Respect & Social Inclusion. People can be present or reside in a community and still be socially excluded. Those who are socially included have a number of societal ties (listed to the right). In a respectful community, all people can feel safe, supported, and engaged. This section explores the relationship between health and measures of respect and social inclusion, including social vulnerability, LGBTQ equality, youth and older adult experiences, and crime.

Social inclusion means that people:

          • Experience a sense of belonging
          • Are accepted (for who they are) within their communities
          • Have valued roles in the community
          • Are actively participating in the community
          • Are involved in activities based on their personal                              preferences
          • Have social relationships with others whom they chose and              share common interests
          • Have friends

Social inclusion is an important "determinant of health." When people experience some or all of the conditions above in their lives, they are more likely to be happier and healthier. Conversely, without inclusion, people are more likely to experience poor health (including poor mental health), loneliness, isolation and poor self-esteem.

Information on social inclusion's importance is from The New Brunswick Association for Community Living. 

Click the following to read more — Why Social Inclusion?

Community Conversations. Since 2016, staff at the Napa County Library have been conducting community conversations to learn more about the aspirations of the community. Using the Harwood Method, they conducted several kitchen-table talks aimed at learning about what Napa’s people want in a positive, forward-thinking way. As of fall 2018, 20 community conversations including more than 200 people have been held. Having an inclusive and diverse community was a common thread in these conversations. 

The word cloud on the left is from the first 17 conversations held by Napa County Library.

Social vulnerability 

refers to the degree to which a community experiences certain social and economic vulnerabilities, such as overcrowded households or poverty, which may affect that community’s ability to prevent or limit adverse health outcomes and financial losses in the event of a disaster or other health hazard. Measuring social vulnerability can help provide insight into community resiliency in the face of external stresses.

The Social Vulnerability Index (SVI) combines 15 social and economic conditions that may affect a community’s resiliency. Compared to the State, Napa County is higher (more vulnerable) in two out of the 15 SVI indicators; 1) the population aged 65 or older and 2) civilians with a disability. At the sub-county level, the level of social vulnerability among each of the 15 indicators varies across the County, and no neighborhoods stand out as being highly vulnerable across all categories.

The SVI and its individual indicators can be used to identify communities that need support in preparing for hazards or recovering from disasters; it can also be used to identify communities that may benefit from additional support to reduce certain social and economic conditions that adversely affect health. By reducing social vulnerability, we can improve health outcomes not only in a disaster but also in daily life.

Notes about the SVI map below. The map displays all 15 layers, or community conditions measured, of the SVI. You can click layers on and off in the legend to the left of the map. The layers are semi-transparent, and you can overlay multiple layers at one time to create your own composite index that you consider most relevant to Napa County. Due to mapping limitations, however, you may only select up to four layers at one time.

Click on the following links to read more about the index  Social Vulnerability & The Resilience Toolkit

I've heard from LGBTQ teens that they feel accepted but excluded. Teens and young adults feel Napa has nothing for them & [is] too expensive.

– Representative from a non-profit organization serving youth.

The Municipal Equality Index (MEI)

As a nationwide evaluation of municipal law, the MEI was developed to assess progress in the adoption of lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ)-inclusive policies and laws. Napa County and its cities are not among jurisdictions selected for inclusion in the 2017 MEI report; however, the components of the index were created for Napa County using report methodology.

The policies and laws highlighted in this index are selected because they help to promote a safe and inclusive community where LGBTQ people can live, work, play, and raise families. This is important to all because a community that is mindful of building a safe and inclusive community for specific sub-groups is a safe community for all. The index describes how Napa County scores in five (5) categories: non-discrimination law, employment, services, law enforcement and leadership on LGBTQ equality.

Napa County Library conducted a community conversation with Napa County residents who identify as part of the LGBTQ community. These residents said they want a more open-minded, accepting, safe, and positive community that celebrates all, where there is no judgment. A participant stated that he felt “accepted but not included” in Napa.

Click on the following links to to read more Municipal Equality Index & Standards for Credit

Childhood bullying can harm both an individual and their community for decades, negatively impacting everything from personal health to social relationships and socioeconomic status

Frequent bullying in childhood is associated with higher rates of depression, anxiety disorders, and suicidality in adulthood. A safe learning environment is essential for students of all ages. Without it, they are unable to focus on learning the skills needed for a successful education and future. 

California Healthy Kids Survey (CHKS) asks students in grades seven, nine, and eleven whether they’ve experienced bullying. Results from the 2017 CHKS indicate that, for 9th grade students in Napa, 26% of Hispanic students (one in four), 47% of Asian students (nearly one in two), and 39% of Black students (more than one in three) reported being bullied, which are the highest rates of bullying reported for these demographic groups among the grades surveyed. White students, as a group, reported highest rates of bullying in the seventh grade (33%, or one in three).

Youth who identify as lesbian, gay, bisexual, transgender, questioning, or ‘queer’ often report higher levels of bullying than peers who identify as heterosexual and cisgendered (i.e. gender identity and expression align with sex assigned at birth). 

Such was the case in Napa County in 2017, as reported in that year’s California Healthy Kids Survey. Of the 5,000+ youth surveyed, only 55% of LGBTQ respondents reported feeling safe at school, compared to 69% of students overall. LGBTQ youth were also more likely than their heterosexual or gender-typical peers to report all types of bullying, including being made the object of jokes or having one’s looks or speech ridiculed. LGBTQ students also reported being threatened with harm or injury at twice the rate of the general student population.

Cyber-bullying has brought an enduring health risk factor for youth, bullying, into the digital age. Youth who are cyber-bullied frequently report adverse mental health experiences ranging from anxiety and depression to suicidality. Cyber-bullying is also associated with poorer health outcomes, such as increased substance abuse and delinquency, among perpetrators. Nationally, about 34% of students report experiencing cyber-bullying during their lifetime.

In 2017, one in five seventh and ninth graders (20%) in Napa County experienced at least one incident of cyber-bullying. The number was lower for eleventh graders (18% of students surveyed) and higher for non-traditional students (23%, or nearly 1 in 4 students surveyed). Non-traditional students are those in alternative public education settings/pathways (e.g., independent study, Valley Oak High School, etc).

Childhood experiences, both positive and negative, have a tremendous impact on lifelong health and opportunity. Adverse Childhood Experiences (ACEs), which include abuse, neglect, and family/household challenges, are common. About two thirds of people report experiencing at least one ACE. As an individual’s ACEs count (or “score”) increases, so does the risk for poor health outcomes. In Napa and Sonoma Counties, it is estimated that 22% of the population has four or more ACEs. As someone's ACEs score increases so does their risk of alcoholism, substance abuse, obesity, chronic disease, mental illness, suicide and a number of other conditions, including early death. Preventing adverse experiences by supporting parents and increasing resilience in the community is an important public health strategy.

Neighborhood safety and the absence of violence have clear connections to positive health outcomes, but other factors such as neighborhood satisfaction, the feeling of having an influence over one’s surroundings, and having a sense of connection with neighbors can also decrease stress and increase mental, physical, and emotional well-being  particularly as we age.

In 2015, Napa County’s Healthy Aging Population Initiative (HAPI) completed a survey of older adults living in Napa County. Results of the survey showed that respondents felt safe alone in their neighborhood (90% of respondents), were satisfied with their neighborhood (89%), believed their neighbors were trustworthy and helpful (79%), and felt they had at least some influence in their neighborhood (60.5%).

People want an inclusive, diverse community where all ages are welcome, which is affordable and resident friendly, and where residents can easily access services and opportunities... They believe we need to focus on recognition of changing demographics and the needs of residents.

-Napa County Library Community Conversations project

Crime-free streets and public areas are essential for vibrant and social communities. In addition to the direct effects of crime-related stress on psychological well-being, crimes negatively impact social cohesion and perceptions of personal and neighborhood safety, which can adversely impact mental health across a population.  

The Crime page is currently

in development and will be 

linked here when available.


Youth Experiences

Takizawa, R., Maughan, B., & Arseneault, L. (2014). Adult health outcomes of childhood bullying victimization: evidence from a five-decade longitudinal British birth cohort. American Journal of Psychiatry, 171(7), 777-784. DOI:

Nixon, C. L. (2014). Current perspectives: the impact of cyberbullying on adolescent health. Adolescent Health, Medicine and Therapeutics, 5, 143. DOI:

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.

Older Adult Experiences

Kruger, D. J., Reischl, T. M., & Gee, G. C. (2007). Neighborhood social conditions mediate the association between physical deterioration and mental health. American Journal of Community Psychology, 40(3-4), 261-271. DOI:

Morris, K. S., McAuley, E., & Motl, R. W. (2008). Neighborhood satisfaction, functional limitations, and self-efficacy influences on physical activity in older women. International Journal of Behavioral Nutrition and Physical Activity, 5(1), 13. DOI: