Healthcare

From San Diego Public Policy and Fiscal History

Population Health[edit | edit source]

The Population Health of San Diego County has been reported to score a 78 out of 100 on the scale of this category. It is defined on the understanding of what exactly the Population Health category measures. That being the healthy behaviors, health conditions, mental health and resulting health outcomes within the different communities/population residing in San Diego County.[1] For more detail on understanding what population health is and what it measures the National Library of Medicine does a deeper dive into this. This states that it is the health outcomes of a group of individuals, including the distribution of outcomes within the group that includes health outcomes, patterns if health determinants, and policies and interventions that may link the two aforementioned.[2]


The population health report of San Diego County reported some key points that showed the county’s approach to overcome the national average of some issues such as an 11% smoking rate versus a national average of 20%, life expectancy of 82.2 years versus the National Median of 77.5 years, and even population without Health Insurance at a rate of 8.9% versus the National Rate of 11%. Despite these more standout points for San Diego County’s overall score, looking into the details of what gave the score we see that some categories have lower results compared to others which leads to the lowering of a potential higher score.

Looking into some of the details listed can help improve the well being of San Diegans and improve policy making in regards to health related issues.

Ranking of Categories[edit | edit source]

This is broken down into 5 separate and general categories (as well as other background details), each category has different subjects/metrics that compose the general category it is listed under. The metrics scored together produce the final score of the category it is under. While we wish to always improve on all accounts of health, we should look into the first 2 categories as they have the lowest ranked scores.

This is a chart of the Metrics for the Access to Care category that measures the level on a County, State, and National level as well as Peer Group.[1]
  • Access To Care [Score: 55/100]:  Defined as the ability to have access and obtain healthcare services such as diagnosis, treatment, prevention, and management of diseases, illness, disorders, and other health issues. The key point that truly defines accessibility of healthcare, is to be affordable and convenient. It is known that many people don’t have access to decent healthcare.[3] The Metrics used for this category are Hospital Bed Availability, Population With No Health Insurance, and Primary Care Doctor Availability.
This is a chart of the Metrics for the Health Behavior category that measures the level on a County, State, and National level as well as Peer Group.[1]
  • Health Behaviors [Score: 64/100]: Defined as actions people take that affect their health directly or indirectly. This includes actions that lead to improved health, such as healthy eating and physically active habits. This also includes actions that increase a person’s risk of disease, such as smoking, excessive drinking, and risky sexual behavior.[4] The listed metrics that measure this category are Adult Flu Vaccination Rate, Adults With No Leisure-Time Physical Activity, Adults With Recent Preventive Care Visit, and Smoking Rate.
  • Health Conditions [Score: 77/100]: This is defined as the illnesses, injuries and impairments that affect our ability to function and live life. These may be related to but not limited to food/nutrition from food allergies and intolerances, dental and gut health, and non-communicable diseases (diabetes, cancers, etc.)[5] The Metrics used for this category are Cancer Incident Rate, Heart Disease Prevalence, and Preventable Hospital Admissions Among Medicare Beneficiaries.
  • Health Outcomes [Score: 79/100]: This is defined as events occurring as a result of health related intervention. This may vary and measured clinically (physical examination, imaging, laboratory testing such as blood sample tests), self-reported, or even observed (such as gait or movement fluctuations seen by a healthcare provider or caregiver).[6] The Metrics used for this category are Adults in Poor or Fair General Health, Babies Born With Low Birth Weight, Life Expectancy, and Teen Birth Rate.
  • Mental Health [Score: 79/100]: This is defined as emotional, psychological, and social well-being. This affects how one will think, feel, and act. It also helps determine how we handle stress, connect with other, and make overall healthy choices. This is something that can affect an individual at any point of their life from infancy to adolescence to adulthood.[7] The Metrics used to measure this category are Adults With Frequent Mental Distress, Deaths Through Despair, and Depression Among Medicare Beneficiaries (Facilities that perform services for those with Mental Health disorders).

Healthcare Districts[edit | edit source]

A Healthcare District is a special district developed to create and operate hospitals and health care facilities/services for all types of communities. Healthcare Districts are local forms of government, directly accountable to their communities. This close connection to their voters and community ensures openness and transparency. Residents not only vote to create Healthcare Districts, they also elect the public boards that oversee the spending of their local tax dollars in pursuit of improved community health.[8] Typically, these districts are governed by a locally elected five-member board of directors, California currently has over 75 healthcare districts throughout the state. Within San Diego County there are 4 different healthcare districts:

  • Tri-City Healthcare District: North San Diego County, in the coastal community of Oceanside.[9]
  • Palomar Health District: Two locations, Poway Valley and Escondido.[10]
  • Grossmont Healthcare District: Boundaries are from La Mesa to the mountains and from the border to Santee.[11]
  • Fallbrook Regional Health District: Located in Fallbrook the district serves residents of the Bonsall, Rainbow and De Luz areas of northern San Diego County.[12]

Contemporary Political Issues[edit | edit source]

San Diego County has been considered to be in a good position in terms of its healthcare systems and policies compared to many other parts of the country and even the rest of California. Despite this, there are still issues and concerns that people have voiced to their local governments for them to approach and create solutions for. While there have been some obstacles to the goal of improvement, the County of San Diego Health, Department of Public Health Services (PHS), and Human Services Agency (HHSA) have developed the Public Health Services Strategic Plan FY 2021-22 and 2022-23[13].

Obstacles and Issues Present of Healthcare Improvement[edit | edit source]

Data Breach of Healthcare Facilities[edit | edit source]

News coming from Sharp Healthcare (02/06/2023) notified their patients that about 62,777 of their total patient database had been compromised in a hacking attack on the systems of San Diego's largest healthcare provider. [14] While this breach didn't affect any serious information such as bank accounts, credit card information, Social Security, or health records/insurance information that was compromised was different from one another. The information stolen was limited to patient names, Sharp identification numbers, invoice numbers, payment amounts and the names of the Sharp entities receiving payment.[14] This attack was thankfully on the surface level of Sharp's website and not the web portal for its patients. There was a process that went through each affected patient's billing to see if anyone was charged during this attack.

While a major blow was avoided, this brings back recent recollection of more damaging hacking attack on UCSD Medical and Scripps Health. Back in 2020 and 2021 each provider was hit with attacks that compromised personal information of many patients such as names and addresses. This brought class-action lawsuits to UCSD and Scripps due to these breaches.

Planned Initiation of Public Health Improvement[edit | edit source]

Public Health Services Strategic Plan FY 2021-22 and 2022-23[edit | edit source]

The objective of this plan is to create improvements and overall update the previous FY 2019-21 (3-Year) plan. While it was initially used to approach and deal with the impact and spread of COVID-19 on the residents of San Diego County, the plan will also advance Live Well San Diego. This is another regionally based plan built on better health and safe living that aligns with the health priorities at a state and federal level (which has included the federal Health People 2020 documentation and the Let's Get Healthy California Plan). This action to move past a sole focus on COVID-19 related issues comes from San Diego's achievement of the highest vaccination rate in Southern California and is among the highest of counties in California as a whole through the T3 strategy (Test, Trace, and Treat). Thanks to the County wide strategy that implemented the entire engagement of county enterprises and many partners of similar strategies. A key aspect of this plan is to show the importance of a strong public health infrastructure that we saw effective during the pandemic and implement it again here. Greater development of stronger communication and collaboration with partners with similar goals that can continue to communicate with local officials across the jurisdictions.[13]


The Strategic Plan has created individual plans for each of the seven branches—six programmatic and one administrative. To read more in depth about the details of this plan, you can check the documentation here. The structure for each Branch plan begins by identifying the units and programs within the Branch. Goals are identified, followed by strategies and objectives to achieve the goals, and then metrics by which progress is tracked. A simple outline to understand this structure is as follows:[13]

  • Branch: Name of the branch within PHS.
  • Unit: Refers to an organizational unit within the Branch that includes one or several programs.
  • Program: Set of related activities, created, sponsored and/ or funded by federal, State and local resources.
  • Goal: Aspiration or broad statement of what we want to achieve in the longer term (three to five years).
  • Strategy: Approach or how we will go about achieving the goal which should be based on, or informed by, the research, evidence or best practice.
  • Objective: The change or improvement we seek or hope to accomplish in the shorter term (one to three years).
  • Metric: How progress is to be measured (begins with numerical target provided if there is one).
Branches Listed[edit | edit source]
  • Administration of Public Health Service
  • California Children’s Services (CCS)
  • Epidemiology and Immunization Services (EISB)
  • HIV, STD, and Hepatitis (HSHB)
  • Maternal, Child, and Family Health Services (MCFHS)
  • Public Health Preparedness and Response (PHPR)
  • Tuberculosis Control and Refugee Health (TBC-RH)
Organization[edit | edit source]

For certain branch plans, the goals are organized by program while others have goals that span across every program. For example CCS, HSHB, PHPR, and TB utilize similar plans using cross-cutting goals that reflect major areas of effort. Other branches like EISB have organized its own goals by individual programs, and MCFHS uses a combination of goals by program with the exception of its Chronic Disease and Health Equity Unit, in which one goal captures all programs related to creating an environment and policy changes to advance health and health equity. PHS Admin has organized itself to meet national public health accreditation standards and has organized its goals by the Baldrige Performance Excellence Framework. These goals are to be aligned to local, state, and national initiatives, which shows the importance of working together and leveraging limited resources. The goals for the branch are related to and aligned to various national and State Initiatives such as County's Live Well San Diego vision, Let’s Get Healthy California, the National Prevention Strategy, The 10 Essential Public Health Services and Healthy People 2020.

General Public Health Services[edit | edit source]

There are previously established public health services in San Diego County that are dedicated to community wellness and health protection. These services work to prevent epidemics and the spread of disease, as well as protection against hazardous environments, prevent injuries, and promote and encourage general healthy behaviors. This also leads into responding to disasters and assisting communities in need of recovery aid, and ensuring access to quality health services across the County. There is provided information of the administration unit and the different documentation it has available for public view. This includes Frameworks, Plans, Reports, Brochures, Health System Assessments, Research, Organization Charts, and also includes an Archive of older material; follow the link here.[15] This also provides information of all the established service areas listed below.

Established Public Health Service Areas[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 https://www.usnews.com/news/healthiest-communities/california/san-diego-county
  2. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447747/#:~:text=These%20determinants%20include%20medical%20care,%2C%20genetics%2C%20and%20individual%20behavior.
  3. ↑ https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/health-care-access#:~:text=Health%20care%20access%20is%20the,have%20access%20to%20adequate%20healthcare.
  4. ↑ https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-factors/health-behaviors#:~:text=Health%20behaviors%20are%20actions%20individuals,intake%2C%20and%20risky%20sexual%20behavior.
  5. ↑ https://www.who.int/data/gho/data/major-themes/health-and-well-being#:~:text=The%20WHO%20constitution%20states%3A%20%22Health,of%20mental%20disorders%20or%20disabilities.
  6. ↑ https://www.sciencedirect.com/topics/medicine-and-dentistry/health-outcomes#:~:text=Health%20outcomes%20are%20defined%20as,a%20healthcare%20provider%20or%20caregiver).
  7. ↑ https://www.cdc.gov/mentalhealth/learn/index.htm#:~:text=What%20is%20mental%20health%3F,1
  8. ↑ https://www.achd.org/achd-message
  9. ↑ https://www.tricitymed.org/
  10. ↑ https://www.palomarhealth.org/
  11. ↑ https://www.grossmonthealthcare.org/
  12. ↑ https://www.fallbrookhealth.org/
  13. ↑ 13.0 13.1 13.2 https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/documents/PHS%20Strat%20Plan%202021-22%20and%2022-23.pdf
  14. ↑ 14.0 14.1 https://www.sandiegouniontribune.com/news/health/story/2023-02-06/sharp-notified-x-patients-of-data-breach
  15. ↑ https://www.sandiegocounty.gov/hhsa/programs/phs/
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