South Los Angeles Health Equity Scorecard

Home , Central Los Angeles, Downtown Los Angeles, Healthy Way LA, Los Angeles City Council, South Los Angeles

Annie Park, MSW

Nancy Watson, MSW

Lark Galloway-Gilliam, MPA

December 2008 Community Health Councils, 2008

Community Health Councils (CHC) is a non-proﬁt, community-based health advocacy, policy and educational organization. Established in 1992, our mission is to improve health and increase access to quality healthcare for uninsured, under-resourced and underserved populations.

Coalition for Health & Justice (CHJ), founded in 2004 to address the growing healthcare crisis in South Los Angeles, is a coalition of diverse leadership throughout South Los Angeles working to ensure access to quality healthcare for underserved residents of South Los Angeles.

This project was made possible with generous funding from

The California Endowment • Robert Wood Johnson Foundation • UCLA Center for Community Partnerships South Los Angeles Health Equity Scorecard 75 77 78 51 3 8 10 14 17 21 1 Nutrition Activity Physical Public Safety Housing Schools Air & Land Quality Healthcare Facilities Workforce Healthcare Healthcare Financing Healthcare Coverage Access Care Primary & Preventive Care Utilization Primary & Preventive Appendix 1: Data Sources, Notes and Limitations Appendix 1: Data Sources, Appendix 2: Scoring Methodology Areas Appendix 3: Maps and Zip Codes of Study of Community Profile Measures Table Appendix 4: of Health Status Outcomes Table Appendix 5: Appendix 6: Bibliography ...... Acknowledgments Appendices Next Steps/Conclusion Scorecard Domain 2: Resources Environment Physical Introduction Introduction Design Study Community Profile Health Status Scorecard Domain 1: Resources Healthcare Environment Summary Executive Table of Table Contents South Los Angeles Health Equity Scorecard 2 South Los Angeles Health Equity Scorecard 7% 59% 22% 38% 27% 39% 24% 42% 182% 103% 103% 104% West LA 5% -76% -65% -30% -34% -24% -28% -17% -24% -43% -76% -55% 3 South LA EXECUTIVE SUMMARY SUMMARY SUMMARY EXECUTIVE EXECUTIVE Assess the extent to which the inequities in the resource environment determine and shape the determine environment in the resource the inequities to which Assess the extent health of the community health inequities mirror disparities in these to which Determine the degree health equity. steps to achieve Identify incremental Healthcare Workforce Healthcare Healthcare Financing Healthcare Coverage Access Care Primary & Preventative Care Utilization Primary & Preventative Healthcare Facilities Public Safety Housing Schools Air & Land Physical Activity Options Activity Physical Nutrition 1. 2. 3. Healthcare Environment Resources Healthcare Environment Physical Environment Resources Environment Physical The study compiled, calculated, and synthesized 50 socioeconomic and environmental factors that and environmental synthesized 50 socioeconomic compiled, calculated, and study The categorized and discussed as follows: These factors are outcomes. and behaviors influence health The following chart summarizes the status of South LA and West LA for each broad category of healthcare LA for each West summarizes the status of South LA and chart following The healthcare for the overall Thus, to the county as a whole. relative resources environment or physical more LA has 72 percent West and than LA County, fewer resources South LA has 43 percent environment, communities. points between the two for a total disparity of 115 percentage than LA County, resources West while than LA County, resources environment fewer physical South LA also has 43 percent Similarly, disparity of 85 percentage for an overall of this type than LA County, more resources LA has 42 percent communities. points between the two The Findings The Study and factors that influence health behaviors examined 50 socioeconomic and environmental study The for the 100-square-mile area of South LA, and for comparison, the outcomes. Scores were calculated against our Both areas were evaluated health outcomes. more favorable there are LA, where West area of of capacity were grouped into broad categories resources The Angeles County. of Los baseline: the whole in comparison to the county as a whole. scored category was and access (see Chart), then each To assess the extent to which these inequities determine and shape the health of the South LA community, of the South LA community, these inequities determine and shape the health assess the extent to which To study in a year-long with the Coalition for Health and Justice Community Health Councils collaborated What emerges is a Health in the area. resources environment examining the healthcare and physical takes into account the multiple public and private Equity Scorecard of the health status of South LA that the their lack—in the health of area residents through investments—or policies that ultimately influence Scorecard also The the community. healthcare systems that serve economic, education, housing, and health equity. South LA can be helped to achieve which by identifies incremental steps is the culmination of a year-long study conducted by by conducted study of a year-long is the culmination Equity Scorecard Angeles Health South Los The city. of the inner plight and struggle an icon for the has become Angeles South Los as area known The was Scorecard The Justice. for Health and the Coalition with in collaboration Health Councils Community the health consequences encapsulates Angeles Los million people, South more than one Home to to: developed and services in Los income, goods, of power, disturbing inequality in the distribution resulting from the and often inferior fewer by are constrained choices Options and opportunities for healthy Angeles County. care services to healthy hospitals, clinics, and preventive From resources. and physical basic healthcare are forced South LA residents and adequate schools, safe housing, active, physically foods, places to be impact is a population with the highest social and economic The their families with less. and raise to live as coronary conditions preventable in the county from such of disease and premature deaths rates overall of other region More than any crashes. and motor vehicle diabetes, lung cancer, heart disease, homicide, in the healthcare and inequities and harmed by LA is disproportionately disadvantaged South the county, environments. resource physical South LA, an area encompassing nearly 100 square miles and more than one million people, represents South LA, an area encompassing nearly 100 square miles and more Angeles within Los challenges some of the greatest assets and most troubling health and socio-economic the access, capacity and quality data were used to compare and contrast The and across the country. resource Angeles against both the overall in South Los health and economic resources of community, health Angeles with more favorable Los West area of of LA County and the contrast environment and infrastructure a disproportionate disparity in access to care, resources, data document The outcomes. that unequivocally shows study The Angeles County. in South LA in comparison to other regions of Los to healthcare to from inadequate access regional resources, South LA does not share equally in the overall and is less healthy population of South LA residents As a result, the overall food options. of healthy a lack disease and premature deaths. of preventable at the top in LA County for rate ranks South Los Angeles Health Equity Scorecard 87 87 68 61 85 79 24 56 34 115 258 127 207 106 Disparity (Percentage points) (Percentage 7% 59% 22% 38% 27% 24% 16% 63% 39% 182% 103% 101% +72% +42% West LA insufficiently staffed, resourced, and without a clean, a without and resourced, staffed, insufficiently 4 5% -43% -28% -76% -65% -30% -34% -24% -43% -55% -17% -40% -43% -106% South LA South South LA and West LA Compared to LA County LA Compared West and South LA Disparities in Healthcare and Physical Environment Resources: Environment Physical and in Healthcare Disparities 176 of South LA’s schools are classified as classified are schools LA’s South of 176 safe, and functional learning environment. Only eight schools in West LA did not meet these LA West in Only eight schools safe, and functional learning environment. standards. 37% of South LA households are overcrowded compared to fewer than 8% in West LA. West compared to fewer than 8% in 37% of South LA households are overcrowded South LA has approximately twice the number of liquor stores and only half as many large- only half as many South LA has approximately twice the number of liquor stores and LA. West scale grocery stores as South LA has over four times as many uninsured people as West LA. 30% of adults between West as uninsured people four times as many South LA has over LA and 22% in LA West in the ages of 18 and 64 are uninsured in South LA, compared to 12% County overall. Uninsured women in South LA are less likely to receive preventive screening services. Only screening preventive likely to receive in South LA are less Uninsured women occurred through the South LA PPP clinics, women per 1,000 uninsured 34 mammograms LA PPP West through per 1,000 uninsured women screenings compared to169 mammogram LA County. throughout clinics and 41 mammograms In South LA, there are approximately 11 pediatricians for every 100,000 children. In West LA, West In 100,000 children. 11 pediatricians for every In South LA, there are approximately has 57 pediatricians LA County overall children. 100,000 there are 193 pediatricians for every 100,000 children. for every

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Healthcare Facilities Healthcare Workforce Healthcare Healthcare Financing Healthcare Coverage Primary & Preventive Care Access Care Primary & Preventive Primary & Preventive Care Utilization Primary & Preventive Nutrition Physical Activity Options Activity Physical Public Safety Housing Schools Air & Land shows significant inequities in the distribution, capacity and quality of resources for and quality of resources in the distribution, capacity significant inequities Scorecard shows The scored far LA, on the other hand, West Angeles County in all areas. to Los South LA in comparison widening the and benefits but also the potential opportunities demonstrating better than LA County, LA. equity gap for South points between South percentage has a disparity of 115 Resources Healthcare Environment overall The LA County than LA (72% more resources West and overall) than LA County LA (43% fewer resources overall). points between South has a disparity of 85 percentage Resources Environment combined Physical The LA has 42% West while overall, than LA County LA. South LA has 43% fewer resources West LA and than LA County overall. more resources LA scores: West between South LA and chasms indicators revealed domain, several each Within LA County overall has 57 pediatricians for every 100,000 children. In South LA, there are 100,000 children. has 57 pediatricians for every LA County overall compared to 193 pediatricians for every 100,000 children, approximately 11 pediatricians for every LA. West in 100,000 children In South LA, of adults between the ages of 18 and 64 are uninsured. 22 percent In LA County overall, LA. West in of adults are uninsured, compared to 12 percent 30 percent screening services. Only 34 preventive in South LA are less likely to receive Uninsured women (PPP) Partner Private occurred through the South LA Public per 1,000 uninsured women mammograms LA PPP West through screenings per 1,000 uninsured women clinics, compared to 169 mammogram LA County. at PPP clinics throughout per 1,000 uninsured women clinics and 41 mammograms LA. West in South LA has 8.5 liquor stores per square mile compared to 1.97 stores LA has 0.14 per square mile. West South LA has 0.10 large-scale supermarkets per square mile, while GORY CATE Healthcare Environment Resources Healthcare Environment Physical Environment Resources Environment Physical 2. 3. 4. 1. s Key Finding The data in and of themselves do not add up to a groundbreaking discovery. They represent a first attempt attempt a first represent They discovery. groundbreaking up to a not add do themselves and of data in The and opportunities policy health with immediate of the community’s overview comprehensive to link a in health. banish disparities and ultimately environment in the resource inequities tools to eliminate , the Scorecard Through disparities exist. the degree to which results is from the Scorecard What emerges Angeles Los sectors in private across public and support and galvanize a framework to provide we seek . health equity. for community reinvestment and change policy County for . . . . . Several other healthcare and physical environment indicators reveal chasms between conditions in South chasms indicators reveal environment other healthcare and physical Several LA: West LA and Disparities for specific groupings of resources are, in some instances, even greater. For example, the greater. are, in some instances, even of resources Disparities for specific groupings points LA is 258 percentage West between South LA and workers difference in the number of healthcare difference in the The multiple facilities in South LA since 2000). (due in large part to the closing of that unequivocally shows points. In short, the study food options is 207 percentage of healthy availability resources. regional in the overall South LA does not share equally South Los Angeles Health Equity Scorecard The The 5 Conclusions and Incorporate health into local government planning including the general plan, redevelopment, and plan, redevelopment, including the general planning health into local government Incorporate planning. transportation vehicles to funding, and other financing targeted tax credits, redevelopment grants, block Provide new retail supermarkets and develop stores liquor and convenience to transform business owners food products. tied to healthy and 33% through staff training by in the next 3 years schools Williams Reduce the number of changes. targeted policy distribution of affordable housing through Establish a citywide plan for the equitable geographic rebuilding public housing. mixed-use neighborhoods particularly when the quality and and enforce Enhance the role and authority of local health departments to regulate condition of food in local markets. Reopen LA County Martin Luther King Jr Medical Center and reestablish the facility as a teaching as a teaching Center and reestablish the facility Martin Luther King Jr Medical Reopen LA County levels. of county outpatient services restoration hospital along with Center for South LA healthcare previously allocated for MLK Medical of funding the level Preserve fund. of SB 474 South LA Preservation through the extension providers through services in the South LA community clinic network Increase primary and urgent care funding. funding from the county and an infusion of capital Partnership equitable Public Private financial eligibility categories to reduce enrollment barriers for Streamline enrollment systems and public programs. through higher disease and management of chronic treatment, Strengthen systems for prevention, care. of continuous, coordinated quality disease management reimbursement for delivery provider Physical Environment Resources Environment Physical 1. 2. 3. 4. 5. Healthcare Environment Resources Healthcare Environment 1. 2. 3. 4. 5. In South LA, 37 percent of households are overcrowded compared to fewer than 8 percent of percent than 8 to fewer compared overcrowded are households of 37 percent LA, In South LA. West in households a and without resourced, staffed, as insufficiently are classified of schools LA, 64 percent In South Only 8 settlement standards. Williams according to learning environment and functional clean, safe, not meet these standards. did LA schools West of percent . . beyond the limits of any single city and the limits of any LA is a “condition” that goes beyond Inequality in the health of South and across jurisdictions. of government level every at and cooperation necessitates collaboration is the first to link a comprehensive Health Equity Scorecard is the first to link a comprehensive compilation of data presented in the The opportunities to eliminate inequities in the policy health with immediate of the community’s overview findings What emerges from the Scorecard health disparities. and ultimately banish environment resource to galvanize which from a framework findings provide These disparities exist. is the degree to which and community change policy Angeles County for sectors in Los support across public and private for health equity. reinvestment To bring health equity to all residents of Los Angeles County will take coordinated leadership and bring health equity to all residents of Los To social capital in economic, political and that reinvests change agenda for policy a comprehensive the reversing toward go a long way an agenda can Such parity. communities to achieve underserved policies that isolate public, economic, and institutional of positive intentional or unintentional absence of the population from access and opportunity. segments whole The data in and of themselves do not add up to a groundbreaking discovery: It has long been clear that discovery: do not add up to a groundbreaking data in and of themselves The wealthier sections. However, health than those in the worse part of the county have residents in the poorer that contribute to health, high factors many to the interrelationship among point study the findings of this to health outcomes, of residents of South LA. Similar depressed socioeconomic status among them the a result found in South LA are not simply in the socioeconomic conditions and disparities the challenges policies and and private segregation and public of racial an outgrowth but rather behavior of individual poverty. systems that concentrate s Conclusion has that silos and the political gridlock artificial policy Scorecard is designed to help break through the revitalization of South LA. prevented are conclusive: The opportunities and resources for South LA residents to for South resources opportunities and The the Scorecard are conclusive: results of The of the in other parts than for residents are far more limited health services or obtain choices make healthy The Scorecard outcomes. the best health that benefit from LA West as such in communities county or change. agenda for policy and a comprehensive need for coordinated leadership the clear demonstrates The addressing these indicators. work hard at and organizations are already A number of coalitions recommendations include: the agenda for South LA. Immediate Scorecard is intended to guide Recommendations South Los Angeles Health Equity Scorecard encies Ag able ccount A Governor Arnold Schwarzenegger Governor Care Services California Department of Health California State Legislature Services Centers for Medicare and Medicaid County Board of Supervisors Angeles Los Officer County Chief Executive Angeles Los County Department of Health Services Angeles Los California State Legislature Congressional Delegation Angeles Los County Board of Supervisors Angeles Los Los Angeles County Board of Supervisors Angeles Los Officer County Chief Executive Angeles Los Angeles County Department of Health Services Los District Angeles Unified School Los California Department of Health Services/MRMIB Angeles County Department of Health Services Los Los Angeles Congressional Delegation Los California State Legislature California Department of Health Services/ Angeles County Board of Supervisors Los LA County Public Health/Health Services 6 • • • • • • • • • • • • • • • • • • • Public Health • • Environment Resources Healthcare ction Needed A Reopen LA County Martin Luther King Jr. King Jr. Reopen LA County Martin Luther facility Medical Center and reestablish the hospital along with the as a teaching of county outpatient services restoration levels. Preserve the level of funding previously the level Preserve for allocated for MLK Medical Center the through South LA healthcare providers extension of SB 474 South LA Preservation fund. Increase primary and urgent care services Increase primary and urgent care network in the South LA community clinic Partnership Private Public equitable through funding from the county and an infusion of capital funding. Streamline enrollment systems and financial eligibility categories to reduce enrollment barriers for public programs. Strengthen systems for prevention, Strengthen systems for prevention, treatment, and management of chronic disease through higher provider of continuous, reimbursement for delivery coordinated quality disease management care. on Steps on cti 1. 2. 3. 4. 5. A number of coalitions and organizations are already hard at work addressing these indicators. The The addressing these indicators. work hard at and organizations are already A number of coalitions key recommendations, the following the agenda for South LA through Scorecard is intended to guide implementation: agencies accountable for their presented here with A joint power agreement is needed between county and city elected officials and their respective agencies agencies respective city elected officials and their is needed between county and agreement A joint power to and political hurdles contributing to address the economic, social plan that outlines a comprehensive for public accountability. and performance standards identifies benchmarks poor health and Achieving health equity in both physical and healthcare resources will take coordinated leadership and leadership and take coordinated will healthcare resources and equity in both physical health Achieving City Hall and of walls the must extend beyond efforts These change. for policy agenda a comprehensive will require step leadership. Every and faith-based business of community, participation active include the multiple stakeholders. efforts across coordinated A South Los Angeles Health Equity Scorecard encies Ag able ccount A City and county planning agencies county planning City and Authority Transportation Metropolitan Angeles Los Los Angeles City Council and other city councils Angeles City Council and Los other District and Angeles Unified School Los County Office of Education Angeles Los LA Housing Authority LA Housing LA Building/Safety CRA City Councils Planning Departments Los Angeles County Board of Supervisors Angeles Los County Department of Public Health Angeles Los 7 • • • etc.) Hawthorne, (Compton, Inglewood, Departments • Community Development • Districts City School • • • • • • • • Resources Environment Physical Needed ction A Incorporate health into local government into local government health Incorporate plan, including the general planning and transportation redevelopment, planning. Provide block grants, targeted tax credits, targeted tax credits, grants, block Provide and other funding, redevelopment owners to business vehicles to financing stores liquor and convenience transform supermarkets tied new retail and develop food products. to healthy In the next three years, reduce the number reduce years, In the next three substandard deemed as having of schools through staff 33 percent facilities by changes. and targeted policy training Establish a citywide plan for the equitable Establish a citywide plan for the equitable distribution of affordable geographic housing through mixed-use neighborhoods rebuilding public particularly when housing. Enhance the role and authority of local Enhance the role and authority of enforce health departments to regulate and in local the quality and condition of food markets. 1. 2. 3. 4. 5. South Los Angeles Health Equity Scorecard 8 INTRODUCTION healthcare facilities including hospital and ER beds, community clinics, – healthcare facilities including hospital and ER beds, community clinics, Healthcare Facilities and pharmacies HIV/mental health providers, – doctors, specialists, dentists Workforce Healthcare – public funding and costs of care Healthcare Financing – the uninsured population Healthcare Coverage of care, difficulties in accessing care Access – regular source Care Primary & Preventive as cancer Care Utilization – utilization of recommended services, such Primary & Preventive screenings, regular doctor and dentist visits. Nutrition – grocery stores, farmers’ markets lanes – parks and green space, bicycle Activity Physical accidents and traffic Public Safety – crime rates safety of housing units Housing – age and structural safety and structural – proximity to freeways Schools sites. Air & Land Quality – toxic waste ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ We begin by providing a profile of the community using demographics and socioeconomic indicators and a profile of the community using demographics providing begin by We into two itself is divided Scorecard The in South LA. of the health outcomes this with an overview follow domain is Each Resources. Environment and the Physical Resources domains: Healthcare Environment examines the domain Resources Healthcare Environment The of study. scored according to six sub-areas indicators: following synthesizes 50 socioeconomic and environmental factors that influence health behaviors factors that influence health behaviors environmental Scorecard synthesizes 50 socioeconomic and The health outcomes in South LA. Comparisons and contrasts disparate and outcomes and underlie the most health, and economic capacity and quality of community, of access, are made between the levels Angeles, Los West of LA County and environments resource Angeles and the overall in South Los resources artificial The Scorecard is designed to help break through outcomes. health find more favorable we where the revitalization that has prevented political gridlock silos and the intellectual, ethical, and policy both the Scorecard, we seek to galvanize Through unrest. the 1992 civil following of South LA, even immediate Scorecard identifies many The community reinvestment. to drive resources public and private and environment to eliminate inequities in the resource opportunities and tools that can be used policy ultimately disparities in health. South Los Angeles is a series of contiguous communities with a shared history and the highest morbidity highest morbidity history and the with a shared communities a series of contiguous Angeles is South Los with the Councils in collaboration Community Health County. Angeles in Los rates and mortality the community and the health of the between the intersection examined Justice for Health and Coalition result is the South Los The Angeles County. in Los and quality of basic resources distribution, capacity goes of Health” model and Scorecard uses the “Multi-Determinants Scorecard. The Angeles Health Equity health to categorical boundaries of public the “healthcare crisis” and traditional the articulation of beyond and social and economic built environment community in the context of the the health status of the study Social Determinants Health Organization Commission on the World the A recent report by policies. income, distribution of power, the unequal in health are caused by of Health concluded that inequities of sectors data from a wide range compiling by Scorecard tests this conclusion The goods, and services. and (2) determine to environment resource extent inequities exist in the to what to (1) assess and resources analysis from individual shifts the focus and Scorecard The in health. degree they mirror disparities what section Each society. larger socio-economic and political responsibilities we share as a to the behavior more comprehensive a incremental steps that can be taken towards concludes with a summary of the solution. The Physical Environment Resources domain examines: Resources Environment Physical The South Los Angeles Health Equity Scorecard 9 South Los Angeles is a series of contiguous of series a is Angeles Los South communities with a shared history and the highest morbidity and mortality rates Scorecard Angeles County ...The in Los shifts the focus and analysis from to the larger socio- behavior individual economic and political responsibilities we share as a society. ground ack Community Health Councils led the research effort through the collection and analysis of data and the effort through the collection and analysis the research Community Health Councils led the domain Committee, the data collected, Advisory of the After the work of this report. preparation to a broader community of health advocates, were presented research scores, and the accompanying Summit held in and public health officials at the Scorecard Policy policymakers, experts, researchers, and asked to provide into workgroups 100 attendees at the Summit were divided Over 2008. June and respective to their knowledge indicators most relevant recommendations around the data and policy reflect the contributions recommendations included in the Scorecard policy The organizations’ missions. and agenda for policymakers experts for an advocacy of the Summit participants, the CHJ, and other Angeles. the health of South Los to improve community advocates Faced with the downward spiral and impending closure of services at Los Angeles County Martin Luther Angeles County Martin Luther services at Los and impending closure of spiral with the downward Faced Angeles formed in South Los cross section of stakeholders a broad Medical Center, King-Charles Drew Scorecard grew out of Angeles Health Equity South Los The (CHJ). and Justice the Coalition of Health public health of the overall and CHJ to improve Community Health Councils the partnership between and partnerships with community participation accountability, public policy, strengthening South LA by of using community-based participatory Modeled after the idea sector. and the private government on the project relied heavily population health, tool for improving and effective as a strong research and healthcare experts to workers, public health researchers, of advocates, Committee Advisory an Committee prioritized and selected indicators, Advisory the 2007, in February guide its efforts. Formed means, needs not identified through traditional on community advised recommended data sources, input and reviewed content. provided B of this size and scale, many indicators were left out were left indicators many scale, size and of this Scorecard a community at first attempt is the As this and as lessons learned not as faults, but take these We and data. of time, resources, due to constraints policy concludes with sub-sections of the scored domain Each the next report. to improve opportunities hope the Scorecard . It is our publication of until the next steps to pursue and action recommendations community within the and organizing catalyst for education as a tool and will be used that the Scorecard interest areas. and across South Los Angeles Health Equity Scorecard

i 10 GN DESI STUDY Metro Valley San Fernando Valley San Gabriel South South Bay West Target Area Zip Codes Target Area Zip Codes SPA Contrast Valley Antelope East

          Figure 1. Los Angeles County SPA Boundaries and Scorecard Target and Contrast Areas and Contrast Target Boundaries and Scorecard Angeles County SPA 1. Los Figure Los Angeles County is divided into eight Service Planning Areas (SPA). Each SPA is responsible for planning public health and is responsible for planning SPA Each Areas (SPA). into eight Service Planning Angeles County is divided Los clinical services according to the needs of the communities within that area. For the purposes of this report, South LA is used to clinical services according to the needs of the communities within that area. For LA, West area, Because the contrast SPA. 6 distinguishes data only for this distinguish the Scorecard target area. South LA – SPA 5 are used interchangeably. LA and SPA West 5, aligns with SPA i As a first step, the Advisory Committee selected a geographic definition of “South Los Angeles.” The Angeles.” Los definition of “South selected a geographic Committee Advisory As a first step, the closely align with the boundaries by a series of zip codes that is defined Angeles Los target area of South Lennox. and unincorporated Inglewood Hawthorne, 6 and the cities of Area (SPA) of Service Planning DEFINITION OF STUDY AREAS OF STUDY DEFINITION Hawthorne, Inglewood and Lennox—though incorporated in SPA 8 under the county service planning 8 under the county service in SPA incorporated and Lennox—though Inglewood Hawthorne, public reasons, including the common LA for several designated as part of South area designations—were these fact that the health outcomes for Angeles” and the are part of “South Los that these areas perception by a series of zip codes LA is defined West 6. in SPA to be consistent with those seen communities tend included in the Scorecard list of zip codes and cities/communities The 5 borders. SPA aligned with the Angeles Los clusters and their locations within along with a map of the zip code areas, target and contrast Appendix 3. in is available County, South Los Angeles Health Equity Scorecard Figure 2. Multiple Determinants of Health of Determinants 2. Multiple Figure 11 Source: Reprinted from R.G. Evans and G.L. Stoddart, 1990, and G.L. Stoddart, 1990, Reprinted from R.G. Evans Source: Social Science and Producing Health, Consuming Health Care, from Elsevier Science Medicine 31:1347–1363, with permission Ltd, Kidlington, UK. A COLLECTION T The indicators, while scored, were not computed for statistical significance, and should not be used or scored, were not computed indicators, while The A more domain. within each category a complete list of indicators by provides 1 Table described as such. Appendix 2. in in depth discussion of the scoring formula and methodology is provided Each indicator is scored based on the percent difference between the target (South LA) and contrast (West (West difference between the target (South LA) and contrast indicator is scored based on the percent Each to compute an “equity score,” LA) areas to LA County; these scores are then weighted and averaged of advantage method has the This first for the domain sub-sections of data and then the larger domain. which as a baseline. Not only does this method show resources using LA County normalizing the data by baseline. area is doing in relation to the each but also how area is performing better, SCORING METHODOLOGY The data in this report come from a variety of sources: public departments, non-profit research departments, non-profit research public of sources: data in this report come from a variety The the different enterprises. Data were collected by and private organizations, academic institutions, area zip codes. Every aggregated based on the target and contrast boundaries and in some cases were there are several areas as uniform as possible, though made to keep target and contrast effort was data were the to slightly adjust the boundaries based upon how we were forced indicators where indicators, particularly made to use a consistent time period of review across effort was collected. Every a possible. Despite this limitation, the data provide not always this was within the categories; however, in LA County. critical health resources reasonable representation of the access, utilization and capacity of Appendix 1. notes and limitations is contained in A list of data sources, DA After defining the geographic boundaries of the boundaries of the the geographic After defining Committee Advisory the areas, project study regularly a list of health outcomes selected among South LA as poor or poorest ranked indicators the health which residents against on the social and were selected. Focusing in the multiple- environments physical Advisory model, the determinants of health an initial list of health Committee developed seen as directly indicator indicators, with each or or more of the worse contributing to one indicators The health outcomes. deteriorating a set of pre-defined against were then evaluated Committee, Advisory the by criteria developed of the data, the availability ready as the such the target and suitability of the data given or more area boundaries, a link to one contrast unassailable to and more. Indicators that were agreed to be relatively health statuses, cost effectiveness, response, were omitted in order as genetic response and to some degree individual outside influence, such The indicators by community advocacy. be influenced issues that could to focus on actionable policy and socio- both physical of resources, a partial picture of the lack included in the Scorecard only provide barriers to good health. a totality of the area’s no means Angeles, and are by economic, in South Los SELECTION OF DATA INDICATORS DATA OF SELECTION South Los Angeles Health Equity Scorecard 12 Table 1. Scorecard Data Indicators Data Scorecard 1. Table Percent of adults who reported having a regular source of care a regular source reported having of adults who Percent reported easily obtaining medical care of adults who Percent 12 months could not afford dental care at least once in the past of adults who Percent of households with no vehicle Percent a year hours spent in diversion of total ER operating Percent being seen per 1,000 population without ER visits that leave Percent of adults (18-64 years) who reported having no insurance reported having who of adults (18-64 years) Percent no insurance reported having who (0-17 years) of children Percent dental insurance do not have who of adults (18-64 years) Percent County funding for Public-Private Partnership clinics per uninsured person Partnership County funding for Public-Private per adjusted patient day Hospitals’ uncompensated care costs day per adjusted patient Hospitals’ net revenue patient day expense per adjusted Hospitals’ operating General practice physicians (Family medicine, general practice, general preventive and internal medicine) per and internal medicine) preventive general practice, medicine, general (Family physicians practice General 1,000 population per 100,000 population (Oncologists, cardiologists, ob/gyn) specialty physicians Key population child per 100,000 Pediatricians dentists per 1,000 population practice General General acute care hospitals per 100,000 population acute care hospitals General per 100,000 population treatment stations Emergency population Bed supply per 1,000 uninsured population partnership) per 1,000 supply (public and public-private Community clinic population per 1,000 uninsured child health centers School-based 100,000 population per (public and publicly-contracted) Mental health agencies population Pharmacies per 100,000 per 100,000 population Agencies that offer HIV/STD screenings Primary and Preventive Care Access Care Primary and Preventive Healthcare Coverage Healthcare Financing Healthcare Workforce Healthcare Healthcare Facilities Healthcare HEALTHCARE ENVIRONMENT RESOURCES ENVIRONMENT HEALTHCARE South Los Angeles Health Equity Scorecard 13 Table 1. (Continued) 1. Table Schools with substandard facilities per total schools in the area substandard facilities per total schools with Schools in the area per total schools within 500 feet of a freeway schools LAUSD LA City region of industrial/manufacturing zoned land by Percent sites per 100,000 population Number of toxic waste facilities per 100,000 population Number of EPA-regulated Percent of housing structures built before 1939 Percent of occupied housing units with 1.0 occupants or more per room Percent housing units of owner-occupied Percent Percent of adults who believe their neighborhood is safe their neighborhood believe of adults who Percent accidents per 1,000 population Traffic Crimes per 1,000 population Percent of children (1-17 years) whose parents reported they could easily get to a park, playground or other they could easily get to a park, playground parents reported whose (1-17 years) of children Percent safe place to play per 1,000 population Acres of green space/recreation areas population lanes per 100,000 Miles of county-maintained bicycle Liquor retail licenses per square mile feet) per square mile Large-scale supermarkets (44,000+ square service that are limited of restaurants Percent per square mile “C” or below facilities rated Food markets per square mile Farmers’ Percent of adults who reported ER use in the past 12 months ER use in the past reported of adults who Percent clinics per 1,000 uninsured women PPP by Number of pap smears clinics per 1,000 uninsured women PPP by Number of mammograms PSA test had a never have who men age 40 and over of Percent to a dentist been never have who population age 2 and over of Percent the past year a doctor at least once within population that saw of Percent Air & Land Quality Schools Housing Public Safety Physical Activity Physical Nutrition PHYSICAL ENVIRONMENT RESOURCES ENVIRONMENT PHYSICAL Primary and Preventive Care Utilization Care and Preventive Primary South Los Angeles Health Equity Scorecard COMMUNITY PROFILE

The South Los Angeles community represents some of the greatest assets and yet the most daunting health and socio-economic challenges in Los Angeles and California. To describe the population and area in the aggregate is a disservice to a community that plays a significant cultural and socio-economic role in the larger region, and should not be taken as a complete representation of this unique community. Conventional data and analyses do not allow for an accurate portrayal of the rich contributions, assets, differences and contradictions in South LA’s complex history and experience. For area residents, South Los Angeles is a series of discrete neighborhoods: Leimert Park, the Crenshaw District, Morningside Park, West Adams, Hyde Park, View Park, Watts, Compton, Willowbrook, and Baldwin Hills. Its previous designation, South Central Los Angeles was once described as more a condition than a place. Perhaps this is the more accurate understanding of all that is “South LA.”

Similar to health outcomes, the challenges and disparities in the socio-economic conditions described below are not simply a result of individual behavior but rather an outgrowth of racial segregation and public and private policies and systems that concentrate poverty. While the population demographics continue to evolve, the geographic area that is now South Los Angeles is in large part a reflection of the historical patterns of desegregation and migration of LA County’s African American population against a backdrop of the urban decline in a changing global economy. The eastern portion represents the gateway and point of entry for those who migrated to the west in the hope of new opportunities. The western edge bookmarks the shift from desegregation and the dismantling of housing covenants to racial segregation reframed through economic policy.

14 South Los Angeles Health Equity Scorecard 65+ 59.20% 18-64  18-64  65+  0-17 1,321,180 651,084 2005 0-17 While comparable While comparable

ii West LA Figure 4. Figure 7.30% South LA Population by Age South LA Population by Age by South LA Population South LA Population by Age South LA Population by Ages by South LA Population Source: United Way Zip Code Data Book, 2007 Way United Source: South LA 33.50% 2000 621,388 1,241,699 15 Source: United Way Zip Code Data Book, 2003 and 2007 Way United Source: 0 rowth in South and West LA West and in South Growth 3. Population Figure 800,000 600,000 400,000 200,000 1,400,000 1,200,000 1,000,000

United Way of Greater Los Angeles, Zip Code Data Book Service Planning Area 5, 6 and 8. May 2007. Data aggregated by 2007. Data aggregated by Area 5, 6 and 8. May Angeles, Zip Code Data Book Service Planning of Greater Los Way United South and West LA area zip codes. West South and ii South LA provides a unique intersection of race, of race, a unique intersection South LA provides the oldest and most ethnicity and culture. It is one of the area, reflecting an well-established communities in and population migration important segment of the history What were once largely white patterns of the region. areas of South many and middle-class communities in and ethnic blend of racial home to a diverse LA are now large South LA is home to particularly backgrounds. (31%) and Latino (62%) residents of Black percentages are LA West in people living 5). In contrast, (Figure and 17% White (61%) with only 7% Black primarily of Latino residents. South LA has the largest percentage American African 45% of the LA County. Area within Service Planning and Latino residents of any Black Angeles County resides in this area; 17% of the Latino population. population of Los The age distribution in South LA also carries significant age distribution in South LA also carries The is 18 33.5% of the population implications for this study: population LA, the youth West In or under. of age years On at 27%. overall stands at 16.8% and in LA County of the population in the other end of the spectrum, 7.3% LA and West in 13.4% South LA is 65 and older versus 10% in LA County. to LA County as a whole, considerably more people living in South LA speak a language other than in South LA speak a language more people living considerably to LA County as a whole, Angeles. Los West compared with English at home when Despite its smaller geographic size, its smaller geographic Despite double has more than South LA West of residents of the number vs 651,000). LA (1.32 million density population Consequently, The times higher. is more than four for population density rate growth has been 50% from 2000 to 2005 LA and triple West higher than for a Angeles County as that of Los whole. Profile Population South Los Angeles Health Equity Scorecard 61.3 Yet for many, these for many, Yet ii West LA West 16.6 7 3.1 0.2 0.4 11.4

Despite this deeper analysis of income levels, levels, Despite this deeper analysis of income iii 16 Given the disparity in unemployment figures across in unemployment the disparity Given ii White Latino Black American Indian Asian/Pacific Islander Other Two or more 62.4 Source: United Way Zip Code Data Book, 2007 Way United Source: South LA Figure 5. Population by Race for South and West LA West South and Race for by 5. Population Figure 31 1 Economically, the South LA region undergoes a high amount of “churn” with new businesses the South LA region undergoes a high amount of “churn” Economically, 3.3 0.2 0.2 1.9 iv Los Angeles Neighborhood Market Drill Down: Catalyzing Business Investment in Inner-City Neighborhoods, July 2008, Social Neighborhoods, July in Inner-City Catalyzing Business Investment Down: Angeles Neighborhood Market Drill Los Los Angeles County Department of Public Health. Extracted from July 1, 2005 Population Estimates, prepared by Walter R. Walter Estimates, prepared by 1, 2005 Population from July Health. Extracted Angeles County Department of Public Los Compact, Inc. figures do not provide an accurate analysis of the “buying power” in South LA. Given the population the population in South LA. Given of the “buying power” analysis an accurate figures do not provide the “income density” is the annual income earned per acre revealed density of the area, an analysis of per acre $350,000 a year South LA than the city of LA as a whole: four times higher in some areas of $91,000 per acre citywide. compared with on average LA (14.1% South West in as those people living to be unemployed South LA residents are twice as likely LA). West 6 vs. 8.2% LA County vs. 6.1% LA/SPA A comprehensive listing of these and other relevant data is contained in Appendix 4. data is contained in listing of these and other relevant A comprehensive regions, it is perhaps not surprising that a much higher percentage of families living in South LA have in South LA have of families living higher percentage that a much regions, it is perhaps not surprising LA (26.5%) or LA County West in than those living Level Poverty 200% of the Federal incomes below (37.7%). highlights socioeconomic differences between South Another factor that replacing those that close down. in South LA with a of people living proportion The in education levels. LA is the disparity West LA and oversimplification be an this may Again, West LA residents. college degree is less than one fifth that of of socio-economic sub-populations that must be fully of a complex community laced with a wide range address the inequities and disparities facing this community. effort to understood and appreciated in any iv iii According to the United Way Zip Code Data Book, the median income for South LA/SPA 6 residents Data Book, the median income for South LA/SPA Zip Code Way According to the United 5 ($60,464). LA/SPA West in less than half that of people living ($27,303) in 2000 was Economic Profile McDonald & Associates, Inc. (WRMA) for Urban Research, LA County CEO, released 5/18/2007. LA County CEO, for Urban Research, Associates, Inc. (WRMA) McDonald & South Los Angeles Health Equity Scorecard 174 LA County ood 199 Inglew of Death ause S TU 223 A Compton C Premature Homicide Coronary Heart Disease Crash Vehicle Motor Diabetes Stroke 17 ST TH 220 th HEAL Southwest use of Dea a 226 South Table 2. South LA/SPA 6 Leading and Premature Causes of Death and Premature Causes of 6 Leading 2. South LA/SPA Table While we find variances within South LA based on geographic sub-areas, the disparities variances within South LA based on geographic While we find Leading C Coronary Heart Disease Stroke Homicide Diabetes Lung Cancer 6 vi Table 3. Death Rate Due to CHD by South LA Health District vs. LA County 3. Death Rate Due to CHD by Table

v 100,000

Age-adjusted Source: Mortality in Los Angeles County 2005: Leading Causes of Death and Premature Death, Los Angeles County Angeles County 2005: Leading Causes of Death and Premature Death, Los Mortality in Los Source: Department of Public Health Source: Mortality in Los Angeles County 2005: Leading Causes of Death and Premature Death, Los Angeles County Death, Los Angeles County 2005: Leading Causes of Death and Premature Mortality in Los Source: Department of Public Health Death Rate per Rank 1 2 3 4 5 Premature death is defined as death before the age of 75. Data compiled by Master Files, Angeles County from the California Death Statistical for Los 1999-2005 Linked Mortality Files Collection and Analysis Unit, Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health. Los Assessment and Epidemiology, of Health Analysis Unit, Office Collection and LA are for West 90304, 90305). Data for 6 plus selected zip codes (90250, 90301, 90302, 90303, Data for South LA include SPA 5. SPA between even the healthier of the sub-regions of South LA exceed those of the overall county. the healthier of the sub-regions of South LA exceed those of the overall between even v vi Coronary heart disease (CHD) death rates have been decreasing throughout the county since 1999. been decreasing throughout the county since have rates Coronary heart disease (CHD) death and in South LA is consistently higher than the county level due to CHD Nonetheless, the death rate and 23% higher than the LA’s West 68% higher than CHD death rate sub-county regions, with South LA’s county overall. Disease Heart Coronary These health outcomes form the foundation of our study. The rates of illness and death are lower in West West in are lower of illness and death rates The of our study. health outcomes form the foundation These a brief provide We of disparity among the three areas is noteworthy. and the depth LA and LA County, be, it as the disparities may As startling and premature causes of death. analysis of the combined leading and not solely individual of health that are the subject of this study is the underlining social determinants the associated risk factors are highlighted to illustrate These health outcomes themselves. or the behavior health crisis in South LA. within the community to fuel the Mortality in Los Angeles County 2005: County 2005: Angeles in Los report, Mortality of Public Health’s Department to the LA County According 6 are in South LA/SPA causes of death leading , the five and Premature Death Causes of Death Leading causes examine the leading When we cancer. diabetes and lung homicide, heart disease, stroke, coronary and motor vehicle to include homicide causes of death change and of premature death, the ranking accidents. South Los Angeles Health Equity Scorecard 4.5 11.1 8.1 2005 West LA 4.1 9.7 7 LA County 2003 18 South LA Similarly, the percentage of adults diagnosed with diabetes of adults diagnosed with diabetes the percentage Similarly, vii 8.1 6.7 4.7 2000 In California, the age-adjusted percent of adults with diagnosed diabetes of adults with diagnosed age-adjusted percent In California, the 1 Figure 6. Percent of Adults Diagnosed with Diabetes Adults Diagnosed of 6. Percent Figure 8 6 4 2 0 12 10 Source: LA County Department of Public Health, Office of Health Assessment and Epidemiology Assessment and Office of Health LA County Department of Public Health, Source:

2 Behavioral Risk Factor Surveillance System. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promo- and Health Atlanta, GA: National Center for Chronic Disease Prevention System. Surveillance Risk Factor Behavioral rose from 5.3% in 1995 to 7.4% in 2005. rose from 5.3% in a marked decrease between LA, with West 2005. and LA County between 2000 and rose in South LA than in 2000. are lower although they also has increased levels, 2000 and 2003, vii Because diabetes is a risk factor for other chronic illnesses, 58% of adults in LA County with diabetes were illnesses, 58% of adults in other chronic Because diabetes is a risk factor for suffered from and 41% 56% were diagnosed with high cholesterol, also diagnosed with hypertension, obesity. In the last 15 years, the prevalence of diabetes in the United States has doubled, with 14.6 million diabetes in the United States has of the prevalence In the last 15 years, in 2005. American diagnosed tes Diabe Risk factors for CHD include smoking, high blood cholesterol and blood pressure, physical inactivity, inactivity, physical pressure, and blood cholesterol high blood smoking, include CHD factors for Risk also to CHD are contributing factors of the many Predictably, and diabetes. overweight, obesity and in South notably higher and mortality are of morbidity rates their profile, as in this Health Status included Angeles. Los accessed September 2008. tion; 2007. http://www.cdc.gov/brfss/ South Los Angeles Health Equity Scorecard 31.0 25.1 22.2 151.9 West LA 35.5 23.3 23.4 158.2 LA County 2005 19

West LA 43.7 27.8 40.2 185.7 South LA 2003 LA County In 2004, of the 883 deaths due to homicide in LA County, 40% (353 total 40% (353 total in LA County, due to homicide of the 883 deaths In 2004, viii South LA 2000 Lung Cancer Breast Cancer Prostate Cancer All Cancer Source: LA County Department of Public Health, Office of Health Assessment LA County Department of Public Health, Office of Health Source: 2005 and Epidemiology, Table 4. Age-adjusted Mortality Rates by Cancer Types Cancer Age-adjusted Mortality Rates by 4. Table 0 70 60 50 40 30 20 10 Source: LA County Department of Public Health, Office of Health Assessment and Epidemiology Assessment and Office of Health LA County Department of Public Health, Source: ancer

This is also true for all-cancer mortality and other types of cancer. is also true for all-cancer This vi vi Figure 7. Crude Mortality Rate from Homicide in 15-44 Year Olds per 100,000 Persons Year Rate from Homicide in 15-44 7. Crude Mortality Figure Homicide rates are the crude mortality rate for people between the ages of 15 to 44. Crude mortality is not adjusted for age for people between the ages of 15 to 44. Crude are the crude mortality rate Homicide rates viii Lung cancer is the fifth leading cause of death in South LA/SPA 6 and the third leading cause of death in of death in South LA/SPA Lung cancer is the fifth leading cause LA and LA West higher in though lung cancer mortality is ranked Even LA County overall. LA and West LA (31) or LA County West higher than for in South LA (43.7) is much the actual mortality rate County, (35.5). Lung C However, these statistics do not tell the whole story. They are perhaps the best illustrations of the illustrations are perhaps the best They story. these statistics do not tell the whole However, (educational and employment in the context of the larger environment importance of examining the data of the underlying social in foster care, etc) to fully appreciate the significance opportunities, children determinants. The crude mortality rate due to homicide in people ages 15 to 44 has been increasing throughout the throughout the been increasing 15 to 44 has in people ages due to homicide rate crude mortality The years. the past five county for icide Hom deaths) were South LA residents. West LA, however, has had fewer than 30 homicides per year since per year 30 homicides has had fewer than LA, however, West South LA residents. deaths) were high as LA County LA and twice as West as high as in South LA is 6 times homicide rate 2005 The 1999. overall. due to previous population specifications (15-44). South Los Angeles Health Equity Scorecard 9.6 9.3 5.7 2005 West LA 11 9.9 5.8 Year LA County 2003 20

vi South LA

vi th Outcomes 7 10.1 9 2000 Source: LA County Department of Public Health, Office of Health Assessment and Epidemiology LA County Department of Public Health, Office of Health Source: al Heal Figure 8: Age-adjusted Motor Vehicle Crash Mortality Rate per 100,000 Persons Mortality Rate Crash Vehicle Motor Age-adjusted 8: Figure 0 2 4 6 8 10 12 Rate Additional health outcomes in which South LA ranks poorly include prenatal care, low-birth weight poorly include prenatal care, low-birth South LA ranks Additional health outcomes in which lead poisoning affecting obesity, babies, and infant mortality affecting mothers and babies; asthma, health risk factors. acuity of illness, and behavioral mental health, disease, cancer, and liver children; Appendix 5 for this data. See Addition Stroke is the second or third leading cause of death for all SPAs and the second leading cause of death and the second leading Stroke is the second or third leading cause of death for all SPAs other area of the county in South LA are higher than for any Stroke mortality rates for LA County overall. 32% higher in South LA was In 2005, the age-adjusted stroke mortality rate Valley. Antelope except the County. LA and LA West than both Stroke

Motor vehicle crashes are ranked among the top five leading causes of premature death for every SPA. SPA. death for every of premature leading causes top five among the are ranked crashes Motor vehicle rest of LA County higher than the is only 3% car crashes due to death rate LA, the age-adjusted In South LA. West than is 68% higher but overall, rash C Vehicle Motor South Los Angeles Health Equity Scorecard Scorecard Domain 1 Domain Scorecard 21 Healthcare Environment Resources Environment Healthcare South Los Angeles Health Equity Scorecard -43% South LA

The uninsured The ix

x +72% West LA West Healthcare Environment Resources Score Resources Healthcare Environment 22 About half of those hospitals served residents in South Los Angeles. Los residents in South About half of those hospitals served 6 And while the And while 3

5 HEALTHCARE ENVIRONMENT RESOURCES ENVIRONMENT HEALTHCARE The high levels of morbidity and of high levels The 4 are 4 times more likely to delay accessing care than those with health coverage, thus increasing accessing care than those with health coverage, are 4 times more likely to delay the acuity of illness. 30.2% of the non-elderly adult (ages 18-64) population in South LA are uninsured. 30.2% of the non-elderly adult (ages full-scale emergency room and trauma center at St. Francis Medical Center in the 94 square-mile Francis center at St. room and trauma full-scale emergency one million residents. over area to serve geographic patients and struggle to provide commercial private increasingly fewer South LA hospitals serve adjusted patient day care per populations. In South LA, charity services to indigent and uninsured level. at three times the countywide is provided Five emergency rooms and/or hospitals have closed in South LA since 2000, leaving only one South LA since 2000, leaving closed in rooms and/or hospitals have emergency Five ♦ ♦ ♦ Los Angeles County Health Survey, LACHS 2005 Survey, Office of Health Assessment and Epidemiology, Los Angeles County Los Assessment and Epidemiology, Office of Health 2005 Survey, LACHS Angeles County Health Survey, Los On October 1, 2007, Los Angeles Metropolitan Medical Center was licensed to operate an emergency room and opened with an emergency licensed to operate Medical Center was Angeles Metropolitan On October 1, 2007, Los Department of Public Health. Estimates are based on self-reported data by a random sample of 8,648 Los Angeles County adults sample of 8,648 Los a random Department of Public Health. Estimates are based on self-reported data by Angeles County. of the population in Los representative four treatment stations. Because of their small size, these stations were not included in the Scorecard. four treatment stations. Because of their small size, these stations were not included mortality in the population are exacerbated by are exacerbated by mortality in the population crisis in the healthcare industry. the growing distribution Escalating cost and disproportionate the capacity and compromised have of resources In South LA quality of the healthcare system. alone: age-adjusted death rate declined by 3.4 percent 3.4 percent declined by rate age-adjusted death and 2003 and 2004, racial nationwide between in mortality are stubbornly ethnic differences persistent. Hospitals across the country are becoming increasingly for-profit and investor owned. With this trend owned. and investor Hospitals across the country are becoming increasingly for-profit healthcare network. comes an uncertainty and erosion of the traditional x ix Millions of people in the United States have United States have of people in the Millions and services. Racial healthcare trouble accessing quality a lower tend to receive ethnic consumers present with the they when of healthcare, even and ability to pay insurance, same illnesses, health population. for care as the white For South Los Angeles and in many other underserved areas, healthcare coverage is inextricably linked coverage areas, healthcare other underserved and in many Angeles South Los For utilization for access and and capacity, for the individual; socio-economic status to employment; regulations are increasingly excluding the federal care, Other than emergency healthcare providers. Act prohibits 2005 Deficit Reduction The of healthcare services for undocumented immigrants. provision This impacts the ability of LA County under Medicaid. benefits undocumented residents from receiving under the state Medicaid waiver. initiative to enroll uninsured adult patients into the local coverage does not adequately support primary care and sectors Healthcare financing both in the public and private and evidenced-based disease management services often fails to include reimbursement for preventive funding is directed specifically to support the uninsured, placing the burden on the Little if any programs. financial burden of the uninsured is not equally distributed The county and local healthcare providers. When MLK Hospital was Angeles County and elsewhere. among the broader healthcare industry in Los acute-care hospital to close general in 2007, it became the fifteenth government the federal by shut down Angeles County since 2000. in Los South Los Angeles Health Equity Scorecard

10, Others argue 9

7 23 Healthcare Facilities Workforce Healthcare Healthcare Financing Healthcare Coverage Access Care Primary & Preventive Care Utilization Primary & Preventive ♦ ♦ ♦ ♦ ♦ ♦ Previous research shows that there is very little agreement on the optimal level of healthcare capacity of healthcare capacity little agreement on the optimal level that there is very shows Previous research points to the supply of hospitals, inpatient beds, and specialist Some evidence needed for a community. health outcomes. a predictor of utilization but not necessarily improved as physicians for re-organization of service delivery and a more equitable geographic distribution of physicians. distribution of and a more equitable geographic for re-organization of service delivery In order to assess the healthcare resource environment, we examined six dimensions of capacity and six dimensions of capacity we examined environment, the healthcare resource In order to assess access: The significance of the dynamic changes occurring within the capacity of the healthcare resource resource healthcare of the capacity the within occurring changes dynamic of the significance The impact at a direct economic and has needs of a community the direct health beyond goes environment and 14.4% of the GDP approximately consumed In 2006, healthcare levels. state and national the local, Medicare Services. Medicaid and US Centers for according to the 2016, by to rise to 20% is expected to jobs, and it continues than 14 million more US providing industry in the is also the largest Healthcare salary and million new wage three will generate that healthcare of Labor estimates Department The grow. other industry. and 2016, more than any jobs between 2006 Whatever the case may be, local advocates and experts agree that South LA’s level of infrastructure and of infrastructure level and experts agree that South LA’s be, local advocates the case may Whatever to residents in need harm causing irreparable and under-funded, remains critically under-staffed resources of quality care. South Los Angeles Health Equity Scorecard LA -28% South 1.23 1.83 3.22 0.43 0.12 0.50 6.91 1.54 20.43 21.81 WEST LA LA 0.90 1.23 2.21 0.24 0.10 0.17 4.26 1.39 59% West West 14.95 15.14 LA COUNTY 0.45 6.66 0.68 1.14 0.22 0.09 0.11 5.75 7.72 1.14 SOUTH LA 24 xvi xvii HEALTHCARE FACILITIES HEALTHCARE xiv xviii xii xii xv INDICATOR xiii xi Licensed available bed supply per 1,000 bed supply Licensed available population bed supply per Licensed acute psychiatric 1,000 population HIV LA Consumer Directory, Office of Aids Program and Policy. < http://www.hivla.org/search.cfm> accessed March 4, 2008. accessed March < http://www.hivla.org/search.cfm> Policy. and Aids Program Office of HIV LA Consumer Directory, Personal research of Arleen F. Brown, UCLA Department of Medicine, Division of General Internal Medicine and Health of General UCLA Department of Medicine, Division Brown, Arleen F. of research Personal Office of Statewide Health Planning and Development, Hospital Annual Financial Profile Report, 2006. Annual Hospital Office of Statewide Health Planning and Development, Los Angeles County Department of Mental Health, Planning Division. 2007. Health, Planning Division. Angeles County Department of Mental Los Los Angeles County Department of Health Services, Office of Planning and Analysis, 2006. Services, Office of Planning and Angeles County Department of Health Los Office of Statewide Health Planning and Development, Hospital Annual Utilization Profile Report, 2006. Hospital Office of Statewide Health Planning and Development, California School Health Centers Association, 2007. Health Centers California School General acute care hospitals per 100,000 acute care hospitals per 100,000 General population medical treatment stations per Emergency 100,000 population (averaged) Bed supply per 1,000 population Community clinic (DHS & PPP) supply per Community clinic (DHS & PPP) supply 1,000 uninsured population health centers per 1,000 School-based uninsured children Mental health agencies per 100,000 population Pharmacies per 100,000 population Agencies that offer HIV/STD screenings per 100,000 population Office of Statewide Health Planning and Development, Hospital Listings, 2006. Office of Statewide Health Planning and Development, xviii xvi xvii xiii xiv xv xi xii Perhaps the most widely-recognized and frequently-studied aspect of aspect and frequently-studied widely-recognized the most Perhaps for the population resources of medical its scarcity Angeles is South Los of assess the capacity To its community. health needs of size and number we examined the resources, environment existing healthcare proportion to the and mental health agencies in of hospitals, clinics or privately-funded, publicly-operated Whether size of the population. critical in South LA that provides infrastructure the existing healthcare dentists, pharmacies, (hospitals, clinics, physicians, medical services the resources clearly inadequate. In some cases, and more) remains 2007 August the as evidenced by diminishing, even and services are in this report are the numbers Though Hospital. closure of MLK-Harbor this snapshot of South LA’s the assets of MLK-Harbor, some of the indicators include from 2006 and thus assessed a number of We a dire situation. nonetheless depicts facilities network loosely-knit healthcare facility capacity as seen below. indicators to measure healthcare Services Research, 2007. Services Research, South Los Angeles Health Equity Scorecard

13 Similarly, another Similarly, 12 W es t LA LA County LA 25 Hyde Park Clinic Hyde Park Jordan High School Health Center High School Jordan School Health Centers in South LA School Manual Arts High School Health Center Arts High School Manual South LA South Accelerated School – School Based Health Center – School School Accelerated Foshay Learning Center, CA Medical Center Clinic CA Learning Center, Foshay Source: California School Health Centers Association, 2007 Association, Health Centers California School Source: 0 0.6 0.5 0.4 0.3 0.2 0.1 Figure 9. School-based Health Clinics per 1,000 Uninsured Children Health Clinics 9. School-based Figure study conducted in inner-city New York found that students with asthma, in addition to having fewer that students with asthma, in addition to having found York New conducted in inner-city study treated at an SBHC. when absenteeism from lower days school hospitalizations, also gained three The supply of available general acute care beds and licensed acute psychiatric beds per 1,000 population acute care beds and licensed acute psychiatric general supply of available The LA has West 1,000 population and is 0.68 in South LA. By comparison, LA County has 1.23 beds per Memorial Hospital in December the closure of both MLK-Harbor and Daniel Freeman 1.83. Following to 0.43 beds per 1,000 population. 2007, the inpatient bed capacity in South LA decreased dramatically medical LA’s West the second-largest disparity between South and Inpatient bed supply demonstrates lower number of EMS treatment stations is another critical area with significantly The facilities’ capacity. West LA County has 14.95 and South LA only has 6.66 EMS stations per 1,000 population, while capacity. LA has 20.43. Expanding the system of school-based healthcare is particularly crucial in South LA, which has a has LA, which healthcare is particularly crucial in South Expanding the system of school-based (28.8%). asthma (8.6%), obesity and overweight suffer from who of children disproportionate percentage School-based clinics are often the first point of medical contact for some student populations. One study populations. One study clinics are often the first point of medical contact for some student School-based department visits decreased decreased 2.4-fold and emergency found that the risk of hospitalization in Ohio. with SBHC’s attended schools students with asthma who 34% for by The largest disparity within health facilities occurs in the supply of school-based health centers. School- centers. health school-based of in the supply occurs facilities health within disparity largest The for children of needed services to a variety access as providing widely recognized centers are based health and and obesity, weight of children’s counseling, supervision mental health including and adolescents, LA has 0.11 conditions. South chronic diabetes, and other of asthma, and treatment early diagnoses County less than the LA or 35% children, per 1,000 uninsured centers (SBHC) health school-based per 1,000 has 0.50 SBHC LA, in comparison, West children. 1,000 uninsured supply of 0.17 per baseline more than the LA County baseline. or 201% uninsured children South Los Angeles Health Equity Scorecard Fewer hospital beds and hospital Fewer xix 26 Hospitals, DHS and PPP Clinics in South LA Hospitals, DHS Central City Community Health Center Central Northeast Community Clinic Healthcare Center Family South Bay Health Center Family South Central Inc. Center, Child and Family Well St. John’s Clinic, Inc. T.H.E. Association, Inc. Medical Muslim University Healthcare Corporation Watts Community Healthcare BAART Neighborhood Medical Group, Inc. Central Health Clinic, Inc. Compton Central Community Service Center El Dorado Medical Clinics, Inc. Sacred Heart Family Hubert H. Humphrey Comprehensive Health Center Hubert H. Humphrey Comprehensive Health Center H. Claude Hudson Comprehensive Care Center Ambulatory Multi-service Martin Luther King, Jr. Dollarhide Health Center Centinela Hospital Medical Center Centinela Hospital Metropolitan Medical Center Angeles Los Center Medical St. Francis Angeles – Suburban Campus Promise Hospital of East Los Community Health Center Kedren ...... Source: Office of Statewide Health Planning and Development; Office of Statewide Health Planning and Development; Source: Services Angeles County Department of Health Los

PPP Clinics DHS Clinics Hospitals Office of Statewide Health Planning and Development, Hospital Annual Utilization Profile Reports, 2000-2006. Hospital Office of Statewide Health Planning and Development, xix emergency room stations create a downward spiral for insured and uninsured patients. Emergency room room patients. Emergency and uninsured for insured spiral create a downward room stations emergency ambulance transports are closed to rooms (the hours emergency rates ER diversion times increase; wait a less competitive and an exit of physicians force fewer hospital beds increase; due to overcrowding) these regional resulting from overflow The the insured. that cover companies for insurance environment and the communities they serve. other neighboring health hospitals shortages impacts The shortage in Emergency Room capacity can be measured by the 129,069 visits lost following the lost following visits the 129,069 by be measured can capacity Room in Emergency shortage The MLK- Hospital, Memorial, Orthopedic Daniel Freeman Memorial, Kennedy F. of hospitals (Robert closures Campus). (Promise Hospital-Suburban rooms and emergency Harbor Hospital) South Los Angeles Health Equity Scorecard early intervention, comprehensive comprehensive early intervention, 16 Early Intervention Program offers Program Early Intervention provides comprehensive medical services comprehensive provides : Community clinics and safety-net hospitals : Community clinics 27 and others have promoted increased integration and and integration promoted increased have and others 14, 15 which is approximately 30% of the adult and 11% of the is approximately 30% of the which 17 : South LA has the highest rates of chlamydia and gonorrhea, of chlamydia : South LA has the highest rates comprehensive HIV/AIDS medical care comprehensive : South LA/SPA 6 has 5.8 mental health agency providers per 100,000 providers 6 has 5.8 mental health agency : South LA/SPA : onsite and mobile, standard and rapid HIV testing and counseling : onsite and mobile, standard and rapid 18 South LA has 7.7 pharmacies per 100,000 population, while LA County had LA County population, while per 100,000 has 7.7 pharmacies : South LA Partial List of Community Agencies Addressing HIV in South LA Addressing HIV Agencies Community List of Partial While fewer adults in South LA report being diagnosed (11.8%) with depression than LA County adults in South LA report being diagnosed (11.8%) with depression While fewer ritionist for people with HIV/ HIV medical care, dental and vision, OB/GYN urgent care and nut AIDS HIV/AIDS medical care, spanning the full spectrum of Clinic offers comprehensive OASIS The primary AIDS. In addition, the HIV clinic provides HIV disease from HIV testing to late-stage diabetes, and women’s care to all patients including disease management of hypertension, health issues. including AIDS drug assistance program, case management, prevention health education and prevention case management, AIDS drug assistance program, including support services AIDS Project Minority AIDS Program: Community Healthcare Corporation Watts Charles R. Drew University of Medicine and Science: Charles R. Drew University AIDS Healthcare Foundation: exams outpatient HIV medical treatment, lab testing and physical comprehensive Health Center: Hubert Humphrey Comprehensive xx ...... child population in South LA. population in South child mental health agencies Fewer but less than the 6.9 available in LA County overall, is more than the 4.3 available population, which West required out-of-home treatment compared to 109 in LA. In 2002, 528 South LA children West in LA. and other American African Latino, rates among LA (16.6%), US trends also find lower West (12.9%) or however, ethnicity, population. Race and make up South LA’s and ethnic groups, all of whom racial likelihood that illness will be persistent, more of mood disorders and the determine under-diagnosis or untreated. severe represent a significant portion of the Healthcare Network for the uninsured. In South LA, there are only for the uninsured. In South LA, Network portion of the Healthcare represent a significant hospitals uninsured population and 0.45 and PPP) per 1,000 clinics (DHS-operated 0.09 community and 0.9 is 0.1 per 1,000 uninsured population clinic supply LA County’s per 100,000 population. to safety-net providers that close proximity shown population. Studies have hospitals per 100,000 to care for the uninsured, increases access screening agencies there are only 1.1 HIV/STD yet county, in the and the highest HIV mortality rate in countywide and 1.5 available available are 1.4 agencies There per 100,000 population. available 100,000 populations. LA, per West Fewer resources for HIV/STD screening resources Fewer Fewer community clinics and safety-net hospitals community clinics Fewer 15.1 and West LA has 21.8 pharmacies per 100,000 population. The supplies of pharmacists supplies of The population. per 100,000 has 21.8 pharmacies LA West 15.1 and care and disease of chronic avenues as possible recent study come under have and pharmacies health outcomes, and improved management Fewer pharmacies Fewer coordination of pharmacies and pharmacists into the safety net. and pharmacists into coordination of pharmacies Department of Mental Health data for services received through DMH in SPA 5 and SPA 6 accessed from http://publichealth. 5 and SPA through DMH in SPA Department of Mental Health data for services received .

. . xx . Additional disparities in the supply of health system facilities include: facilities health system of in the supply disparities Additional accessed September 2008. lacounty.gov/childpc/social.htm#mental South Los Angeles Health Equity Scorecard 28 After the closure of Daniel Freeman Memorial Hospital in 2007, the City of After the closure of Daniel Freeman the issuance of building permits, prohibiting adopted a moratorium Inglewood for non-medical uses in the business tax certificates or licenses zoning approval, the city time designed to give was moratorium The Residential and Medical Zone. the closure on residents’ health and study to assess the impact of the hospital’s Code Section 65858 feasibility of reestablishing services. California Government cities or counties to forgo the procedures otherwise required prior to the allows health, and welfare of adoption of a zoning ordinance to protect the public safety, adopt an interim ordinance measure, a city or county may As an urgency residents. plan, uses in conflict with a contemplated general prohibiting any for 2 years planning commission or body, specific plan, or zoning proposal that the legislative within a reasonable time. or intends to study department is studying South Los Angeles Healthcare Leadership Roundtable Angeles Healthcare Leadership South Los of area Leadership Roundtable is composed Angeles Healthcare South Los The health foundations, research hospital and clinic CEOs, healthcare stakeholders: and members of the business organizations institutions, advocacy and educational the and of government level in concert with each coalition works The community. design a system to increase healthcare capacity and policy sector to amend private Angeles. in South Los Increasing the number of primary care and School-Based Health Clinics is one immediate and relatively one immediate and relatively Health Clinics is care and School-Based Increasing the number of primary on South LA hospitals. In hospitalization and help alleviate the pressure to avert strategy cost effective to aid the Senator Mark Ridley-Thomas signed SB 546 authored by Schwarzenegger 2008, Governor is the use of urgent consideration Another health centers. of new and existing school development the area and in proximity to or associated with hospitals to placed throughout care centers strategically of require a reinvestment All of these recommendations rooms. use of emergency inappropriate divert the healthcare in South LA and planning and coordination not only among funding public and private to and redevelopment but also with city planning, transportation funders and regulators, community, the region. ensure the healthcare capacity of the by services historically provided An effort must also be made to retain existing public funding and portion of swiftly to retain a of MLK Hospital, county and state officials acted the closure With county. otherwise been lost because of current hospital financing have the funding for the hospital that would the county to retain $100 million of the state safety-net care pool under the regulations. SB 474 allowed reallocated to impacted hospitals for the was funding The formerly allocated to MLK. Medicaid waiver funding This services in the region. increase in uninsured patients and to support primary and urgent care should the hospital reopen before then, be 2010 or, August and will sunset in is limited to three years to the reopened facility. diverted The lack access and equity in healthcare facilities and thus services in South LA is a complex issue. In LA is a complex services in South facilities and thus in healthcare access and equity lack The to that fail market forces based on has evolved network the healthcare of regional planning, the absence little if there has been Until recently, population. and underinsured for the uninsured provide adequately A comprehensive their funders or regulators. planning across hospitals, clinics, coordination and joint any the future of this community. healthcare services is critical to regional plan for RECOMMENDATIONS South Los Angeles Health Equity Scorecard 29 The following recommendations are offered to begin the process of rebuilding the healthcare network in network of rebuilding the healthcare are offered to begin the process recommendations following The Angeles. South Los Funding for mental health services has been a challenge since the closure of state facilities in the the closure of state facilities since health services has been a challenge Funding for mental 63, the Mental Health Services passed Proposition California voters 2004, mid-1980s. In November to approach through a comprehensive delivery mental health service sought to improve Act, which implemented prevention MHSA funds, LA County has Through mental health services. community-based competency, cultural to address education and training workforce programs, and early interventions of care service program. and a community-based system improvements, facilities and technology In the absence of a large private sector, the county clinics play an important role in the South LA LA in the South role important an play clinics county the sector, private of a large absence In the as a priority during level current service their or above maintained at and must be network healthcare be carefully system must public healthcare of the county’s proposed privatization The budget shortfalls. a significant of MLK created closure The stakeholders. with community done in consultation studied and A greater failed. have timeline ginal 18-month facility in the ori to reopen the South LA. Efforts deficit in in the region. loss of services further to avoid levels and federal at the state effort is needed and consistent South Los Angeles Health Equity Scorecard GENCY ACCOUNTABLE A ACCOUNTABLE City Councils Angeles County Board of Supervisors Los City and county planning agencies Los Angeles County Department of Health Angeles Los Services California Department of Health Care California Department of Health Services LA County Board of Supervisors California State Legislature LAUSD Los Angeles County Department of Health Angeles Los Services Los Angeles County Chief Executive County Chief Executive Angeles Los Officer Los Angeles County Board of Supervisors Angeles County Board of Los Centers for Medicare and Medicaid Centers for Medicare Services California State Legislature California Department of Health Care California Department Services Governor Arnold Schwarzenegger Governor Los Angeles County Department of Health Angeles County Department Los Services Los Angeles County Chief Executive Executive County Chief Angeles Los Officer Los Angeles County Board of Supervisors County Board Angeles Los

...... 30 POLICY RECOMMENDATION POLICY Working with healthcare providers interested in with healthcare providers Working health services on current or new sites. developing Prohibiting the issuance of building permits, business tax certificates or zoning approvals, licenses for non-medical uses Preserving any current property zoned for medical current property zoned for Preserving any use Developing a formalized structure to govern a formalized structure to govern Developing system of care between or lead an integrated hospitals and primary and urgent care clinics. Creating financial incentives under public funding Creating financial incentives and service integration streams to encourage partnership Formalizing referral and other relationships to and other relationships referral Formalizing care among providers provide Increasing the number of and funding for school- Increasing the number of and funding based clinics. Providing capital funding for expansion of primary capital funding for expansion Providing LA and urgent care facilities in South Allocating additional PPP funding for SPA 6 clinics for SPA Allocating additional PPP funding at least $10 from $4.2 million (FY 2006-07) to for inflation million with annual adjustments

. . Ensure access to healthcare services by: .

. . Leverage existing healthcare resources to expand existing healthcare resources Leverage services in South LA by: . . . Increase primary care services to low-income and care services to low-income Increase primary uninsured populations by: . Reopen MLK Medical Center and gradually build into build and gradually MLK Medical Center Reopen hospital. teaching a full-scale South Los Angeles Health Equity Scorecard LA -76% South 1.27 4.92 19.46 19.97 33.49 193.05 147.15 WEST LA 0.54 6.26 1.37 5.64 57.24 59.79 11.79 LA West 182% LA COUNTY In South LA, there are approximately 0.11 0.12 1.61 0.08 1.59 3.18 11.06 16.20 20 SOUTH LA 31 xxi xxi HEALTHCARE WORKFORCE HEALTHCARE INDICATOR

A decade later, this description continues to be starkly description continues to be starkly this A decade later, xxi xxi 19 Oncologists per 100,000 population Cardiologists per 100,000 population Obstetricians/gynecologists per 100,000 Obstetricians/gynecologists per 100,000 population Medical Marketing Services, Inc., 2007. Key specialists supply per 100,000 population specialists supply per 100,000 population Key (averaged) Physician supply per 1,000 population supply Physician General practice dentists per 100,000 practice General population Pediatricians per 100,000 children Pediatricians depicted in Los Angeles, where the supply of medical professionals— the supply Angeles, where depicted in Los at pediatricians, and dentists—remains specialists, practitioners, general and its neighboring community between South LA levels disparate vastly the number of physicians we examined capacity of the healthcare workforce, assess the To LA. West of to the health needs of the community. areas relative and key specialty pediatricians per 1,000 child population, or 11 pediatricians for every 100,000 children. LA County fares 100,000 children. or 11 pediatricians for every population, pediatricians per 1,000 child LA surpasses the recommended West while slightly better with 0.57 pediatricians per 1,000 children, goals with 1.9 pediatricians per 1,000 children. xxi In 1998, the Council on Graduate Medical Education described the described Medical Education Graduate the Council on In 1998, distribution of an inequitable of having and challenges problems noted that “access report Their communities. across different physicians physicians where United States is affected by to healthcare in the in affluent urban and practice to physicians for tendency The locate. of maldistribution as geographic phenomenon known suburban areas—a and inner- in rural care for people living barriers to physicians—creates city areas.” The largest disparity is seen in the supply of pediatricians per child populations. While there is no While there populations. largest disparity is seen in the supply of pediatricians per child The of professional associations have consensus as to the ideal number of pediatricians needed, a number Committee recommends Advisory Medical Education National Graduate The recommended standards. that Education II Report states the Future of Pediatric while 2,000 children, one pediatrician for every 1,200-1,400 children. one pediatrician is needed for every South Los Angeles Health Equity Scorecard

23 West LA West LA County LA 32 Yet in South LA, there remain only 0.12 primary care in South LA, there remain only 0.12 Yet 21 South LA South Source: Medical Marketing Services, Inc., 2007 Source: South LA, unfortunately, has only 16.2 general practice dentists per practice has only 16.2 general South LA, unfortunately, 22 0 50 250 200 150 100 Figure 10. Pediatricians per 100,000 Children 100,000 per 10. Pediatricians Figure Education and Organizing Concepts in Policy Between 2002 and 2007, Strategic through its Health Care Career more than 900 individuals (SCOPE) successfully served Angeles and the the City of Los by provided Funding was Program. Training Ladder in healthcare were placed graduates Board. 80% of SCOPE’s Investment Workforce workers low-wage not only moved program The of nearly $15. wage jobs at an average healthcare positions, but also helped existing healthcare employees into higher paying positions. into higher-skilled advance physicians per 1,000 population; LA County and West LA have 0.54 and 1.27 primary care physicians, physicians, 0.54 and 1.27 primary care LA have West 1,000 population; LA County and per physicians respectively. health including cardiovascular is strongly linked to systemic conditions and physical health Oral as pre-term delivery outcomes such pregnancy disease, diabetes mellitus, osteoporosis, and adverse infants. and low-birthweight 100,000 populations. In addition, roughly 50% of children in South LA rely on Medi-Cal for their 100,000 populations. In addition, roughly 50% of children higher has been linked to fewer dental visits and a which as Denti-Cal), dental benefits (known insured. are privately who seen a dentist than children having probability of never South LA residents suffer from high rates of cancer, cardiovascular disease, and adverse birth disease, and adverse cardiovascular of cancer, rates South LA residents suffer from high (oncologists, cardiologists, obstetricians/ physicians the supply of key specialty Yet outcomes. of 1.6 specialists per 100,000 population—a far cry from the 6.3 gynecologists) is an average LA. West in countywide and the 19.5 available available specialists per 100,000 population longer life mortality, with lower is associated supply of primary care physicians a larger Having and better birth outcomes. expectancy, . . . The “supply” does not meet the “demand” in South LA when demand is defined by healthcare needs. demand is defined in South LA when “supply” does not meet the “demand” The the largest nation, yet Angeles County or the per population than Los South LA has fewer cardiologists death rates and the highest age-adjusted with hypertension of adults in the county diagnosed percentage of the healthcare workforce Additional disparities in the supply stroke. due to coronary heart disease and include: South Los Angeles Health Equity Scorecard Strategies from recruitment and Strategies 25 33 Charles Drew University of Medicine & Science is constructing the first comprehensive of Medicine & Science is constructing the first comprehensive Charles Drew University The in South LA. decades and the first ever to be built in California in nursing school 2008. in Fall accepting 40 individuals will open by Masters program nursing school’s Programs such as these, which provide targeted provide as these, which such Programs 24 Of the multiple barriers, the major challenge faced is the lack of educational capacity, with nearly half of educational capacity, faced is the lack challenge Of the multiple barriers, the major of space in 2005. due to lack away of nursing applicants in LA turned The workforce shortage goes beyond physicians and physicians shortage goes beyond workforce The shortage The as nursing. includes other professions such legislation passed by in nursing personnel is compounded in an effort to ratios in California that sets nursing staff South regions like the quality of patient care. For improve closure of Martin Luther One of the precipitating factors in the can be greater. the challenge Angeles, Los of the high percentage shortage in permanent nursing personnel and the extraordinary King Hospital was personnel. or nurse registry traveling education and training for future practice in disadvantaged in disadvantaged for future practice education and training of solving the problem of health part areas, are an integral current—and possibly permanent—loss The disparities. at MLK Hospital was slots training of the 250 residency community efforts to improve to another serious blow total Medicaid- last in health. California currently ranks expenditures, a fact that contributes to low per-enrollee in the program. participation physician mentoring to increasing funding for programs are being explored through the LA Health Collaborative, are being explored through the LA Health Collaborative, programs mentoring to increasing funding for Los improving and public organizations dedicated to preserving and a partnership of nearly 70 private situation is not entirely bleak—new funding for UCLA The healthcare safety net. Angeles County’s an opportunity provide and Song Brown initiative as well as the Governor’s of Nursing program Bachelors to increase nursing capacity. Since 1981, the UCLA/Drew Medical Education Program Program Medical Education the UCLA/Drew Since 1981, the mission of providing with physicians has trained recent study A populations. to underserved quality care currently graduates 50% of program found that over are located in medically in California practicing the from only 26% of graduates areas, while disadvantaged in disadvantaged are practicing of Medicine UCLA School areas. RECOMMENDATIONS RECOMMENDATIONS South Los Angeles Health Equity Scorecard GENCY ACCOUNTABLE A ACCOUNTABLE Centers for Medicare and Medicaid Centers for Medicare Services of Health Care California Department Services Angeles Congressional Los Delegation California Medical Assistance Assistance California Medical Commission (CMAC) OSHPD California Healthcare Commission Policy Workforce (CHWPC) Centers for Medicaid and Medicare Services Congressional Delegation Angeles Los California State Legislature Congressional Delegation Angeles Los US Department of Health Services, Bureau of Primary Healthcare California State Legislature of California University California State Legislature Local community colleges and other universities ...... 34 POLICY RECOMMENDATION Developing mentorship and training programs, retaining retaining programs, mentorship and training Developing MLK hospital slots under Medicare for the 250 training as the using funding criteria such and possibly by Act Training and PA/NP Physician Family Song-Brown and health physicians that train programs that favors in medically-underserved professionals for practice communities in California on programs Increasing funding for loan forgiveness Memorial Fund) and federal Thompson the state (Steve levels. Option) Program Practice (Private Supporting the introduction of CINHC to LAC to Supporting the introduction of CINHC to LAC coordinate resources in training for graduate-level scholarships Providing commitment return for a teaching nurses for masters-level Organizing countywide training to teach. . . Increase Medi-Cal reimbursement rates and provide and provide reimbursement rates Increase Medi-Cal to retain existing an incentive a differential to create other underserved Angeles and South Los to serve providers communities. Create incentives to attract new providers to serve South serve to new providers to attract Create incentives by: Angeles Los Provide financial incentives for specialists and dentists financial incentives Provide or reimbursement rates. through loan forgiveness in LA County by: Increase college education of nurses . . . If health inequities are to be eliminated, more has to be done to provide support for the existing health- the existing for support to provide done has to be more to be eliminated, are inequities If health care workforce to attract and retain future professionals. The following recommendations are offered as are recommendations following The professionals. retain future and to attract care workforce steps: critical next South Los Angeles Health Equity Scorecard LA -65% South $65.36 WEST LA $1,024.87 $2,592.16 $2,903.84 LA 22% West $34.05 $1,008.66 $1,914.01 $2,082.26 LA COUNTY W es t LA $27.12 $3,338.94 $1,970.19 $2,350.91 SOUTH LA LA County LA 35 xiii South LA South G FINANCIN HEALTHCARE

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$ $ $ $ $ $ $ xiii INDICATOR xiii Figure 11. Hospitals’ Uncompensated Care Costs per Adjusted Patient Days Adjusted Patient 11. Hospitals’ Uncompensated Care Costs per Figure For hospitals in South LA, financial stability is rarely seen LA, financial stability is hospitals in South For xiv 26 Source: Office of Statewide Health Planning and Development, Hospital Annual Financial Profile Report, 2006 Financial Profile Annual Hospital Office of Statewide Health Planning and Development, Source: County funding for PPP clinics per uninsured County funding for PPP clinics per person Hospitals’ uncompensated care costs per Hospitals’ uncompensated care costs adjusted patient day Hospitals’ net revenue per adjusted patient day per adjusted patient Hospitals’ net revenue expenses per adjusted Hospitals’ operating patient day South LA hospitals provide three times as much uncompensated care per adjusted patient day as West West as patient day uncompensated care per adjusted as much three times South LA hospitals provide care to the indigent and uninsured cost South LA providing LA and LA County hospitals. In 2006, $1,024.87 of LA hospitals provided West comparison, By hospitals $3,338.94 per adjusted patient day. $1,008.66. uncompensated care; countywide the cost was To assess healthcare financing and the sustainability of the healthcare network, we examined several we examined several healthcare network, assess healthcare financing and the sustainability of the To community clinics. indicators for both hospitals and given the expanding number of uninsured and indigent patients, the low the low uninsured and indigent patients, the expanding number of given mix (Medi- inadequate payor public insurance, for reimbursement rates costs of and the escalating insurance), commercial Cal, Medicare and problems account illnesses. Financial chronic a population that suffers from acute healthcare to providing or are sold. close, convert, Angeles County that downsize, the hospitals in Los for a majority of

Safety-net hospitals are under continuous pressure to provide and and pressure to provide continuous hospitals are under Safety-net public reductions in costs, raising amid requirements expand services revenue diminishing increased privatization, consolidations, funding, as seismic such challenges and policy insurers from commercial assessment of California hospitals’ A recent retrofitting and staffing. was 1.3% margin that the median operating revealed financial health operating of hospitals reporting a negative in 2005, with 38.5% margin. South Los Angeles Health Equity Scorecard West LA PPP clinics LA West to offset the costs to to offset xxii West LA : The “profitability” of a hospital is reflected in The : Operating Costs Operating 36 LA County

27 South LA Net Revenue Net $0.00 $3,000.00 $2,000.00 $1,000.00 Less county funding for Public-Private Partnership clinics in South LA: Partnership for Public-Private Less county funding only a third of of $65.36 per uninsured person. South LA clinics receive an average receive for all clinics LA County average overall The person. this amount, or $27.12 per uninsured person. combined is $34.05 per uninsured greater budget deficits South LA hospitals have LA 15, As seen in Figure expense per adjusted patient day. vs. operating revenue net part by LA West and expenses than South and has less of a difference between revenues County overall demonstrates graph the following sample size. However, hospitals, most likely due to the larger in more affluent areas, are struggling with profitability. that all hospitals, including those Source: Office of Statewide Health Planning and Development, Hospital Annual Financial Profile Report, 2006 Financial Profile Annual Hospital Office of Statewide Health Planning and Development, Source: . . Figure 12. Hospitals’ Net Revenue and Operating Expenses per Adjusted Patient Days Patient Adjusted Expenses per and Operating 12. Hospitals’ Net Revenue Figure When MLK-Harbor Hospital was closed in August 2007, LA County implemented a closure plan that redirected patient flow that redirected patient flow 2007, LA County implemented a closure plan August closed in When MLK-Harbor Hospital was Additional disparities in the financial health of hospitals and clinics include: in the financial health of hospitals Additional disparities xxii neighboring hospitals of displaced indigent patients, an analysis conducted by the Hospital Association Association Hospital the by conducted patients, an analysis displaced indigent hospitals of neighboring the prior to the year had shifted throughout utilization trends that inpatient California found of Southern and MLK- LAC+USC, at Harbor-UCLA, levels Hospital. In fact, patient utilization closure of MLK-Harbor in utilization at surrounding of increase a similar level by and were matched Harbor had all decreased Impacted indigent patients prior to the hospitals had been absorbing private The hospitals. private patient and other county policies limiting result of earlier service reductions as a Hospitals Program hospitals to the county. from private transfers With the closures of Daniel Freeman Memorial and MLK-Harbor, South LA lost an estimated $2,089.93 in $2,089.93 estimated lost an LA South MLK-Harbor, and Memorial Freeman of Daniel the closures With in services into a reduction arguably translates This day. per adjusted patient care costs uncompensated of the safety destabilization and further remaining hospitals, burden on the an increased to the indigent, Program Impacted Hospitals implemented its county government Though net. to nine private hospitals in proximity to MLK-Harbor, and thus identified as “impacted” by its closure. If patients were “county by its closure. If thus identified as “impacted” and hospitals in proximity to MLK-Harbor, to nine private be reimbursed for the costs of hospitals would the private responsibility, responsible” and met the criteria of being the county’s Hospital Closure Implementation Plan,” – Harbor to the Board of Supervisors, “Martin-Luther King, Jr. their care. Memorandum 13, 2007. August South Los Angeles Health Equity Scorecard that results GENCY At the local 30 29 ACCOUNTABLE A ACCOUNTABLE California State Legislature Schwarzenegger Governor Congressional Angeles Los Delegation California State Legislature Schwarzenegger Governor California State Legislature Schwarzenegger Governor Angeles Congressional Los Delegation Centers for Medicaid and Medicare Services Bureau of Primary Health Care Angeles Congressional Los Delegation ...... 37 POLICY RECOMMENDATION and the state’s own Medi-Cal payment structure set by the California Medical Assistance Commission Commission Assistance the California Medical structure set by payment Medi-Cal own and the state’s 28 Assess fee for hospitals, health plans and providers who do who and providers Assess fee for hospitals, health plans care 5% charity at least 10% Medi-Cal and provide not serve cost and determined through a annually as measured by Expenses Operating (Charity Care) (Total ratio: cost-to-charge ). Revenue / Gross Patient Expand state’s authority to assess financial solvency of financial solvency authority to assess Expand state’s financial critical safety-net healthcare facilities and provide not meeting minimum help using fees pooled from providers Medi-Cal/uninsured care and up to placing hospital in receivership. Establish a Maintenance of Effort requirement tied to of safety-net hospitals licensing for continued operation number of beds the critical to communities as measured by in use per 100,000 population. Increase the current reimbursement differential from 10 to in MUAs/HPSAs that is tied 20% for Medicare for providers to quality performance. designated in areas already to providers grants Provide MUAs/HPSAs to reapply to maintain their status or reduce application requirements for redesignations. reimburses Southern California hospitals at a lower rate overall than Northern California. than Northern overall rate California hospitals at a lower reimburses Southern The following incremental steps are designed to strengthen the financial viability of and move the South to strengthen the financial viability of and move incremental steps are designed following The equity. and safety net towards LA healthcare network Many areas of South LA qualify as medically underserved or health professional shortage areas. or health professional of South LA qualify as medically underserved areas Many health and other physicians to attract financial incentives receive designations, providers these With large number of physician the relatively However, rates. professionals as well as higher reimbursement The cases. in many prohibitive in an urban area makes the required FTE survey to be surveyed practices costs are quite high and in California, the applicable state and consulting in manpower costs of the survey assistance. technical only provides agency in South LA receiving only about $4.2 million of the more than $50 million annual budget. A disparity A disparity than $50 million annual budget. about $4.2 million of the more only in South LA receiving battled with insurers. In 2006, Centinela Hospital private by reimbursement practices also exists in the the hospital did not receive claiming reimbursement rates, contract its insurance Blue Cross to increase since 2008, owner new The outside the region. compared to other hospitals equitable reimbursement at however, contracts; of its insurance cancelled and renegotiated all has aggressively Prime Healthcare, from the table. away plan walked least one major HMO level, the county’s PPP program funding continues to be allocated by an outdated formula by funding continues to be allocated program PPP the county’s level, Clearly the most significant contributor to South Los Angeles providers’ uncompensated care is the care uncompensated Angeles providers’ South Los contributor to most significant Clearly the more than population that is of a patient to meet the needs of the safety net public funding inadequate in the per enrollee Medi-Cal payments last in ranks in Medi-Cal. California or enrolled half uninsured US RECOMMENDATIONS South Los Angeles Health Equity Scorecard

33 LA 4.0 -30% South 11.8 40.0 West LA 80 8.3 21.8 37.3 70 67.5 LA County LA 38% West 59.3 60

34 30.4 10.7 42.6

50 GE 32 South LA No Insurance

40 xxiii xxv 38 30 27.8 xxiv 20 Government Insurance 15.3 13.8 13.2 8.9 10 HEALTHCARE COVERA HEALTHCARE 3.7 0 Statewide, 18.2% of Californians lacked of Californians lacked Statewide, 18.2% Private Insurance 31 Figure 13. Coverage by Type of Insurance: 2007 (%) of Insurance: Type by Coverage 13. Figure INDICATOR Medicaid Medicare Uninsured Direct purchase Any private plan Military healthcare Employment-based Any government plan Source: US Census Bureau, Current Population Survey, 2008 Annual Social and Economic Supplements. The estimates by estimates by The Annual Social and Economic Supplements. 2008 Survey, US Census Bureau, Current Population Source: year. the during insurance health of type one than more by covered be can people exclusive; mutually not are coverage of type Los Angeles County Health Survey, LACHS 2005 Survey, Office of Health Assessment and Epidemiology, Los Angeles County Los Assessment and Epidemiology, Office of Health 2005 Survey, LACHS Angeles County Health Survey, Los Los Angeles County Health Survey, LACHS 2005 Survey, Office of Health Assessment and Epidemiology, Los Angeles County Los Assessment and Epidemiology, Office of Health 2005 Survey, LACHS Angeles County Health Survey, Los California Health Interview Survey. Los Angeles, CA: UCLA Center for Health Policy Research, 2005. http://www.chis.ucla. Research, UCLA Center for Health Policy Angeles, CA: Los California Health Interview Survey. Percent of uninsured non-elderly adults (18-64 years old) years of uninsured non-elderly adults (18-64 Percent old) (0-17 years of uninsured children Percent Percent of non-elderly adults without dental insurance of non-elderly adults without dental Percent Despite the small increase in the insured, recent efforts to expand increase in the insured, recent efforts Despite the small budget stalled. State and federal met with resistance and coverage resulted in reductions changes have policy deficits and immigration and programs, number of persons eligible for benefits, the in program link between uninsured persons the given trends are alarming, particularly care. Such reimbursement for death. room, and premature use of the emergency of care, increased health outcomes, delay and adverse healthcare coverage in 2007, down from 18.8% the previous year. from in 2007, down healthcare coverage A recent Families USA report estimated that “more than eight working-age Californians or approximately eight working-age USA report estimated that “more than A recent Families of healthcare coverage.” due to lack day 3,100 people in 2006 die each data by a random sample of 6,032 parents/guardians of sample of 6,032 parents/guardians of a random Department of Public Health. Estimates are based on self-reported data by 6 plus selected zip Data for South LA include SPA Angeles County. of the population in Los representative 0-17 years children codes (90250, 90301, 90302, 90303, 90304, 90305). Healthcare coverage in the US represents a patchwork of payors. of payors. in the US represents a patchwork Healthcare coverage xxv xxiv xxiii An estimated 45.7 million people, or 15.3% of the population, live live of the population, people, or 15.3% 45.7 million An estimated million are children United States; 8.1 in the health insurance without the first time For population. total children’s or 11.0% of the under 18 dropped of uninsured in the United States the number in eight years, publicly- by due to an increase in people covered in 2007, largely programs. sponsored health edu/ accessed March 5, 2008. edu/ accessed March Department of Public Health. Estimates are based on self-reported data by a random sample of 8,648 Los Angeles County adults sample of 8,648 Los a random Department of Public Health. Estimates are based on self-reported data by 6 plus selected zip codes (90250, 90301, Data for South LA include SPA Angeles County. of the population in Los representative 90302, 90303, 90304, 90305). South Los Angeles Health Equity Scorecard 6.1 5.8* Lack Lack West LA 36 For adults For 37 8.2 16.6 LA County 26.2 14.1 South LA This becomes relevant when we examine we examine when becomes relevant This 35 39 Healthcare coverage is largely a function of income and age. of income and age. a function is largely coverage Healthcare 31 Table 5. Unemployment and Reliance on Public Insurance 5. Unemployment Table

38 Sources: United Way Zip Code Data Book 2007; LACHS 2005 Survey, Office of Health Assessment and Epidemiology, Assessment and Epidemiology, Health Office of 2005 Survey, Zip Code Data Book 2007; LACHS Way United Sources: Health Angeles County Department of Public Los Percent of adults (18-64 years old) who reported having reported having old) who (18-64 years of adults Percent Medi-Cal Percent unemployed in civilian labor force labor in civilian unemployed Percent *The estimate is statistically unstable (relative standard error ≥23%). estimate is statistically unstable (relative *The Many are afforded coverage through government-sponsored programs such as Medicare for seniors and Medicare for seniors as such programs government-sponsored through coverage are afforded Many source single largest is the coverage While employer-based families. and or SCHIP for children Medicaid uninsured One third of uninsured in 2006. persons were of employed 18.8% coverage, of healthcare per year. less than $20,000 families that earn are in workers of insurance is also associated with the prevalence of obesity in children and adolescents. of obesity in children is also associated with the prevalence of insurance with acute asthma, a lack of insurance leads to consistently poorer quality of care than patients who have have leads to consistently poorer quality of care than patients who of insurance with acute asthma, a lack coverage. The disparity between South LA and West LA is consistent with the lack of economic opportunities, the lack LA is consistent with West disparity between South LA and The More than 13% of reliance on publicly-sponsored insurance. and resulting disparities in unemployment South LA residents are unemployed. Approximately 218,000 (30.4%) of non-elderly adults in South LA are uninsured. For children 17 years 17 years children of non-elderly adults in South LA are uninsured. For Approximately 218,000 (30.4%) LA County has only 21.8% of the non-elderly adult insurance. 46,000 or 10.7% do not have and under, smaller 11.8% uninsured. Children also fare better in LA has an even West population uninsured while In spite of Medi-Cal and only 4.0% uninsured, and 8.3% uninsured throughout the county. LA, with West an estimated 187,000 eligible Families, (SCHIP), or Healthy Program Health Insurance the State Children’s people remain uninsured in LA County. The lack of coverage for children and non-elderly adults plays a significant role in the capacity of the a significant plays and non-elderly adults for children of coverage lack The community and is in by care will vary of uncompensated percentage The network. regional healthcare and deters necessary of insurance The lack patients. of the number of uninsured large part a reflection receipt of in delayed then result These services. care and utilization of recommended regular access to a high are less likely to see We population. within the overall and morbidity rates care, increased acuity rates communities with high uninsured in specialty care providers, particularly of providers, concentration healthcare and universal coverage As the ideas of expanding on Medicaid. of residents or percentages health outcomes also reminder that improving as a South LA serves among policymakers, gain traction and reimbursement for opportunities, infrastructure, employment requires concurrent efforts to improve quality care. the rate of coverage in South LA compared to other regions of the county. in South LA compared of coverage the rate The lack of healthcare coverage leaves these 264,000 residents of South LA exposed to higher risks of leaves of healthcare coverage lack The the recommended to receive for example, are less likely Uninsured women, morbidity and mortality. insurance. have who than women cancer screenings for breast and cervical cancer preventive In 2007, 59.3% of working Americans were insured through their employer, while another 27.8% were were 27.8% another while employer, their through were insured Americans of working 59.3% In 2007, insurance. through public covered

South Los Angeles Health Equity Scorecard West LA Uninsured children LA County 40 Adults with no dental insurance Figure 14. Health and Dental Insurance Dental and 14. Health Figure Uninsured adults South LA 5 0 Source: Percent of uninsured non-elderly adults and children from the Los Angeles County Health Survey. Angeles County Health Survey. the Los from of uninsured non-elderly adults and children Percent Source: 2003; data are from California Health Interview Survey, of non-elderly adults without dental insurance Percent 5 and 6. for SPA 45 40 35 30 25 20 15 10 Less disparity occurs, however, in the percent of adults who do not have dental insurance. In Service dental insurance. do not have of adults who in the percent Less disparity occurs, however, LA County and Service dental insurance. 6 (South LA), 42.6% of adults do not have Area Planning 37.3% and 40.0% of the adult population without dental show LA) respectively 5 (West Area Planning of for the high, but almost equal, levels reasons several Experts surmise that there are insurance. been a shrinking there has the years, sub-county areas. Over the two dentally uninsured adults between dental and completely or removing eliminating some workers either by coverage, of employer-based or private who rely on employer-based of adults West LA has a high proportion vision benefits. Because increased as have for dental care may out-of-pocket pay (82.1%), the number of adults who coverage (26.2% covered insurance on public on the other hand, rely heavily benefits decreased. South LA adults, does not ensure access however, dental benefits. Public dental insurance, includes which Medi-Cal), by are few and far between. providers to dental care because Denti-Cal South Los Angeles Health Equity Scorecard 41 program was implemented in July 2003 with initial in July implemented was Kids program County Healthy Angeles Los enrolled are currently 34,693 children There 5 LA. funding of $100 million from First program The 6 (South LA). in SPA living of these, 6,133 are children in the program; community organizations and enrollment. Five is coupled with funding for outreach in this and other publically-funded children in South LA to enroll eligible are working Crystal list of organizations includes: Community Health Councils, The programs. and Robert Center, Child and Family Well St. John’s Center, Medical Stairs, St. Francis Institute. Kennedy F. The uneven distribution of financial resources, the lack of options for the undocumented, and the of the lack distribution of financial resources, uneven The of poor health all argue that California, if not the nation, needs to expand publicly consequent levels sponsored healthcare programs. Los Angeles County currently receives funding through a Medicaid waiver and SB 1448 that expanded and SB waiver funding through a Medicaid County currently receives Angeles Los users of the county healthcare system. uninsured population, frequent for the low-income coverage and health care coordination $54 million to improve receive LA County would Under this initiative, funding allocation of the Coverage The pre-Medicare patients. ill and elderly, outcomes for chronically LA, unfortunately only designates 18,752 of Way locally as Healthy SB 1448, known by enacted Initiative This has an estimated 185,000 uninsured adults. 6 (South LA), although the area eligible patients to SPA receiving of uninsured adults in the county, LA), with the second highest rate 6 (South into SPA translates SPAs. Fernando only the third highest funding allocation behind the Metro and San Many counties, including Los Angeles, have established local coverage programs for children otherwise for children programs coverage established local have Angeles, Los counties, including Many Kids. is Healthy the local program Angeles County, and Medi-Cal. In Los Families ineligible for Healthy sources sustainable funding have throughout the state do not programs Kids and similar Healthy However, on the children if not disenrollment, of or discontinuation of future enrollment, facing a cap and are now today. program Though these indicators are primarily concerned with the lack of health insurance, there is also a slow a slow there is also insurance, of health with the lack concerned indicators are primarily these Though and even uninsured, underinsured, to the low-income available in the options underway dissipation deficits allow budget as state and federal larger to grow number is expected The insured. the publicly in March SCHIP is set to expire Nationally, and services for these programs. a reduction in benefits that funding will there is a good chance Congress, this legislation be reauthorized by 2009 and should to accept providers Medi-Cal discourages of reimbursement for level the low be decreased. Statewide, beneficiaries. are who the 30% of South LA adults patients, thus creating a barrier for publicly-insured RECOMMENDATIONS South Los Angeles Health Equity Scorecard Y enc Ag ACCOUNTABLE Los Angeles County Board of Supervisors Angeles County Board of Los of Health Angeles County Department Los Services of Health and Human California Department Services California Department of Health Services/ California Department MRMIB of Health Angeles County Department Los Services Los Angeles County Board of Supervisors Angeles Los County Department of Health Angeles Los Services Los Angeles Congressional Delegation Angeles Los Schwarzenegger Governor County Board of Supervisors Angeles Los State of California Legislature California Department of Health Services California Department of Health ...... 42 Recommendation Policy Expand the enrollment criteria under the Coverage criteria under the Coverage Expand the enrollment LA) to maximize participation Way (Healthy Initiative the number of visits and increase in the program 6 appropriate to the need. allotted to SPA Streamline enrollment systems and financial Streamline enrollment to reduce enrollment barriers eligibility categories of eligible but not enrolled children and the number and families. Increase PPP dollars for dental, vision and Increase PPP dollars for dental, vision uninsured mental health services for low-income populations. Expand eligibility for adults up to 133% FPL under Expand eligibility for adults up to Families. Medi-Cal and Healthy Maximize CHDP, emergency Medi-Cal and other emergency Maximize CHDP, coverage. funding streams to support children’s in June 2008 that seek to that seek 2008 in June Summit the Scorecard during developed that were recommendations are Below health reform. of state or national LA in the absence for South number of uninsured reduce the South Los Angeles Health Equity Scorecard LA -34% South 8.1 7.1 8.2 84.8 80.9 20.3 WEST LA 80.2 69.9 25.6 12.6 15.4 11.6 LA 27% West LA COUNTY ccess 74.7 57.3 34.7 21.2 29.2 10.2 SOUTH LA 43 xxvii The Institute of Medicine of Medicine Institute The 39 xxvi CARE A CARE & Preventive PRIMARY INDICATOR xxvi For the purposes of this study, 12 indicators are used to 12 study, the purposes of this For xxvi 40 As South LA already suffers from a lack of physicians and sites of medical care, undoubtedly of physicians from a lack suffers already As South LA xxviii Across the nation, approximately 11% of ambulatory care visits occur in the emergency occur in the emergency 11% of ambulatory care visits Across the nation, approximately 42 41 xxviii United States Census Bureau, Census 2000, Summary File 3. United States Census Bureau, Census 2000, Summary File Annual Utilization Profile Report, 2006. Hospital Office of Statewide Health Planning and Development, Los Angeles County Health Survey, LACHS 2005 Survey, Office of Health Assessment and Epidemiology, Los Angeles County Los Assessment and Epidemiology, Office of Health 2005 Survey, LACHS Angeles County Health Survey, Los Percent of adults who reported having a regular reported having of adults who Percent of care source Percent of adults who reported easily obtaining of adults who Percent medical care could not afford dental care at who of adults Percent least once in the past 12 months with no vehicle of households Percent Percent of total ER operation hours spent in diversion hours spent in diversion ER operation of total Percent a year without being seen per 1,000 ER visits that leave population room, most likely because of its extended hours for unscheduled care and the ability to treat a variety of the ability to treat a variety care and hours for unscheduled room, most likely because of its extended symptoms. assess the availability and adherence to a series of basic recommended and adherence to a series assess the availability and screenings. However, care services primary and preventive and uninsured, obtain the underserved people, in particular many access to a primary care they lack department because care in an emergency non-emergent, primary physician. Of the six indicators for access to primary and preventive care, the largest disparities within South LA care, the largest disparities within primary and preventive Of the six indicators for access to hours spent on diversion of emergency-room are (1) the percentage compared to an LA County baseline of households without a vehicle. and (2) the percent per year the next and sometimes the preferred choice is the emergency room. We have therefore included two two therefore included have We room. is the emergency choice the next and sometimes the preferred typically not considered an element of primary or room care, although indicators related to emergency care. preventive defines primary care as “the provision of integrated, accessible accessible of integrated, care as “the provision defines primary are accountable for addressing who clinicians by healthcare services a sustained personal healthcare needs, developing a large majority of of family and in the context patients, and practicing partnership with community.” xxviii xxvii xxvi Experts agree that early prevention, care coordination, and continuity and continuity care coordination, that early prevention, Experts agree more health system and, more efficient contribute to a of care all outcomes. better health importantly, Department of Public Health. Estimates are based on self-reported data by a random sample of 8,468 Los Angeles County adults sample of 8,468 Los a random Department of Public Health. Estimates are based on self-reported data by Angeles County. of the population in Los representative South Los Angeles Health Equity Scorecard Doctors (closed) Doctors UCLA St. John's Santa Monica- UCLA LA Kaiser-West Marina Centinela Brotman MLK-Harbor (closed) Centinela St. Francis West LA 44 With only two emergency rooms left in the area, one emergency only two With 44 South LA In addition to overcrowding in the ER, ambulance diversion is also a symptom ambulance diversion in the ER, In addition to overcrowding 43 0 9000 8000 7000 6000 5000 4000 3000 2000 1000 Source: Office of Statewide Health Planning and Development, Hospital Annual Utilization Report, 2006 Hospital Office of Statewide Health Planning and Development, Source: Figure 15. Emergency Room Operating Hours Spent on Diversion per Hospital per Diversion Hours Spent on Room Operating 15. Emergency Figure In contrast, West LA emergency rooms spent approximately 7.1% or on average 620 of their 620 of their or on average 7.1% rooms spent approximately LA emergency West In contrast, xxix Office of Statewide Health Planning and Development, Hospital Annual Utilization Report, 2006. Yearly average does not average Yearly Annual Utilization Report, 2006. Hospital Office of Statewide Health Planning and Development, of a number of factors, including boarding patients in the ER due to a lack of inpatient beds, misuse of the of inpatient beds, in the ER due to a lack including boarding patients of a number of factors, staffing. of necessary room, and a lack emergency can assume that diversions will be more frequent and more patients will be re-routed to hospitals further will be more frequent and more patients will be re-routed can assume that diversions away. 14 Office of Statewide Health Planning and Development, Hospital Annual Utilization Report, 2006. Yearly average does not average Yearly Annual Utilization Report, 2006. Hospital 14 Office of Statewide Health Planning and Development, status. include Centinela due to nondiversion xxix Since the closure of MLK Medical Center, the closest county hospital (Harbor-UCLA Medical Center) Medical Center) the closest county hospital (Harbor-UCLA of MLK Medical Center, Since the closure department the emergency the patient leaves to when the patient arrives time when has seen treatment and 13 minutes at longer than the 9 hours is significantly This and 14 minutes. increase to 12 hours View/ at Olive needed to treat ER patients and the 10 hours and 14 minutes Medical Center, LAC+USC UCLA Medical Center. Diversion status occurs when hospital emergency rooms are full beyond capacity and ambulances are re- and ambulances capacity beyond are full rooms emergency hospital when status occurs Diversion care is presumably emergency the patient to receive time it takes for The to neighboring facilities. directed MLK Medical Center and Centinela Freeman, rooms (St. Francis, emergency three South LA’s lengthened. hours during 3,800 hours or on average of their operating 29.2% diversion closure) were on before its 2006. on diversion spent more time rooms South LA emergency for the same year. on diversion hours operating LA residents. West to rooms available emergency than the seven include Centinela due to nondiversion status. include Centinela due to nondiversion South Los Angeles Health Equity Scorecard 8.1 West LA 12.6 LA County do not have South LA do not have of households in : 21.2% 45 This is further complicated by the noted deficiencies the noted deficiencies by is further complicated This : South LA’s three emergency rooms, in addition to being three emergency : South LA’s 45 : Only 74.7% of South LA adults reported having a reported having : Only 74.7% of South LA adults 48 34.7% of adults in South LA could not afford to see a dentist in the 34.7% of adults in South LA could not afford to see a dentist in the 47 Figure 16. Percent of Households with No Vehicle No of Households with 16. Percent Figure 21.2 South LA Source: US Census 2000, Summary File 3 US Census 2000, Summary File Source: 46 0 5 10 15 20 25 Percent in LA County’s public transportation system including overcrowding that must now be addressed under now that must system including overcrowding transportation public in LA County’s court order. on diversion status, had 10.2 visits per 1,000 people who registered but left before being treated. This This treated. registered but left before being status, had 10.2 visits per 1,000 people who on diversion significantly higher than the LA County baseline of 11.6 visits per 1,000, but actually lower is rate and of timely medical care is a significant factor in the level lack The of 8.2. LA rate West than the of illness and health outcomes. prevalence More likely to leave the ER without treatment More likely to leave Less likely to afford dental care: LA adults and 25.6% of LA County adults reported West only 20.3% of past 12 months. By contrast, the link between dental disease and given This is significant dental care. financial barriers to receiving is again higher in South LA mortality disease, for which illnesses including cardiovascular other chronic Angeles. other region of Los than in any Less likely to have access to a medical home access Less likely to have Similarly, LA County. LA and 80.2% for overall West to 84.8% in of care in contrast regular source 81% medical care while only 57.3% of South LA adults indicated they were able to easily obtain LA adult respondents reported ease in access to care. Most of overall LA adults and 70% West of of care and a regular source have did not why they when asked respondents identified financial barriers with a medical home are more likely care. Individuals difficulties they had in obtaining medical what care. preventive to receive , compared to 12.6% in all of LA County and 8.1% in West LA. Travel burden has burden Travel LA. West and 8.1% in of LA County to 12.6% in all , compared a vehicle access to use of services, the use of mammography as such behaviors to a number of health been linked already and missed appointments. services, pharmacy Less likely to have access to ready transportation ready access to to have Less likely . . .

. Additional disparities in access to primary and preventive care services reveal patients in South LA are: South LA in patients reveal care services preventive and to primary in access disparities Additional South Los Angeles Health Equity Scorecard GENCY ACCOUNTABLE A ACCOUNTABLE Los Angeles Congressional Delegation Angeles Los County Board of Supervisors Angeles Los California State Legislature California State Legislature California Department of Public Health Angeles Congressional Delegation Los LA County Public Health ...... 46 There are currently 57 PPP providers with over 100 different sites throughout LA 100 different sites throughout with over PPP providers are currently 57 There formed of these have Seven are located in South LA. providers Thirteen County. Coalition clinics offer The of Community Health Centers. the Southside Coalition care, and conducted more care services, including dental primary and specialty visits in 2006. than 300,000 patient POLICY RECOMMENDATION The crisis and bailout gave rise to the closure of a number of county clinics and in turn, the and in turn, the of county clinics of a number rise to the closure bailout gave crisis and The 49 Retain and allocate SB 474 funds and seek match federal and/or Expand services at the MLK MACC week 24hour/7day PPP clinics to provide service Increase PPP clinic funding. Increase number of patient advisors and Increase number of patient advisors interpreters WIC, and education at Increase outreach settings and childcare preschools public health media campaigns by Develop and community-based agencies to medicine pediatricians and general Train educate patients.

...... Expand access to and funding for urgent care Expand access to and funding for centers including: health education and Expand funding for oral to: programs prevention Clearly, these service reductions, added to the barriers of poverty, culture, linguistics and transportation, culture, linguistics and transportation, added to the barriers of poverty, these service reductions, Clearly, and uninsured population in accessing recommended, regular preventive present significant hurdles to the of primary and illnesses, targeted expansion of chronic the high rates primary care. In order to reduce for the uninsured is necessary. care access preventive to reduce services in public settings and shift care for the uninsured Since then, the county has continued a redesign of the the Board of Supervisors approved In the summer of 2002, sector. into the private the High the closure of 11 county health centers and converted health services system that included redesign This (MACC). Ambulatory Care Center into a Multi-service Valley Antelope Desert Hospital in and better management of limited in light of budget deficits that called for cost savings necessary was again proposed the idea of shifting all primary care services to the county has More recently, resources. plan is still under privatization This health services budget. a stable the PPP clinics in order to provide for board for December 2008, with an updated plan scheduled with a public hearing scheduled study 2009. action in January establishment of the Public Private Partnerships between the county and primary care safety-net providers. between the county and Partnerships the Public Private establishment of In 1995, Los Angeles County applied for and received a Section 1115 Medicaid Waiver that called for that Waiver Medicaid a Section 1115 for and received County applied Angeles Los In 1995, out of financially- shifting patient care by system delivery health services of the county’s a restructuring and preventive on primary care settings focused outpatient community-based, hospitals and into burdened services. RECOMMENDATIONS South Los Angeles Health Equity Scorecard LA -24% South 4.7 43.7 84.3 19.3 168.8 363.3 West LA 5.3 41.2 59.0 82.8 21.7 102.2 LA West 103% LA County 7.8 34.4 63.8 81.4 25.9 50.0 South LA 47 xxx xxx xxxi PRIMARY & PREVENTIVE CARE UTILIZATION CARE & PREVENTIVE PRIMARY xxxi Indicator xxxi xxvi California Health Interview Survey, 2003. http://www.chis.ucla.edu/ 2003. http://www.chis.ucla.edu/ California Health Interview Survey, Office of Statewide Health Planning and Development, Clinic Annual Clinic Office of Statewide Health Planning and Development, Percent of the population that saw a doctor at least of the population that saw Percent once in the past year Percent of men over 40 years of age who have not have age who of 40 years of men over Percent had a PSA test Percent of the population 2 years and over that has and over of the population 2 years Percent been to a dentist never Number of mammogram screenings conducted by by screenings conducted Number of mammogram PPP clinics per 1,000 uninsured women Number of pap smear screenings conducted by PPP conducted by Number of pap smear screenings clinics per 1,000 uninsured women Percent of adults who reported ER use in the past 12 reported ER use of adults who Percent months The largest disparities within the utilization indicators were by far the number of pap smears and far the number of indicators were by largest disparities within the utilization The PPP clinics are not the Though per 1,000 uninsured women. screened at PPP clinics mammograms can obtain these recommended women only sites where to other areas travel LA may screenings and residents of South clinics are an obvious of the county for services, local PPP PPP clinics For for uninsured women. choice and available in South LA, only 50 pap smear and 34.4 mammography West screenings were conducted per 1,000 uninsured women. 168.8 higher at 363.3 pap smears and drastically was rate LA’s screenings per 1,000 uninsured women. mammography xxxi xxx Beyond physical structures and facility capacity, consumers often consumers often facility capacity, structures and physical Beyond through an that are best illustrated barriers to care experience a number we examined assess utilization To of utilization. examination screening for services including and prevention of the basic primary annual prostate cancer as well as recommended cervical, breast and an ER for care. dentist and reliance on visits to the doctor, Geographic areas are by SPA 5 and 6 boundaries. SPA areas are by Geographic Utilization Report, 2006. South Los Angeles Health Equity Scorecard 63.8% of men While cervical cancer While cervical 49 168.83 West LA 7.8% of the SPA 6 population 7.8% of the SPA

363.28 50 Mammograms 48 41.19 Approximately 25.9% of South LA adults reported LA County 102.17 Pap Smears 34.36 South LA 50.02 Source: Office of Statewide Health Planning and Development, Clinic Annual Clinic and Development, Office of Statewide Health Planning Source: Utilization Profile Report, 2006 0 50 400 350 300 250 200 150 100 going to an emergency room within the past 12 months. Only 21.7% of LA County and 19.3% room within the past 12 months. Only 21.7% of LA County going to an emergency would This room within the past 12 months. visiting an emergency LA adults reported West of of with the higher level suggest less access to primary and urgent care services consistent during non- of access to primary care physicians lack The acuity and illness in the population. at emergency emergent conditions to seek care do not have people who business hours drives departments. been to a dentist: the population that has never of Percent compared to 5.3% again is high when This been to a dentist. has never and over 2 years not seen a dentist. LA that have West 5 or of LA County and 4.7% of the population in SPA absenteeism, disease, higher school Dental disease can result in higher risk for cardiovascular disability. performance, and permanent decreased school Percent of adults who reported ER use: adults who of Percent over 40 in South LA have not been tested for prostate cancer; in LA County the rate is 59.0% LA County the rate not been tested for prostate cancer; in 40 in South LA have over West (41.79) is far higher than prostate cancer mortality rate LA’s LA 43.7%. South West and in LA (19.48) or LA County (21.86). Percent of men over 40 who never had a Prostate-Specific Antigen (PSA) test: had a Prostate-Specific never who 40 men over of Percent Figure 17. Cancer Screenings Conducted by PPP Clinics per 1,000 Uninsured Women Uninsured per 1,000 Clinics PPP by Conducted Screenings 17. Cancer Figure . . . Additional disparities in primary and preventive care utilization measures include: care Additional disparities in primary and preventive rates or mortality are not available for the region, we can assume that they would be high as well given the be high as well given for the region, we can assume that they would or mortality are not available rates One simple explanation for the of screening. rates and the low in the population overall high cancer rates in South LA (125,000 uninsured women uninsured women of screening is that there are more rate lower to spread in a larger fewer clinic resources LA) and thus West in women in South LA vs. 18,000 uninsured screenings as there is a women in South LA to receive be more difficult for uninsured population. It may that van rely on a mobile mammography LA PPP clinics West and both South higher demand. Currently, lists and also result in months-long waiting may This services. is on-site once a month for mammography as to why these measures require more study Obviously, from making return appointments. deter women higher. LA are significantly West the disparities between South and The under utilization or non-compliance with recommended screenings is significant as South LA (SPA 6) with recommended screenings is significant as South LA (SPA under utilization or non-compliance The women. deaths due to breast cancer among first in LA County for premature ranks South Los Angeles Health Equity Scorecard The The 52 49 chronic disease program in Compton incorporates in Compton incorporates disease program Charge! chronic Take Similar to what occurred in 1995 following the announcement to the announcement in 1995 following occurred Similar to what 51 implement service plans in their community that implement service plans in their community Best Babies Collaboratives Mothernet’s Mothernet’s and case management; healthcare coverage family-focused in-home education participating in the program No children enrollment; and access services. before being in the in the year treatment, compared to 80% sought emergency adhered to treatment regimens participants 87% of diabetic program program. stress reduction and standards of care. including glucose monitoring, diet, The and birth outcomes. pregnancy and improve are designed to reduce disparities To combat the lack of primary and specialty care services at traditional healthcare specialty care services at traditional of primary and combat the lack To of a wide-range developed have local community-based organizations providers, examples are: Two health education programs. . . or community health workers or community health workers use of promatoras The 54 In LA County, uninsured patients typically wait much longer than the insured to get referred for much typically wait uninsured patients In LA County, 53 Many of South LA’s hospital-based programs focusing on heart disease, diabetes and cancer have focusing on heart disease, diabetes and cancer have hospital-based programs of South LA’s Many through a patchwork South LA community clinics struggle to subsidize education programs dwindled. and patient reimbursement from other services. Federal of grants competing budget commitment to community clinics, hampered by promise up to prior years’ has not lived priorities and the economy, The current budget only contains to make significant expansions. a $27 million increase for community health centers (Section 330 etc). program, specialty care in the overwhelmed public healthcare system. specialty care in the overwhelmed serves as an alternative or complement to the traditional medical or complement to the traditional as an alternative serves the and recognition by credentialing system of clinic and hospitals, yet mainstream health systems limit sustainability and expansion. close many county clinics, outpatient services at county run clinics in South LA have declined by 130,000 declined by clinics in South LA have outpatient services at county run county clinics, close many visit increase across 13,000 The of the MLK crisis. 2002-03 to 2005-06 as a result visits or 21% from enough to make up the difference. not nearly the same time period was all PPP clinics during healthcare system remains oriented toward more costly, tertiary care rather than primary, preventative preventative than primary, care rather tertiary more costly, remains oriented toward healthcare system and to prevent services or programs cap or do not reimburse certain payors private care. Public and to eliminate financial helped have and HMO coverage insurance While public diseases. manage chronic still lag behind their privately public coverage with years 40–64 women barriers to mammography, costs remain a barrier to use for uninsured and out-of-pocket insured counterparts in using mammography women. RECOMMENDATIONS a number of LA residents face South capacity notwithstanding, and coverage of healthcare A lack of the effort services, thus complicating care and preventive primary obstacles to obtaining additional and care to primary and emergent inpatient specialty, utilization from costly attention and refocusing practices, beliefs and cultural personal and language proficiency, resources, care. Financial preventive of access and utilization ready contribute to an individual’s all been found to have and social networks services. recommended medical South Los Angeles Health Equity Scorecard GENCY ACCOUNTABLE A ACCOUNTABLE Los Angeles Congressional Delegation Angeles Los County Department of Public Health Angeles Los of California University colleges universities/community Private Health plans California State Legislature of Health Services/Public California Department Health Congressional Delegation Angeles Los County Board of Supervisors Angeles Los Services LA County Public Health/Health County Board of Supervisors Angeles Los County Department of Health Angeles Los Services Los Angeles Congressional Delegation Los Health Care Bureau of Primary ...... 50 POLICY RECOMMENDATION POLICY and the PPP program to reimburse to and the PPP program Providing professional certification Providing and other educational at universities institutions. Establishing reimbursement for CWH Establishing reimbursement for CWH payors services under public and private Creating employment opportunities at all opportunities at Creating employment of the health system including public levels health agencies and healthcare providers reimbursement for number of screenings and reimbursement for number of screenings extended office hours. Healthy Families and other state contracts on and other state contracts Families Healthy or continuous, of “total care,” the provision disease coordinated quality care including etc. management, lifestyle education, or higher incentives Providing Basing provider rates through Medi-Cal, through rates Basing provider xxxii Section 330 of the Public Health Services Act provides for federal funding for public and private nonprofit entities that provide that provide nonprofit entities funding for public and private for federal Act provides Section 330 of the Public Health Services

. . Expand the hours/days of mammography of mammography Expand the hours/days Health Women’s screenings at the MLK-MACC to connect Center and create a liaison position health PPPs and public to the community, centers for referrals. Long-term investment in community health Long-term investment by: for health education and outreach workers . . . Strengthen systems for prevention, treatment, for prevention, Strengthen systems disease by: of chronic and management Increase funding for community health clinics Increase funding programming, 330 grant Section through federal etc. equipment screening purchase screenings or to increase the number to or hire staff for outreach access screenings. of patients who care to medically-underserved populations. care to medically-underserved to address these these to address Summit Policy Scorecard the during developed were below listed recommendations The disparities. xxxii South Los Angeles Health Equity Scorecard

Scorecard Domain 2

Physical Environment Resources

51 South Los Angeles Health Equity Scorecard PHYSICAL ENVIRONMENT RESOURCES

Environment is defined as the totality of physical conditions and context where people live, work, and play. It is a combination of the built environment or external physical resources and conditions—air, parks, schools, liquor stores, fast- food chains, housing—that affect and influence South LA access, opportunity and human development. -43% The environment contributes to major health outcomes, the prevalence of chronic diseases, and rates of mortality in significant ways. We know the emission of diesel fuel and exposure to cockroaches are associated with asthma; West LA chemicals such as radon or particulate matter +42% from air or land pollution lead to cancer and aggravate heart diseases.55 We also know that legislative policy can help control the negative impact of the environment on health. Restricting Physical Environment Resources Score the use of lead-based paint, for example, resulted in significant drops in childhood lead poisoning. Local, state and federal bodies now carefully monitor and control air quality and the water supply, thereby significantly improving population health status in the US.

In contrast, a study commissioned by the United Church of Christ on environmental justice first in 1987 and again in 2007 found that polluting industries are routinely located closer to racial and ethnic minority neighborhoods and that these communities are not equally protected by environmental laws. The 2007 report ranked Greater Los Angeles first among major urban areas with the most people living near hazardous waste facilities. The report found that the placement of these hazardous sites is the intentional result of local, state and federal land-use policies.

Given the inextricable relationship between the environment and health, the limited capacity of the healthcare system and the high number of uninsured in communities such as South LA, it is critical that the focus of early prevention shifts from individual behavior to the built environment and the policies that intentionally or unintentionally pollute neighborhoods. In this section of the Scorecard we examine the extent to which there are inequities in existing resources to support healthy life choices and environmental risk in South LA for 19 variables grouped into six categories: ♦ Nutrition ♦ Physical Activity ♦ Public Safety ♦ Housing ♦ Schools ♦ Air & Land Quality.

These indicators should not be seen as the full context of South LA’s environment; they are a starting point to eliminating the regional factors that contribute to current health disparities. In the following sections, we analyze these and other findings by topic and provide policy recommendations to address South LA’s environmental disparities. While the topics are addressed separately, they are in many cases interdependent.

52 South Los Angeles Health Equity Scorecard 0.14 0.03 0.08 1.97 40.80 West LA Further, the Further, 57

56, 0.05 0.05 0.02 1.56 47.70 1.97 West LA LA County Nutrition 0.10 0.21 0.06 8.51 71.80 1.56 LA County South LA 53

xxxvi 61 xxxiv

60,

xxxv 58,59, 8.51 The largest disparities within the Environment section are found in section Environment within the largest disparities The food options, healthful of South LA’s assess the availability To nutrition. retail stores, measures including liquor nutrition we examined five facility public health food food restaurants, supermarkets, non-fast and farmers’ markets. ratings, South LA xxxiii Figure 18. Liquor Stores per Square Mile Figure xxxvii LA South -106% 9 8 7 6 5 4 3 2 1 0 sq. ft.) per sq. mi. + Source: California Department of Alcoholic Beverage Control, State of California Alcoholic Beverage California Department of Source: INDICATOR LA West California Certified Farmers’ Markets, California Federation of Certified Farmers’ Markets. http://www.cafarmersmarkets.com/ of Certified Federation Farmers’ Markets, California California Certified 101% California Department of Alcoholic Beverage Control, State of California. http://www.abc.ca.gov/datport/LQSMenu.html State of California. http://www.abc.ca.gov/datport/LQSMenu.html Control, Alcoholic Beverage California Department of Los Angeles County Department of Public Health Food Facility Rating, LA County Department of Public Health. http://www. Facility Health Food Angeles County Department of Public Los Reference USA, Info USA. http://www.referenceusa.com/ accessed 30 May 2008. accessed 30 May Reference USA, Info USA. http://www.referenceusa.com/ 2002 Economic Census, U.S. Census Bureau. http://www.census.gov/econ/census02/. Percent limited service restaurants Percent “C” per sq. mi. below facilities rated Food markets per sq. mi. Farmers’ Supermarkets (44,000 Liquor retail stores per sq. mi. Liquor retail stores The most striking disparity is the approximately 8.51 liquor retail stores per square mile in South LA; most striking disparity is the approximately The in LA County overall. the 1.56 available LA and West mile in nearly four times the 1.97 per square find-market/index_html?county=Los+Angeles&submit=Go%21. Nutritious, healthy food options are scarce in South LA. The area has a disproportionately high number The in South LA. food options are scarce Nutritious, healthy processed, non- markets often selling liquor retail stores, and smaller convenience of fast-food chains, impact on the health food options in South LA likely has a profound of healthy lack The perishable items. well-linked to the prevention disease and a strong indicator of chronic of residents. Nutritious eating is diseases and cancers. disease, especially diabetes, cardiovascular of risk for chronic lapublichealth.org/rating/ accessed 6 March 2008. accessed 6 March lapublichealth.org/rating/ accessed 30 January 2008. accessed 30 January xxxvii xxxiv xxxv xxxvi availability of healthy foods where we live has been shown to influence what we choose to eat and the we what to influence has been shown we live foods where of healthy availability of obesity and diabetes. prevalence xxxiii South Los Angeles Health Equity Scorecard For each each For 69

Risky sexual Risky 62 64

63, 54 Because research has linked increased availability of alcohol of alcohol availability has linked increased Because research 66 The study examined 261 local food retailers in South LA and 69 examined 261 local food retailers study The 71 Community Coalition, a local South LA CBO, has long-championed a long-championed has CBO, South LA a local Coalition, Community crime near stores. South LA to reduce stores within in the 200 liquor reduction is a long process stores of individual to target the closing with the city Working to accomplish. community pressure continuous and requires Fast-food restaurants frequently offer high calorie menus and bargain priced large frequently offer high calorie menus and restaurants Fast-food 68 Studies have shown a significant relationship between the physical availability of alcohol availability between the physical a significant relationship shown Studies have To curb the proliferation of fast food, the LA City Council adopted an interim ordinance of fast food, the LA City Council adopted an interim ordinance curb the proliferation To xxxviii 65

72 67 The number of quality food retailers falls short of the community health need. We examined examined We health need. number of quality food retailers falls short of the community The 70 Los Angeles County Health Survey, LACHS 1999 & 2005 Surveys, Office of Health Assessment and Epidemiology, Los Assessment and Epidemiology, Office of Health 1999 & 2005 Surveys, LACHS Angeles County Health Survey, Los Angeles County Department of Public Health. 1999 estimates are based on self-reported data by a random sample of 8,354 Los a random data by Angeles County Department of Public Health. 1999 estimates are based on self-reported Angeles County. in Los of the population Angeles County adults representative The negative health effects of alcohol are numerous. Consuming alcohol, particularly large amounts, are numerous. Consuming alcohol, health effects of alcohol negative The and increased risk lead to hypoglycemia may nutritional process, which the body’s harms all facets of from the organs being malnourished. function disease and impaired brain of liver to a larger variety of fresh food products. of fresh food products. or larger—as a proxy for access to a larger variety large stores—44,000 square feet in South in size, many 44,000 square feet of the 0.10 supermarkets per square mile that are over However, supermarkets per square mile, has a larger selection of LA, with 0.14 West warehouses. LA are value CHC of food retailers found conducted by A study stores offering organic foods and healthier products. 5,957 persons per store in South LA vs 3,763 Angeles: more people in South Los fewer markets serve LA. West persons per store in placing a moratorium on new fast-food restaurants in South LA to provide an opportunity to attract more an opportunity to attract in South LA to provide restaurants on new fast-food placing a moratorium restaurants. sit-down Many studies have shown that regularly eating fast food can lead to higher body-mass index scores. higher body-mass that regularly eating fast food can lead to shown have studies Many in South LA, compared of the restaurants comprise 71.8 percent Limited service or fast-food restaurants of obesity among children rate The and 47.7% of LA County restaurants. LA restaurants West to 40.8% of LA and 23.3% for all children West in 17.6% obesity among children in South LA is 28.8% compared to in the county. and alcohol problems. Even small increases in the availability of alcohol lead to increased use; alcohol of alcohol lead to increased small increases in the availability Even and alcohol problems. with violence. use has been associated stores in West LA, documenting notable differences in the availability of health-supporting foods. Fresh of health-supporting notable differences in the availability LA, documenting West stores in LA West bread, and nonfat milk were less likely to be found in South LA than in the grain produce, whole community. Retail food outlets and grocery stores tell an equally alarming story. Research has found that the presence has Research tell an equally alarming story. Retail food outlets and grocery stores consumption. is linked to higher fruit and vegetable of a supermarket in a neighborhood portions. Research has shown that consumers presented with menu labeling at the point of service make that consumers presented with menu labeling at the point has shown portions. Research restaurants. requiring menu labeling in chain in 2008 California passed a law healthier food choices. to higher sales, the World Health Organization supports limiting alcohol outlets to reduce negative to reduce negative supports limiting alcohol outlets Health Organization World to higher sales, the outcomes. additional supermarket, the likelihood of residents meeting nutritional guidelines increases by one- of residents meeting nutritional guidelines increases by additional supermarket, the likelihood third. xxxviii behavior, infant mortality, unintentional injuries and violence are also associated with too much alcohol alcohol much are also associated with too unintentional injuries and violence infant mortality, behavior, consumption. South Los Angeles Health Equity Scorecard . Data

74 . Only 6 farmers’ markets are available in . Only 6 farmers’ markets are available 55 For the healthy food options that do exist, South LA retailers are the healthy For 75 However, we found: However, 73 show that 21% of food facilities subject to monitoring under the LA DPH food ratings program program that 21% of food facilities subject to monitoring under the LA DPH food ratings show LA and the 5% in West higher than the 3% in in South LA—much of “C” or below a grade receive is partially responsible strong tourist economy LA’s West Experts surmise that the county overall. tourists will seek where rows” as “restaurant areas colloquially known for this; there are several the familiarity of system is not a national program, the facility rating Though out dining venues. for global understanding of the scoring system and its meaning, and scale allows A-F grading the anecdotal evidence suggests As a means of remaining competitive, tourists. adapted by is quickly performance measures to employee grade the restaurant are tying owners LA restaurant West that managers. and offering financial bonuses to restaurant A rating of “C” or lower among food facilities is the second highest nutrition disparity among food facilities is the second highest nutrition of “C” or lower A rating Fewer farmers’ markets are available across South LA farmers’ markets are available Fewer access to farmers’ markets in under-resourced maximize To LA. West South LA compared to 16 in community organizing, a focus on selling basic, affordable areas, experts recommend subsidies, transportation. staff, and providing foods, hiring residents to be sales . . more likely to offer products under unhealthy conditions. more likely to offer products under unhealthy In a community with limited healthy food options, farmers’ markets can help fill some of the void. A void. some of the food options, farmers’ markets can help fill In a community with limited healthy at farmers’ a greater number of fruits and vegetables purchase women found that low-income recent study markets than at supermarkets. The Los Angeles County Health Department gives a letter grade to restaurants based on how they score on based on how to restaurants a letter grade Angeles County Health Department gives Los The equipment and facilities adequate cooking of food, cleanliness of and temperature, proper food storage as well as safe food handling/hygiene. South Los Angeles Health Equity Scorecard 56 RECOMMENDATIONS healthy the county and better resourced, nutritional assets into greater balance with bring South LA’s To (1) planning and land use; (2) economic development; in three key areas: areas, we turn to public policy quality the access, but also to enrich not simply to improve must be objective The and (3) public health. for new the limited number and size of parcels Given environment. of the existing food resource and incentives role in providing and creative a more active must play local government development, A number of cities in California communities. in underserved resources planning for access to healthy plans, and general activities in their redevelopment of nutritional resources addressed the issue have of Los City The decisions in cities. and land use a blueprint for zoning, development provide which of these plans are part of the South Three of its 35 community plans. Angeles is currently updating 12 Angeles. Los Hills-Leimert, Southeast, and South Adams-Baldwin West region, including Angeles Los Southeast by 2009, followed in Fall Hills-Leimert is expected to be completed Adams-Baldwin West and other nuisance 2010. Placing a limit on the number of fast-food outlets and South LA in March the physical update or area-specific zoning ordinances can provide businesses either through the plan of healthy space and economic opportunity for the development as South food outlets in communities that are “food deserts” such food funds can be used to ensure that healthy LA. Redevelopment in new projects. are incorporated resources At the state and local levels, the Health Department is responsible for enforcing state laws associated state laws for enforcing the Health Department is responsible levels, At the state and local food preparation, commonly associated with cleanliness, standards are These standards. with food safety that maintains retail establishment Although any foods and sanitary practices. for perishable temperatures the Angeles County) falls under its purview, feet in Los of food products (e.g., 10 square a certain amount individual sold in grocery stores. It is up to the quality of the food does not evaluate Health Department of food. stores to ensure the safety and quality osses several jurisdictions. Federal regulation regulation Federal jurisdictions. several and crosses matter is another stores retail/grocery food Monitoring Both the US stores. before it reaches of food limited to the processing are generally and oversight the products regulate (FDA) Administration and Drug Food and the (USDA) Agriculture of Department and other meat meat, poultry for produce, standards grading provides USDA The in stores. that are sold are no There meats. products that contain contents of most the labels and It also regulates products. of labels and contents regulates the the FDA offers. Similarly, meat that a store for produce or standards not a federal dates on food products are expiration food products. Unfortunately, non-meat containing and the of a product the expiration food to provide it is up to the manufacturer of the mandate. In fact, foods. not still contain these “expired” do the store to ensure that their shelves responsibility of South Los Angeles Health Equity Scorecard

Existing license, permit and health surveillance provisions should be strengthened and expanded to increase access to healthy food in communities. Current state policy regulating the number of liquor outlets is based on population. As South LA’s population has grown, new alcohol outlets have been allowed to open without exceeding the threshold. Reevaluating this policy and establishing limits based on geography may be more effective. While the state has the authority to license liquor stores, local governments have responsibility for appropriate use including the sale of liquor through the building permit process for new outlets and the alteration or expansion of existing stores. LA County has adopted a restaurant rating program; however, there is very little regulation of food retail outlets.

The Nutrition Workgroup analyzed the data and these policy opportunities during the Scorecard Policy Summit in June 2008 and developed the following policy recommendations to address disparities in healthy food access and liquor outlets.

POLICY RECOMMENDATIONS ACCOUNTABLE AGENCY Provide grants and below-market rate micro-loans to . Los Angeles City Council and other transform liquor stores and convenience stores and city councils (Compton, Inglewood, to develop new retail supermarkets through the use Hawthorne, etc.) of block grants, targeted tax credits, redevelopment . Community Development Departments funding and other financing vehicles based on fresh food products as a specific percentage of the product line or square footage of retail space. Utilize state and local regulatory authority to limit . City councils alcohol sales by: . California Department of Alcoholic . Re-evaluating state policy to place limits on the Beverage Control number of liquor stores based on the size of the geographic area to account for population density . Developing city zoning regulations and limits on the total number and density of liquor stores in South Los Angeles . Adopting city standards regarding location and hours and conditions of liquor store operation through zoning tools or conditional use permits. Extend the South LA “Fast-Food” moratorium limiting . City councils the number of fast-food restaurants until an ordinance and land use policy that supports investment in South LA by healthier food resources is adopted.

Establish a centralized position within the city to . City councils help streamline and expedite the permit process for the private sector and other entities to establish supermarkets based on their ability to meet a set of criteria and standards of quality. Enhance the role and authority of local health . Los Angeles County Board of Supervisors departments to regulate and enforce the quality and . Los Angeles County Department of condition of food in local markets. Public Health

57 South Los Angeles Health Equity Scorecard LA -55% South 85.1 70.1 1.92 West LA Safe routes 76

78 LA 24% West 83.1 97.2 0.97 LA County 1.2 58 74.7 0.42 South LA PHYSICAL ACTIVITY ACTIVITY PHYSICAL xl xli Indicator xxxix

77 Los Angeles County Health Survey, LACHS 2005 Survey, Office of Health Assessment and Epidemiology, Los Angeles County Los Assessment and Epidemiology, Office of Health 2005 Survey, LACHS Angeles County Health Survey, Los LA County Department of Public Works, Programs Development Division, 2007. Division, Development Programs Works, LA County Department of Public Percent of children (1-17 years old) years (1-17 of children Percent reported they could easily parents whose or other safe get to a park, playground place to play Acres of green space / recreation areas Acres of green space / recreation per 1,000 population Miles of county bicycle lanes per Miles of county bicycle 100,000 population GreenInfo Network, 2007. GreenInfo Network, South LA’s physical activity options contribute to lower health status and the low levels of exercise of exercise levels health status and the low options contribute to lower activity physical South LA’s death leading causes of preventable and poor nutrition are the second activity of physical reported. Lack South LA and the rest of the nation. in the US and are the primary culprits in the obesity epidemic facing increases risk for a overweight Among children, or obese reduces life expectancy. Being overweight activity or bone problems. Physical number of health problems including asthma, depression, diabetes, is also activity and mental health. Increased physical disease prevention is a key indicator of chronic associated with delinquency. outcomes and negatively associated with school positively can reduce reliance on cars and encourage walking or biking that promotes health. Cities must address or biking that promotes health. walking can reduce reliance on cars and encourage National Center for Safe Routes to School The get to school. to safety to create safe passage for children paths, and connected facilities, separate scaled to pedestrians, bicycle lighting sidewalks, calls for paved roadways. - chil sample of 6,032 parents/guardians of a random Department of Public Health. Estimates are based on self-reported data by County. Angeles of the population in Los representative dren 0-17 years xl xli South LA does not have equal access to physical activity options, options, activity to physical equal access have South LA does not The health disparity. highest environmental making this the second is clear evidence of this disparity. of green space or parks lack Three measures were scored that represent capacity and access to and access represent capacity were scored that measures Three whose are (1) children measures These options. activity physical green (2) amount of access to a safe place to play; parents report easy lanes. of bicycle space; and (3) miles xxxix The LA County Health Survey results indicate only three-quarters of the population have access to a access to only three-quarters of the population have results indicate LA County Health Survey The respectively. LA and LA County West in compared to 85% and 83% to play, safe place for children vigorous LA and 51.8% reported West 61.9% in activity, of physical When asked about the frequency active. Only 45.9% in South LA met the criteria for being physically activity. to moderate South Los Angeles Health Equity Scorecard CHC conducted a 80

79 59 FUNDING OPPORTUNITIES

a park and environmental bond measure passed in 2002 by California passed in 2002 by bond measure a park and environmental 81 : a park-bond measure passed in 1996 by voters in the City of LA to in the City of LA to voters passed in 1996 by : a park-bond measure : a state law designed to generate funding for park development that requires funding for park development designed to generate : a state law Proposition K and local of state includes $832.5 million for the acquisition and development that voters parks and recreation areas to develop programs for local assistance parks including grants and facilities. address the inadequacies and deterioration of the city’s “youth infrastructure”—parks and infrastructure”—parks “youth of the city’s and deterioration address the inadequacies and for park, recreation, childcare, the currently unmet need recreation centers—and for 30 years $25 million per year Proposition K generates in the city. community facilities of city parks and recreational construction, and maintenance for acquisition, improvement, facilities. Act Quimby in-lieu funds or set aside land for park and recreational uses within, to either pay developers subdivisions. or in the immediate vicinity of, new Proposition 40: . . . City Controller Laura Chick conducted an audit of the City Department of Recreation and Parks in 2006 conducted an audit of the City Department of Recreation and Parks Chick City Controller Laura of services provided.” the diversity citing “inequity regarding access to recreational opportunities and and that the department allocated staffing resources found inequities in the manner in which study The and are less likely to idized programs “less affluent communities are more dependent on Department subs plan, appropriate strategic of a five-year audit called for the development The programs.” offer as many of a community assessment every performance standards and measurements along with the completion years. five community assessment in 2001 that both inventoried and examined the capacity of a wide variety of and examined the capacity of a wide variety both inventoried community assessment in 2001 that assessment concluded The Angeles. Los West in South LA in comparison to resources activity physical While LA (52%). West (72%) than in LA were publicly owned that far more of the facilities in South fewer adults in South LA have similar basic services for older adolescents, relatively both areas have the of vulnerability the suggests LA South in facilities public towards imbalance The choices. and resources in ensuring access and also points to the important role that cities play community to budgetary problems LA were much West in recreational facilities The communities. in underserved to recreational resources of nature for adults and, in keeping with the public-private of programs more likely to offer a wide range LA residents were more West In return, day. and longer each open more days environment, the resource residents in South LA. Other services than activity 20%) for their physical a fee (62% versus likely to pay access to adequate accessibility, use of parks is most intense in areas of low that while shown studies have and modes of transportation available recreational opportunities is dependent upon proximity to parkland, hours of operation. The environment within the community can significantly influence a child’s risk of obesity and how and of obesity risk child’s a influence can significantly the community within environment The and 128 cities ranked Public Health report LA County A recent exercise. individuals frequently same areas on the also ranked study The rates. obesity according to child in LA County communities and obesity relationship to child determine their per capita to and park area hardship indicators economic obesity. with child associated park area was found that Other features of the physical environment, including access to facilities, aesthetics of the facilities/ including access to facilities, aesthetics environment, Other features of the physical as well. activity affect the amount of physical neighborhoods and land use mix, South Los Angeles Health Equity Scorecard

82 Policy instruments Policy 84 The CDC’s review of the evidence finds high CDC’s The 83 60 economic benefit for environmental and policy approaches to increasing access. approaches policy and economic benefit for environmental such as building codes, circulation and design standards and zoning ordinances must be utilized by must be utilized by and design standards and zoning ordinances codes, circulation as building such options. activity promotion and accessibility of physical the walkability, cities and the county to improve and shopping near work, as locating schools, such strategies should include Planning and development and adopting joint use for open space in new developments; parks and requirements homes; incorporating Policies activity. physical in equity better ensure to facilities school and parks of use shared for agreements activity street-scale urban design and land-use policies that support physical that involve and interventions interventions These activity. increases of 35% in physical average also resulted in on a neighborhood level projects to increase safety of street crossings, use of street lighting, infrastructure can include improved parkways, enhanced street landscaping, circles), (e.g., speed humps, traffic calming approaches traffic City of LA is currently The routes. as well as school safety at parks and public facilities and improved trails opportunities activity to increase physical ensure strategies plan and should on its transportation working and adequate bike pedestrian-friendly streets, bike/pedestrian pathways, improvements, as sidewalk such at public parks, shopping centers, and workplaces. racks Additional economic factors work against the development of new parks. There is an inherent financial is an inherent There new parks. of against the development factors work Additional economic parks budget shortfalls. Not only do when cities face of parks, particularly conflict in the development dollars that the tax but they also do not generate costs or liabilities to the city, operating represent ongoing development. come from private The need for more parks and physical activity options to combat the rising rates of childhood obesity and of childhood the rising rates options to combat activity need for more parks and physical The that creating demonstrates research Growing areas, is clear. particularly in low-income disease, chronic of persons result in a 25% increase in the percent can activities physical or enhancing access to places for least the recommended 3 times a week. at exercise who RECOMMENDATIONS Compounding the inequitable distribution of parks, “park poor” communities such as South LA receive receive LA as South such communities poor” parks, “park of distribution the inequitable Compounding released an City Controller Angeles the Los 21, 2008 February funding. On less public disproportionately Quimby in unspent $129 million over identified audit The Uses.” Collection and Fee of Quimby “Audit audit concluded The of parks. to support the development been used otherwise that could have funding projects be allocated for funds can only requirement that as the such ordinances, Quimby that current of to the failure fees, contributed the that generated from the development radius two-mile within a projects are disproportionately since subdivision concluded have Other studies program. the Quimby resources. of Quimby little in the way receive older inner city neighborhoods “suburban,” South Los Angeles Health Equity Scorecard

85 61 Several residential areas in South Los Angeles represented innovations in urban design for design in urban innovations represented Angeles Los in South areas residential Several needs to be community and is good about the of what examples and provide their time Green. Village and Leimert Park examples are Two or built upon. restored design company landscape brothers, an influential the Olmsted designed by was Leimert Park Capitol, New the United States including high-profile projects, numerous that completed Louisville. as Seattle, Boston, and systems in cities such and entire park Park, Central York’s in Southern planned communities first comprehensively one of the was Leimert Park considered a model of It was and middle-income families. for low- California designed minimized, utility wires was and churches near schools automobile traffic urban planning: planted trees lined its streets. from view in alleys, and densely were buried or hidden the constructed during was Green,” Village “The commonly called Village, Hills Baldwin The Apartment no through-streets. apartment complex with the first experimental 1940s. It was open space located in surround a village green-like parkways extensive by units, connected to condominiums and were converted project. In the 1960s, these units the center of the remain so today. The challenges in urban communities such as South LA are at least twofold: (1) equitable funding; are at least twofold: as South LA in urban communities such challenges The to be yet after the city audit, major recommendations have years Two and (2) land use prioritization. allocated to remedy dollars designated for park expansion and maintenance must be Tax implemented. to need to be reevaluated as Quimby communities. Public policies such the inequity in open space across infused with areas that are rarely in the neglected low-income ensure the goal of more parks is achieved as Proposition 84, a bond measure funds. State funding, such Quimby to generate new developments to be needs for local and regional park improvement, grants that contains $400 million for competitive repurposed and Abandoned industrial land must be restored, targeted for “park-poor” communities. and successful in increasing access to parks has proven involvement include open space. Community further development. Angeles over open space in South Los South Los Angeles Health Equity Scorecard GENCY ACCOUNTABLE A ACCOUNTABLE City/county planning agencies City/county Transportation Angeles Metropolitan Los Authority other city Angeles City Council and Los councils Supervisors Angeles County Board of Los other District and Angeles Unified School Los Hawthorne, districts: Inglewood, school Lennox etc. & Recreation Department of Parks Angeles Los and other city parks agencies & Recreation County Parks Angeles Los Recreation and California Department of Parks City/county planning agencies Transportation Metropolitan Angeles Los Authority City/county planning agencies Transportation Metropolitan Angeles Los Authority ...... 62 POLICY RECOMMENDATIONS POLICY Incorporate health into local government planning planning into local government health Incorporate and redevelopment plan, including the general transportation. Fully implement the recommendations from the Fully implement of including the development City Controller audit for parks. plan a citywide strategic from and state revenues county, Allocate city, bonds to address the current taxes and designated and maintenance development inequities in park and and ensure a system of parks, schools, to equal access recreation centers that provide for all South LA. activity physical use Increase the number of joint community parks and recreation agreements between schools, property and use of school departments to allow activity. facilities after hours for physical the and improve Establish safe routes to school safety of parks and streets. The Physical Activity Workgroup examined the data and arrived at the following policy recommendations recommendations policy the following at and arrived the data examined Workgroup Activity Physical The resources. activity disparities in physical to reduce South Los Angeles Health Equity Scorecard LA -17% South 3.6 89.6 11.7 16.8 30.1 West LA Exposure to 86 6.6 80.9 12.5 17.5 28.4 LA 7% West LA County 88

61.5 14.7 11.9 26.2 19.0 87, South LA

63 afety S Public xliii xlii xliv INDICATOR Violent crimes (homicide, rape, robbery, robbery, (homicide, rape, crimes Violent assault) per 1,000 population aggravated larceny) car theft, Property crimes (burglary, per 1,000 population Statistical Digest, 2005. Los Angeles Police Department, Information Technology Division, Management Report Unit. Division, Technology Department, Information Police Angeles Statistical Digest, 2005. Los Office of the Attorney General, State of California, Department of Justice, Criminal Justice Statistics Center, 2005. http://ag.ca. Justice Statistics Center, Justice, Criminal State of California, Department of Attorney General, Office of the Los Angeles County Health Survey, LACHS 2005 Survey, Office of Health Assessment and Epidemiology, Los Angeles County Los Assessment and Epidemiology, Office of Health 2005 Survey, LACHS Angeles County Health Survey, Los Percent of adults (18+ years old) who believe believe old) who of adults (18+ years Percent their neighborhoods are safe Traffic accidents per 1,000 population Traffic Crimes per 1,000 population violence impacts both fears of crime as well as changes or restrictions in lifestyle such as physical activity activity as physical such or restrictions in lifestyle as well as changes violence impacts both fears of crime minors. and possession of guns by or illegal purchase level xliii xliv Perception of neighborhood safety is the largest contributor to the safety is the largest contributor to of neighborhood Perception with only 62% of South LA safety West LA and differences in South perception low The their neighborhood is safe. LA adults believing statistics that report high rates by safety is validated of neighborhood crimes per 1,000 were 11.86 violent There LA. of crime in South West population in LA, compared to 3.57 per 1,000 population in South the immediate physical beyond disparity in violence extends The County overall. LA and 6.58 for LA and other hazards has been exposure to violent crime health risks. Continual danger to longer-term disease. associated with cardiovascular stress and has been physiological to provoke shown We examined three indicators of public safety: adult perception of perception safety: adult of public examined three indicators We rates. and crime accidents, traffic safety, neighborhood

gov/cjsc/statisticsdatatabs/CrimeCity.php. Numbers for the City of Los Angeles from the Los Angeles Police Department. Angeles Police Los Angeles from the Numbers for the City of Los gov/cjsc/statisticsdatatabs/CrimeCity.php. xlii Department of Public Health. Estimates are based on self-reported data by a random sample of 8,648 Los Angeles County adults, sample of 8,648 Los a random Department of Public Health. Estimates are based on self-reported data by Angeles County. of the population in Los representative South Los Angeles Health Equity Scorecard In xlvi . While South LA had While South . . Part 1 offensives include violent 1 offensives . Part In the City of Los Angeles, 16% In the City of Los 90 . The increasing number of single parent households number of single parent households increasing The 64 xlv 91

89 is a public/private collaboration to keep parks and to keep parks collaboration is a public/private Summer Night Lights The open until Angeles City in eight high crime districts in Los recreation centers 2008. in beginning September through July from week each nights four midnight for environment a safe and constructive to provide designed was program The reporting districts that the and families and deter crime. In the youth children, an 86% decrease in homicides, 23% reduction there was served, SNL programs in shots fired, and a 17% reduction in assaults, 32% reduction in aggravated was in the reporting districts most significant reduction The gang related crime. a 32% reduction in gang related there was SNL, where Jim Gilliam by served to 6 for the same time period in 2007. crime and zero homicides as compared and officials, jobs, $40,000 in coaches $250,000 in youth project provided The and $70,000 in with local vendors $81,000 in artist fees, $63,000 spent All these jobs went to residents of the SNL neighborhoods. jobs. intervention The disparity in total combined Part 1 offenses did not vary widely offenses did not vary 1 disparity in total combined Part The and property crimes. South LA had 19.0 crimes per 1,000 population, with West LA’s rate slightly rate LA’s West 19.0 crimes per 1,000 population, with and property crimes. South LA had period. of 17.5 during the study at a rate the two at 16.8 and LA County between lower LA and LA County West in South LA are 2-3 times higher than in crimes Violent a higher rate of violent crime than West LA, West LA showed a higher rate of property crime at 30.1 a higher rate LA showed West LA, West of violent crime than a higher rate per 1,000 population in 2006. per 1,000 population. In South LA, there were 26.2 property crimes Los Angeles County Children’s Planning Council, Los Angeles County 2006 Children’s Scorecard. Angeles County 2006 Children’s Planning Council, Los Angeles County Children’s Los Appendix for more details for City of LA communities. See Data only available . Other results are as follows: . Traffic accidents are also a significant disparity in South LA. Traffic accidents contribute to motor vehicle to motor Traffic accidents contribute accidents are also a significant disparity in South LA. Traffic 6. deaths and are the third leading cause of premature death in SPA of all traffic accidents occurred in south LA City, at a rate of 14.7 accidents per 1,000 population. at a accidents occurred in south LA City, of all traffic west LA City, only 11% of LA City traffic accidents occurred locally at a rate of 11.7 accidents per 1,000 a accidents occurred locally at only 11% of LA City traffic west LA City, This of 12.5 accidents per 1,000 population. rate Angeles had an overall City of Los The populations. also been have conditions example, traffic indicators. For disparity also affects other environmental activity. of physical associated with levels No one factor contributes to crime but rather multiple, often interrelated issues ranging from from ranging issues interrelated often multiple, rather crime but to contributes factor No one for The findings a role. play and substance abuse family support to school to difficulty in unemployment higher than at 14.1% or 131% in South LA stands rate unemployment The this claim. reinforce South LA attending public gap” for students “achievement The county. than the overall LA and 72% higher West of public LA), a mere 13.7% 6 (South In SPA extensively. LA has been documented in South schools math at 33.7% were doing and only average the national above reading at or were third graders school in lowest 6 (South LA) are the in SPA rates graduation Public high school the national average. or above 62.4% of students graduating. with only the county, strains the family support system. Zoning and planning codes and enforcement may also inadvertently also inadvertently may codes and enforcement system. Zoning and planning the family support strains are not likely familiar with and architects owners being built, and property result in unsafe facilities crime. designing to prevent xlvi xlv South Los Angeles Health Equity Scorecard Statewide, 92 GENCY ACCOUNTABLE A ACCOUNTABLE City Council Agency Community Development District School City Council Enforcement Law District School Transportation Department of Enforcement Law City Planning ...... 65

93 POLICY RECOMMENDATION Increase funding for multi-disciplinary gang and expand community safety prevention enforcement, law partnerships between schools, neighborhood associations and other key stakeholders. Create safety corridors on South LA roadways. Increase funding and access to prevention Increase funding and access to prevention with a focus on academic for youth programs retention and job training. remediation, school The Public Safety Workgroup analyzed these public safety indicators and recommends the following and recommends the following analyzed these public safety indicators Workgroup Public Safety The focuses: policy To prevent injuries from motor vehicle occupant injury, the CDC recommends ensuring adherence to the CDC recommends occupant injury, injuries from motor vehicle prevent To creation of safety zones in areas with high The safety seats and safety belts. existing policies for DUI, child and signs, signal optimization, should utilize lane restriping, traffic traffic incidence of accidents or heavy islands and single- traffic Creating more bike lanes, safety laws. of increased education and enforcement reliance on bikes and pedestrians and lower passage for motor vehicles, lane roundabouts can create safer motor vehicles. California voters passed Proposition 36 in 2000, which required that those convicted of a non-violent, of a non-violent, required that those convicted passed Proposition 36 in 2000, which California voters and community-based drug treatment in lieu of a prison drug-related offense be offered probation there is that, while shown have and evaluations implementation studies and second year sentence. First to state and local a significant benefit in cost-savings there was in the program, room for improvement governments. There are a number of opportunities to build upon successful program models. The City of Los Angeles Angeles Los City of The models. program opportunities to build upon successful are a number of There services in and reduction intervention gang prevention, $168 million in funding for has recently released citywide strategy This coordinated strategy. with a comprehensive, an attempt to address gang violence Program, the Gang Reduction local initiative, of a federally-funded is based upon the promising results Heights neighborhood. in gang-related crime in the Boyle a 44% reduction saw which Public safety is a public health issue, and the level of violence is a public health crisis. The issue of issue The crisis. a public health of violence is the level issue, and is a public health Public safety approach a multi-disciplinary addressed through and must be suppression goes beyond public safety and environment behavioral the socioeconomic, at changing aimed strategies prevention that includes Job Corps and early intervention programs, accidents. Mentoring to violence and traffic factors that lead After among participants. crime successful in preventing been shown Start have as Healthy such programs student outside the classroom to support recreation and tutoring is needed including programming school focuses on direct problem policing, which or community A “safer communities” approach, achievement. is a best practice factors that contribute to crime the underlying social and economic solving as well as the use of design and condition of neighborhoods, the physical in Improvements enforcement. among law the safety of communities. features are also useful tools in improving design architectural streetscapes and RECOMMENDATIONS South Los Angeles Health Equity Scorecard LA -40% South 7.9 40.2 13.3 West LA LA 16% West 22.9 47.4 12.9 LA County 36.8 38.1 18.1 66 In this section, three housing measures are presented three housing measures are presented In this section, South LA 94 ng sing Hou xlix xlviii INDICATOR The median year in which LA County housing units were built was 1961, with 13% of homes LA County housing units were built was in which median year The 95 xlvii xlvii The definition of overcrowded housing is adopted from Census guidelines and includes occupied housing units with 1.0 or housing is adopted from Census overcrowded definition of The

Percent of owner-occupied housing units of owner-occupied Percent Percent of housing structures built before Percent 1939 Percent of occupied housing units that are Percent (1.0 or more occupants per overcrowded room) United Way of Greater Los Angeles, Center for Community Research and Solutions. 2007 Zip Code Databook. Angeles, Center for Community Research of Greater Los Way United United States Census Bureau, Census 2000. Summary File 3. United States Census Bureau, Census 2000. Summary File The definition of overcrowded housing is adopted from Census guidelines and includes occupied housing units with 1.0 or overcrowded definition of The as affecting health including housing stock built before 1939, owner-occupied housing, and overcrowded and overcrowded housing, owner-occupied built before 1939, including housing stock as affecting health housing. built before 1939. In comparison, South LA reports 18% of pre-1939 housing and 13% in West LA. West housing and 13% in built before 1939. In comparison, South LA reports 18% of pre-1939 more occupants per room. xlix 18 xlvii xlviii Substandard housing conditions, which are more likely to be found in are more likely to be found conditions, which Substandard housing outcomes to a multitude of poor health areas, contribute low-income injuries. Long-term lead poisoning and unintentional including asthma, later develop housing conditions may in poor children living studies find disabled or die younger. diseases, become chronic Quality, affordable housing is essential to the quality of life and health the quality of life is essential to housing affordable Quality, has changed South LA region Housing in the community. in any pressure prices placing with rising the last few years in dramatically followed the integrity of their neighborhood, on residents to preserve from the and falling prices stemming a high number of foreclosures by national credit crisis. more occupants per room. Age of housing is a concern for lead paint exposure, which was not banned until 1978 for its adverse not banned until 1978 for its adverse was Age of housing is a concern for lead paint exposure, which hypertension and children to seizures or death in deficits, health effects from intellectual and behavioral equate with substandard housing does not always While older housing stock kidney disease in adults. areas this is the case more often LA County), in low-income historic neighborhoods in (there are many than not. For all three indicators, South LA experiences a deficit compared to West LA and to LA County for percent West LA and to LA County for percent a deficit compared to all three indicators, South LA experiences For greatest The of housing units that are overcrowded. 1939 and percent of housing structures built before 37% of occupied housing units housing—approximately disparity within housing occurs in overcrowded LA housing that is West and a half times the 8% of is more than four This in South LA are overcrowded. housing Overcrowded in LA County. higher than the 23% overcrowding and sixty percent overcrowded with the spread of infectious represents a potential health threat and has historically been associated and influenza. as tuberculosis diseases such South Los Angeles Health Equity Scorecard

1 The percentage of residents of residents percentage The 96 67 Racial segregation concentrates poverty and excludes and excludes poverty Racial segregation concentrates 97 The Housing Authority of the City of Los Angeles, accessed September 30, 2008. of the City of Los Authority Housing The and isolates communities of color from the basic and quality resources needed for socio-economic from the basic and quality resources and isolates communities of color housing funds. fund in 2000 to leverage City of LA created an affordable trust equality and health. The created $1 billion in bonds for housing for the have rejected a measure in 2006 that would Voters proposed requiring affordable housing of LA 2007, the Mayor families. In homeless and low-income current more razing to prevent changes recommended but other policymakers in new developments, public and political will are required to break this leadership and greater affordable housing. Innovation, . and pattern of housing segregation stranglehold Overcrowding, exposure to lead paint and substandard housing are simply symptoms or outcomes of exposure to lead paint and substandard Overcrowding, arise largely from problems associated with housing and fundamental problem. The greater a much residential segregation and discrimination. Many of these projects are isolated from basic services creating high concentrations of poverty and of poverty these projects are isolated from basic services creating high concentrations of Many substandard public housing with and now replaced overcrowded have violence. Cities across the country and to diversify opportunities for ownership construction to provide new mixed-income and mixed-use of its confronts the need to replace several Angeles now The City of Los the economic profile of the area. Angeles. in Los the profile of poverty creates an important opportunity to change This housing projects. South LA includes five out of 15 of the large public housing developments and 29 of the 47 scattered and 29 of the 47 scattered developments out of 15 of the large public housing five South LA includes Angeles (HACLA). of the City of Los Authority the Housing by and managed public housing sites owned A home also represents individual and family life savings and, historically, an opportunity for upward an opportunity for upward and, historically, and family life savings individual A home also represents and decline in home values in a rapid the recent mortgage crisis has resulted However, mobility. highest rate renters, South LA has among the of Despite the higher percentage increased foreclosures. loans were previously qualified for mortgage not have families that may low-income of foreclosures as mortgage schemes. caught in sub-prime in South LA who are renters and do not own their home is slightly higher than in West LA and almost 10 LA and almost West than in is slightly higher their home not own are renters and do LA who in South owned, in South LA are housing units 38% of occupied LA County overall. higher than points percentage reported for LA County. LA and the 47% West in units of owner-occupied to the 40% comparable 1 The third measure provides an indication of the number of families that rent their homes as opposed to as opposed homes their that rent of families number of the an indication provides measure third The blood lead elevated associated with characteristic is another housing Renter status their homes. own and age of housing owner-occupied of variables found that the recent study One in children. levels requiring hospitalization. of pediatric injury rate were linked to the housing South Los Angeles Health Equity Scorecard GENCY Additional public 99 As part of its public housing As part of its public housing 98 ACCOUNTABLE A ACCOUNTABLE LA Housing Authority LA Housing LA Building/Safety CRA City Councils Planning Departments Housing Departments Angeles of the County of Los Authority Housing Angeles of the City of Los Authority Housing City Councils LA County Public Health LA City Council LA Housing Authority LA Housing LA Building/Safety CRA City Councils Planning Departments Health County Environmental ...... 68 POLICY RECOMMENDATION Establish policy and a citywide plan to provide and a citywide plan to provide Establish policy distribution of affordable for equitable geographic housing through mixed use, particularly in rebuilding public housing. Develop a strategic plan to leverage and maximize plan to leverage a strategic Develop funding funding to increase local, state and federal to maintain and build affordable housing. Strengthen and enhance the role, monitoring and Strengthen and enhance the role, public health agencies to assess the reporting by satisfaction. quality of public housing and resident Review and revise existing housing codes to Review and revise existing housing with health risks associated reduce environmental injury moisture, carpeting, molds, ventilation, privacy, hazards, exposure to toxic substances, particularly in noise, lighting and other factors, subsidized housing. policy, such as the lead abatement program, is needed to reduce health risk associated with older housing is needed to reduce health risk as the lead abatement program, such policy, announced new regulations recently The EPA owners for upgrades. financial aid to property with stock After analyzing the data, the Housing homes built before 1978. renovating for housing contractors recommendations to close the gaps in the indicators. four policy developed Workgroup Reporting on housing quality and resident satisfaction with housing can provide a basis not only for policy not only for policy a basis with housing can provide quality and resident satisfaction Reporting on housing in their community. housing improve to and advocates but also for residents change reconstruction effort, the Seattle Housing Authority has created High Point, a mixed-income community has created High Point, Authority the Seattle Housing reconstruction effort, and a walkable reduce health disparities through number of units and also seeks to that doubles the “green” design. Research suggests that helping individuals who live in high concentrations of poverty relocate to lower to lower relocate poverty of concentrations in high live who helping individuals suggests that Research assistance and tenant-based rent vouchers Portable health outcomes. can improve neighborhoods poverty efforts that challenge must also be legal There strategies. housing mobility most common been the have housing in high opportunity of affordable and target development segregation residential and school is arguably a focus on quality, address poor housing and health to approach effective most The areas. human/social capitol. overall for all as well as improving affordable housing RECOMMENDATIONS South Los Angeles Health Equity Scorecard LA -43% South 0.04 0.08 West LA 100 LA 63% West 0.08 0.30 LA County 0.06 0.64 South LA 69 ls Schoo The link between health education attainment and poorer link between health education The 101 li lii INDICATOR In contrast, the percentage of the population in South the percentage In contrast, xlv LAUSD schools within 500 feet of a freeway within 500 feet of a freeway schools LAUSD in area per total schools Schools with substandard facilities (Williams substandard facilities (Williams with Schools in the area per total schools schools) Schools in Proximity to Freeways, Presentation to the Facilities Committee. Los Angeles Unified School District Office of Envi- District Office of Angeles Unified School Committee. Los Presentation to the Facilities in Proximity to Freeways, Schools Los Angeles County Office of Education, 2007 Reports of Williams Legislation Monitoring. 2007 Reports of Angeles County Office of Education, Los health status and outcomes is also well established. And, as noted previously in the report, education health status and outcomes is also well established. crime. a role in preventing plays ronmental Health and Safety. 8 November 2007. 8 November ronmental Health and Safety. LA that possesses a high school diploma (18.9%) is relatively similar diploma (18.9%) is relatively a high school LA that possesses data on educational the while (19.9%). But county rate to the overall school The tells part of the story. is compelling, it only achievement and development an equally potential risk to the represents environment the reason, we go beyond this For of children. educational achievement health and safety of measures and examine the academic performance facilities. school lii The state of South LA’s schools contributes to less academic success and in turn bad health among contributes to less schools state of South LA’s The lead among those with less education, may is concentrated for example, which literacy, residents. Low quality of care. It has also been and lower communication with healthcare providers to ineffective health outcomes. associated with negative In LA County, 594 schools were identified in violation of Williams standards, with 176 or 30% of were identified in violation of 594 schools In LA County, that were comparison, had only eight schools LA, by West located in the South LA area. the schools comprise 64% of area, non-compliant schools in each of total schools As a percentage designated. difference leading to a 111% LA, and 30% in LA County overall, West in South LA, 8% in schools LA and LA County. West between South LA and LA County and a 73% difference between Education figures strongly in the immediate and long-term health of and long-term in the immediate figures strongly Education of under 18 years population is LA, 33.5% of the In South children. public 6 (South LA) in SPA population enrolled 62.4% of the age. Only 79.4% LA and West to 78.6% in compared graduate, high schools countywide. li To assess the quality of a school, we applied the Williams schools designation. This designation is This designation. schools Williams applied the we assess the quality of a school, To the State of California and the California filed against 2000 class-action lawsuit the result of a May the basic educational resources these agencies failed to provide Department of Education that contended facilities. Under the settlement and safe and decent school teachers, of instructional materials, qualified were deemed in violation of in California 2004, some 2,200 public schools August in agreement reached yearly monitoring. and are subject to Williams legislation the basic standards codified in the South Los Angeles Health Equity Scorecard

102,103,104 The district must confront The 105 70 Figure19. Williams Schools in Los Angeles County Angeles in Los Schools Williams Figure19. LAUSD is undergoing an unprecedented $19 billion effort to build new schools and modernize and repair and modernize is undergoing an unprecedented $19 billion effort to build new schools LAUSD additions. and 70 school existing facilities, resulting in 150 new schools Based on this knowledge, state law now prohibits new schools from being built within 500 feet of a prohibits new schools now state law Based on this knowledge, 6% for is feet of a freeway within 500 number of schools The loopholes exist. although several freeway schools. LA but less than the 8% for all LAUSD West South LA, more than the 4% in in schools the challenge of adhering to the 500 feet law when there is limited undeveloped land or the choice of land or the choice there is limited undeveloped when of adhering to the 500 feet law the challenge attend the school. children potentially displacing families whose The conditions and disparities in inner city schools are not intractable but require vigilant monitoring and are not intractable conditions and disparities in inner city schools The tested (9 out schools of the LAUSD 30 percent found investigation April 30, 2008, KNBC’s reporting. On reduce these environmental To is safe. says the government what above with lead levels of 30) had water should schools Williams and repair projects for South LA construction or modernization risks, new school bond initiatives. school be prioritized under the various RECOMMENDATIONS Beyond the ability of South LA schools to meet student educational requirements, the health of the to meet student ability of South LA schools the Beyond Asthma is one students that inhibits learning. can trigger illness among of the school environment physical proximity to traffic a link between residential absenteeism. Studies show of the leading causes of school asthma, and lung-function growth. as wheezing, outcomes such health and children’s and freeways South Los Angeles Health Equity Scorecard

106 GENCY ACCOUNTABLE A ACCOUNTABLE California Department of Education California Department of Education California State Legislature California Department of Education California Department California State Legislature State Department of Education District and other Unified School Angeles Los Districts City School County Office of Education Angeles Los ...... 71 POLICY RECOMMENDATION Increase enforcement of the school-freeway of the school-freeway Increase enforcement review period and distance with an extended public district requests an mitigation measures if a school exception under the law. Decile 1-3 South Williams Reduce the number of at least 33%. by in the next 3 years LA schools hearings to examine Conduct state legislative action, examine critical status of corrective greater public issues and provide schools Williams accountability. Mandate completion of structural (retrofitting) of structural Mandate completion regulations related to comply with improvements a by air quality of all schools to indoor/outdoor designated time. In line with its core design principles, local school districts should make every attempt to find alternatives find alternatives attempt to make every districts should school principles, local its core design In line with air quality or in places where facilities as industrial pollutants such and other near freeways to building exceeded. risk standards are Primary prevention policies to address child asthma should focus on retrofitting school buses and buses school retrofitting focus on should asthma child to address policies prevention Primary and building bicycle use, transportation increasing public emissions, vehicle reducing diesel trucks, include should approaches prevention Secondary buses. school idling of preventing paths, and walking roadways. from schools separating near schools, vehicles limiting air in schools, or filtering conditioning South Los Angeles Health Equity Scorecard LA 5% South These These 20 lvi 1.77 3.23 1.97 West LA LA 39% West 1.83 5.82 6.21 LA County 1.33 5.45 7.34 South LA 72 Quality & Land Air Of this 8%, approximately 6% is reserved for manufacturing purposes Of this 8%, approximately 6% is reserved 107 liv lv INDICATOR liii City of Los Angeles Department of Planning and the Community Redevelopment Agency. Los Angeles’ Industrial Land: Los Agency. and the Community Redevelopment Angeles Department of Planning City of Los

Community General Plan Land Use Report, Los Angeles City Planning Department, January 2008. Angeles City Planning Department, January Plan Land Use Report, Los Community General Envirofacts Data Warehouse, Environmental Protection Agency. http://www.epa.gov/enviro/ accessed June 20, 2008. accessed June http://www.epa.gov/enviro/ Agency. Protection Environmental Warehouse, Data Envirofacts EnviroStor Database, California Department of Toxic Substances Control. http://www.envirostor.dtsc.ca.gov/public/ accessed Substances Control. http://www.envirostor.dtsc.ca.gov/public/ Toxic Database, California Department of EnviroStor City of Los Angeles Department of Planning and the Community Redevelopment Agency. Los Angeles’ Industrial Land: Los Agency. and the Community Redevelopment Angeles Department of Planning City of Los Number of EPA-regulated (TRI) facilities per Number of EPA-regulated 1,000 population Number of toxic waste (DTSC) sites per Number of toxic waste 100,000 population Percent of industrial/manufacturing land by LA of industrial/manufacturing land by Percent City region The higher percentage of industrial/manufacturing land may speak to the historical concentration of heavy of heavy speak to the historical concentration of industrial/manufacturing land may higher percentage The and other main arteries and Boulevard industrial and manufacturing businesses in South LA along Slauson large industrial areas continue to exist, but are not in use reflect current use. Several does not accurately or used for purposes other than previously zoned. and is heavily concentrated in the greater downtown Los Angeles city area. Los in the greater downtown concentrated and is heavily poses, as opposed to the other zoning for industrial purposes, as opposed to the other zoning areas include land that is zoned specifically City LA to limited are measure this for data The facilities. public and commercial, residential, of categories land industrial-zoned The Angeles. Areas and exclude cities outside Los Planning Department Community In city. LA and slightly less than the overall West in South LA city planning areas is three times the area of to the city planning department asking issued a directive Villaraigosa Antonio Angeles Mayor 2005, Los balancing the need for affordable limited industrial zones while for recommendations to protect the city’s acres—or Angeles has approximately 19,000 City of Los the land uses. Currently, housing and alternative Angeles and Los of Los of total city land—zoned for industrial uses (excluding the Port eight percent Airport). Angeles International Sustaining a Dynamic City Economy. December 2007. Sustaining a Dynamic City Economy. Sustaining a Dynamic City Economy. December 2007. Sustaining a Dynamic City Economy. lv 20 lvi liii liv Rail systems, freeways and air traffic from LAX airport crisscross from LAX airport and air traffic freeways Rail systems, the largest urban one of by is bordered community The South LA. Field), refineries, LAX airport Oil Inglewood Hills/ oil fields (Baldwin industrial sites, of abandoned an over-abundance and peppered with transportation and repair shops and body centers, automotive recycling of the influence the quality and safety characteristics These depots. hazard free land are vital and water Clean air, air. land and region’s assess air and land To health. community’s and the to an individual’s zones, the amount of industrialized/manufacturing we examined quality, facilities in South LA. and EPA-regulated sites (“brownfields”), toxic waste Industrial or manufacturing-zoned land makes up the largest disparity in air and land quality. The The land makes up the largest disparity in air and land quality. Industrial or manufacturing-zoned Plan Land Use Report, were used to the Community General six classifications, taken from following limited manufacturing, by region: commercial land of industrial/manufacturing define the percentage manufacturing. light manufacturing, light industrial, and heavy manufacturing, limited industrial, June 20, 2008. June South Los Angeles Health Equity Scorecard The The 108 Heavier industry, industry, Heavier 110 In addition, because state and federal state and federal In addition, because lvii 21 73 High temperature operations at industrial sources also contribute to also contribute sources at industrial operations High temperature 109 To assess these sources and to identify more specifically the presence of toxic more specifically the presence of and to identify assess these sources To Liberty Hill Foundation is working with researchers, environmental groups and environmental with researchers, is working Liberty Hill Foundation corridor Nuys, the Figueroa Van LA, Pacoima, local community residents in South to inventory Wilmington and Commerce Heights, Maywood, Boyle downtown, known effort, The in neighborhoods. potentially toxic and hazardous sites toxic and picture of an accurate is designed to provide as “ground truthing,” communities. health of nearby they affect the hazardous sites and how 112 Though there may be some overlap between the two databases (DTSC EnviroStor (DTSC EnviroStor databases between the two be some overlap there may Though lviii 111 Environmental Protection Agency, Envirofacts Multi-system Query. Envirofacts Agency, Protection Environmental

Department of Toxic Substances Control, EnviroStor Frequently Asked Questions and Answers. Asked Questions and Frequently Substances Control, EnviroStor Toxic Department of nitrogen oxide, and short- and long-term air exposure is linked to respiratory illness. to respiratory air exposure is linked and long-term oxide, and short- nitrogen release among industry, we gathered data from state and federal regulatory databases for the county and regulatory databases for and federal we gathered data from state release among industry, database tracks Substances’ (DTSC) EnviroStor Toxic Department of California The areas. study the two It also need further investigation. or sites that may contamination to have known and identifies sites waste. that are permitted to handle hazardous identifies facilities effects of exposure to toxic chemicals released into air or land can be acute or accumulate over time, and over be acute or accumulate air or land can released into chemicals exposure to toxic effects of cancer. to cause are known many such as oil field production, uses equipment that releases a variety of pollutants from particulate matter to pollutants from particulate matter variety of a uses equipment that releases as oil field production, such sulfur dioxide. The rate of DTSC sites per 100,000 population in South LA (5.45) is consistent, but slightly lower than in South LA (5.45) is consistent, but slightly lower of DTSC sites per 100,000 population rate The is There LA (3.23 per 100,000). West of almost twice the rate It is, however, LA County (5.82) overall. drop for South LA in the number of less stringently federally- contradictory a precipitous and somewhat in and or the decline in related businesses be attributed either to under-reporting may This reported sites. this data. is needed to validate the area. Further research and EPA Envirofacts), because California environmental policies establish higher thresholds than the policies establish because California environmental Envirofacts), and EPA that report to DTSC are not required to report to EPA. of the businesses many EPA, federal guidelines have differing threshold levels for reporting businesses, we also analyzed the EPA’s Envirofacts Envirofacts for reporting businesses, we also analyzed the EPA’s threshold levels differing guidelines have toxic databases, including those tracking of environmental a variety database for facility information from handling processes, and air permit compliance, hazardous waste discharge release sites, water chemical emission estimates. lvii lviii stations add to the list of and planes, dry cleaners and gas including vehicles other sources Many LA. pollutants in South Heavy manufacturing plants are one of the sources known to contribute to outdoor air pollution and air pollution to outdoor to contribute known sources of the are one plants manufacturing Heavy to cause or suspected is known Air pollution during production. release toxic chemicals potentially and asthma. as birth defects such health conditions with other serious is associated cancer and South Los Angeles Health Equity Scorecard GENCY ACCOUNTABLE A ACCOUNTABLE AQMD Substances Toxic California Department of Agency Protection Environmental LA City Planning and Zoning Administrator LA City Planning and Zoning Agency LA City Redevelopment Los Angeles County Board of Supervisors Los California State Legislature LA City Planning and Zoning Administrator LA City Planning and Zoning LA City Council Agency LA City Redevelopment ...... 74 The public often is not aware of these processes and public public often is not aware The 114 This includes improved technology for garbage sites, industry sites, industry for garbage technology improved includes This 113 POLICY RECOMMENDATIONS Develop and implement a system to gather data and Develop reflects air a set of indicators that accurately provide and land quality. Strengthen coordination between responsible city regional departments to ensure more cohesive zoning, planning for parks, transportation, and housing. redevelopment Establish a fund similar to the federal CERCLA or Establish a fund similar to the federal Superfund that imposes fees on businesses to be responses. or other corrective used for removal Strengthen adherence to planning and design requirements for buffering and clean-up of heavy and light industrial use. and others to prevent release of contaminants. The EPA now stringently regulates and addresses land stringently regulates now EPA The of contaminants. release and others to prevent of hazardous and cleanup for the evaluation provides Superfund or CERCLA, which quality through the to adverse near an industrial area is linked that living clearly demonstrated While it is not yet sites. waste risk is present and the City of place, the potential in each because of the variances health outcomes possible always this is not zones. However, to buffer residents with lighter industrial LA has attempted community is organizing for a Hills Baldwin The a housing development. industry precedes where the production by expansion of oil drilling and District to regulate the planned Community Standards required impact study of the environmental adjacent to the community as part PXP on land oil company in the environment put in place to protect was law The Act. Quality Environmental under the California forward EIR, but projects can still move or mitigation through the alternatives allowing communities by if specific hardships are demonstrated. even ents of neighboring cities to provide the city planning departments of neighboring cities to provide Greater coordination is needed among reporting of land use. Reporting of current land use should be improved uniform standards, measures and As the need for more affordable housing variances. with limits placed on local of government at all levels design standards must upon industrially-zoned areas, encroaches and responsible mixed-use development be more strictly enforced. Of equal concern is the lack of coordination by city agencies for the significant number of current projects city of coordination by Of equal concern is the lack (Crenshaw-Prairie); DOT and MTA corridors by includes planning for transit This and developments. Project areas; the City of the nine South LA Redevelopment within mixed use and retail development Master Plan, Hills Park planning; and Baldwin and Recreation strategic Department of Parks Angeles Los function may planning and redevelopment Greater coordination or consolidation of the to name a few. plan community The priorities. health community and economic balancing plan cohesive more a facilitate should be used to strengthen existing standards and set limits update through the planning departments basis, including light manufacturing and sites on a geographic on the occurrence of potentially hazardous repair shops subject to DTSC reporting. hearings may go unnoticed or unattended. go hearings may A number of state and federal agencies are responsible for monitoring environmental standards including standards including environmental for monitoring are responsible agencies of state and federal A number and the EPA. Control Board Resources Water District, State Management Air Quality Coast the South better control allowed have levels and state at the federal changes and policy regulation More stringent air and land pollutants. and reduction of RECOMMENDATIONS South Los Angeles Health Equity Scorecard NEXT STEPS

Although the disparities highlighted in the South LA Health Equity Scorecard are not new, national attention on the need for healthcare reform and the existence of several current local initiatives provide an opportunity “to get it right.” More than any single finding documented in this report, the Scorecard is designed to demonstrate that the health of a community is not the sole responsibility or authority of the county or the healthcare sector. Rather, just as the health of the population is influenced by multiple factors in both the healthcare environment and the physical environment, so must the response to poor health outcomes address the universe of these influences.

Even agencies that don’t typically see health as their responsibility have a powerful decision-making role that contributes to or diminishes health at a neighborhood, community and regional level. Local public health agencies across the country are starting to partner with urban planners, schools, businesses, and municipalities to focus on neighborhoods or “places” where many of the exposures to social determinants of health occur. Initiatives include, for example, rebuilding and expanding public housing to include recreational space such as bike paths and parks and increasing the number of affordable housing units throughout a community.

In the face of the current national economic crisis, greater attention must be given to the needs of the inner city as part of any economic stimulus or recovery plan if we are to avoid exacerbating inequities and prevent further erosion of the health of whole populations. These factors—highlighted by the Scorecard results—leave no doubt that the time for coordinated leadership and a comprehensive agenda for policy change is now. The recommendations outlined in this report are more than just the output of a project; they are a call for leadership and provide blueprints for an actionable agenda.

Success will require vision and forward thinking by policymakers and responsible agencies, along with a recognition that what works in one place may not work in another. The Mayor of Los Angeles recently released a South LA Strategic Initiative that opens a process of coordination among the various city departments to expedite a number of outstanding redevelopment projects and to support job creation. In cities such as Inglewood and Compton, as well as elsewhere in the region, there is increased development. However, the old political argument that “something, albeit inferior, is better than nothing” can no longer be tolerated. It is no longer in the best interests of the health of communities such as South LA to allow development or redevelopment in the absence or outside of a strategic plan for building a healthy community and sustainable economy. Job creation alone does not result in better access to quality services or community economic development. A job is not a job—part-time minimum wage jobs at fast-food restaurants or big box retailers do little to stimulate the re-entry of quality food retailers, better schools or to lift families out of poverty. An economic strategy is needed that not only stops the “leakage” of consumer spending but also results in the recirculation and reinvestment of dollars back into the community. Plans calling for higher housing density must be tempered by well-designed communities that support physical activity and disperse low-income housing in a rational and equitable manner.

This requires collaborative and strategic planning beyond any immediate project or sector initiative. The transportation agenda must support housing development; housing development must be supported and complemented by economic development and job creation. With redevelopment and increased density must come new opportunities for open space, improved infrastructure and additional support for education. The funding and resources are in place, but they need to be better aligned and leveraged with the benefit of the community foremost.

75 South Los Angeles Health Equity Scorecard The process begins with a commitment to health equity. Health equity does not take away from one community to improve the condition of another. Health equity is the targeted reinvestment of economic, political and social capital in underserved communities to achieve parity. It is the dismantling of intentional, unintentional or absence of public, economic and institutional policies that isolate whole segments of the population from access and opportunity as we see in South LA. It is the proactive creation of access and opportunity by decision makers and the community.

The inequality in the health of South LA is a “condition” that goes beyond the limits of any single city and necessitates collaboration and cooperation at every level of government and across jurisdictions. County and city elected officials and their respective agencies must develop a joint power agreement that outlines a comprehensive plan to address the economic, social and political hurdles and that identifies benchmarks and performance standards for public accountability. There must be a targeted and strategic commitment of resources insulated from fluctuations in the budget process.

The efforts to achieve health equity must extend beyond the walls of City Hall and include the active participation of community, business and faith-based leadership. A great deal can be done at the community level. Despite a history of economic, social and political obstacles, the residents of South LA have demonstrated creativity, resilience and a great capacity for creating a community rich in assets in a desert of equitable public and private investment. The many coalitions, outstanding community- and faith- based organizations, and the network of neighborhood councils and associations should be tapped and engaged in this effort.

The Coalition for Health & Justice and the Disparities in Healthcare Advisory Committee have already agreed to push forward on the recommendations in the Scorecard pertaining to Primary and Preventive Care Access and Utilization. Having discussed and expanded the recommendations in great detail, these coalitions are mobilizing on a number of action items, such as a postcard campaign for an increase of county funding for safety-net clinics, a future partnership with health-educator training programs, and the publication of a South LA Health Resources Guide. These action items were carefully chosen and developed to improve one or more of the 12 indicators of South LA’s deficient access to and utilization of primary and preventive care services. Both coalitions will be moving on these actions—and more— during the next year.

Much like the members of the Coalition for Health & Justice and the Disparities in Healthcare Advisory Committee, others attending the Policy Summit expressed interest in partnering with leaders working to eliminate disparities, either by conducting research or establishing connections for recommendations that lack an advocate. CHC is working with a number of the coalitions and groups through the publication of the Scorecard and establishment of a website to help provide greater public accountability and engagement. Our hope is that this report is only the beginning of a collaborative process, with every intention that in forthcoming editions the data will demonstrate progress achieved and thus a discernible improvement in the health of the South LA community.

76 South Los Angeles Health Equity Scorecard 77 T.H.E. Clinic T.H.E. Healthy City Healthy The City Project The Data Collection: Bailitt Health, LLP GreenInfo Network GreenInfo Network corecard Advisors: Scorecard Girl’s Club Girl’s Gloria Davis, Charles Drew University Charles Drew University /Cal-State Dominquez Hills Janice French, LA Best Babies French, Janice LA City Planning Department Tonya Gorham, LA Best Babies Tonya Los Angeles Police Department Angeles Police Los Medical Marketing Service, Inc. Environmental Protection Agency Agency Protection Environmental Acknowledgments California Health Interview Survey California Health Interview Survey United Way of Greater Los Angeles Angeles of Greater Los Way United Los Angeles Unified School District Angeles Unified School Los LA County Department of Public Works Works LA County Department of Public Los Angeles County Office of Education Los LA County Department of Public Health LA County Department of Mental Health California Office of the Attorney General Attorney General California Office of the LA County Department of Health Services Marqueece Dawson, Community Coalition Marqueece Dawson, California School Health Centers Association Health Centers California School American Cancer Society American Cancer Cynthia Oredugba, California Department of Toxic Substance Control Substance Control Toxic California Department of Southern California Air Quality Management District Southern California Watts Healthcare Corporation Watts Seamster, Roderick Dr. California Department of Alcoholic Beverage Control Alcoholic Beverage California Department of Office of Statewide Health Planning and Development Office of Statewide Health Planning and Development Healthy African American Families African Healthy Young-Brinn, Angela Alison Herrmann, UCLA Center to Eliminate Health Disparities South Central Family Health Center Family South Central Filmardirossian, Genevieve USC School of Policy Planning and Development of Policy Sloane, USC School David Southside Coalition of Community Health Centers Southside Coalition of Community Health Vacarro, Nina Strategic Concepts in Organizing and Policy Education Concepts in Organizing and Policy Ito, Strategic Jennifer —SPA 6 Health Angeles County Department of Public —SPA Los Vick, Nicole Los Angeles County Department of Mental Health Angeles County Department Los Wilcoxen, Jacquelyn —SPA 6 Health Angeles County Department of Public —SPA Los Travis, Martina RAND Corporation: Urban Community Research Center Urban Community Research Bluthenthal, RAND Corporation: Ricky Dr. Editor: Janice Taylor, Communications Director, Community Health Councils Community Communications Director, Taylor, Editor: Janice CHC Woods, Sadio CHC, and Robin Gilliam; Research: Flournoy, Korie CHC; Photography: Nomachi, Data: Jonathan Obioha Nkechi Ming Li, Katherine Mack, Jew, Jessica Lauren Frank, Anne Ferree, Interns: and assistance. A special thanks to all CHC staff for additional research Additional thanks go to the following individuals and organizations who contributed their ideas and resources to the ideas and resources contributed their who and organizations individuals following thanks go to the Additional been possible. not have the Scorecard would their participation, Without Scorecard project. South LA Health Equity Community Health Councils thanks everyone who participated in the Community Health Councils / Coalition for Councils / Coalition Community Health participated in the who thanks everyone Health Councils Community and into the data indicators insights Your Summit. Scorecard Policy Health Equity Angeles South Los Justice Health & of this Scorecard. in the development were invaluable recommendations the policy South Los Angeles Health Equity Scorecard The The Every attempt was attempt was Every For example, the supply of licensed acute example, the supply of licensed acute For 78 made to collect data across like years. However, the report incorporates data from multiple the report incorporates However, across like years. made to collect data not utilize the could We and methods. different data collection periods repositories with data were in which ways in the nor can we assure consistency indicator, on every same year gathered. area. geographic for the equivalent not available Scorecard data in some cases are Scorecard data reflect multiple years and different methods of collection. years and different methods multiple Scorecard data reflect was of the data through zip codes, but much area were determined boundaries of the study Areas. Planning as cities or Service boundaries such geographic under other only available boundaries than the for different geographic cases, indicators and their data are In several proximity to of this is school areas. One example specified Scorecard target and contrast therefore data from other LA County school Data were collected only from LAUSD; freeways. Appendix 1. indicator in are noted by boundaries districts were excluded. Geographic for statistical significance and should not be represented as Scorecard data are not computed and noted accordingly. Some data are statistically unreliable such. indicators. Some data are duplicated among psychiatric beds is the maximum number of psychiatric beds a hospital is licensed to operate beds a hospital is licensed to operate beds is the maximum number of psychiatric psychiatric of beds, but this does not a certain number be licensed to operate Hospitals may time. at any those beds with patients. to occupy and staff resources the physical necessarily mean they have beds represents the number of beds that can be staffed, supply of licensed available The supply bed a patient within 24 hours. Licensed available for use by equipped, and ready Because of this, the supply of licensed acute psychiatric includes beds for all specialty services. or weighted in an In these instances, data were averaged beds is included among the data. effort to offset duplication. . . . . South Los Angeles Health Angeles Health South Los The this study. occur within and uses, limitations data collection As with all US Census, LA from the widely-known ranging data sources multiple incorporates Equity Scorecard and Office of Statewide Health Planning and California Health Interview Survey, County Health Survey, delivery departments, health service planning data sets gathered from schools, to specific Development include: that should be acknowledged data limitations bodies, etc. General agencies, state licensing APPENDIX 1: Data Sources, Notes and Known Limitations and Known Notes Sources, 1: Data APPENDIX South Los Angeles Health Equity Scorecard 62% 36% 37% 28% 44% 11% 49% 59% 135% 211% 237% 146% 201% 182% Percent Percent Percent Percent West LA West West LA West Difference Difference -9% -81% -73% -78% -74% 35% -76% -50% -55% -35% -49% -18% -45% -28% Percent Percent Percent Percent South LA South LA Difference Difference GE GE 0.73 2.65 0.33 5.48 0.03 0.33 6.68 0.15 0.60 87.36 13.19 135.81 West LA West West LA West AVERA AVERA Difference Difference 1.49 -0.45 -8.29 -0.01 -0.06 -7.42 -0.25 -0.55 -0.42 -4.65 -46.18 -43.60 South LA South LA Difference Difference LA 3.22 0.43 0.12 0.50 6.91 1.54 1.83 1.27 4.92 1.23 West West 20.43 21.81 33.49 19.97 19.46 193.05 147.15 West LA West 79 0.90 2.21 0.24 0.10 0.17 4.26 1.39 1.23 5.64 0.54 6.26 1.37 14.95 15.14 11.79 57.24 59.79 LA County LA County HEALTHCARE RESOURCES HEALTHCARE LA LA 1.14 1.14 0.22 0.09 0.11 5.75 7.72 0.45 6.66 0.68 3.18 1.59 0.12 1.61 0.08 South South 11.06 16.20 9 10 6 2 1 10 3 4 10 7 10 8 5 OB/GYN supply per 100,000 population Cardiologists per 100,000 population Oncologists per 100,000 population Acute psychiatric bed supply per Acute psychiatric 1,000 population Licensed available bed supply per Licensed available 1,000 population population General physicians’ supply per physicians’ General 1,000 population Pediatricians per 100,000 children Pediatricians Community clinic supply (DHS and PPP) per 1,000 uninsured population Healthcare Workforce Healthcare Healthcare Facilities Key specialists’ supply per 100,000 Key population dentists per practice General 100,000 population General acute care hospitals per acute care hospitals General 100,000 population Mental health agencies per 100,000 Pharmacies per 100,000 population Emergency medical treatment Emergency population stations per 100,000 population Bed supply per 1,000 (averaged) health centers per School-based population 1,000 uninsured child Agencies that offer HIV/STD screenings per 100,000 population . Notations . Notations Scorecard for this used the scoring data, and their indicators, list of a full provide below tables The end of the are at the of specific indicators and limitations collection the source, regarding and explanations tables. South Los Angeles Health Equity Scorecard -2% 6% 92% 35% 22% -7% -39% 29% 46% 52% 16% 21% 36% 54% 27% 38% Percent Percent West LA LA West Percent Percent Percent West LA West LA West Difference Difference Difference 3% -13% -20% -65% -231% -7% 12% Percent Percent -39% -29% -14% -18% -36% -68% -90% -34% -30% South LA Percent Percent Percent Percent Difference South LA South LA Difference Difference GE GE GE 31.31 -$16.21 3.4 4.3 4.6 5.3 4.5 8.3 $678.15 West LA LA West -2.7 -$821.56 10.0 11.0 AVERA Difference West LA West West LA West AVERA AVERA Difference Difference -6.93 $56.18 -$268.65 South LA -8.6 -2.4 -5.3 -5.5 -9.1 -$2330.28 Difference 1.36 -8.6 -12.6 -13.8 South LA South LA Difference Difference LA LA 4.0 8.2 $65.36 8.1 7.1 11.8 40.0 84.8 80.9 20.3 West LA West West West West West $1024.87 $2592.16 $2903.84 80 8.3 15.4 21.8 37.3 80.2 69.9 25.6 12.6 11.6 $34.05 $1008.66 $1914.01 $2082.84 LA County LA County LA County LA LA 29.2 74.7 57.3 34.7 30.4 10.7 42.6 21.2 South South 10.2 $27.12 South LA $3338.94 $1970.19 $2350.91 14

16 18 12 14 (20%)

13 13 14 18 17 11 14 15 (40%) Primary and Preventive Care Access Care Primary and Preventive (40%) Healthcare Coverage Healthcare Financing Healthcare Percent of adults (18-64) who of adults (18-64) who Percent no insurance reported having reported of adults who Percent of care source a regular having PPP dollars per uninsured PPP dollars person per Hospital net revenue adjusted patient day Hospital uncompensated care Hospital uncompensated day per adjusted patient Hospital operating expense per expense Hospital operating adjusted patient day Percent of adults who reported easily reported who adults of Percent obtaining medical care Percent of children (0-17) who (0-17) who of children Percent no insurance reported having do not of adults (18-64) who Percent dental insurance have could not of adults who Percent afford dental care at least once in the past 12 months of households with no Percent vehicle of ER hours spent in Percent a year diversion without being ER visits that leave seen per 1,000 population South Los Angeles Health Equity Scorecard 2% 14% 40% 11% 26% 11% -26% 178% 300% 101% 256% 310% 103% Percent Percent Percent Percent West LA West West LA West Difference Difference 59% 22% 38% 27% 72% 182% 103% West LA West 86% -2% -8% -51% 200% -19% -51% -17% -47% -320% -445% -24% -106% Percent Percent Percent Percent South LA South LA South Difference Difference GE GE 2.4 1.5 0.6 15.3 0.09 6.90 0.02 0.06 261.1 127.6 -0.41 West LA West West LA West AVERA Difference AVERA Difference -76% -65% -30% -34% -24% -28% -43% South LA -4.2 -6.8 -4.8 -1.4 -2.5 -52.1 South LA South 0.04 0.04 -6.94 -0.16 Difference -24.10 South LA Difference LA 4.7 19.3 43.7 84.3 West West 363.3 168.8 81 1.97 0.14 0.03 0.08 40.80 West LA West 5.3 21.7 41.2 59.0 82.8 102.2 LA County LA 1.56 0.05 0.05 0.02 47.70 County LA 7.8 50.0 34.4 63.8 81.4 25.9 South South LA 8.51 0.10 0.21 0.06 PHYSICAL ENVIRONMENT RESOURCES ENVIRONMENT PHYSICAL South 71.80 HEALTHCARE ENVIRONMENT RESOURCES HEALTHCARE 20 24 14 16 16 22 23 19 19 21 16 Liquor retail stores per sq. mi. Supermarkets (44,000+ sq. ft.) per sq. mi. Nutrition Food facilities rated below “C” below facilities rated Food per sq. mi. markets per sq. mi. Farmers’ Percent limited service Percent restaurants Healthcare Workforce Healthcare Healthcare Financing Healthcare Coverage Access Care Primary and Preventive Care Utilization Primary and Preventive SCORE TOTAL Healthcare Facilities Percent of adults who reported ER reported of adults who Percent past 12 months use in the Number of pap smears by PPP pap smears by Number of 1,000 uninsured adult clinics per women PPP by Number of mammograms adult clinics per 1,000 uninsured women have who of men 40+ years Percent had a PSA test never Percent of people 2+ years who have have who of people 2+ years Percent been to a dentist never a of population that saw Percent within the past doctor at least once year Primary and Preventive Care Utilization Preventive and Primary South Los Angeles Health Equity Scorecard 2% 4% 7% 7% 97% -3% 24% 11% 66% -28% 16% -15% Percent Percent Percent Percent Percent Percent West LA LA West West LA West West LA West Difference Difference Difference -9% -24% -18% -17% -99% -10% -56% -60% -20% -40% -55% -40% Percent Percent Percent Percent Percent Percent South LA South LA South LA Difference Difference Difference 0.7 8.7 0.9 2.0 -7.2 -0.4 15.1 0.95 -27.05 West LA West West LA West West LA LA West AVERAGE AVERAGE AVERAGE Difference Difference Difference -2.2 -9.3 -5.2 -8.4 -1.54 -19.4 -13.8 -0.55 -95.93 South LA South LA South LA Difference Difference Difference LA 82 7.9 3.6 85.1 70.1 1.92 40.2 13.3 West West 16.8 30.1 89.6 11.7 West LA West West LA West LA LA LA 6.6 28.4 17.5 80.9 12.5 22.9 47.4 12.9 97.2 83.1 0.97 County County County LA LA LA 1.2 11.9 26.2 19.0 61.5 14.7 36.8 38.1 18.1 74.7 0.42 South South South

28 14 25 17 26 15 29 17 27 Violent crimes (homicide, Violent aggravated robbery, rape, assault) per 1,000 population Property crimes (burglary, per 1,000 car theft, larceny) population Percent of children whose parents whose of children Percent Miles of county bicycle lanes per lanes per Miles of county bicycle Acres of green space / recreation Acres of green space Crimes per 1,000 population reported they could easily get to a could easily get reported they safe place to play 100,000 population Physical Activity Physical areas per 1,000 population Percent of adults who believe believe of adults who Percent their neighborhoods are safe Percent of housing structures built Percent before 1939 Traffic accidents per 1,000 Traffic population Percent of occupied housing units Percent (1.0 or more that are overcrowded occupants per room) Public Safety Housing Percent of owner-occupied of owner-occupied Percent housing units South Los Angeles Health Equity Scorecard 3% 73% 53% 44% 68% 63% 39% Percent Percent Percent West LA LA West LA West Difference Difference 7% 24% 16% 63% 39% 42% 101% West LA West 6% 5% 25% 27% -18% -43% -111% Percent Percent Percent South LA South LA Difference Difference GE GE .22 0.04 2.59 0.06 4.24 West LA LA West LA West AVERA AVERA Difference Difference 0.02 0.37 0.50 -0.34 -1.13 South LA South LA Difference Difference LA LA 5% 0.08 0.04 1.97 3.23 1.77 West West West -55% -17% -40% -43% -43% -106% South LA 83 LA LA 0.30 0.08 6.21 5.82 1.83 County County LA LA .64 7.34 5.45 1.33 0.06 South South PHYSICAL ENVIRONMENT RESOURCES PHYSICAL 31 32 33 30 34 Schools with substandard facilities with substandard Schools per schools) Williams (Decile 1-3 in the area total schools of industrial/manufacturing Percent LA City region zoned land by Nutrition Air and Land Quality Schools Physical Activity Options Activity Physical LAUSD schools within 500 ft. of a schools LAUSD in area per total schools freeway facilities Number of EPA-regulated per 1,000 population Number of toxic waste (DTSC) sites Number of toxic waste per 100,000 population Public Safety Housing Schools Air and Land Quality SCORE TOTAL South Los Angeles Health Equity Scorecard 84 1 Office of Statewide Health Planning and Development (OSHPD), Hospital Listings, 2006. Only general acute care hospitals acute care hospitals general Listings, 2006. Only (OSHPD), Hospital Planning and Development of Statewide Health 1 Office codes were included. LA zip West and South LA zip codes located in in South by hospitals located queried station supply Report, 2006. EMS treatment Utilization Profile Annual Hospital 2 OSHPD non-reporting hospitals. supply excludes County EMS treatment LA zip codes. LA West and (excluding nursery daily complement of beds beds are the average Available Report, 2006. Annual Financial 3 OSHPD Hospital beds placed in Excludes use, regardless of staffing levels. for overnight existing and actually available bassinets) physically Available services within 24 hours. cannot be placed into to non-patient care uses which units converted suspense or in nursing non-reporting zip codes. LA County bed supply excludes LA West located in the South and hospitals bed supply queried by to non- Angeles-Suburban Campus due Los LA excludes Promise Hospital of East bed supply in South Available hospitals. reporting. comparable for psychiatric beds are beds licensed specifically Acute psychiatric Annual Utilization Profile Report, 2006. 4 OSHPD Hospital LA zip codes. West the South and hospitals located in bed supply queried by psychiatric patients. Licensed acute 2007. Community clinic supply Analysis, Office of Planning and Department of Health Services (LADHS), Angeles County 5 Los LA zip West centers located in the South and health sites and DHS health centers and comprehensive includes all PPP clinic codes. codes. LA zip West South and centers queried by health Association, 2007. School-based Health Centers 6 California School 2007. Mental health agencies include DMH Angeles County Department of Mental Health (LADMH), Planning Division, 7 Los 5. 6 and Areas (SPA) are for Service Planning facilities. Numbers facilities and DMH-contracted and Health Internal Medicine of General of Medicine, Division UCLA Department Brown, Arleen F. of research 8 Personal (90250) and Inglewood 6 and the additional zip codes for Hawthorne 2007. South LA numbers are for SPA Services Research, 5. LA numbers are for SPA West (90301, 90302, 90303, 90304, 90305). 4, 2008. Accessed March . http://www.hivla.org/search.cfm Policy. and Aids Program of Office 9 HIV LA Consumer Director, LA zip codes. West South and Queried by practice, general family practice, supply includes physicians’ practice General 10 Medical Marketing Services, Inc., 2007. obstetrics, and obstetrics and and internal medicine. OB/GYN supply includes gynecology, medicine, preventive general West and dentists located in South and office- and hospital-based physicians queried by and dentist supply Physician gynecology. LA zip codes. Year 2006-2007. Fiscal Analysis, 2007. PPP dollars are for 11 LADHS Office of Planning and charity care, county indigent Report, 2006. Uncompensated care costs include Profile Annual Financial 12 OSHPD Hospital Angeles-Suburban campus in care costs exclude Promise Hospital of East Los care, and bad debt care. Uncompensated program hospitals reporting. Costs aggregated by LA due to non-comparable West LA in Hospital-West South LA and Kaiser Foundation LA County costs exclude non-reporting hospitals. LA zip codes. West located in South and by hospitals located expenses queried and operating Report, 2006. Net revenue Profile Annual Financial 13 OSHPD Hospital Campus in South LA and Kaiser Angeles-Suburban Promise Hospital of East Los LA zip codes. Excludes West in South and reporting. LA County excludes non-reporting hospitals. LA due to non-comparable West LA in Hospital-West Foundation Angeles County Los Assessment and Epidemiology, Health Office of 2005 Survey, LACHS Angeles County Health Survey, 14 Los Angeles County 8,648 Los sample of a random are based on self-reported data by Department of Public Health. Estimates additional zip codes for 6 and the South LA numbers are for SPA County. Angeles of the population in Los adults, representative 5. are for SPA LA numbers West (90301, 90302, 90303, 90304, 90305). (90250) and Inglewood Hawthorne Angeles County Los Assessment and Epidemiology, Health Office of 2005 Survey, LACHS Angeles County Health Survey, 15 Los sample of 6,032 parents/guardians of a random Department of Public Health. Estimates are based on self-reported data by 6 and the additional South LA numbers are for SPA Angeles County. of the population in Los representative 0-17 years children 5. LA numbers are for SPA West 90302, 90303, 90304, 90305). (90301, (90250) and Inglewood zip codes for Hawthorne 5 and Footnotes to Appendix 1 Appendix to Footnotes South Los Angeles Health Equity Scorecard Street Community Police Stations; Stations; Police Street Community th 85 west LA City accidents queried by West LA and Pacific Community Police Stations. Police Stations. Community LA and Pacific West by accidents queried west LA City jurisdiction. by queried Data Center. Statistics Justice Criminal Justice, of Department California Profile. Justice Criminal 2005 28 numbers are These from the 2005 Statistical Digest. Stations (see reference 27) Police Community by LA City data queried Statistics Center. Justice reported to the Criminal zip by 2007. Data queried Area 5, 6 and 8. May Planning Angeles, Zip Code Data Book Service of Greater Los Way 29 United LA. West codes for South and Williams schools Decile 1-3 Angeles County Office of Education. Annual Report. Los 2007 Settlement Legislation Williams 30 for Education LA zip codes from the National Center West in South and schools Total LA zip codes. West South and queried by 2008. Accessed June . Statistics, http://nces.edu.gov/index.asp Health and Environmental District Office of Angeles Unified School 2007. Los November in Proximity to Freeways, 31 Schools only. schools LA zip codes. Data are for LAUSD West South and queried by Schools Safety. include commercial City Planning Department. Zones Angeles 2008. Los Land Use Report, January Plan 32 Community General South manufacturing. manufacturing, light industrial and heavy manufacturing, limited industrial, light manufacturing, limited Adams-Baldwin West Angeles, and Angeles, Southeast Los Areas South Los Plan and west LA City regions include Community West Los Venice, Vista-Del Rey, Palms-Mar Palisades, Crest, Brentwood-Pacific Air-Beverly Hills-Leimert for south LA City; Bel for west LA City. Westwood and del Rey, Westchester-Playa Angeles, . Substance Control. http://www.envirostore.dtsc.ca.gov/public/ Toxic of Database. California Department 33 EnviroStor LA zip codes. West South and sites queried by Toxic 7, 2007. Accessed November Accessed January . http://www.epa.gov/enviro/html/multisystem.html Agency. Protection Database. Environment 34 Envirofacts LA zip codes. West South and sites queried by 11, 2008. Envirofacts 25 GreenInfo Network, 2008. Includes parks, open space, recreation areas, green space. Information queried by South and West West and South by queried space. Information green areas, space, recreation open Includes parks, 2008. Network, 25 GreenInfo LA zip codes. lanes III bicycle Includes Class I, II and 2007. Division, Development Programs Works, Public Department of 26 LA County codes. LA zip West South and and queried by Angeles County of Los the by maintained Unit. Data are Management Report Division, Technology Information Department, Angeles Police Digest. Los 27 2005 Statistical and 77 Newton, Southwest, queried by South LA City accidents Angeles. of Los for the City South Los Angeles Health Equity Scorecard The 15.1 -9.3 -7.2 -13.8 -occupied = = = = 7.9 36.8 47.4 47.4 West LA West South LA Baseline Baseline LA County LA County . Positive indicators are those seen as assets . Positive indicators — — — — 86 Housing Units vercrowded nits wner-occupied Housing U 23.0 23.0 38.1 40.2 Baseline Baseline West LA West LA County LA County South LA Percent of O = = = = Percent of O West LA Difference West South LA Difference West LA Difference West South LA Difference For example, in South LA, 38.1% of housing units are occupied by their owners. In West LA, 40.2% of West In their owners. units are occupied by example, in South LA, 38.1% of housing For has the highest number of owner-occupied LA County overall their owners. housing units are occupied by The areas. county is performing better than the target and contrast housing units at 47.4%. Hence the LA. West LA County from South and subtracting calculation is executed by In calculating the distance of the target and contrast areas to the LA County baseline, we needed to to the LA County baseline, we areas distance of the target and contrast In calculating the calculating the did this by We . indicators in our Scorecard and negative address the mixture of positive better. is always difference so that the higher number to the community; we would like to see an increase in those areas. Negative indicators are those that hurt the those areas. Negative indicators are we would like to see an increase in to the community; of owner the housing sub-domain, the percent be reduced. For example, within community and should long-term wealth. a sign of economic investment and as positive: home ownership is housing units is seen future we hope to decrease this is seen as a negative, and in the housing units, however, percent of overcrowded number. Each indicator was first identified as a positive or negative factor first identified as a positive or negative Each indicator was Appendix 2: Scoring Methodology 2: Scoring Appendix and Resources Healthcare Environment domains: into two Scorecard are organized data for this The indicators with several six sub-domains consists of domain Each Resources. Environment Physical between difference on the percent is scored based indicator Each complete list). Appendix 1 for a (see the percent provide we also comparison, baseline. For and the LA County area (South LA) the target LA) and the LA County baseline. area (West a contrast difference between For negative indicators, the score is calculated by subtracting South LA/West LA from the LA County LA/West South subtracting the score is calculated by indicators, negative For baseline. South Los Angeles Health Equity Scorecard -60% 65.6% -19.6% -15.2% = = = = 47.4 47.4 23.0 23.0 Baseline Baseline Baseline Baseline LA County LA County LA County LA County LA County 87 ÷ ÷ ÷ ÷ Housing Units vercrowded g Units Housin wner-occupied -9.3 -7.2 15.1 -13.8 West LA West West LA West South LA South LA Difference Difference Difference Difference Percent of O of O Percent = = = = Percent Percent Percent Percent Percent Percent Percent Percent West LA West West LA West South LA South LA Difference Difference Difference Difference Each of the percent differences was averaged to obtain sub-domain scores, and then averaged once to obtain sub-domain scores, and then averaged averaged differences was of the percent Each Environment and Physical Resources again to find a total domain score for both Healthcare Environment scores are presented in the Scorecard report. These Resources. To provide equal significance to each indicator and offset data limitations, indicators were weighted in indicator equal significance to each provide To calculated. difference was percent In some cases, weighting occurred before the different ways. several the number beds overlaps supply of hospital beds, for example, the number of licensed available the With indicators and used of the two the results that reason, we averaged beds. For of licensed acute psychiatric done after the percent difference. In other cases, weighting was percent to calculate the that average of we weighted the percent sub-domain, the Healthcare Coverage Within differences were calculated. adults without of as twice that of the percent children of uninsured uninsured adults and the percent health are critical to overall and the resulting oral While we agree that dental insurance dental insurance. benefits (including mental health, vision, dental health, our priorities lie with expanding comprehensive coverage. under healthcare coverage) Each indicator was then divided by the LA County baseline to find the percent difference. percent the to find baseline LA County the by divided then was indicator Each South Los Angeles Health Equity Scorecard 1 90061 – West Compton LA/Co. West 90061 – LA 90062 – University 90220 – Compton 90221 – Compton 90222 – Compton 90262 – Lynwood 90723 – Paramount 90301 – Inglewood 90302 – Inglewood 90303 – Inglewood (Lennox) 90304 – Inglewood 90305 – Inglewood 90250 – Hawthorne 88 South LA Zip Codes, Cities and Communities 90002 – South Central LA/Co. 90002 – South Central LA 90003 – South Central LA 90007 – University LA/Co. 90008 – Crenshaw LA 90011 – University LA 90016 – Crenshaw LA 90018 – University LA 90037 – University LA/Co. 90043 – Crenshaw LA/Co. 90044 – South Central LA/Co. 90047 – South Central LA/Co. 90059 – South Central 90001 – South Central LA/Co. 90001 – South Central Appendix 3: Maps and Zip Codes of Study Areas Study of Zip Codes and 3: Maps Appendix South Los Angeles Health Equity Scorecard 1 90230 – Culver City/Ladera 90230 – Culver City/Ladera 90232 – Culver 90263 – Malibu 90265 – Malibu Palisades LA 90272 – Pacific LA Vista Venice/Mar 90291 – LA/Co. Vista Venice/Mar 90292 – del Rey LA 90293 – Playa 90401 – Santa Monica 90402 – Santa Monica 90403 – Santa Monica 90404 – Santa Monica 90405 – Santa Monica 89 West LA Zip Codes, Cities and Communities West 90024 – West L.A. LA West 90024 – 90025 – West L.A. LA West 90025 – L.A. LA West 90034 – L.A. LA West 90035 – LA Westchester 90045 – LA 90049 – Brentwood City/Ladera 90056 – Culver L.A. LA West 90064 – LA Vista Venice/Mar 90066 – L.A. LA West 90067 – Air LA 90077 – Bel Hills 90210 – Beverly Hills 90211 – Beverly Hills 90212 – Beverly ___ Angeles and and areas that include portions of the City of Los “LA” by are followed Angeles 1 Communities in the City of Los communities are identified cities and unincorporated Other incorporated “LA/Co.” by County areas are followed unincorporated Zip Code Data Book. Way name. See United by South Los Angeles Health Equity Scorecard n/a n/a n/a n/a 7.0 0.2 0.4 3.1 61.3 16.6 11.4 65.2 12.3 29.8 25.3 2005 4.8% 3,087 651,084 West LA -- n/a 6.8 0.2 0.4 3.5 6.1† 62.3 16.1 10.7 28.2 65.3 12.3 29.8 26.5 2000 2,775 621,338 $60,464† n/a n/a n/a 9.0 0.3 0.2 2.0 28.9 47.0 12.5 45.8 18.8 15.9 36.8 2005 6.0% 2,472 $48,248 10,088,274 LA County -- 8.2 9.5 0.3 0.2 2.3 32.0 31.1 44.6 12.1 36.2 45.9 18.8 16.1 37.7 2000 2,332 $42,189 9,518,361 n/a n/a n/a n/a 3.3 0.2 1.9 0.2 1.0 7.3 43.2 19.7 60.0 62.4 31.0 2005 6.4% 13,996 90 1,321,180 South LA -- n/a 1.2 5.7 3.8 0.2 2.0 0.2 35.6 43.4 19.8 61.5 57.4 35.2 2000 14.1† 11,759 $27,303† 1,241,699 1 1 2 1 1 1 1 1 1 1 1 1

1 1 1 1 1 Denotes that data are for Service Planning Areas 5 and 6. Denotes that data are for Service Planning Population density – persons per sq. – persons per density Population mi. Race – Percent White Race – Percent in civilian unemployment Percent labor force degree/ with high school Percent equivalency Population growth Population Race – Percent Latino Race – Percent Black Race – Percent American Indian Race – Percent Islander Asian/Pacific Race – Percent Other Race- Percent or more Two Race- Percent born Foreign - Percent Nativity English Home language – Percent Median household income degree with a Bachelor’s Percent 200% FPL families below Percent Total Population Total Median age † Appendix 4: Table of Community Profile Measures Profile of Community Table 4: Appendix 1 United Way of Greater Los Angeles, Zip Code Data Book Service Planning Area 5, 6 and 8. February 2003 and May 2007. 2003 and May 6 and 8. February Area 5, Data Book Service Planning Angeles, Zip Code of Greater Los Way 1 United LA. West zip codes for South and Data aggregated by R. Walter Estimates prepared by 1, 2005 Population from July Angeles County Department of Public Health. Extracted 2 Los released 5/18/2007. LA County CEO, Associates, Inc. (WRMA) for Urban Research, McDonald & __ South Los Angeles Health Equity Scorecard 5.8 4.2 7.7 2.6 0.4 7.0 4.5 4.9* 14.1 17.6 16.8 22.2 19.0 43.0 31.0 25.1 10.8 14.0 69.8 2005 198.6 151.9 127.7 West LA n/a n/a n/a n/a n/a 9.0 6.3 6.8 1.9 4.7 10.9 17.0 15.0 21.5 29.2 10.8 53.0 35.0 25.0 12.0 2000 159.0 179.0 9.2 7.3 5.0 0.6 8.8 8.1 20.9 23.3 11.3 23.4 23.4 92.8 12.0 43.4 35.5 23.3 15.9 26.5 2005 413.4 158.2 173.7 108.0 LA County n/a n/a n/a n/a n/a 6.4 4.9 6.7 24.9 16.7 20.4 14.0 19.1 12.5 18.5 57.0 41.0 24.0 24.0 2000 105.5 169.8 220.0 8.1 5.7 1.3 8.6 40.2 28.9 28.8 13.9 28.2 11.7 15.1 11.1 56.9 43.7 27.8 17.4 42.7 2005 929.1 135.4 185.7 214.4 308.2 South LA n/a n/a n/a n/a n/a 8.1 7.4 6.9 39.6 23.1 25.1 17.8 20.6 14.7 20.2 78.2 49.9 26.6 39.5 2000 151.4 206.8 274.5 91 7 6

8 5 5 5 4 3 6 2 1 1 6

8 8 8 8 8 8 8 1 1 INDICATOR Percent of live births by births by of live Percent late or received mothers who care no prenatal Percent of obese children Percent of adults diagnosed Percent with diabetes Coronary heart disease (age-adjusted per death rate 100,000 population) (age- Cancer death rate adjusted per 100,000 population) Rate of gonorrhea (per 100,000 population) Percent of low birth-weight birth-weight low of Percent births live mothers births by Rate of live per 1,000 ages 15-19 years births live per Rate of infant mortality births 1,000 live 5 years Number of children and under with elevated per 1,000 blood lead levels population child 0-17 ages children of Percent with asthma years (per Rate of chlamydia 100,000 population) (age- Diabetes death rate adjusted per 100,000 population) Incidence of AIDS (newly Incidence of diagnosed cases) per 100,000 population Breast cancer death rate Breast cancer death rate (age-adjusted per 100,000 population) Prostate cancer death rate (age-adjusted per 100,000 population) Lung cancer death rate Lung cancer death rate (age-adjusted per 100,000 population) Percent of obese adults Percent (age- Stroke death rate adjusted per 100,000 population) Liver disease death rate disease death rate Liver (age-adjusted per 100,000 population) Rate of early syphilis (per 100,000 population) Percent of adults diagnosed Percent with hypertension HEALTH DISEASE DISEASE DISEASE CANCER OBESITY DIABETES MEASURE SEXUALLY SEXUALLY SEXUALLY SEXUALLY CHILDHOOD LIVER DISEASE TRANSMITTED TRANSMITTED PRENATAL HEALTH PRENATAL CARDIOVASCULAR CARDIOVASCULAR Appendix 5: Table of Health Status Outcomes Status of Health Table 5: Appendix South Los Angeles Health Equity Scorecard 8.2 5.7 9.9 16.6 19.4 61.9 13.3 17.4 2005 West LA * n/a 7.0 8.8 13.2 12.1 19.2 10.6 2000 9.3 4.9 14.6 51.8 19.5 12.9 14.6 17.3 2005 LA County n/a 9.0 8.8 5.0 8.7 11.6 17.9 18.1 2000 9.6 11.8 10.7 11.2 45.9 14.0 59.6 17.1 2005 South LA n/a 7.2 5.5 9.4 9.3 53.5 10.1 20.0 2000 92 8 6 6 6 8 6 INDICATOR 9 6 Average length of stay at a length of stay Average hospital Motor vehicle crash death rate death rate crash Motor vehicle (age-adjusted per 100,000 population) reported of adults who Percent active being physically smoke of adults who Percent cigarettes Percent of adults diagnosed of adults diagnosed Percent with depression Percent of adults who reported of adults who Percent binge drinking in the past month Crude mortality rate from rate Crude mortality in persons 15-44 homicide population per 100,000 years Percent of adults who reported of adults who Percent and consuming 5+ fruits a day vegetables FACTORS MEASURE ACCIDENTS VIOLENCE AND VIOLENCE MENTAL ILLNESS MENTAL BEHAVIORAL RISK BEHAVIORAL ACUITY OF ILLNESS ACUITY Los Angeles County public schoolchildren, grades 5, 7, and 9. Prepared by Los Angeles County Department of Public Health, the Los Prepared by 5, 7, and 9. grades Angeles County public schoolchildren, Los Data compiled by Master Files, Angeles County from the California Death Statistical for Los 1999-2005 Linked Mortality Files acute care Annual Utilization Profile Report, 2006. Only general Hospital Office of Statewide Health Planning and Development, California Department of Health Services, Center for Health Statistics, Vital Statistics, 1999-2005. Received from the Los Angeles from the Los Statistics, 1999-2005. Received Vital Center for Health Statistics, California Department of Health Services, Angeles County Department of Public from the Los received blood lead levels and under with elevated 5 years Number of children County Angeles Los Assessment and Epidemiology, Office of Health 2005 Survey, LACHS Angeles County Health Survey, Los Data estimates from the Zip Code Population 2005. Angeles County Department of Public Health, HIV Epidemiology Program, Los Disease Transmitted 2006 Sexually Disease Program, Transmitted Health, Sexually Angeles County Department of Public Los Angeles Los Assessment and Epidemiology, Office of Health 1999 & 2005 Surveys, LACHS Angeles County Health Survey, Los

Office of Health Assessment and Epidemiology, Epidemiology Unit, from data obtained from the 1999 and 2005 California Physical Epidemiology Unit, from data obtained from the 1999 and 2005 California Physical Assessment and Epidemiology, Office of Health tables. data the in 2000 year the for used are estimates 1999 Education. of Department California respectively, Program, Testing Fitness LA are for SPA West 90304, 90305). Data for 6 plus selected zip codes (90250, 90301, 90302, 90303, Data for South LA include SPA 5. 8 Angeles County Department of Public Health. Data Los Assessment and Epidemiology, of Health Analysis Unit, Office Collection and 5. LA are for SPA West 90305). Data for 6 plus selected zip codes (90250, 90301, 90302, 90303, 90304, for South LA include SPA 9 LA Zip codes were included. West hospitals located in South LA zip codes and 1 selected plus 6 SPA include LA South for Data Programs. Health Adolescent and Child Maternal, Health, Public of Department County 5. LA are for SPA West 90304, 90305). Data for zip codes (90250, 90301, 90302, 90303, 2 and under from 2005 Los 5 years estimates for children 2005. Population Program, Prevention Health, Childhood Lead Poisoning Assessment and Epidemiology. Department of Public Health, Office of Health Angeles County Los Angeles County Health Survey, of the representative 0-17 years, sample of 6,032 parents/guardians of children a random by Estimates are based on self-reported data 6 plus selected zip codes (90250, 90301, 90302, 90303, 90304, South LA include SPA Data for Angeles County. population in Los 5. LA are for SPA West 90305). Data for 3 sample of 6,032 parents/guardians of children random a are based on self-reported data by Department of Public Health. Estimates 6 plus selected zip codes (90250, Data for South LA include SPA Angeles County. of the population in Los representative 0-17 years, 5. LA are for SPA West Data for 90301, 90302, 90303, 90304, 90305). 4 zip codes (90250, 90301, 90302, 6 plus selected Angeles, 2007. Data for South LA include SPA of Greater Los Way Book, United 5. LA are for SPA West 90303, 90304, 90305). Data for 5 5 and 6. SPA LA are for West Areas. Data for South and 2: Service Planning Vol. Morbidity Report, 6 Angeles sample of 8,354 Los a random data by County Department of Public Health. 1999 estimates are based on self-reported a random 2005 estimates are based on self-reported data by Angeles County. of the population in Los County adults, representative 1999 estimates are used for the Angeles County. of the population in Los representative Angeles County adults, sample of 8,648 Los 6 plus selected zip codes (90250, 90301, 90302, 90303, 90304, 90305). 2000 in the data tables. Data for South LA include SPA year 5. LA are for SPA West Data for 7 __ *Data is statistically unstable. 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