity.or g/182/Youth-Family- Services Mid/ South City of Fremont Youth and Family Services Clinic Family-focused behavioral health services for children and youth ages 0 to 21 years old to improve social-emotional well- being, strengthen family relationships, reduce delinquency, and increase school achievement. https://www.fremont.gov /government/department s/human- services/mental-health- services/family- counseling South Crisis Support Services of Alameda, County 24-Hour Crisis Line Gives round-the-clock telephone support to people coping with difficult circumstances or emotions, or suicidal thoughts or feelings. https://www.crisissuppo rt.org/crisis-services 24-hour line: 988 (call or text) AC Cronin House Residential treatment program for men age 18+ living with mental health and substance use disorders. https://www.horizonservi ces.org/cronin-house/ Mid CURA, Inc. Helps individuals experiencing difficulties with substance abuse achieve sobriety, health, and wellness. https://www.curainc.co m/Home.html AC DeafPlus Integrated adult day program that serves deaf adults with disabilities, including addressing social isolation. https://deafplus.us/ South Davis Street Community Center Behavioral Health Services for adults and children. https://www.davisstreet. org Mid East Bay Agency for Children Offers comprehensive services designed to reduce the incidence/impact of adverse childhood experiences and other traumas. http://www.ebac.org/ AC Alameda County Public Health Department • 2025–2027 CHA 288 Resource Name Summary Description Website Area Eden I&R, Inc. Serves as a centralized source of health, housing, and human services information. http://edenir.org/ Mid Family Education and Resource Center Offers educational information on health, family relationships and well-being. http://askferc.org/ AC Family Paths 24- Hour Parenting Stress Hotline Provides free, confidential counseling and information to anyone in need of parenting support as well as referrals to nearly 900 community resources. Staffed by professional and volunteer counselors, who support parents and caregivers around a variety of parenting issues. https://www.familypaths .org/ 1-800-829-3777 AC First 5 Alameda County Offers continuous prevention and early intervention programs that promote optimal health and development, narrow disparities and improve the lives of children ages 0–5 and their families. http://www.first5alamed a.org/ AC Flourish Agenda Strives to help youth of color flourish. https://flourishagenda.c om/ AC Fred Finch Youth & Family Services Comprehensive behavioral health services for children, youth, young adults, and their families to address challenges that may include mental or emotional impairment, developmental disability, early trauma and abuse. https://www.fredfinch.or g AC Fremont Family Resource Center Combines the best efforts of multiple social services programs, including providing mental health services for all ages and substance use intervention for teens. https://www.fremont.gov /government/department s/human- services/fremont-family- resource-center South Alameda County Public Health Department • 2025–2027 CHA 289 Resource Name Summary Description Website Area Friends of Children with Special Needs Provides information and assistance to children with special needs, adults with special needs, and their communities. https://fcsn1996.org/ South Gamblers Anonymous 12-step program for people coping with a gambling addiction. http://www.gamblersano nymous.org/ga/ AC George Mark Children’s Home Offers round-the-clock skilled pediatric nursing, fun activities for children with complex medical conditions, transitional care, end-of-life care, respite care, and bereavement care. https://georgemark.org/ Mid Girls, Inc. Runs programs designed to empower and inspire girls and young women. https://girlsinc.org/ AC Hively Hively Mental Health provides counseling services to individuals, families and children via MediCal and private payment options. We serve ALL ages. https://behively.org/men tal-health-services/ AC Horizon Services, Inc. Provides preventive, educational, and therapeutic services and environments for individuals, families, and the community. https://www.horizonservi ces.org/ AC Hume Center Provides mental health prevention, intervention, and support. http://www.humecenter. org TV, SAC Jewish Family and Community Services East Bay Promotes the well-being of individuals and families of all ages, races, and religions with essential mental health and social services at every stage of life. https://jfcs-eastbay.org/ AC Kidango, Inc. Runs free and reduced-cost pre- school/ child care centers. https://www.kidango.org / AC Alameda County Public Health Department • 2025–2027 CHA 290 Resource Name Summary Description Website Area La Familia Counseling Services Supplies mental health and community support services to underserved multicultural communities. https://livelafamilia.org/ Mid Lambda Project Eden Drop-In Center Provides mental health services and support to young people aged 12-24 who identify as LGBTQIA+. https://www.horizonservi ces.org/project- eden/lambda-youth- project/ Mid Lincoln Families Provides children with support and services, from an early age through high-school graduation. http://lincolnfamilies.org / AC Mindful Life Project Empowers underserved children to gain self-awareness, confidence, self- regulation, and resilience through mindfulness and other transformative skills. https://www.mindfullifep roject.org/ AC Narcotics Anonymous 12-step program for individuals coping with substance abuse or drug addiction. https://www.na.org/ AC National Alliance on Mental Illness (NAMI) Offers education, support, and advocacy for people affected by mental illness. http://www.namiacs.org/ AC Niroga Offers programs in schools to strengthen resilience and empathy, using trauma- informed Dynamic Mindfulness. https://www.niroga.org/ AC OneChild Helps youth take action against sex trafficking through education, advocacy, mobilization, and survivor care and empowerment. https://www.onechild.ca / AC Overeaters Anonymous 12-step program for people coping with compulsive overeating, undereating, food addiction, anorexia, bulimia, binge eating and/or excessive exercising. https://oa.org/ AC Alameda County Public Health Department • 2025–2027 CHA 291 Resource Name Summary Description Website Area Pacific Center for Human Growth Delivers LGBTQ-proficient mental health and wellness services to enhance the well- being of community members. http://pacificcenter.org/ AC Partnership for Trauma Recovery Addresses the psychosocial impacts of trauma among international survivors of human rights abuses through culturally aware, trauma-informed, and linguistically accessible mental- health care, clinical training, and policy advocacy. https://traumapartners.o rg/ AC Project Eden Provides adult outpatient addiction recovery treatment. https://www.horizonservi ces.org/project-eden- adult-outpatient/ TV RAMS: Pacific Islander Wellness Initiative Screening, individual and group counseling, workshops, and other services for all ethnicities and populations, with a special focus on Pacific Islanders. https://ramsinc.org/prog rams/prevention-early- intervention/pacific- islander-wellness- initiative/ Mid REACH Ashland Youth Center Provides youth programs in the areas of arts, recreation, education, career development, and health and wellness. https://reachashland.org / Mid Second Chance, Inc. Offers individual and group substance abuse treatment. https://secondchanceinc .com/ AC Seneca Center Provides a comprehensive continuum of school, community-based and family- focused treatment services for children and families experiencing high levels of trauma who are at risk for family disruption or institutional care for the children. https://www.senecafoa. org/ AC Senior Support Program of the Tri-Valley Provides programming and referrals for older adults, including case management, 1:1 counseling and emotional https://seniorservicesco alition.org/senior- support-program-of-the- tri-valley/ TV Alameda County Public Health Department • 2025–2027 CHA 292 Resource Name Summary Description Website Area fitness). Side by Side Helps youth overcome traumas caused by adversity and embrace resilience. https://www.sidebysidey outh.org/ AC Through the Looking Glass Home-based support for parents with intellectual disability and their children. Adaptations (e.g. cognitive adaptations, adaptations in communication) and case management. http://www.lookingglass. org AC Tobacco Control Coalition of Alameda County Grassroots coalition of educators, professionals, and community members that work to prevent, reduce, and limit tobacco use in Alameda County through education, advocacy, and policy. https://tobaccofreealam edacounty.org/ AC Tri-Valley Haven Offers services to survivors of domestic violence, sexual assault and homelessness, including restraining order assistance, counseling groups, financial assistance for survivors, groceries, and more. https://trivalleyhaven.org / TV Tri-Valley Seek and Save Marriage & Family Christian Therapists available to support women and men in crisis. https://www.trivalleysee kandsave.org/ TV Twins by the Bay: Daytime Support Group for New and Expectant Parents of Multiples Support group for new or expectant parents of multiples. http://www.twinsbytheb ay.org North Union City Family Center Connects youth, families and community members to urgent living resources, and offers support groups and empowerment workshops. https://www.unioncityfa milycenter.org/ Mid/ South Alameda County Public Health Department • 2025–2027 CHA 293 Resource Name Summary Description Website Area Wellness Together Partners with K-12 school districts and colleges to provide mental health services for students, families, and educators. https://www.wellnesstog ether.org/ AC Willow Rock Center 24-hour mental health crisis stabilization and outpatient services for youth. https://www.telecarecor p.com/willow-rock- center Mid Women and Men on the Way Provides an alcohol and drug free environment and recovery services in a home like setting for a period of 6-12 months with an ongoing aftercare plan. https://womenandmeno ntheway.org/ AC Women on the Way Recovery Center Helps women who have limited resources or are experiencing homelessness recover from substance abuse through housing, treatment, and aftercare support. https://www.rehab.com/ women-on-the-way- recovery-center/ AC YMCA of the East Bay Offers a variety of programs through its five health and wellness centers, 20-plus childcare sites, a teen center, and three camps. https://ymcaeastbay.org / AC Alameda County Public Health Department • 2025–2027 CHA 294 COMMUNICABLE DISEASES Respiratory Infections Resource Name Summary Description Website Area Alameda County Public Health Department (ACPHD) Monitors and makes efforts to prevent and reduce the spread of respiratory viruses, including COVID-19, influenza (flu), and respiratory syncytial virus (RSV). Supports community vaccination clinics (calendar and locations available at website). https://covid- 19.acgov.org/ AC ACPHD, Div. of Communicable Disease Control & Prevention, Pertussis Monitor pertussis (whooping cough) cases, provides education and vaccination resources to the public. https://acphd.org/pertus sis/ AC ACPHD, Div. of Communicable Disease Control & Prevention, Tuberculosis Control Monitor tuberculosis (TB) cases and determine steps that need to be taken to control TB in the county. This includes education, connection to physicians, medication compliance efforts, tracing contacts to prevent TB spread, and help with basic needs. https://acphd.org/tb/tb- control/ AC Long COVID Alliance Network of patient-advocates, scientists, disease experts, and drug developers who have joined together to leverage their collective knowledge and resources to educate policy makers and accelerate research to transform the understanding of post-viral illness. https://longcovidalliance .org/resources/patients/ AC Long Covid Families Improve the quality of life for families affected by Long COVID and work towards a future where every family receives the support they deserve. https://longcovidfamilies .org/resources/ AC Alameda County Public Health Department • 2025–2027 CHA 295 Sexually Transmitted Infections (STIs) Resource Name Summary Description Website Area Alameda County Health, Div. of Communicable Disease Control & Prevention Multiple programs to address STIs: • Chronic Hepatitis Program • Immunization Program • MPox • Perinatal Hepatitis B Prevention Program • Office of HIV Care and Prevention • Sexual Health Capacity Building https://acphd.org/ about/our- organization/dcdcp / AC East Bay Getting to Zero Bring people together to collaborate on creative ways to implement the East Bay HIV strategic plan, supporting community members to have more equitable access to HIV testing, prevention and treatment services. https://www.ebgtz. org AC Hep B Free Alameda County Collaborative Community collaborative to end hepatitis B through testing, educating and treating. https://acphd.org/ hep-b/hep-b-free- alameda-county- collaborative/ AC HIV/AIDS Care and Treatment Program (CA Dept. of Public Health) Includes primary medical care and essential support services for people living with HIV who are low income and uninsured or underinsured. https://www.cdph. ca.gov/Programs/C ID/DOA/Pages/OA_ care_program.aspx AC HIV Education and Prevention Project of Alameda County Provide harm reduction-based services in Alameda County and Contra Costa County, serve people who are at increased risk for HIV, hepatitis C and other infectious diseases. https://heppac.org/ North I Know Free home test kit program is a simple and confidential way for young women, girls, transmen, and any person with a vagina to test for chlamydia and gonorrhea in the privacy of their own home. https://alameda.do ntthinkknow.org/fr equently-asked- questions/home- test-kit-faq AC Alameda County Public Health Department • 2025–2027 CHA 296 Resource Name Summary Description Website Area Oakland TGA Network of comprehensive services for people living with HIV. https://oaklandtga. org/ AC STI testing clinics directory Maintains an extensive list of public and private STD testing locations and in-home STD testing options. https://www.safers tdtesting.com AC Other Vaccine-Preventable Diseases Resource Name Summary Description Website Area Alameda County Family Justice Center: Immunization Clinic Offers free vaccinations by appointment only for children and adults who are county residents and are either low-income or uninsured. https://acfjc.org/fa mily-justice- immunization- clinic/ North Alameda County Health, Div. of Communicable Disease Control & Prevention Multiple programs to address infectious diseases: • Chronic Hepatitis Program • Immunization Program https://acphd.org/ about/our- organization/dcdcp / AC Immunization Partnership of Alameda County (IPAC) Collaborative of private and public organizations interested in improving vaccine protection rates for all people of Alameda County, focusing on education and training for medical providers, school and child care personnel and parent groups. On hiatus / rebuilding AC Alameda County Public Health Department • 2025–2027 CHA 297 Attachment 9: Public Health Accreditation Board Checklist Community Health Assessment Requirements by the Public Health Accreditation Board, v 5.13.2024. Required Documentation Number(s) Notes for Reviewer (optional) 1a A list of participating partners involved in the CHA process. Participation must include: i. At least 2 organizations representing sectors other than governmental public health. (Chapter 7), page 142 (Attachment 1), and pages 147–168 (in Attachment 3) list the agencies and organizations that hosted focus groups; most were not associated with the governmental public health sector. Att. 3’s final section lists all organizations participating in interviews and focus groups and the populations represented, and provides counts of community members who participated in each focus group. ii. At least 2 community members or organizations that represent populations who are disproportionately affected by conditions that contribute to poorer health outcomes. Page 142 (Attachment 1), and pages 147–168 (in Attachment 3) 1b collaborated in developing the CHA. (in Chapter 4) collaborative process for developing the CHA. 1c Comprehensive, broad-based data. Data must include: i. Primary data. (in Chapter 4), and pages 201–241 (Attachment 7) primary data is provided in Att. 3 (see 1a) and Att. 7 (pages 210-241). The latter provides the English- language versions of interview and focus group surveys and guides. More information on secondary data is provided in Att. 4 (pages 169-184, further secondary statistical data and a summary of limitations), Att. 5 (page 185, list of secondary reports), and Att. 6 (pages 186- 209, index of secondary statistical data and sources). different sources. (in Chapter 4), and pages 169–209 (Attachments 4, 5, and 6) Alameda County Public Health Department • 2025–2027 CHA 298 Required Documentation Number(s) Notes for Reviewer (optional) 1d A description of the demographics of the population served by the health department, which must, at minimum, include: i. The percent of the population by race and ethnicity. Pages 17–22 (Chapter 3) Ch. 3 covers the county’s demographics, including race/ethnicity (page 19), languages (page 20), and other demographic characteristics. jurisdiction. (Chapter 3) as appropriate for the jurisdiction. (Chapter 3) 1e A description of health challenges experienced by the population served by the health department, based on data listed in required element (c) above, which must include an examination of disparities between subpopulations or sub-geographic areas in terms of each of the following: 126 (Chapter 5) descriptions of the identified health needs, including examination of disparities of health status and health behaviors. 1f A description of inequities in the factors that contribute to health challenges (required element e), which must, include social determinants of health or built environment. 126 (Chapter 5) descriptions of the identified health needs, including contributing inequities. Pages 52-107 specifically cover social determinants of health. 1g Community assets or resources beyond health care and the health department that can be mobilized to address health challenges. (Chapter 7), and pages 242–299 (Attachment 8) list of community assets and resources that can be mobilized to address the identified needs and challenges. The CHA must address the jurisdiction as described in the description of Standard 1.1. See right-most column of table above. Alameda County Public Health Department • 2025–2027 CHA 299 Attachment 10: Endnotes 1 Harrell, J. A., & Baker, E. L. (1994). The essential services of public health. Leadership in Public Health, 3(3), 27–30. 2 Dada, O. O., Bekemeier, B., Flaxman, A., & de Castro, A. B. (2022). Associations between local health department expenditures on foundational capabilities and PHAB Accreditation Standards Scores. Frontiers in Public Health, 10, 861587. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9174657/. 3 U.S. Census Bureau. (2023). American Community Survey, Demographic and housing 5-year estimates, 2019–2023: Table DP05. Retrieved from https://data.census.gov/table/ACSDP5Y2023.DP05?q=Alameda+County,+California 4 County of Alameda, Board of Supervisors, District 1. (2021). Agricultural Resources. Retrieved from https://district1.alamedacountyca.gov/agricultural-resources/. 5 UC Berkeley Centers for Educational Justice & Community Engagement. (2025). Ohlone Land. Retrieved from https://cejce.berkeley.edu/ohloneland. 6 California Demographics by Cubit. (2024). Alameda County Demographics Statistics. Retrieved from https://www.california-demographics.com/alameda-county-demographics. 7 U.S. Census Bureau. (2021). Racial and Ethnic Diversity in the United States: 2010 Census and 2020 Census. Retrieved from https://www.census.gov/library/visualizations/interactive/racial-and-ethnic-diversity-in-the-united-states-2010- and-2020-census.html. 8 For race/ethnicity, N=approximately 180; exact number of respondents not available because only summary data were available for some focus groups conducted by Alameda County Public Health. 9 This report also draws on the findings from three focus groups with youth under age 20 that were conducted for the Eastern Alameda County Human Services Needs Assessment. The youth are not included in these demographics. 10 Centers for Disease Control and Prevention. (2026). About Chronic Diseases. Retrieved from https://www.cdc.gov/chronic-disease/about/index.html. 11 Centers for Disease Control and Prevention. (2025). Chronic Disease: Fast Facts. Retrieved from https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html. 12 Centers for Disease Control and Prevention. (2025). Chronic Disease: Preventing Chronic Diseases. Retrieved from https://www.cdc.gov/chronic-disease/prevention/index.html. 13 The Mayo Clinic. (2025). Asthma Overview. Retrieved from https://www.mayoclinic.org/diseases- conditions/asthma/symptoms-causes/syc-20369653. 14 Centers for Disease Control and Prevention. (2024). About Asthma. Retrieved from https://www.cdc.gov/asthma/about/index.html. 15 World Health Organization. (2024). Asthma. Retrieved from https://www.who.int/news-room/fact- sheets/detail/asthma. 16 Holden, K.A., Lee, A.R., Hawcutt, D.B., & Sinha, I.P. (2023). The impact of poor housing and indoor air quality on respiratory health in children. Breathe, 19(2), 230058. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10461733/. 17 American Lung Association. (2026). What Causes Asthma? Retrieved from https://www.lung.org/lung-health- diseases/lung-disease-lookup/asthma/learn-about-asthma/what-causes-asthma. 18 National Cancer Institute. (2021). What is Cancer? Retrieved from https://www.cancer.gov/about- cancer/understanding/what-is-cancer. 19 Centers for Disease Control and Prevention (CDC). (2024). Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. 20 National Cancer Institute. (2025). Cancer Disparities. Retrieved from https://www.cancer.gov/about- cancer/understanding/disparities. Alameda County Public Health Department • 2025–2027 CHA 300 21 Tong, M., Hill, L, and Artiga, S. (2022). Racial Disparities in Cancer Outcomes, Screening, and Treatment. KFF.org, Topics: Racial Equity and Health Policy. Kaiser Family Foundation. Retrieved from https://www.kff.org/racial-equity-and- health-policy/racial-disparities-in-cancer-outcomes-screening-and-treatment/ 22 University of California, San Francisco. (2012–2021). California Health Maps website, https://www.californiahealthmaps.org/: Cancer incidence rates by race/ethnicity. From: California Cancer Registry. 23 National Cancer Institute. (2025). Cancer Disparities. Retrieved from https://www.cancer.gov/about- cancer/understanding/disparities. 24 Memory and Aging Center, UCSF Weill Institute for Neurosciences. (2026). Healthy Aging. Retrieved from https://memory.ucsf.edu/brain-health/healthy-aging. 25 Centers for Disease Control and Prevention (CDC). (2024). Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. 26 National Institute on Aging. (2022). What Do We Know About Healthy Aging? Retrieved from https://www.nia.nih.gov/health/healthy-aging/what-do-we-know-about-healthy-aging. See also: U.S. Centers for Disease Control and Prevention. (2024). Healthy Aging at Any Age. Retrieved from https://www.cdc.gov/healthy- aging/about/index.html. 27 Alameda County Public Health Department. (2024). Alameda County Healthy Brain Initiative: Preliminary Community Needs Assessment. 28 Shen, C., Rolls, E.T., Cheng, W., Kang, J., Dong, G., Xie, C., Zhao, X.M., Sahakian, B.J. and Feng, J. (2022). Associations of social isolation and loneliness with later dementia. Neurology, 99(2), e164-e175. Retrieved from https://www.oxcns.org/papers/650%20Shen%20Rolls%20et%20al%202022%20Associations%20of%20Social%20Isolat ion%20and%20Loneliness%20With%20Later%20Dementia.pdf. See also: Manca, R., De Marco, M., Colston, A., Raymont, V., Amin, J., Davies, R., Kumar, P., Russell, G., Blackburn, D.J. and Venneri, A. (2022). The impact of social isolation due to COVID-19 on symptom progression in people with dementia: findings of the SOLITUDE study. Frontiers in Psychiatry, 13, 877595. Retrieved from https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.877595/full. 29 Martin, S.S., et al. (2024). 2024 heart disease and stroke statistics: A report of US and global data from the American Heart Association. Circulation, 149(8), e347–e913. Retrieved from https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001209. 30 Centers for Disease Control and Prevention (CDC). (2024). Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. 31 Centers for Disease Control and Prevention. (2024). Stroke Facts. Retrieved from https://www.cdc.gov/stroke/data- research/facts-stats/index.html. 32 Graham, G. (2015). Disparities in cardiovascular disease risk in the United States. Current Cardiology Reviews, 11(3): 238–245. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4558355/. 33 Centers for Disease Control and Prevention. (2024). Risk factors for stroke. Retrieved from https://www.cdc.gov/stroke/risk-factors/index.html. And: Heart disease risk factors. Retrieved from https://www.cdc.gov/heart-disease/risk-factors/index.html. 34 The Mayo Clinic. (2026). Heart disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/heart- disease/symptoms-causes/syc-20353118. 35 The Mayo Clinic. (2026). Strategies to Prevent Heart Disease. Retrieved from https://www.mayoclinic.org/diseases- conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502. 36 The Mayo Clinic. (2026). Diabetes overview. Retrieved from https://www.mayoclinic.org/diseases- conditions/diabetes/symptoms-causes/syc-20371444. 37 Centers for Disease Control and Prevention. (2024). Preventing Type 2 Diabetes. Retrieved from https://www.cdc.gov/diabetes/prevention-type-2/index.html. 38 Centers for Disease Control and Prevention. (2026). Diabetes Basics. Retrieved from https://www.cdc.gov/diabetes/about/index.html. Alameda County Public Health Department • 2025–2027 CHA 301 39 National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Risk Factors for Type 2 Diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2- diabetes. 40 Centers for Disease Control and Prevention. (2024). About Obesity. Retrieved from https://www.cdc.gov/obesity/php/about/index.html. 41 Centers for Disease Control and Prevention. (2025). Obesity: Risk Factors for Obesity. Retrieved from https://www.cdc.gov/obesity/risk-factors/risk-factors.html. 42 Healthy Alameda County. (2023). California Health Interview Survey, 2022–2023: Adults with Diabetes. From: UCLA Center for Health Policy Research. 43 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2025). Social Determinants of Health. Healthy People 2030. Retrieved from https://health.gov/healthypeople/objectives-and- data/social-determinants-health 44 County Health Rankings & Roadmaps. (2026). Clinical Care. Retrieved from https://www.countyhealthrankings.org/health-data/community-conditions/health-infrastructure/clinical-care. 45 Agency for Healthcare Research and Quality. (Undated). Six Domains of Healthcare Quality. Retrieved from https://www.ahrq.gov/talkingquality/measures/six-domains.html. Based on Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press. 46 Alameda County Health, CAPE Unit. (2025). Personal correspondence, September 3, 2025. 47 UCLA Center for Health Policy Research. (2023). AskCHIS Dashboard. See https://healthpolicy.ucla.edu/our-work/askchis. 48 The data source indicates that its data on dental insurance for people of other races/ethnicities was unstable. 49 University of Illinois at Chicago, College of Dentistry. (2019). The Surprising Connections Between Oral Health and Well Being. Retrieved from https://dentistry.uic.edu/news-stories/the-surprising-connections-between-oral-health-and-well- being/ 50 Public school students’ access to school nurses was also worse in Alameda County (3,385 students to each nurse) versus access statewide (2,410:1). Data from: National Association of School Nurses, & School-Based Health Alliance. (2021). School nursing and school-based health centers in the United States. As cited on KidsData.org, Summary: Pupil Support Services. Retrieved from https://www.kidsdata.org/topic/24/pupil-support-services/summary. 51 International Committee of the Red Cross. (2020). Economic Security Strategy 2020-2023. Retrieved from https://www.icrc.org/sites/default/files/wysiwyg/Activities/ecosec_strategy_2020-2023.pdf. 52 Center on Budget and Policy Priorities. (2018). Economic security, health programs reduce poverty and hardship, with long-term benefits. Off the Charts blog, February 9, 2018. Retrieved from https://www.cbpp.org/blog/economic-security- health-programs-reduce-poverty-and-hardship-with-long-term-benefits. 53 County Health Rankings & Roadmaps. (2024). American Community Survey, 5-year estimates, 2017–2021: Gender Pay Gap. From: United States Census Bureau. 54 Staub, E. (2013). Building a peaceful society: Origins, prevention, and reconciliation after genocide and other group violence. American Psychologist, 68(7), 576. See also: Alameda County Public Health Department. (2025). Promoting Peaceful Families and Communities: Maintaining Progress in Reducing Gun Violence in Alameda County. 55 Krug, E.G., Mercy, J.A., Dahlberg, L.L., & Zwi, A. (2002). The world report on violence & health. The Lancet, 360(9339), 1083–1088. 56 Alameda County Health, Public Health Department. (2025). Promoting Peaceful Families and Communities: Maintaining Progress in Reducing Gun Violence in Alameda County. June 2025. 57 WestEd. (2020). California Healthy Kids Survey (CHKS) and Biennial State CHKS, California Department of Education: Gang membership and Bias-related bullying/harassment, by grade level. Retrieved from https://www.kidsdata.org/. 58 Pew Trusts/Partnership for America’s Economic Success. (2008). The Hidden Costs of the Housing Crisis. Retrieved from https://www.pew.org/- /media/legacy/uploadedfiles/wwwpewtrustsorg/reports/partnership_for_americas_economic_success/8120pctshousin Alameda County Public Health Department • 2025–2027 CHA 302 gcitationspdf.pdf. See also: Iton, T. Tony B. (2021). When It Comes to Your Health, Does Your Zip Code Matter More Than Your Genetic Code? Retrieved from https://www.youtube.com/watch?v=7OAYAN0u5V0. 59 O’Connell, J.J. (2005). Premature Mortality in Homeless Populations: A Review of the Literature. Nashville, TN: National Health Care for the Homeless Council. 60 Iton, T. Tony B. (2021). When It Comes to Your Health, Does Your Zip Code Matter More Than Your Genetic Code? (Speech to the Texas Primary Care Consortium.) Retrieved from https://www.youtube.com/watch?v=7OAYAN0u5V0. 61 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2025). Neighborhood and built environment. Healthy People 2030. Retrieved from https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment. 62 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2025). Injury prevention. Healthy People 2030. Retrieved from https://odphp.health.gov/healthypeople/objectives-and-data/browse- objectives/injury-prevention. 63 Lu, W., McKyer, E., Lee, C., Ory, M., Goodson, P., & Wang, S. (2015). Children’s active commuting to school: an interplay of self-efficacy, social economic disadvantage, & environmental characteristics. International Journal of Behavioral Nutrition & Physical Activity, 12(1), 29. 64 Hamann, C., Peek-Asa, C., & Butcher, B. (2020). Racial disparities in pedestrian-related injury hospitalizations in the United States. BMC Public Health, 20(1), 1-7. 65 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2024). Environmental health. Healthy People 2030. Retrieved from https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/environmental-health. See also: Morris, G. & Saunders, P. (2017). The environment in health and well-being, Oxford Research Encyclopedias. 66 Air quality indicators: • California Public Health Alliance. (2024). Healthy Places Index: Air Pollution - Particulate Matter. From: Environmental Public Health Tracking Network. (2019). Average daily density of fine particulate matter in micrograms per cubic meter (PM2.5). Retrieved from https://www.healthyplacesindex.org/. • California Public Health Alliance. (2024). Healthy Places Index: Air Pollution – Diesel. From: California Office of Environmental Health Hazard Assessment, CalEnviroScreen 4.0. (2016). Average daily amount of particulate pollution from diesel sources. Retrieved from https://www.healthyplacesindex.org/. • County Health Rankings & Roadmaps. (2024). Health Data: Traffic Volume. From: U.S. Environmental Protection Agency, EJSCREEN: Environmental Justice Screening and Mapping Tool. (2019). Volume of traffic per linear meter of roadway. Retrieved from https://www.countyhealthrankings.org/health-data. 67 First Street. (2024). Does Alameda County Have Heat Risk? Retrieved from https://firststreet.org/county/alameda- county-ca/6001_fsid/heat. 68 First Street. (2024). Does Alameda County Have Wildfire Risk? Retrieved from https://firststreet.org/county/alameda- county-ca/6001_fsid/fire. 69 Researchers define structural racism as all of the historical, cultural, and institutional ways a society fosters racial discrimination through inequitable systems that reinforce one another, such as education, credit/banking, health care, and criminal justice, all of which in turn reinforce discriminatory values, beliefs, and resource distribution. See Krieger, N. (2014). Discrimination and health inequities. International J. of Health Services, 44(4), 643-710. See also: Bailey, Z.D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M.T. (2017). Structural racism and health inequities in the USA: evidence and interventions. The Lancet, 389(10077), 1453–463. 70 Centers for Disease Control and Prevention. (2023). Racism and Health. CDC Museum Digital Exhibits. Retrieved from https://cdcmuseum.org/items/show/1553. 71 Gee, G. C., Walsemann, K. M., & Brondolo, E. (2012). A life course perspective on how racism may be related to health inequities. American Journal of Public Health, 102(5), 967–974. 72 Substance Abuse and Mental Health Services Administration. (2026). What is Mental Health? Retrieved from https://www.samhsa.gov/mental-health/what-is-mental-health. Alameda County Public Health Department • 2025–2027 CHA 303 73 Centers for Disease Control and Prevention. (2026). How to Prevent STIs. Retrieved from https://www.cdc.gov/sti/prevention/index.html. 74 Centers for Disease Control and Prevention. (2026). Health Equity and STIs. Retrieved from https://www.cdc.gov/sti/php/projects/health-equity.html. 75 World Health Organization. (2026). Coronavirus Disease (COVID-19). Retrieved from https://www.who.int/health- topics/coronavirus. 76 American Lung Association. (2025). The truth about how vaccines prevent respiratory diseases and save lives. Each Breath blog. July 28, 2025. Retrieved from https://www.lung.org/blog/vaccines-prevent-respiratory-illness. 77 Mayo Clinic. (2024). Long COVID: Lasting Effects of COVID-19. Retrieved from https://www.mayoclinic.org/diseases- conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351. 78 National Institutes of Health, National Institute on Aging. (2023). Vaccinations and Older Adults. Retrieved from https://www.nia.nih.gov/health/immunizations-and-vaccines/vaccinations-and-older-adults. 79 Sheehy, J. (2023). Why childhood vaccinations matter. Speaking of Health blog, Mayo Clinic Health System, August 7, 2023. Retrieved from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/the-facts-about- vaccinations. 80 Hest, R. (2024). Revised Childhood Vaccinations Measure on State Health Compare Shows Vaccination Rates Vary by State, Race/Ethnicity, and Insurance Coverage. State Health Access Data Center (SHADAC). Retrieved from https://www.shadac.org/news/childhood-vaccinations-rate-by-state-ethnicity-insurance. 81 For example, the experiences of the LGBTQ+ community are often obscured by statistics that represent an entire county’s population rather than the LGBTQ+ community as a particular sub-group. This CHA convened a focus group of LGBTQ+-identifying community members to better understand their needs. 82 Only individuals who consented to be recorded were interviewed. 83 Only individuals who consented to be recorded were included in focus groups. To preserve their anonymity, community members are not listed in the report. Participants in community-member focus groups could take the pre-survey online or on paper. In a few cases, participants in the focus groups conducted by the Public Health Department were not asked to provide any demographic information. 84 One attendee did not give permission to be listed in this appendix. 85 County Health Rankings & Roadmaps. (2024). Health Data. Retrieved from https://www.countyhealthrankings.org/health-data. 86 ATOD stands for Alcohol, Tobacco, and Other Drugs. 87 MH stands for Mental Health. 88 ENV stands for Environment. 89 ECON stands for Economic. 90 EDUC stands for Education. 91 QUAL stands for Quality. 92 MAT stands for Maternal.