The State of Health Care in San Diego County: Learnings from the 2025 Community Health Needs Assessment

The State of Health Care in San Diego County: Learnings from the 2025 Community Health Needs Assessment

February 2, 2026 Community

Background on the CHNA

The Community Health Needs Assessment (CHNA) is a comprehensive research study conducted every three years, representing a collaboration between the Hospital Association of San Diego & Imperial Counties (HASD&IC), the SDSU Institute for Public Health, and all of San Diego County's hospitals and health care systems. The CHNA provides a look at the region's top health needs, suggesting where organizations should focus their investments and strategic priorities. The Grossmont Healthcare District is one of the many stakeholders that work with HASD&IC staff on the CHNA's design and implementation.

The most recent 2025 report pulls data from current existing research, such as demographic data and hospital discharge records, and combines this with new research from 1,625 participants - 465 field interviews, 1,037 online survey responses, and 123 individuals in 40 focus groups. Research teams from the San Diego Refugee Communities Coalition and the San Diego County Promotores Coalition conducted these in-person interviews, asking participants these two main questions:

1) What are the most pressing needs of our community
2) How can hospitals and health systems help address those needs?

Key Findings

The main theme that emerged from all methods of data collection highlighted that San Diegans are facing "significant, ongoing, debilitating stress." This is not just impacting patients; it is also affecting caregivers and health professionals who feel overburdened by the health system.

Some of the top causes of this stress include:

• The high cost of living in San Diego
• Discrimination
• Ongoing challenges from COVID-19
• And climate-related public health emergencies, such as the Tijuana River Valley & Beach Water Sewage Crisis

The impact of stress is linked to a variety of health issues. Using the data, let's better understand how stress can develop into multiple health concerns that impact both individuals and their patients through a hypothetical scenario:

Nervous Nelly is a nurse at a hospital emergency unit. Nervous Nelly depends on her anti-anxiety medication to help manage her symptoms of stress. Anxiety has been a lifelong mental health struggle for her that also sometimes causes gastrointestinal issues and poor sleep quality. Nelly works long days and doesn't have time for healthy meals, so all her meals are either processed or from fast food restaurants, which affects her immune system. She is sick so often that she has no available sick days left and must take time off without pay to recover. In San Diego, with the high cost of living, this feels burdensome. She's already feeling financially strained, and now will have fewer hours worked on her upcoming paystub. For her team at the hospital, this feels burdensome; they are down another person. For patients waiting to be seen, this is burdensome. An emergency is an emergency, but due to Nelly's absence, each patient now has increased wait times. Due to the nature of Nelly's job, her heart rate and lungs are constantly working overtime. Although she understands her health is a priority, she is more concerned about caring for her family and for her patients, so she begins to neglect her own health. In 10 years, this ongoing stress without management means she is at a higher risk of developing chronic cardiovascular and respiratory diseases, diabetes, obesity, and cancer.

While Nervous Nelly's situation is unfortunately becoming more common, it's important to note that there are resources for relief, opportunities for her to prevent this from becoming her reality, and innovative solutions being implemented to help improve the health system.

Other Key Findings

To help mitigate this stress, findings suggest people need:

• Help managing specific health conditions
• A different kind of health experience: timely care, transportation options, better relationships with their care providers, and help navigating the system
• Protection and care for their service providers
• Recognition of and assistance with disabilities and trauma
• Help with public health and climate-related crises
• Better data collection, sharing, and coordination
• And less burden on emergency departments

What's working well currently is:

• Partnerships between clinics and schools
• Dental offices in clinics with sliding fee scales
• Home visits for chronic condition management
• Mobile health services
• Taxi voucher programs and free parking
• Voluntary identification programs that allow people to be discreetly recognized as disabled
• Hospital emergency departments are coordinating resources for Substance Use Disorder
• Discharge kits with health information, equipment, and easy-to-understand instructions

Top Health Conditions

In alphabetical order, these are the specific health conditions people need help managing:

• Asthma:
  • Between 2020-2022, data showed a statistically significant increase in inpatient hospital discharges for asthma.
  • The rate increased by 100% and an alarming 266% for children (ages 0-17).
• Blood Pressure:
  • 29% of field interview respondents listed this as their top concern. From 2020-2022, emergency department discharge rates for hypertension increased across all ages, including children.
• Cancer:
  • Cancer remains the leading cause of death in the region, with 24% of online survey respondents listing it as their top health concern.
• Dental health:
  • Dental care seems to be a challenge for those experiencing extreme stress. Participants describe difficulties with insurance, language barriers, and concerns over the trustworthiness of dentists when it comes to the services provided and the cost of those services.

• Diabetes:
  • Diabetes was mentioned across all data collection strategies as a worrisome health condition. In San Diego, 9.8% of people have diabetes.
• And mental health:
  • 43% of survey respondents identified mental health as the health condition having the most serious impact on adults, and another 40% identified this as a serious impact on children.
  • Data from the Youth Behavioral Risk (YRBS) in the San Diego Unified School District, echoes this concern, as 40% of high school students in the school district reported feeling sad or hopeless almost every day, with 21% reporting having seriously considered suicide.
  • Death by suicide is the most common among males, people 65 and older, Non-Hispanic Whites, and people living in the East region.

"East County Health: A Community Conversation" Event

In April 2025, the Grossmont Healthcare District held a public event, "East County Health: A Community Conversation," to discuss these findings with presentations from local experts, Lindsey Wade and Stephanie Phann (Hospital Association of San Diego/Imperial Counties), Captain Joseph Thomas (CAL FIRE) and Amy Dull, RN (Sharp Grossmont Hospital, and Suhail Zavaro, MD. The event was a discussion forum for the East County community and community partners, with the District's Board of Directors and other public officials and their representatives also in attendance.

We asked East County additional discussion questions and received the following responses:

• Are there any specific sources of chronic stress that are more severe for people who live in East County? If yes, please describe.
  • "I think many people in East County are struggling with stress like mental health and instability, especially high-risk populations like children in foster care, senior citizens, and people with disabilities. This can lead to homelessness and other issues like drug use."
  • "I was diagnosed with stage four lung cancer back in 2022…I have never smoked in my life. But a study just came out from the American Lung Association that San Diego has high levels of particulate matter, which comes from fire and auto emissions and ozone levels. And all I could think about when I was diagnosed was that 2003 Cedar fire. You know, because they said I'm super healthy. My heart's strong. I surf, I hike. I spend time outdoors. Now we can't even go outdoors. And that's something that's also really concerning to me."
    
• How could hospitals and other health care providers better support patients who are dealing with ongoing stress?
  • "One that I hear about from the African American community a lot is when patients are seen by doctors, they often complain they feel their comments are ignored. They try to explain what's bothering them and don't feel they are taken seriously. They also feel that they're not getting the same care as others. Whether it be for medication, they don't feel doctors believe them when they say they have pain. It's an internal issue directed mostly at doctors, not nurses."
  • "There's a lack of cultural competency in mental health services that address the needs of refugee and immigrant communities. Most of the services they use require interpreters. For example, if I have issues with substance use, there is a lot of shame and blame. I do not feel comfortable bringing up these concerns with my own community, so we need to find ways to bring services directly to them."
    
• Have stress or challenging life circumstances affected your ability to get the health care you need? If yes, please describe.
  • "Yes. Managing the care of my aging and ailing parents while managing and maintaining my own health."

The Grossmont Healthcare District is committed to supporting the health and wellbeing of those we serve through strategic investments, partnerships, and programs that expand access to quality care, promote wellness, and elevate health education and healthcare workforce training. Stay tuned for Part 2 of this series showcasing how, as a public agency, we've already begun addressing some of these community needs.

If you would like to add any additional comments, feel free to send them through our Community Health Survey link.