For second consecutive year, Sonoma County’s overall health ranking declines

For the second year in a row, Sonoma County’s rank in a key national measure of community health and wellness has declined when compared with other California counties.

According to the 2019 County Health Rankings compiled by the Robert Wood Johnson Foundation and the University of Wisconsin’s Population Health Institute, Sonoma County dropped to No. 8 in overall health outcomes of its residents among the state’s ?58 counties, a slip from No. 7 in 2018 and a high of No. 5 in 2017.

The annual health ranking includes a variety of issues, such as premature death, low birth weight, education attainment, income inequality, smoking, obesity, insurance coverage and violent crime, in an attempt to show how health is influenced by where people live, learn, work and play.

This year’s nationwide health rankings report zeroed in on the burden of high housing costs and the effect on people’s health.

The report found that more than 11 percent of households in the United States spend more than half of their monthly income on housing costs.

In Sonoma County, 24 percent of county residents experience at least one of four problems with housing: overcrowding; high housing costs; inadequate kitchen and plumbing.

Public health official say adverse housing conditions have a complex array of effects on the health and welfare of local residents.

Locally, there’s a longstanding housing affordability crunch that was exacerbated by the 2017 wildfires.

Political and business leaders continue collaborating on a variety of potential solutions to the widespread problem.

The two-year decline in the county’s health ranking, after years of steady improvement, runs counter to a stated goal local public officials: making Sonoma County the healthiest in the state by 2020.

Sonoma County Supervisor Shirlee Zane said the area economy and health care landscape continue to suffer from the ongoing recovery from the 2017 fires and recent Russian River flooding.

“We definitely have work to do,” Zane said. “With the fires and lack of housing and the recent flooding, we’ve definitely declined in our rankings. We have to work extra hard to change that trajectory.”

Zane said the county’s ranking in the individual category called “physical environment,” which includes air pollution, drinking water violations and severe housing problems, dropped from No. 27 last year to No. 39, compared with other counties statewide.

In 2016, the county ranked No. 19 in that category.

Lisa Ward, chief medical officer of Santa Rosa Community Health, the largest system of health centers in Sonoma County, said people undoubtedly will prioritize housing above all else, even their own health.

“People spend so much of disposable income on housing,” she said. “They prioritize that over medications or healthier food, or they decline to come to that extra medical visit.”

Ward said working families or individuals with modest incomes are particularly vulnerable to high housing costs. She said those who can’t afford a health insurance plan with comprehensive coverage but make too much money to qualify for Medi-Cal, the state’s version of the federal Medicaid program, often face crippling medical costs.

Increasingly, they’re buying high-deductible health insurance plans with high out-of-pocket expenses, copayments and prescription medicine costs. Zane said the nexus between poor health and the lack of affordable housing was undeniable.

“It affects your anxiety when you’re living from paycheck to paycheck,” she said. “There’s no doubt that if you’re spending 60 percent of your paycheck on housing and only ?40 percent for food, transportation, entertainment and health, maybe you’re not using all of your prescriptions like you should be.”

Zane said she often hears of seniors who are rationing their prescriptions, in some cases taking half of what they should be taking.

The county supervisor said one particularly disheartening statistic in the new report was the decline locally in mammography screenings, which went from 64 percent in 2018 to 40 percent in 2019.

“What it shows you is that we’re heading in the wrong direction,” she said, adding that after the Affordable Care Act was implemented such preventative screenings became free. “We know that screenings save lives. There has been degradation of our health care benefits.”

Despite the county’s declining health ranking, there was some good news.

The report found that the teen birthrate fell from 15 to 13 for every 1,000 teens.

Counties often move up or down the annual report relative to how other counties perform statewide. The real value in the ranking is to give county health officials and leaders the health measures needed to plan broad-based public health strategies, Zane said.