The city of Berkeley recently completed the 2018 Health Status Report, assessing a broad range of data to better understand the social inequities of health conditions affecting our community, assess prevention efforts and identify emerging health threats. This information is crucial because if we can better understand not just the current prevalence of serious health conditions, but disparities among communities and trends over time, then we can improve critical intervention programs to improve public health for everyone.
The findings of the report are alarming. For example, the proportion of families living in poverty is eight times higher among Black families, five times higher among Latinx families and three times higher among Asian families, compared to white families. Income inequality and childhood poverty are directly linked to higher rates of heart disease, low birth weight, diabetes and premature death.
Despite these concerning statistics, there is evidence that Berkeley’s public health interventions are working. Low birth weight among Black babies plummeted from nearly 15 percent to just below 8 percent after the city implemented the Berkeley Black Infant Health Program. This shows the power of statistically supported and research-based solutions to health inequities.
Just as important as the data in front of us is the data that’s not. The report unfortunately falls short in assessing the health status of LGBTQ+ communities and indicates the need for deeper examination of access to health care for immigrant communities.
Immigrant communities face challenges in gaining access to health insurance. While California has extended Medi-Cal to children under the age of 19, undocumented adults remain ineligible for the benefits of the Affordable Care Act that help people afford plans offered through Covered California. Nearly 14 percent of Berkeley’s foreign-born noncitizens are uninsured. We must better understand and overcome this and additional barriers to immigrant access to health care, despite the fears prompted by the Trump administration’s attacks on immigrant communities. For fear of being rejected from receiving green cards, undocumented immigrants have been dropping out of the supplemental nutrition program Women, Infants, and Children. This is alarming not only from the perspective of health equity, but in light of the need for prevention, early detection and treatment of communicable diseases to protect public health.
Future reports need to also thoroughly include information on health inequities that the LGBTQ+ community faces. LGBTQ+ individuals, including broader identities such as queer and nonbinary, encompass all races, ethnicities and social classes. Even in the absence of widespread data collection or data specific to the city of Berkeley, however, research suggests that LGBTQ+ individuals face health disparities linked to social stigma, discrimination and denial of civil and human rights.
Research also indicates that LGBTQ+ youth are two to four times more likely to experience suicidal thoughts or engage in self-harm. They are also more likely to be homeless, as nearly 40 percent of homeless youth identify as LGBTQ+. Statistically, lesbians and bisexual women are less likely to receive preventive services for cancer. Lesbians are at a greater risk for mortality linked to being overweight or obese. Gay and bisexual men are more likely to be at risk of HIV and other STIs, especially among communities of color. Elderly LGBTQ+ individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers. The LGBTQ+ community also reports higher rates of drug, alcohol and tobacco use. Research from the Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Reducing Disparities Project found that California respondents reported difficulty finding medical providers knowledgeable about and accepting of sexual orientation and gender identity concerns.
Transgender individuals have an even higher prevalence of HIV and STIs, victimization, mental health needs and suicide, and are less likely to have health insurance than heterosexual or LGB individuals. The unemployment rate for transgender individuals is two to three times the national average, and up to 44 percent are underemployed. Studies have found that about half of transgender individuals earn less than $15,000 per year, even though 71 percent have earned a level of postsecondary education.
These inequities LGBTQ+ and immigrant communities face are alarming, but we can’t assess progress toward health equity without meaningful data. The city of Berkeley should work with its contractors and partners to build on data analysis, such as the 2013 Status of LGBTQ Health: Santa Clara County report, and innovative programming led by the San Francisco Department of Public Health to ensure access to sexual and mental health services and to strategically include LGBTQ+ communities in robust public health promotion. The Berkeley Public Health Division and community clinics should continue to find ways to expand access to PrEP, STI testing and treatment and culturally competent counseling to reduce health disparities affecting the LGBTQ+ community.
The 2018 City of Berkeley Health Status Report is an opportunity to understand the health disparities affecting our community, revealing income inequality and poverty as root causes of many pressing health issues. But health disparities affecting LGBTQ+ and immigrant communities require additional review as the Public Health Division moves ahead with a new strategic plan for developing and prioritizing public health programs. The report must be supplemented so the city’s future interventions can lead to improved health equity for all.
Andy Katz is a member of the Berkeley Community Health Commission.