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Social factors affecting health

Health begins where people live, learn, work, and play. Characteristics of a community — such as access or lack of access to affordable, healthy foods and safe spaces to walk — can either support health or make it harder to be healthy. 

Why look at social factors affecting health?

Research has found that the conditions in which we live and work have an enormous impact on our health. Findings indicate that only about 20% of our health happens in a doctor’s office — the remaining 80% happens, every day, in places like our homes, our schools, and our communities.

80% 
of our health has to do with where we live, learn, work and play.
County Health Rankings_What Matters for Health 2.png
INCOME & pOVERTY

Income often provides access to resources that promote good health—like good schools, health care, healthy food, and safe neighborhoods. Conversely, having a higher income can also help individuals avoid health hazards like air pollution and subpar housing conditions. As a result, low-income groups in the U.S. are more vulnerable to a variety of health issues compared to their higher-income counterparts.

In SLO County, life expectancy varies by as much as 14 years across the county — a difference the California Endowment attributes to the effects of poverty.

$82,514
Median household income in SLO County
$84,097
Median household income in CA
$69,021
Median household income in the U.S.
13.1%
Persons in poverty in SLO County
12.3% 
Persons in poverty in CA
11.6% 
Persons in poverty in the U.S.

Source: American Community Survey QuickFacts.

The Census Bureau defines poverty using a set of money income thresholds that vary by family size and composition to determine who is in poverty. The official poverty thresholds do not vary geographically, but they are updated for inflation using the Consumer Price Index. See more about how poverty is defined.

Perception of health By Income

Of SLO County residents surveyed in 2023, 60% of respondents with a household income of $130K or more answered 'very good' or 'excellent' to 'How would you rate your (physical) health?' compared to just 25% of those making household incomes less than $50K.

25%

of SLO County respondents making less than $50K in household income answered 'very good' or 'excellent' to 'How would you rate your (physical) health?'
60% 

 
of SLO County respondents making more than $130K in household income answered 'very good' or 'excellent' to 'How would you rate your (physical) health?'

“What makes it hard to be healthy here?  The price of living on the Central Coast. Having to work multiple jobs just to make ends meet. Not having any time with kids, family or for yourself.”

- Community Health Survey respondent

Other Measures of Poverty

Since federal poverty estimates don't take into account regional differences in costs or the income needed for housing, child care, health care, transportation, food, and taxes, other measures are often used to understand those living below the poverty line in the state of California.

The United Way uses the Real Cost Measure, which better incorporates these additional costs.  Their calculation estimates that 31% of SLO County households actually fall below the threshold needed to meet basic needs — more than double the traditional federal poverty estimate.

31%

of households in SLO County struggle to meet their basic needs

Source: The Real Cost Measure in California 2023. United Ways of California. 

Other agencies use the Self-Sufficiency Standard to understand the income needed for families to meet their basic needs without public or private assistance. Their standard estimates that an annual income of $82,251 is needed to meet basic needs for a household with 1 adult, 1 preschooler, and 1 school-aged child, with estimates varying based on age and family composition.

$82,251

estimated annual income needed in SLO County for a household with 1 adult, 1 preschooler, and 1 school-aged child
Self-Sufficiency Standard Calculator

Both models apply a basic needs budget approach, share many similarities, yield comparable results and better assesses changing costs over time compared to federal poverty estimates.

have funds that could cover expenses for 3 months if needed

Of SLO County residents surveyed in 2023, 67% of respondents answered 'yes' to 'Do you have emergency funds that would cover your expenses for 3 months if needed?' Several groups were less likely to have emergency funds, including those under the age of 65 (57%), Spanish-speakers (45%), and those making less than $50K in household income (38%).

67%

of SLO County respondents answered 'yes' to 'Do you have emergency funds that would cover your expenses for 3 months if needed?'
Source: 2023 SLO County Community Health Survey (n=3,123). For more data like this, visit the Community Health Survey Summary​.

“Affordable housing for the working middle class is a huge challenge. We work multiple jobs and make too much for assistance but not enough to afford rent.”

- Community Health Survey respondent

pOVERTY ACROSS THE COUNTY

Data on economically disadvantaged students gives a sense of differences across the county in households struggling to meet their basic needs. Approximately one in two students in SLO County are economically disadvantaged, meaning their family income falls below 185% of the federal poverty guideline (e.g., $51,338 for a family of four in 2022-23). That number, however, varies widely across the county.

50.2%

of SLO County students are economically disadvantaged

Economically disadvantaged Students
% eligible for free or reduced-Price Meals
FRPM Legend.PNG
Source: CA Dept of Education. Free or Reduced-Price Meal (Student Poverty) Data. 2021-2022.

'Economically disadvantaged' is defined as those eligible for free or reduced price meals.

These are students whose family income falls below 185% of the federal poverty guideline (e.g., $51,338 for a family of four in 2022-23).
Housing

SLO County has one of the most expensive housing markets in the U.S.—at a time when home prices are already at historic highs. According to Harvard's Joint Center for Housing Studies, the national home price-to-income ratio shows the median sales prices in SLO County as 5.3 times the median household income. By comparison, price-to-income ratios averaged 3.9 in the 2010s, 4.1 in the 2000s, and just 3.1 in the 1980s.

Among 234 communities in the U.S., San Luis Obispo County ranked as the 7th least affordable area for housing in the first quarter of 2023, just behind the San Francisco-San Mateo-Redwood City metro area.

 

This financial burden can strain families' budgets and also prevent residents from meeting other basic needs such as nutrition, child care, and health care.

7th

least affordable metro area out of 234 metro areas in the U.S.
$783,000

Median home price in SLO County
$365,000

Median home price in the U.S.
9%

of homes are affordable for a median income family in SLO County
46% 

of homes are affordable for a median income family in the U.S.
Percent of Homes affordable for a median income family
Source: National Association of Home Builders.The NAHB/Wells Fargo Housing Opportunity Index: Complete History by Metropolitan area. 2023 1st Quarter report. Accessed July 2023.
Least Affordable Metro Areas in U.S.

"I live in one of the cheapest studios in SLO, but it is still so expensive (as is all housing here) that I have a lot of stress about money and about where I'd go if my rent got raised."

- SLO County resident

Could not pay rent or mortgage in the past 12 months

Of SLO County residents surveyed in 2023, 18% of respondents answered 'yes' to 'During the past 12 months, was there a time when you were not able to pay your mortgage or rent?' Several groups were more likely to struggle with rent or mortgage, including those under the age of 65 (27%), Spanish-speakers (38%), and those making less than $50K in household income (32%).

18%

of SLO County respondents answered 'yes' to 'During the past 12 months, was there a time when you were not able to pay your mortgage or rent?'
Source: 2023 SLO County Community Health Survey (n=3,128). For more data like this, visit the Community Health Survey Summary​.
Subsidized hOUSING

With such a high cost of housing, subsidized housing units are key to prevent people from slipping into homelessness. SLO County trails CA counties in the number of subsidized housing units, with just 93.4 housing units per 10,000 people. By contrast, top performing counties in CA provided as many as 377.4 units per 10,000 people.

Number of Subsidized Housing Units per 10,000 People by County, 2022 

Source: California's Master Plan for Aging. MPA_Goal 1_Strategy A-More Housing Options.  Accessed July 2023.  See full county list.

Image by Kenny Eliason

“When we think of people who can’t afford housing, we often think of people receiving public assistance and those working at minimum wage or entry level jobs. Yet, in this county, some of the people who cannot afford housing includes elementary school teachers, bank tellers, and many government workers. It includes most of the people working in our largely agriculture and tourist-driven economy.”

Grand Jury Report, June 2019

Homelessness

People experiencing homelessness have higher rates of illness and die on average 12 years sooner than the general U.S. population. In a state-funded study to better understand CA's homelessness crisis, researchers at the University of California found that at least 90% of adults who are experiencing homelessness in the state became homeless while living in California due primarily to the dire lack of affordable housing.

Study authors also noted that, while some people reported heightened mental health and substance use problems before becoming homeless, the trauma of being on the streets can lead to or amplify those conditions, including drug use and depression. 72% reported experiencing physical violence in their lifetime and 24% said they had experienced sexual violence. The homeless population is also aging. 47% of all adults surveyed in the homeless study were age 50 or older. 

The statewide study showed more than half of the homeless adults surveyed relied on the emergency room for health care and nearly a quarter said they couldn’t access the care they needed. A majority who said they were experiencing mental health problems either weren’t being treated or got care through emergency rooms.

 

SLO County's 2022 homeless point-in-time count showed similar findings. The count identified 1,448 homeless individuals, with 92% of individuals noting that they were residing in SLO County when they became homeless. Four out of five (80%) persons experiencing homelessness in SLO County were unsheltered, meaning living in places not intended for human habitation. 

 

When asked what would have prevented them from becoming homeless, the most common response was “benefits/income,” reported by 38% of survey respondents. This was followed by 31% who reported needing rental assistance.

When asked about their most common health conditions, the most common responses were post-traumatic stress disorder (46%); a psychiatric or emotional condition (43%); drug or alcohol abuse (35%); and chronic health problems (31%).

SELF REPORTED HEALTH CONDITIONS BY HOMELESS RESPONDENTS IN slo cOUNTY (%)
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PIT Count Image 2.PNG
Responses FOR Ways that Homelessness could have been prevented (%)

“Finding affordable housing when you are elderly and living on social security. I was lucky to find a room to rent through a friend, but the thought of having to move scares me to death. There's nothing worse than finding yourself being elderly, disabled, living at or below the poverty line, and finding yourself homeless."

- Community Health Survey respondent

Image by Dimi Katsavaris

Some good news out of SLO County's 2022 homeless point-in-time count: the number of homeless veterans plunged.  The count, which stood at 144 in 2019 fell to just 16 in 2022 — a feat that represented a major success in outreach and recovery efforts.  See how they did it.

Access to hEALTHY Food

Access to healthy foods (e.g., fruits, vegetables, and other nutrient-dense foods) also impact health. Neighborhoods with accessible and healthy food options see lower rates of chronic diseases like obesity, diabetes, heart disease, and stroke. When healthy food is too expensive or when healthy options are inconvenient, people turn to less healthy options that are typically within reach.

23,710  (8.4%)

People experience food insecurity
in SLO
County
Have convenient, affordable opportunities to get healthy food in my neighborhood (e.g. farmers markets, grocery stores) (% who agree)
Source: 2023 SLO County Community Health Survey. (n=2,573). For more graphs like this, visit the Community Health Survey Summary​.
uNHEALTHY FOOD OPTIONS

Access to less healthy food options, like processed foods or those high in sugar or saturated fat, also impact a person's opportunity to be healthy.  Fast food options tend to be more concentrated in low-income neighborhoods, adding to the disease burden already experienced by people living nearby.

 

Lower income neighborhoods in SLO County were more likely to see students identified as overweight or obese in the California Physical Fitness Test.  

“Prices for fresh produce and foods are much higher than less healthy meals, when people have to choose between healthy foods and feeding their whole family it's not a true choice.”

- Community Health Survey respondent

SAFE neighborhoods to walk, bike and play

Safe neighborhoods that allow people to walk or bike to work, school, parks, and errands allow physical activity to be incorporated into everyday life. This design also increases community connection, reduces social isolation and enhances the quality of life for residents.

Have safe, convenient opportunities to exercise/recreate in my neighborhood (e.g. parks, walking trails) (% who agree)
Source: 2023 SLO County Community Health Survey. (n=2,574). For more graphs like this, visit the Community Health Survey Summary​.

“Many streets are very dark in the evening or nighttime, limiting outdoor activity to daylight hours. This makes it very hard to get outside because I work full time and leave at dawn, come home at dusk for most of the year.”

- Community Health Survey respondent

iStock-1266364224.jpg

The Healthy Communities Workgroup created a checklist that outlines the top features that health-promoting neighborhoods have. The tool can be used by planners and developers when thinking about community design. See their recipe for success.

“I have the ability to walk to work along the walking path that's parallel to the train tracks, which has made a tremendous impact on my mental health each day. I wish this for everyone.”

- Community Health Survey respondent

VIOLENCE

Violence affects people in all stages of life. Violence includes physical acts such as rape, robbery, assault and homicide, as well as emotional and psychological violence that can occur within homes, schools and neighborhoods. Violence can cause chronic stress and worry, lead to social isolation, and impact overall well-being.

Children are particularly vulnerable. Witnessing and experiencing violence disrupts early brain development and causes longer term behavioral, physical, and emotional problems.

hate crimes reported by bias type (%)
2002-2020

Many of the hate crimes reported in SLO County were primarily motivated by race/ethnicity, sexual orientation or religion. 

Source: CA Department of Justice; U.S. Census Bureau. California Immigrant Data Portal.

Bullying and violence at school

Nationally, bullying in school and online has also received significant attention, with numerous students reporting harassment or bullying on school property. 

 

In 2019-2021, 26% of 11th grade students in SLO County reported some form of harassment at school.

 

Of students surveyed, both female students and LGBTQ+ students were more likely to report experiencing some form of bullying over the past 12 months, with students reporting being made fun of, insulted, or called names at nearly twice the rate of non-LGBT students.

Reported Any harassment at school, 11th Graders (%)
26%

of 11th grade students in SLO County reported some form of bullying in the past year
by gender
by sexual orientation
Source: California Healthy Kids Survey (CHKS). California Dept. of Education. Pulled from calschls.org.
Violent Crime

Among violent crimes, aggravated assault is the most reported crime in SLO County, followed by rape, robbery, and, to a much lower degree, homicide.

Source: California Department of Justice. OpenJustic Data Portal. Crime Statistics. 2012-2021. https://openjustice.doj.ca.gov/exploration/crime-statistics/crimes-clearances. 

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