New HPI Study: Improving Community Conditions Could Save Tens of Thousands of Lives Annually

Up to 24% of All Deaths & 72% of COVID-19 Deaths Could Have Been Prevented by Addressing Social Determinants of Health in California Communities

A groundbreaking new study by the Public Health Institute’s Public Health Alliance of Southern California, using their Healthy Places Index (HPI) platform, has quantified how community conditions directly impact mortality rates across California. Using the HPI—a composite measure of 23 factors, including economic standing, education, housing, transportation, environmental quality, and access to health care—researchers found that 24% of all deaths in the state, over 60,000 per year, could have been prevented by addressing inequities in community conditions, also referred to as social determinants of health (SDOH). This figure jumps to a staggering 72% when looking specifically at COVID-19 deaths (26,000 in 2020-2021) during the pandemic. The study, “California Mortality and the Healthy Places Index,” was published in the American Journal of Epidemiology.

Key Findings from the Study:

• Community Conditions Are a Matter of Life and Death: Improving community conditions like affordable housing, good paying jobs, transportation options, and access to a pollution-free and green environment, could have prevented up to 24% of all deaths and 72% of COVID-19 deaths in California.
• Structural Inequities Worsen Health Outcomes: Unequal neighborhood resources and systemic racism drive significant differences in mortality rates within and between racial and ethnic groups across the state.
• Proven Solutions for Public Health: The Healthy Places Index (HPI) has guided critical interventions, including California’s equity-focused COVID-19 vaccine rollout, which helped prevent over 160,800 COVID-19 cases and 675 deaths. It has also directed over $4 billion in investments to areas that need it most.
• A Roadmap for Future Interventions: Beyond crises, the HPI offers a data-driven framework for long-term health improvements across California, helping communities thrive regardless of race or location.

The study confirms that SDOH–such as access to education, good paying jobs, affordable housing and transportation, and healthy air, food, and water–are a leading cause of preventable and unfair deaths in California. Eliminating health inequities related to SDOH could have had a profound impact on mortality rates both before and during the COVID-19 pandemic. Importantly, the findings show that while impacts are greatest in poorest neighborhoods, about 65% of preventable deaths happen in working class, middle-class, and upper middle-class areas.

This study is the first of its kind in California to highlight the magnitude of the burden of disease faced by Californians living in low resource communities. Moreover, the lack of a SDOH-based health equity component in California’s public health surveillance systems limits its ability to track and address these issues effectively. The study advocates for integrating SDOH measures into routine mortality surveillance to provide critical insights for public health policy and evaluation.

Dr. Neil Maizlish, Senior Data Advisor of the Public Health Alliance of Southern California, emphasized the broader implications of these findings:

The HPI has already been successfully used by hundreds of government agencies, healthcare institutions, community groups, and other sectors. Beyond crisis response, the HPI serves as a roadmap for long-term public health interventions and resource allocation, enabling policymakers to pinpoint where to focus resources and efforts to reduce health inequities across California. The report’s findings will also help funders—from philanthropic organizations to local governments—make more strategic decisions and provide all stakeholders with clearer measures to demonstrate the impact of policies and funding.

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The Public Health Alliance of Southern California is a coalition of the executive leadership of 11 local health departments serving 60% of the state’s population. The Alliance advances health equity through innovation, best practices, data, policy and system transformations. The Alliance is fiscally administered by the Public Health Institute.