Marin ranks healthiest in state, grapples with equity challenges

Marin has yet again ranked the healthiest of California’s 58 counties, according to the Robert Wood Johnson Foundation.

Marin residents have an average life expectancy of 85.2 years, the foundation reported. The state average is 81 years, San Francisco is 83.7 years, and the lowest overall ranked county in the state, Trinity, is 74.6 years.

Underpinning the top score were high rankings in quality-of-life categories such as high-quality health care, clean air and water, and access to green space and healthy foods. But the county still faces challenges related to suicide, substance abuse and racial disparities for health outcomes.

“As proud as we are, and we really take pride in the fact we are the healthiest county, we want people to understand that there is a segment of our population where this isn’t the story for them. And we need to work on that,” said Niccore Tyler, chief strategy officer for the Marin County Health and Human Services Department.

Marin has been ranked at the top statewide in the last 13 of the 14 years; in 2017 it slipped to No. 2, below San Mateo County. The 2023 “County Health Rankings & Roadmaps” report, released March 29, is compiled by the Robert Wood Johnson Foundation and the University of Wisconsin.

The annual rankings compare California counties on more than 30 factors.

“Many of the disparities in communities occur because of the social determinants of health, such as socioeconomic status, education, employment, housing, as well as access to health care,” said Benita McLarin, director of the county health department.

But, she added, that they are not always applied equally.

“Through our many HHS programs, services and partnerships, we are working to alleviate many of these challenges, though we recognize there is much, much more work that can be done by us and others who care about equity,“ she said.

Average life expectancy among Black residents in Marin County, about 3% of the county’s population, is about seven years lower –– 78.3 years. For Latino residents, about 16.8% of the population, life expectancy is 86.7 years; for Asian residents, about 6.9% of the population, it is 90.6 years; and for White residents, about 70.1% it is 85.3 years.

“There’s lots to celebrate here,” said Dr. Matt Willis, the county public health officer. “The rankings reinforce what we’re doing right and show us where we have work to do. It’s important to see that a single ranking can hide real disparities in Marin.”

The prevailing argument is that the conditions someone is born into, and where they live or work, will contribute to their health. The most common determinants of overall health can include socioeconomic status, education, employment, housing and access to health care.

Tyler credited proactive health interventions, or preventative work intended to improve quality of life or longevity, for the county’s performance.

Much of the most recent efforts are offshoots of strategies honed during three years of the COVID-19 pandemic, Tyler said.

During that time, the county set up teams in southern Marin and Marin City, western Marin, Novato and the Canal neighborhood of San Rafael. While those teams were geared toward testing and vaccinations, they have since pivoted to a wider public health platform and even into disaster preparedness.

“Irregardless of your race or your socioeconomic background, we would like to see the same life expectancy,” Tyler said.

The county’s public health division plans to develop a data dashboard to display life expectancy and causes of preventable death that aims to inform equity-focused interventions in some of the county’s most vulnerable neighborhoods.

County departments have also collaborated on the development of equity analyses to help focus service distribution.

Often, the efforts are multi-disciplinary and span various departments. The behavioral health division offers services as part of the county’s “Clean Slate” program, which offers non-violent offenders a chance to clear their criminal records.

Todd Schirmer, director of Marin County Behavioral Health and Recovery Services, said that the OD Free Marin program will increase the availability of the overdose reversal spray naloxone and broaden access to substance abuse treatment and mental health services.

The division is focused on targeting suicide and substance abuse, he said. The program has increased access and education to substance abuse treatment and has assisted in Narcan distribution, medication assisted treatment and recovery coaches.

Marin’s suicide rate is 14 per 100,000 in population, compared to a statewide rate of 10 per 100,000, according to the county. Marin also reports that 22% of its population engages in binge or heavy drinking, compared to 18% of the state. Marin has an overdose rate of 17 per 100,000, equal to the state.

“There is certainly more work to do, particularly around those area of substance abuse in our community,” Schirmer said.