South Los Angeles Health Equity Scorecard 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 South Los Executive Summary 3 Introduction 8 Study Design 10 Community Profile 14 Table of Health Status 17 Contents Scorecard Domain 1: Healthcare Environment Resources 21 . Healthcare Facilities . Healthcare Workforce . Healthcare Financing . Healthcare Coverage . Primary & Preventive Care Access . Primary & Preventive Care Utilization Scorecard Domain 2: Physical Environment Resources 51 . Nutrition . Physical Activity . Public Safety . Housing . Schools . Air & Land Quality Next Steps/Conclusion 75 Acknowledgments 77 Appendices 78 Appendix 1: Data Sources, Notes and Limitations Appendix 2: Scoring Methodology Appendix 3: Maps and Zip Codes of Study Areas Appendix 4: Table of Community Profile Measures Appendix 5: Table of Health Status Outcomes Appendix 6: Bibliography 1 South Los Angeles Health Equity Scorecard 2 South Los Angeles Health Equity Scorecard South Los EXECUTIVE SUMMARY The South Los Angeles Health Equity Scorecard is the culmination of a year-long study conducted by CommunityThe area known Health as SouthCouncils Los inAngeles collaboration has become with thean iconCoalition for the for plight Health and and struggle Justice. of Thethe innerScorecard city. was developedHome to more to: than one million people, South Los Angeles encapsulates the health consequences resulting1. Assess from the disturbingextent to which inequality the inequities in the distribution in the resource of power, environment income, goods, determine and andservices shape in theLos Angeleshealth County. of theOptions community and opportunities for healthy choices are constrained by fewer and often inferior basic2. healthcareDetermine and the physical degree toresources. which these From inequities hospitals, mirror clinics, disparities and preventive in health care services to healthy foods,3. placesIdentify to incrementalbe physically steps active, to achieve safe housing, health and equity. adequate schools, South LA residents are forced to live and raise their families with less. The social and economic impact is a population with the highest overallThe study rates compiled, of disease calculated, and premature and synthesized deaths in the 50 countysocioeconomic from such and preventable environmental conditions factors as that coronary heartinfluence disease, health homicide, behaviors diabetes, and outcomes. lung cancer, These and factors motor are vehicle categorized crashes. and More discussed than any as otherfollows: region of the county, South LA is disproportionately disadvantaged and harmed by inequities in the healthcare and physical resource environments. SOUTH LA WEST LA ToHealthcare assess the Environmentextent to which Resources these inequities determine and shape the health of the South LA community, Community Health Councils collaborated with the Coalition for Health and Justice in a year-long study examiningHealthcare the healthcare Facilities and physical environment resources-28% in the area. What59% emerges is a Health EquityHealthcare Scorecard Workforce of the health status of South LA that takes-76% into account the 182%multiple public and private policies that ultimately influence the health of area residents through investments—or their lack—in the economic,Healthcare education, Financing housing, and healthcare systems-65% that serve the community.22% The Scorecard also identifiesHealthcare incremental Coverage steps by which South LA can be-30% helped to achieve health38% equity. Primary & Preventative Care Access -34% 27% THEPrimary Study & Preventative Care Utilization -24% 103% Physical Environment Resources The study examined 50 socioeconomic and environmental factors that influence health behaviors and outcomes.Nutrition Scores were calculated for the 100-square-mile-76% area of South LA,104% and for comparison, the area ofPhysical West LA, Activity where Options there are more favorable health-55% outcomes. Both areas24% were evaluated against our baseline: the whole of Los Angeles County. The resources were grouped into broad categories of capacity and accessPublic (seeSafety Chart), then each category was scored -17%in comparison to the county7% as a whole. Housing -24% 103% Schools -43% 42% THE FINDINGS Air & Land 5% 39% The following chart summarizes the status of South LA and West LA for each broad category of healthcare or physical environment resources relative to the county as a whole. Thus, for the overall healthcare Southenvironment, LA, an areaSouth encompassing LA has 43 percent nearly fewer 100 squareresources miles than and LA more County, than and one West million LA people,has 72 percent represents more someresources of the than greatest LA County, assets forand a most total troublingdisparity ofhealth 115 andpercentage socio-economic points between challenges the two within communities. Los Angeles andSimilarly, across South the country. LA also The has data43 percent were used fewer to physicalcompare environment and contrast resourcesthe access, than capacity LA County, and quality while West ofLA community, has 42 percent health more and resources economic of resourcesthis type than in South LA County, Los Angeles for an against overall both disparity the overall of 85 percentageresource environmentpoints between of LAthe Countytwo communities. and the contrast area of West Los Angeles with more favorable health outcomes. The data document a disproportionate disparity in access to care, resources, and infrastructure in South LA in comparison to other regions of Los Angeles County. The study shows unequivocally that South LA does not share equally in the overall regional resources, from inadequate access to healthcare to a lack of healthy food options. As a result, the overall population of South LA residents is less healthy and ranks at the top in LA County for rate of preventable disease and premature deaths. 3 South Los Angeles Health Equity Scorecard South Los The data in and of Disparitiesthemselves do in notHealthcare add up to and a groundbreaking Physical Environment discovery. Resources: They represent a first attempt to link a comprehensive overview of the community’s health with immediate policy opportunities and tools to eliminate inequitiesSouth in the LAresource and West environment LA Compared and ultimately to LA County banish disparities in health. What emerges from the Scorecard results is the degree to which disparities exist. Through the Scorecard, CATEgORY SOUTH LA WEST LA Disparity we seek to provide a framework and galvanize support across public and private sectors in Los Angeles (Percentage points) County for policy change and community reinvestment for health equity.. Healthcare Environment Resources -43% +72% 115 Healthcare Facilities -28% 59% 87 KEYHealthcare FINDIN gWorkforceS -76% 182% 258 1. TheHealthcare Scorecard Financing shows significant inequities in the-65% distribution, capacity22% and quality of resources87 for South LA in comparison to Los Angeles County in all areas. West LA, on the other hand, scored far Healthcare Coverage -30% 38% 68 better than LA County, demonstrating the potential opportunities and benefits but also widening the equityPrimary gap & for Preventive South LA. Care Access -34% 27% 61 2. ThePrimary overall & HealthcarePreventive CareEnvironment Utilization Resources has-24% a disparity of103% 115 percentage points127 between South PhysicalLA (43% Environment fewer resources Resources than LA County overall)-43% and West LA (72%+42% more resources than85 LA County overall). Nutrition -106% 101% 207 3. ThePhysical combined Activity Physical Options Environment Resources -55%has a disparity of 24%85 percentage points between79 South LA and West LA. South LA has 43% fewer resources than LA County overall, while West LA has 42% morePublic resources Safety than LA County overall. -17% 7% 24 Housing -40% 16% 56 4. Within each domain, several indicators revealed chasms between South LA and West LA scores: Schools -43% 63% 106 Air. & LandIn South LA, there are approximately 11 pediatricians5% for 39%every 100,000 children.34 In West LA, there are 193 pediatricians for every 100,000 children. LA County overall has 57 pediatricians for every 100,000 children. Disparities for specific groupings of resources are, in some instances, even greater. For example, the difference. inUninsured the number women of healthcare in South workersLA are less between likely Southto receive LA and preventive West LA screening is 258 percentage services. pointsOnly (due in large34 part mammograms to the closing per of 1,000 multiple uninsured facilities women in South occurred LA since through 2000). the The South difference LA PPP in clinics, the availability