San Francisco’s population is expected to grow to 983,000 by 2030 and to 1.2 million by 2060.
San Francisco is expected to see a 38% increase in the number of residents 65 years and over by 2030 – more than any age group.
Fifty-eight percent of San Francisco’s population is non-White and the ethnic diversity score is increasing.
Twenty-four percent of San Francisco residents 5 years and older have limited English proficiency – 57% of those persons speak Chinese.
The percent of persons living in family households and households with unrelated roommates is increasing, while the percent of people living alone is decreasing.
Asthma and Chronic Obstructive Pulmonary Disease
Asthma continues to be a major public health concern with a continually increasing prevalence.
COPD is the third leading cause of death in the nation. Additionally, it was estimated in 2010 that COPD-related expenses cost the nation approximately $49.9 billion annually.
The prevalence of asthma among cigarette smoker adults (18 %) in San Francisco is 63% higher than that for non-smokers (11%).
Black/African American and Filipino middle (23.75% and 23.35%) and high school (24.9% and 25.9%) students were more likely than other ethnicities to have asthma.
Asthma hospitalization rates among children age 0-4 are much higher than other age groups.
Rates of asthma and COPD hospitalizations are highest for Black/African Americans and are almost 10 times higher than for Whites. The Rates are also higher in the Tenderloin, SOMA, and Bayview Hunters Point neighborhoods.
Breastfeeding
San Francisco does not meet the national Healthy People 2020 target of 46 percent of women exclusively breastfeeding at 3 months.
Only 36 percent of women in San Francisco are exclusively breastfeeding at 3 months.
San Francisco has significant breastfeeding disparities. Among women who intend to exclusively breastfeed, rates of exclusive breastfeeding drop more sharply between 1 month and 3 months for lower income and non-White women than they do for higher income and White women.
Cancer
The most common cancers in San Francisco were breast (females), prostate, lung & bronchus, colon & rectum and non-hodgkin lymphoma.
The leading types of cancer causing death were: lung & bronchus, colon & rectum, liver, pancreas and breast.
Between 2010 and 2014, rates of invasive cancer per 100,000 population decreased from 438.24 to 390.17.
In general, rates were higher among Whites and Black/African Americans as compared to other ethnicities.
Among males, death rates due to lung & bronchus, prostate, liver, colon & rectum and pancreas were 85 percent to 213 percent higher for Black/African Americans than all males citywide.
Similarly, among females, rates of lung & bronchus, breast, colon & rectum, pancreas and lymphoma & multiple myeloma were 46 to 132 percent higher for Black/African Americans.
Cardiovascular Disease And Stroke
Cardiovascular disease and stroke are largely preventable yet heart disease and stroke remain the first and third leading causes of death in the United States.
Black/ African Americans are 30% more likely to die from heart disease and two time more likely to have a stroke.
Native Americans are twice as likely to die of cardiovascular disease before the age of 65 compared to all Americans.
The percent of high blood pressure among male increased to 32.71% from 10.21% in 2014 and Black/African Americans had the highest percentage 33.50% in 2011-16.
The hospitalization rates due to hypertension or heart failure for Black/African American were 3-5 times higher than all other races.
The impact of cardiovascular disease in San Francisco is higher among residents in the southeast half of San Francisco and among those who live in households earning less than 300 percent of the Federal Poverty Level (FPL).
Childcare And Education
There are 6.8 infants 0-2 years old for every licensed childcare slot.
The annual mean cost of infant childcare in a licensed center is $21,384 – 18% of the median family income for households with minor children.
The number of children receiving childcare subsidies has decreased.
The percent of 3-4 year olds enrolled in preschool has been increasing, up to 70% in 2016.
Educational outcomes are the poorest for African American/Black students across all measures reported here.
The percent of students that are “ready” for kindergarten and high school has been increasing.
The percent of SFUSD students with regular attendance has decreased slightly.
Overall rates for suspension and expulsion in San Francisco public schools have decreased since the 2012–13 school year, but disparities exist by sex and ethnicity.
60% of African American/Black SFUSD 3rd grade students do not meet state standards for English language arts/literacy.
SFUSD cohort graduation rates have increased to 87%, but not all ethnic groups have experienced this rise.
Children’s Oral Health
Tooth decay is the most common chronic disease among school-aged children in the United States. One third of students in San Francisco public schools have experienced tooth decay by the time they are in kindergarten
18 percent of kindergarteners have untreated tooth decay, a leading cause of school absences
Dental services to prevent tooth decay reach fewer than 20 percent of Denti-Cal eligible children ages 1-2 years in San Francisco
Low-income, Asian, Black/African American, and Latino children are twice as likely to experience tooth decay by the time they are in kindergarten than higher-income and White children
Civic Participation
Voter turnout is lower in more socioeconomically disadvantaged neighborhoods.
The number of neighborhood block party permits has been increasing over time.
Around 20% of San Francisco adults report meeting with others to deal with community problems and 10-14% report volunteering with a community organization.
Climate And The Natural Environment
The annual number of days with “Good” air quality has increased since 2009 to a high of 310 in 2016; however, there is no clear indication that the trend toward improvement is permanent and more frequent wild fires may jeopardize progress.
The South of Market neighborhood is the most impacted by air pollution exposure.
San Francisco lags behind peer cities in tree canopy coverage – some neighborhoods have less than 5% coverage.
San Francisco has made significant progress towards greenhouse gas reduction goal, largely due to reducing residential and landfill organics emissions.
Thee neighborhoods with the greatest extreme heat vulnerability include Chinatown, Tenderloin, South of Market, Japantown, and Mission.
The neighborhoods that are most vulnerable to the negative health effects associated with flooding include South of Market, Bayview, Tenderloin, and North Beach.
Crime And Safety
There was an increase in all crime types, except for drug crime, between 2013-2015.
Asian, Black, and Latino/a residents have significantly lower perceptions of safety during the day and night compared to White residents.
Despite citywide decreases, the rate of substantiated child maltreatment cases for Black/African American children remains 17 times higher than the rate for Asian/Pacific Islander children or White children.
Rates of at school and electronic bullying are the highest for middle and high school students that do not identify as heterosexual.
Gay, lesbian, and bisexual identified middle and high school students experienced at least twice the rate of dating violence than their heterosexual peers.
Black youth make up over 57% of the youth booked at Juvenile Hall, even though they make up only 6% of the youth population.
Both male and female Black and Pacific Islander residents experience higher levels of ER admission for assault compared to other ethnic groups.
Diabetes
Diabetes is the 8th leading cause of death in San Francisco. It is a major contributor to cardiovascular disease, which is the leading cause of death, and is the leading cause of kidney failure and need for dialysis.
Women who are diagnosed with gestational diabetes are 7.4 times more likely to develop diabetes within about 10 years after pregnancy than other women. In San Francisco, the prevalence of gestational diabetes increased significantly from 5.4 (5.2-5.7) to 7.1 (6.9-7.4) percent of live births between 2007-2001 and 2012-2016.
Over the past 30 years the prevalence of diabetes among Black/African Americans quadrupled. Black/African Americans are 70 percent more likely to develop diabetes than Whites. In San Francisco, rates of hospitalization are 3-6 times higher and rates of death are 2-3 times higher among African Americans compared to all other race/ethnicities.
People living in households earning less than 200 percent of the Federal Poverty Level (FPL) are 3 times more likely to have diabetes than those who earn more in San Francisco.
Residents in the eastern zip codes (94102, 94110, 94115, 94124, and 94130) are more likely to be hospitalized due to diabetes than those living elsewhere in San Francisco. The hospitalization charge due to diabetes as a primary cause in 2016 was $85,000,000 and the number was 15.8 times higher for diabetes as an underlying cause.
In 2016, In San Francisco, diabetes resulted in more than $87 million in hospitalization charges. Diabetic patients may require a higher level of care resulting in increased hospitalization costs; hospitalization costs for diabetes patient hospitalizations in the 2011 California study were estimated to be $2,200 higher than costs for non-diabetic hospitalizations.
Economic Environment
The self-sufficiency income in 2014 for 2 adults, 1 infant, and 1 school aged child in San Francisco was $83,522.
72% of 25-35 year old residents in San Francisco have a bachelors degree or higher.
Black/African American residents have both the lowest labor force participation (55%) than other ethnic groups (White – 76%, Latino/a – 72%).
46% of residents 75 years and older live below 200% of the federal poverty level.
The median household income in Areas of Vulnerability (AOV) is half ($50,000) that of areas that are not AOVs ($111,000).
San Francisco has the second highest income inequality in the Bay Area.
Enteric Diseases
Salmonellosis incidence rates in San Francisco are consistently above the HP 2020 target of 11.4 cases per 100,000 residents.
The rate of salmonellosis is highest among Asians and Pacific Islanders.
Rates are highest among children under five years of age.
Rates of shigellosis in San Francisco are consistently one of the highest in the state, with an incidence rate of 21.4 cases per 100,000 residents in 2016.
Generally, Shigellosis rates among men are significantly higher than women in San Francisco. This is primarily attributed to sexual transmission among men who have sex with men.
Mental Health
In San Francisco, 22.5 percent of adults surveyed reported needing help for mental health or substance use issues in 2016. The local prevalence is higher than the statewide prevalence of 16.4 percent
One quarter of pregnant women with Medi-Cal insurance in San Francisco reported prenatal depressive symptom in 2013-2015
26.1 percent of San Francisco high school students reported prolonged sad or hopeless feelings in the past year in 2017
Over 10 percent of high school and middle school students in San Francisco considered attempting suicide in 2017
In 2012-2016, the rate of emergency room (ER) visits due to major depression increased from 16.768 to 20.427 per 10,000 residents;
The ER rate due to self injury decreased significantly by more than 50 percent, but suicide rates increased by 87 percent to 11.8 per 100,000 population in 2013-2016
Mental health issues were more common among females than males, people ages 18-24 and 45-54 years old than other age groups, White, Filipino, Latino and Black/African American than other race-ethnic groups, people living with incomes below 200 percent of the Federal Poverty Limit than people with higher income, and people identifying as bisexual, gay or lesbian. Rates of mental health issues were highest in the Tenderloin and South of Market neighborhoods
Housing
San Francisco falls behind the most in construction of moderate income housing (80-120% AMI) – which has made up only 4% of all housing built between 2015-2017.
Between 1990 and 2014/15 there was a significant decrease in the percent of low income San Francisco workers (<80% AMI) that lived in San Francisco – suggesting that these workers must contend with higher transportation costs.
The South of Market Planning District alone accounted for over half of all housing units built between 2015-2017.
Asian residents are the most likely to own their home, while Black and Latino/a are the least likely.
In Chinatown, only 71% of households live in uncrowded conditions.
There was a significant decline in eviction notices in 2017.
Supervisor Districts 6 and 10 are home to 65% of San Francisco’s unsheltered homeless population.
Immunizations And Vaccine Preventable Diseases
Vaccine-preventable diseases can be very serious—even deadly—especially for infants and young children.
Influenza and pneumonia affect millions of people in the United States every year and together were the ninth leading cause of death in the United States in 2010, and the seventh among those 65-plus.
In 2016-2017, 94.2% of children entering daycare and 94.2% of children entering kindergarten had all required immunizations.
Data suggest that Asian and Asian Pacific Islander and Latino children were more likely to be vaccinated than Black/African American and White children. Foreign-born children were less likely to be completely vaccinated than those born in the United States.
The annual incidence rate of pertussis in San Francisco typically varies between two and seven cases per 100,000 residents. In 2014, San Francisco again saw high case numbers in the setting of a statewide epidemic. Measles is very rare in San Francisco, and is not endemic. The city reports fewer than five cases a year.
Influenza and pneumonia disproportionately affect Black/African Americans and people living in the eastern half, and especially the southeastern quadrant, of the city.
Hepatitis B And C
San Francisco has the highest rate of liver cancer in the country, which is mostly caused by viral hepatitis.
Asian Pacific Islanders in San Francisco are disproportionately affected by hepatitis B (HBV), comprising one-third of San Francisco’s population but representing nearly 90 percent of reported cases.
Black/African Americans in San Francisco are disproportionately affected by hepatitis C (HCV), comprising almost eight percent of San Francisco’s population but representing over 30 percent of reported cases.
Viral hepatitis is a health equity issue; End Hep C SF and SF Hep B Free have emerged as innovative campaigns to increase awareness of HCV and HBV, and ultimately eliminate HCV and HBV as public health threats in San Francisco.
Healthcare Access And Quality
The percent of San Franciscans that lack health insurance has fallen dramatically since 2010, to a low of 3% in 2016.
Females 18-24, persons earning less than $50k per year, Black and Latino/a residents and persons living in Areas of Vulnerability are more likely to not have health insurance.
During certain survey periods young adults report higher rates of delaying medical care or not having a usual source of care than seniors 65+.
Outlying neighborhoods, including Lakeshore, Visitacion Valley, and Treasure Island have significantly lower transit access to health care facilities.
Asian, Black, and Latio/a physicians are under-represented relative to the San Francisco population.
There is a shortage of physicians that speak Chinese and Tagalog based on the linguistic composition of the San Francisco population.
Preventable emergency room rates are higher in females than males, and higher for Black and Pacific Islander residents compared to other ethnicities.
94130, 94102, 94103, and 94124 have the highest preventable emergency room rates.
Transportation
The number of enrollees in free Muni programs has been steadily climbing between 2016-2018, indicating the programs’ ongoing popularity.
Areas of San Francisco that are designated as Areas of Vulnerability have a slightly lower ratio of bike lanes/paths to street miles (0.18) compared to parts of the city that do not have this designation (0.20).
Households that live within the borders of the MacLaren Park neighborhood have lower car access compared to the surrounding Visitacion Valley neighborhood, likely because much of the population that falls within its borders lives in the Sunnydale Public Housing site, where residents may not have the income necessary to have a car. Previous analysis of the Sunnydale site as part of the HOPE SF redevelopment has indicated that public transportation is often challenging for residents, thus Sunnydale residents may struggle with greater transportation challenges than elsewhere in the city.
Between 2007-2011 and 2012-2016 there was a significant decrease in the percent of people diving alone (38% to 35%), while there were significant increases in the percent of workers commuting by bike (3% to 4%) and those that use other modes (including Lyft/Uber, taxi, and motorcycle – 2% to 3%).
The neighborhoods that are most impacted by local traffic density include Tenderloin, Japantown, South of Market, Financial District, Hayes Valley, Chinatown, and Nob Hill, which all have over 70% of residents living in the most traffic dense parts of the city.
The Tenderloin neighborhood is by far the most impacted by traffic injury and the rate of severe and fatal traffic injuries is nearly six times as high as the city overall. Other highly impacted neighborhoods include all of the neighborhoods that border the Tenderloin, including: South of Market, Nob Hill, Japantown, Western Addition, Mission, and Hayes Valley.
Tobacco Use
Tobacco, the number one preventable cause of the death, claims nearly half a million lives a year in the United States and estimates have shown that 18% of all US deaths could have been avoided if not for tobacco products. Tobacco products are cancer-causing and contribute to nearly every type of cancer.
Tobacco industry targeting commences early, as tobacco addiction starts early in the developmental period, with over 90% of adult tobacco users having started smoking prior to age 18.
In 2016, 0.98% of new mothers in San Francisco reported smoking before or during pregnancy. The percentage has been dropping in the last 10 years from 2.71% in 2007. However, it was still 6-15 times higher among Black/African American women (6.83%) than all other races and ethnicities.
Districts in San Francisco with higher concentrations of smokers, ethnic minorities, and youths are associated with a higher density of tobacco retailers, despite the fact that all the districts have approximately the same number of residents.
Substance Abuse
In 2015, 36% of adults in San Francisco self-reported binge drinking on at least one occasion. In 2017, 5.7% of high school students reported binge drinking and 0.97% of middle school students reported binge drinking.
Hospital admission rates due to alcohol abuse among adults citywide decreased in 2014-2016 from 10.53 to 1.12 per 10,000, but Latinos and Black/African Americans still had the highest rates.
The density of off-sale alcohol permits is highest in the Tenderloin, where there are 104.4 licenses per square mile, compared to 16.26 licenses per square mile for the city as a whole.
In 2017, 25.65%, 10.98%, and 10.15% of high school students in San Francisco reported they had used Marijuana, unauthorized pain medications, and other drugs (including methaphetamines, inhalants, ecstasy, and cocaine).
More than 40% of White, Black/African American, and Latino/a high school students as well as more than 10% of Black/African American and Latino/a middle school students reported having before used marijuana.
The age-adjusted rate of mortality due to drug use disorders decreased from 18.97 per 100,000 in 2015 to 10.58 per 100,000 in 2017. The rate among Black/African Americans over that period was over five times as high as that among other races/ethnicities.
Neighborhoods like the Tenderloin and South of Market with large Black/African American populations also have much higher mortality rates due to drug use disorder.
Sexual Health
The estimated rate of new HIV infection in San Francisco has decreased from 56 per 100,000 in 2012 to 40 per 100,000 in 2014.
Between 2013 and 2016, incidence rates for chlamydia, gonorrhea, and early syphilis increased by 60 percent, 107 percent, and 13 percent, respectively.
Incidence rates for HIV and each STD are higher among men; men contract chlamydia and gonorrhea up to 9 times more often than woman.
In 2016, rates of chlamydia, gonorrhea, and early syphilis were 4.7, 7.3, and 5.2 times higher among Black/African Americans, respectively, than among Asians and Pacific Islanders, who experience the lowest rates of STDs in San Francisco.
Among sexually active San Francisco youth, only 71 percent of middle school and 58 percent of high school students used a condom in 2017.
From 2015 to 2017, alcohol or drug use before sex decreased among high school students but increased among middle school students.
Quality of Life and Functioning
Self-assessed health status is a more powerful predictor of morbidity and mortality than many objective measures of health.
Higher levels of well-being are associated with decreased risk of disease, illness, and injury; better immune functioning; speedier recovery; and increased longevity.
In 2016, 15% of residents reported having fair or poor health and 10.8% reported having a disability in 2012-2016.
Latino and Asian residents were more likely to report poor or fair health than were Whites; Black/African American residents were more likely to have a disability.
Those living in households earning less than 200 percent of the federal poverty level are 3.5 times more likely to report fair or poor health and disability than those with higher household incomes in 2013-2016.
Preterm Birth
Annually, over 700 infants are born in San Francisco before 37 weeks of gestation.
In 2012-2016, 414 infants were born before 32 weeks gestation.
Preterm birth disparities persist for Black/African American women and vulnerable population groups.
Physical Activity
San Francisco scores well on the Trust for Public Land’s “Park Score” – however, it falls short with regards to supply of amenities, including playgrounds, recreation centers, and restrooms.
Treasure Island, Potrero Hill, and Financial District/South Beach have the lowest access to public recreation facilities.
There has been a steady increase in the percent of target child care centers with no television visible.
50% of San Francisco adults report walking for at least 150 minutes each week for leisure or transportation.
Female, Chinese, Latino/a, and bisexual students are less likely to be active for 60+ minutes each day of the week.
Lower percentages of Black, Latino/a, and economically disadvantaged students meet 5+ standards from the California Physical Fitness Test.
Overweight or Obesity
Over 30 percent of 5th grade SFUSD students and over 40 percent of adults in San Francisco are overweight or obese
Overweight or obesity disproportionately affects individuals with low-income and individuals of color
For individuals with low income, increased risk of becoming overweight or obese is associated with specific zip codes and community-level factors, such as type of housing, child care center, and hospital
Nutrition
Available data suggest that the diets of many San Franciscans do not meet minimum recommendations for vitamins and water and exceed maximum recommendations for salt, fat, and added sugar. Two thirds of children and teens in San Francisco report less than 5 servings of vegetables and fruit daily.
Not meeting dietary recommendations is associated with low income, Hispanic and Black/African American race-ethnicity, and neighborhood, Southeastern San Francisco and Treasure Island, in particular.
Food insecurity is prevalent among students in public school, low income pregnant women, housing insecure adults and older adults with disabilities.
53 percent of students in San Francisco Unified School District qualify for free or reduced-price meals; 72 percent of pregnant women participating in the WIC-Eat SF program report food insecurity; 84 percent of people living in single-residency-occupancy hotels (SROs) report food insecurity; An estimated 20,000 older adults with disabilities are estimated to be food insecure.
Despite increases in the number of food outlets in San Francisco, the number of vendors that accept SNAP decreased by 7 percent, widening disparities in access to food.
Maternal and Infant Mortality
San Francisco does not meet the national Healthy People objective for maternal mortality of no more than 3.3 deaths per 100,000 live births. The estimated local rate is 11.2 deaths per 100,000 live births.
Each year, in San Francisco, about 1 woman dies from complications of pregnancy or childbirth. The top 3 local causes of maternal death are embolism, infection, and chronic disease.
In the past 5 years, 122 infants died within 12 months of birth. The top 3 local causes of infant death are low birth weight related to preterm birth, sudden unexpected infant death (SUID), and birth asphyxia or trauma.
Over the past 10 years, Black/African American mothers had about 4 out of 100 births, but experienced 5 out of 10 maternal deaths, and 15 out of 100 infant deaths. Significant maternal and infant death disparities persist
Mortality
The Leading causes of death are predominately chronic diseases including heart diseases, cancers, Alzheimer’s, Chronic Obstructive Pulmonary Disease, and Diabetes.
Mortality rates of both Alzheimer’s Disease and Diabetes are increasing in San Francisco.
Drug and alcohol use and suicide are also leading causes of death in San Francisco. Drug and alcohol use are especially important among adults 18 to 64 while suicide is one of the leading 5 causes of death for residents aged 13 to 34.
Additional important causes of premature death in San Francisco include assault, traffic accidents, injuries and HIV. While each of these kill relatively few residents, those afflicted are typically younger.
Overall Life Expectancy is high in San Francisco with the typical resident living to 83 years. Similar to trends seen nationwide, Life Expectancy in San Francosco has decreased since 2014.
Life expectancy varies by race/ethnicity and gender. Black/African Americans and Pacific Islanders have the lowest life expectancy.
