In an attempt to simplify California’s unwieldy and confusing vaccination program, Gov. Gavin Newsom last week announced yet another strategic change, mapping out a new vaccination plan with an eye on one special goal: find a way to ensure that residents of under resourced communities don’t get left out.
But the announcement lacks details so far, and has left Sacramento-area county health officials confused.
Equity has been elusive during the 12-month pandemic. Disadvantaged groups, notably Latino, Black, Pacific Islander and immigrant communities, as well as people in poorer neighborhoods, are disproportionately hit by the virus, and may be among the groups with the least direct access to vaccinations.
The governor is proposing two tracks: After finishing with inoculations of health care workers, first responders and some essential workers, the state will move to an age-based system. Simultaneously, an undisclosed number of doses will be set aside for each county to take into neighborhoods where residents have a lower life expectancy.
“Vaccines will be allocated to make sure low-income neighborhoods and communities of color have access to vaccines, and providers will be compensated in part by how well they are able to reach under-served communities,” the governor’s office said in a statement.
State officials have been telling counties to use a state database called the California Healthy Places Index to find where people in each county are most at-risk based on key health measures, including access to health insurance, age, income, employment, grocery access, and other indicators.
But local officials say relying solely on the location-based Healthy Places Index may leave out some groups who are vulnerable but don’t necessarily live clustered in the same neighborhoods. Several say they would also like to work with community-based groups to identify people at risk.
Meanwhile, they await further word.
“We don’t have a clear, well-communicated approach from the state about what this new (age-based, plus equity-based) construct will look like,” said El Dorado County spokeswoman Carla Hass. “There is no skin on the bone as far as we have been told. Until we see more specifics, I hesitate to say how we are going to address it.”
A Sacramento Bee review of the HPI in the four-county Sacramento metropolitan area suggests counties likely will have to rely on a hybrid approach – partly based on the HPI and partly based on local knowledge of at-risk groups – in deciding where to disperse their allotment of “equity-based” doses.
Here are 10 communities in the Sacramento region whose residents could be targeted for shots, based in part on their Healthy Places Index rankings, as well as on county health officials’ early assessments:
South Sacramento, Florin area
The hardest-hit neighborhoods in the county in the last 30 days are in the southern metropolitan area centered around ZIP codes 95823 and 95828. That includes the Florin area and the Parkway and Valley Hi areas. The two ZIP codes have registered more than 2,300 new COVID-19 cases in just the last month.
These south Sacramento neighborhoods are some of the city’s most ethnically diverse, and also some of its low-income — in one Parkway census tract, the median household income is roughly $28,775.
In some census tracts in the area, one in three people 18 to 64 years old are uninsured, according to state data.
A part of the area sits just south of the University of California Davis Medical Center, a key national research center for the COVID-19 virus vaccine. That area was among the first hard-hit areas of the county during the early stages of the pandemic, in part because it has a large amount of group homes.
If county health officials focus equity vaccination efforts more tightly on neighborhood HPI squares, the Fruitridge Pocket area is a must. It includes the the least healthy census tract in the four-county region.
That tract sits mainly west of Stockton Boulevard and east of Highway 99, south of 14th Avenue and north of Fruitridge Road.
It is among the least healthy urban areas in the state, according to the HPI: Only about 1.3% of the state’s communities rank worse.
Key metrics such as poverty, income levels, employment, automobile access and voting are among the lowest in the state in that area. About 86% of the tract’s residents are people of color.
About 30% in the core census tract are foreign-born, and nearly 50% speak a language other than English at home. Community advocates have stressed that vaccine plans must be multilingual to be effective.
Del Paso Heights
Three tracts in North Sacramento feature similar characteristics. Each of these tracts ranks in the lowest 2% of the state on an array of community health data.
Last fall, the north Sacramento ZIP code of 95838 — which includes Del Paso Heights, Hagginwood and Robla — had the highest number of COVID-19 cases in the county per capita. Roughly one in 13 residents there have tested positive for COVID-19.
The core tract, census tract 65, centers on Grand Avenue south of Interstate 80 and Bell Avenue north of the freeway. Nearly half of low-income renters pay more than 50% of their income on housing costs, according to state data, ranking worse than roughly 95% of other California communities.
“Access to service, access to healthy foods, access to opportunity for employment is lower” in these neighborhoods, said Mutual Assistance Network executive director Danielle Lawrence. That can negatively impact health outcomes, she said.
Noralto, Old North Sacramento
Census tracts 68 and 69 straddle El Camino Avenue in an older corner of North Sacramento in one of the city’s most diverse neighborhoods.
Census tract 69, representing Old North Sacramento and Woodlake, ranks better than just 2% of other California communities on the Healthy Places Index. Census tract 68, covering Old North Sacramento and parts of Noralto, ranks better than just 1.7%.
Accessible pop-up clinics will be extremely important for inoculating residents in the area: North of El Camino Avenue, about one in three people 18 to 64 years old are uninsured, and about one in five don’t have access to a car, according to state data.
Of the 40 neighborhoods or census tracts in the region with the lowest HPI scores, only one is outside Sacramento County. That is tract 102.03, located on the western edge of West Sacramento.
This tract has healthier conditions than just 3.4% of the state’s communities. It ranks in the bottom 10% on multiple measures, including poverty, income, employment and health insurance. About 62% of the tract’s residents are people of color.
“If you travel around West Capitol Avenue, there are folks living on the fridges, moving from motel to motel,” said Yolo County Supervisor Oscar Villegas, who represents the area. “Off-the-radar folks who are not engaging with social media and City Council meetings, just people trying to survive on a daily basis.”
The Broderick neighborhood of West Sacramento, an area that is both one of the oldest and most modest residential neighborhoods of the region, also has low HPI scores and higher poverty rates.
Another higher-risk area in Yolo County is Woodland, which has a high Latino population and many low-income residents.
County health officials say they will use the HPI as a starting point to determine where in the county they will focus vaccines, but point out that to achieve equitable distribution, they also intend to rely on community-based non-profits that have already been helping them get the word to at-risk communities.
Spokeswoman Katie Combs-Prichard said that likely would include groups who helped in outreach to Latinos last summer, when that groups’ infection numbers spiked. The north shore of Lake Tahoe, a working class community with a Latino population, is a likely spot for the county to focus vaccines, she said.
The problem is that the county does not have a good idea of which communities are getting vaccinated and which are falling behind, given that private entities are doing much of the vaccinating. Combs-Prichard said the county hopes to get a better view of where vaccinations are taking place in the coming weeks as the state consolidates vaccine data.
Elders Corner in North Auburn
The tract with the lowest HPI score in Placer County is north of Auburn along Highway 49 north of Bell Road. That tract in particular has healthier conditions than only about 17.4% of the state, with low rankings on income, access to a car, and health insurance among adults.
The modest and historic neighborhood that borders Vernon Street in old downtown Roseville, bisected by Riverside Avenue and Douglas Boulevard, also ranks low overall on the state HPI. Poverty there is high for Placer County, education levels are low, and many do not have easy access to healthcare.
The HPI, though, is an imperfect tool for determining disadvantaged communities for vaccine purposes. Some retirement communities, such as the Sun city area in the city of Lincoln, notably rank high in the HPI. But while many in Lincoln are older residents, which puts them at higher risk for more severe bouts of COVID-19, the area’s residents rank as healthy with respect to health care access, education, home value, and clean living environment.
El Dorado County
El Dorado does not have any sizable communities that rank low on the HPI, but there are some rural areas on the outskirts of the city of South Lake Tahoe that rank in the lower one-third of California communities on health issues. County officials say they too plan to seek guidance from organizations around the county.
That includes part of the Al Tahoe area where residents, some of whom are workers in the casinos and hotels, have incomes in the lower 24% of state residents and have less access to health care than all but 21% of the rest of the state.
Pollock Pines and Georgetown
Sections of the rural or semi-rural towns of Pollock Pines, Georgetown and Diamond Springs also are among the least healthy neighborhoods in the county, according to the state HPI, but that may be in part because those areas have higher numbers of retirees, who typically score lower on the HPI for lack of income and a few other potentially misleading indicators.
Nevertheless, in Pollock Pines north of Highway 50, residents have average health care access, but poverty levels are higher than state averages.
Similarly, in the hills around Georgetown, state data that the number of people with health insurance is lower than state average.