A wide range of factors influence how long and how well we live. It is well known that access to quality medical care, as well as personal health behaviors such as alcohol and tobacco use, play a role in determining the length and quality of our lives. However, beyond these, there are other underlying factors. These factors are known as the social determinants of health and these are actually the strongest predictors of morbidity and mortality.

The social determinants of health includes economic factors (e.g., your income level), social factors (e.g., your level of family support) and your physical environment (e.g., how close you live to parks and local air quality). See the graphic below.

Live Healthy Napa County has adopted the Livable Communities framework. The eight domains of this framework encompass various conditions in the places where people live, learn, work and play that that can positively affect a community’s health and well-being.

The underlying social determinants of health strongly influence the length and quality of our lives. As a result, this section will highlight the following conditions that could be prevented or minimized with improvements to the social determinants of health, especially for those populations with the most limited choices and resources:

• Obesity
• Life Expectancy
• Top 10
• 3-4-50
• Years of Potential Life Lost

Obesity is a serious, chronic disease that increases the risk of many health conditions including heart disease, stroke, type 2 diabetes, certain cancers, infertility, mental health and death (all-causes). In fact, if the obesity epidemic is not addressed, the current generation of children, for the first time in 100 years, is expected to have a shorter life expectancy than their parents.

There are many factors that contribute to the obesity epidemic, from unhealthy eating behaviors and a sedentary lifestyles to high levels of stress. However, the social determinants of health also play a key role. For example, a person may not choose to bike or walk to work and school as a way to increase their physical activity because there are no sidewalks, streetlights or safe routes to their destinations. To learn more about the obesity epidemic and the social determinants of health, click here or play the video on the right.

The obesity epidemic is prevalent throughout the entire population, affecting both adults and children. Locally, the obesity rate for adults is on the rise. In Napa County, the adult obesity rate, measured using body mass index (BMI), rose from 26.4% in 2011-2013 to 29.3% in 2014-2016 — an increase of 11%. The 2014-2016 Napa County adult obesity rate is also higher than the statewide level of 27.6%. 

While data is not available at the subgroup level for Napa County, nationally obesity is highly prevalent in some racial and ethnic minorities including African Americans, Hispanics and certain native populations. Among African Americans and Hispanics, women are more likely to be obese then men. To learn more about nutrition and obesity, visit the Emergency Food System Study page

Unhealthy body composition of children has been stable in recent years but remains high. Body composition is measured by BMI and fat compositions and can be used as a measure of obesity. In Napa County, 17% of fifth, seventh, and ninth graders are considered to be obese, meaning they have a body composition score that puts them at higher risk for health issues. This percentage is below the state level (20%). 

The factors which may affect the higher rate of obesity in Napa County include lack of access to healthy food, lack of spaces and opportunities for exercise, lower exclusive breastfeeding rates and lack of knowledge on habits to maintain a healthy weight. To learn more about Napa County’s food system, visit the Emergency Food System Study page.

This map of Napa County shows life expectancy at birth by census tract, a geographical area that roughly represents a neighborhood. The areas in red have the shortest life expectancy and the areas in green have the longest life expectancy. In the Napa County, the average life expectancy is 81, slightly above that national level (79 years) and the same as the statewide average (81 years). 

While data is not available at the subgroup level for Napa County, men have a lower life expectancy than women nationally, and non-Hispanic blacks have a lower life expectancy than Hispanics and non-Hispanic whites. Within the county, there is a 12-year gap between neighborhoods with the highest life expectancy (88 years) and the lowest life expectancy (76 years). 

While the factors that determine life expectancy are complex, social determinants of health, such as income and education are directly correlated with life expectancy. For example, in the city of Napa, the neighborhood with the highest life expectancy has a median income of $106,513 and the neighborhood with the lowest life expectancy has a median income of $61,345. For more information on the association between social determinants of health and life expectancy, click here or play the video on the right.

TOP 10 CAUSES OF DEATH


Cancer, heart disease and cerebrovascular diseases including stroke are the top three causes of death in Napa County. During the 2013-2015 time period, cancer accounted for 25% of all deaths, heart disease accounted for 23%, and cerebrovascular diseases accounted for 6% of all deaths. These diseases are also the leading causes of death statewide. At the national level, the leading causes of death are heart disease, cancer, and accidents/unintentional injuries. The top three causes of death in Napa County are largely preventable. Nearly 80% of heart disease and stroke and nearly 35% of cancers could be prevented by eliminating four behaviors: tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. 

Click on the following links to learn more about cancer and the four health behaviors — Cancer Report, Emergency Food System Study & Alcohol/Tobacco Retail.

Napa/Solano Area Agency on Aging Health Needs Assessment

The Napa/Solano Area Agency on Aging (AAA) completed a comprehensive senior needs assessment in 2019. Based on the social determinants of health (SDoH) and equity frameworks, focus groups and key informant interviews were conducted to identify issues, challenges and barriers for the aging population in the region. Mortality data analysis was conducted to identify the leading causes of death in older adults. Click on the box to the right to read the full report.

3-4-50


3-4-50 is a framework for preventing chronic disease and improving community health. Three factors (physical inactivity, unhealthy diet and tobacco use) lead to four chronic diseases (cancer, heart disease and stroke, type 2 diabetes and lung disease) that cause over 50 percent of deaths worldwide. 

3 factors  contribute to 50% of deaths:

1) physical inactivity
2) unhealthy diet
3) tobacco use 


For more information on diet, visit the Emergency Food System Study page


For more information on physical activity and tobacco retail, visit the Outdoor Spaces and Buildings domain (page is being developed and will be linked when available). 

This trend in mortality has also been experienced nationwide, statewide and locally. In 2016, more than half of all deaths (59%) in Napa County were attributed to the four conditions (cancer, heart disease and stroke, type 2 diabetes and lung disease). Despite a downward trend in 3-4-50 related death percentages (9% from 2007 to 2016), cancer, heart disease, and stroke continue to be the most common causes of death among Napa County residents.

The 3-4-50 framework can be used as community health strategy to align efforts of a diverse group of stakeholders (such as community organizations, healthcare providers, schools, business and the government) to foster policy, social environment and built environment change to encourage healthy lifestyles. For example, in June of 2018, the City of St. Helena updated municipal code to incorporate electronic smoking devices and expand the definition of smoking to include e-cigarettes and cannabis. This action made clear that anywhere smoking of traditional (combustible) cigarettes is prohibited, emerging electronic products and cannabis are also prohibited. Smoke-free air laws protect community members from second-hand smoke, which is a contributor to respiratory illness and disease.

PREMATURE DEATH


What is Years of Potential Life Lost (YPLL)?

YPLL is a measurement of the number of years of potential life lost before the standard life expectancy. It is used to reflect the impact of premature mortality (death) on a population. Seventy-five years is used as the standard life expectancy and YPLL is calculated by subtracting the age at the time of death from 75. For example, a man who died from heart disease at age 60 would have 15 years of potential life lost, while a man who died at 80 would not contribute any years of life lost. The total number of years of life lost is often summed for the population and a rate is calculated so that comparisons can be made across groups (e.g., by geographic location). 

Measuring premature mortality, rather than overall mortality, is a way to focus attention on deaths that could have been prevented. Substance use disorders are the leading cause of premature death (years of life lost before age 75) in Napa County, followed by ischemic heart disease, unintentional injuries, and suicide. The majority of substance use years of potential life lost (an average of 568 years from 2015-2017) were due to alcohol and opioid use. Although heart disease is second to cancer as the leading cause of death overall, it remains a top cause of early death, with an average of 548 years of potential life lost from 2015-2017. Within the category of unintentional injuries, the most years of life lost were to road injuries, which includes motor vehicle, pedestrian and bike related accidents. Finally, there were 368 years of potential life lost to suicide among people under 75 from 2015-2017. The overall age adjusted rate for suicide during the same time period was 13 suicides for every 100,000 people. 

For the 2014-2016 time period, the total YPLL rate per 100,000 persons in Napa County was 4,383 years, lower (fewer years lost from premature deaths) than both the California average (5,217 years) and the nine Bay Area county average (4,445 years). The YPLL rate, or premature mortality rate, for Napa County was lower than Solano, Sonoma, Contra Costa and San Francisco Counties but higher than Marin, San Mateo and Santa Clara Counties.


The Center for Disease Control and Prevention (CDC) examined the number of deaths, from the top five causes of death, which could have been prevented. In the United States, at least 1 in 3 (39%) unintentional injuries (accidents) could have been prevented. This statistic is also true for chronic lower respiratory diseases, heart disease and stroke - at least 1 in 3 deaths from each of these diseases was premature. Approximately 1 in 5 deaths from cancer was premature. These conditions can be prevented by developing community health strategies, based on the 3-4-50 framework, that focus on the connection of three behaviors (physical inactivity, unhealthy diet and tobacco use) and the social determinants of health.

Technical Note: The annual County Health Rankings Report pools together the most recent three years of mortality data available from the National Center for Health Statistics to calculate the YPLL rate. For the 2018 Report, the latest data provided is from 2014 to 2016.

References


Obesity

Biro, F. M., & Wien, M. (2010). Childhood obesity and adult morbidities. The American Journal of Clinical Nutrition, 91(5), 1499S-1505S. https://doi.org/10.3945/ajcn.2010.28701B 

Centers for Disease Control and Prevention. (2018) Adult Obesity Causes & Consequences. Retrieved December 11, 2018 from https://www.cdc.gov/obesity/adult/causes.html

National Heart, Lung, and Blood Institute. (2018) Overweight and Obesity. Retrieved December 11, 2018 from https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity


Life Expectancy

Cantu PA, Hayward MD, Hummer RA, Chiu CT. New estimates of racial/ethnic differences in life expectancy with chronic morbidity and functional loss: Evidence from the National Health Interview Survey. (2013). J Cross Cult Gerontol, 28(3), 283-97. https://doi.org/10.1001/jama.2018.0158

US Burden of Disease Collaborators. (2018). The state of US health, 1990-2016: Burden of diseases, injuries, and risk factors among US states. JAMA, 319(14), 1444–1472.

Xu, J, Murphy, S.L., Kochanek, K.D. et al. (2018). Deaths: Final data for 2016. National Vital Statistics Reports, 67(5). Retrieved December 12, 2018 from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf.


Mortality 

Centers for Disease Control and Prevention. (2014). Up to 40 percent of annual deaths from each of five leading US causes are preventable. Retrieved December 13, 2018 from https://www.cdc.gov/media/releases/2014/p0501-preventable-deaths.html

Centers for Disease Control and Prevention. (2017). Leading Causes of Death. Retrieved December 13, 2018 from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

County Health Rankings & Roadmaps. (2018) What is Health? Retrieved December 10, 2018 from http://www.countyhealthrankings.org/what-is-health