Homelessness remains a problem in San Francisco because of the lack of affordable housing, incomes below subsistence levels, and behavioral, mental and physical problems (SFDPH).
Racial disparities are another social determinant of health (SFDPH, 2003). While White households in the subject State of the report earned more than $75,000, African-American and Latino households earned less than a quarter of that level. According to the California Budget Project, a family with 2 children needs to earn more than $50,000 to live in modest comfort in San Francisco. Transportation is another social determinant to health. Traffic and commuting safety, pollution by air or noise, social isolation or interaction, a substitute for exercise, and time pressure are among the ways transportation affects health. Tabulations show that most people in San Francisco traveled by car, truck or van alone (SFDPH).
According to the California Health Interview Survey conducted in 2001, about 28.8% strove to provide regular food (SFDPH, 2003). Of this number, 9.4% experienced physical hunger. The lack of assured access to sufficient food through socially appropriate means constitutes food insecurity (SFDPH).
Physical environment as another determinant has to do almost exclusively with air quality (SFDPH, 2003). The federal Clean Air Act empowers the Environmental Protection Agency to set heath standards for air pollutants, such as ozone, nitrogen dioxide and particulates. Standards for ozone and nitrogen dioxide standards were kept above the minimum but larger particulates went over the State standard in the last 4 years. Particulates can induce asthma and other respiratory conditions or make them worse (SFDPH).
Behavioral determinants are psychological factors influence health (SFPDH, 2003). These are smoking, physical inactivity, diet and abuse of alcohol and drugs. The U.S. Surgeon General identified cigarette smoking as the leading preventable cause of both disease and death in the country. California has a lower smoking rate than the national average, but it is still the major contributing factor to the State's disease and death rates. Tobacco use differs between the sexes and among income and educational levels. Men smoke more than women, most of them Whites and African-Americans. Most smokers earn lower incomes than those who earn higher incomes. The second leading determinant of death in the country is physical inactivity. The Surgeon General encouraged those who are inactive to increase their activity level in order to improve health and reduce the risk of dying or developing serious diseases. These include heart disease, diabetes, high blood pressure, and colon cancer, which are all associated with physical activity. In San Francisco, males are less inactive than females, Whites than ethnic groups and the highest income group also less inactive than lower income groups. Unhealthy diet accounts for much mortality in the U.S. Adequate knowledge about the importance of a healthy diet can prevent many health conditions, including obesity. The U.S. Healthy People Program contains specific objectives and schemes in creating a healthy diet. On the other hand, illness and death rates from alcohol and substance abuse continued to rise to crisis levels for San Francisco. The main alcohol and drug-related causes of death in San Francisco during the period were poisoning, alcohol use, cirrhosis of the liver, and drug use. A study conducted by the National Institute of Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism conducted on the costs of the addictions showed that $246 billion was spent in 1992 alone. Most of the treatment cost went to hospitalizations and half of all the expenses went to drug-related crime. On top of all, many young lives are lost to drug and alcohol abuse (SFDPH).
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