HealthyCal.org is an independent, non-profit journalism project supported with initial funding from the California Endowment. The site’s mission is to inform Californians about public health and community health issues, to engage readers in an ongoing conversation about matters ranging from health care policy to land-use, transportation, environment, criminal justice and economic policy, and to show how all of these things are connected.

 

By Derek Walter

For Jen Smith, just feeding her family requires mind-bending effort — three times a day. That’s because her 8-year-old son Marty Smith is allergic to a host of foods, including those that contain or are cooked in peanut oil, soy or dairy.

He has a condition called eosinophilic esophagitiswhich is exacerbated by food allergies and causes his esophagus to become inflamed.

To get dinner on the table, Smith, a teacher in Clovis, must carefully examine all ingredients and find recipes that work with her son’s limited diet. She ends up spending hours each week on extra food prep for her son and hundreds of dollars annually on specialty foods that her son isn’t allergic to.

Coping with food allergies can be daunting for any family, but, due to the extra labor and grocery costs, they often hit low-income families hardest.

“When you buy packaged foods expect the price to double or triple,” said Smith, who carefully budgets food expenses to feed her family of five on a teacher’s salary. “If I’m baking something with chocolate chips, I have to use a specific brand that is far more expensive. But it’s the only choice, because everything else is made with soy.”

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By Hannah Guzik

If the federal Affordable Care Act is repealed, as some Republican lawmakers and President-elect Donald Trump have proposed, nearly 5 million Californians could lose health coverage, according to a new report.

In the last two years, the health law has enabled about 3.7 million California adults to enroll in the state’s low-income health program, known as Medi-Cal, and 1.2 million residents to receive subsidies to help them pay for insurance through Covered California. Repealing the health law could have a “devastating impact” on these groups, according to the December report from the UC Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research.

In recent days, Trump and some Republican legislators have said that they want to repeal the health law and replace it with something else. It’s unclear whether the replacement would still provide funding for health coverage to adults under Medi-Cal or provide subsidies to those who purchase insurance on the state’s exchange.

Under the ACA, the number of uninsured residents in the state has decreased by almost half, from 6.5 million in 2013 to 3.3 million in 2015, according to the report. Since the majority of the health law’s provisions took effect in 2014, California has seen the largest decline in the uninsured rate of any state nationwide.

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By Claudia Boyd-Barrett

Amid life’s everyday challenges and responsibilities, two worries weigh constantly on Jorge Zaleta’s mind.

The first is the health of his intellectually disabled son, Jorge Zaleta Jr., who at 15 years old needs around-the-clock supervision.

Second, Zaleta worries about his and his wife’s undocumented immigration status, which he fears could get them deported from the United States at any moment — leaving their son, who is an American citizen, to fend for himself.

“You’re always living under that uncertainty, that from one moment to the next, (while you’re) walking in the street or driving, you might get stopped,” said Zaleta, a Spanish speaker who immigrated to the United States 17 years ago and lives in Oakland. “We don’t have stability as a family to be able to give (our son) stability.”

Zaleta and his wife are among hundreds, if not thousands, of undocumented parents in California struggling to take care of U.S.-born children with special needs while at the same time living in fear of deportation. These parents face the same pressures any parent of a special needs child contends with: making sure their child gets the medical care, therapy, educational help and supervision they need, while balancing jobs and household responsibilities. But these families also grapple with the uncertainty of living in the shadows, and are barred from receiving the full range of government assistance that could help them care for their disabled children.

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By Lynn Graebner

One third of California residents and half of the state’s children qualify for Denti-Cal, the state’s Medi-Cal dental program. So leaders in counties like Santa Cruz, where 82 percent of the dentists don’t take Denti-Cal, are seeking new ways to serve this long-suffering low-income population.

“Most California dentists want nothing to do with Denti-Cal,” stated an April report by the Little Hoover Commission, an independent state oversight agency. It hammered Denti-Cal — calling it a broken system that has alienated its partners in the dental profession. Less than half of Denti-Cal beneficiaries use their benefits because they simply can’t find a dentist who will see them.

That has left counties, community clinics, nonprofits and private dentists to cobble together programs and safety nets for thousands of residents. Some of those are showing promise and some counties plan to expand them by applying for part of the $740 million state and federal agencies have allocated for the new Dental Transformation Initiative. It is meant to incentivize more dentists to offer preventative dental care to children.

While the California Dental Association, counties and private dentists say this is an encouraging step, there’s a long way to go to reviving the dysfunctional system, they say.

Dientes Community Dental Care, a community dental clinic receiving federal funding through Santa Cruz County, decided to commission its own report: Increasing Access to Dental Services for Children and Adults on the Central Coast, released in April. It showed that of the 80,000 people on Medi-Cal in Santa Cruz County, only 31 percent of them were able to see a dentist in 2014. Thirty-one percent of children under age 11 in the County have never seen a dentist and seniors on Medicare have no dental benefits except for extreme needs.

“Insurance does not equal access,” said Laura Marcus, Dientes’ executive director.

Despite its expansions, Dientes has to reject about 20 calls daily for dental service. Gaye Hancock was among them. She lost her job during the economic downturn and is working again but now has Denti-Cal. She started calling Dientes two years ago and finally resorted to getting her teeth cleaned at the Cabrillo College Dental Hygiene Clinic by student hygienists. They found cavities and bone loss which have forced Hancock to chew on just one side of her mouth since 2014.

“I’m 63, I’m just fighting to keep my teeth healthy,” she said.

As a result of the Santa Cruz report, the Santa Cruz County Oral Health Access Steering Committee emerged, including Santa Cruz and Monterey County government, education and dental industry representatives among others. They plan to present strategies in December 2016.

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By Claudia Boyd-Barrett

It took a year for Elvira Gomez of El Monte to realize something was wrong with the therapy her son was supposed to be receiving at school.

Jose Antonio Suarez, then 5 years old, was scheduled to see a therapist once a week in his kindergarten class at a Los Angeles County elementary school. But in 2014, a year after the therapy started, Gomez had yet to see any improvements in her son’s hyperactive and aggressive behavior.

“I went to the school and asked, ‘How often is the therapist going (to the classroom)?’” recalled Gomez, a native Spanish speaker. She was shocked to find out that the therapist came only once or twice a month.

“I thought, I have to be more on top of this,” she said.

Gomez is one of thousands of parents across the state who have struggled to get their children adequate mental health services at school. She’s also part of a population that advocates believe is especially vulnerable to having their children’s special education and mental health needs neglected: parents with limited English skills.

Legally, school districts are supposed to provide students experiencing emotional and behavioral difficulties with mental health assessments and individualized services to help them benefit from their education. But a report earlier this year by leading advocacy organizations found half of all students with these difficulties get no mental health help at all.

Other students who do receive services, the researchers found, frequently don’t receive them enough or don’t receive the right kind of intervention to make a difference.

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By Derek Walter 

It’s not just students that are trekking off to school for another year of learning. Many parents will be headed to class as well, as schools are ramping up their efforts to make sure they see parents more often than at the beginning of the year or back to school night.

The goal isn’t to find volunteers to make copies, but to partner with parents in helping to improve student nutrition, sleep and other health habits that can impact school performance.

Schools are now required to address parent engagement as part of the state’s Local Control and Accountability Act, a law implemented in 2013 that gives school districts more autonomy over their own funds.

Some districts, particularly in the Central Valley and Los Angeles area, are taking advantage of the new law and hoping parent outreach translates into better student health and academic performance. The thinking is that parents who are more involved will feel a greater tie to the school and will motivate students to be more engaged.

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By Fran Kritz

Dozens of freshmen headed to Humboldt State University this fall will have access to something most many of their classmates take for granted: a credit card they can swipe in exchange for food.

During the spring semester a new debit machine was installed at the university’s College Creek Marketplace, which lets the market now accept electronic benefit transfer (EBT) debit cards for many grocery purchases.

EBT was formerly known as food stamps, and now called the Supplemental Nutrition Assistance Program or SNAP. The marketplace is the only campus food outlet, for now, that accepts the cards. And Humboldt State is one of the few campuses anywhere in the U.S. that lets students, faculty and staff use an EBT card for grocery purchases.

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By Hannah Guzik

The sun has just nosed above the horizon when Maria Espinosa (not her real name) ties a bandana over her face to protect herself from pesticides and dust, and reaches for a blackberry bush. Paid by the amount of berries she picks plus a $3-per-hour wage, Espinosa works feverishly for 10 hours, stopping only briefly for short breaks and lunch. For that day in early May, Espinosa would receive no overtime pay.

California’s 441,000 agricultural employees harvest one-third of the nation’s vegetables and two-thirds of its fruits and nuts. The state’s 76,400 farms and ranches earned approximately $54 billion for their 2014 harvests, according to the most recent crop report. Yet the median personal income of farmworkers statewide is just $14,000 a year.

Unlike nearly all other employees in the U.S., farmworkers aren’t eligible for overtime pay unless they work more than 10 hours a day or 60 hours a week. Because of pressure from Southern lawmakers who wanted to maintain a low-wage black workforce, farm workers (along with domestic workers and other primarily African-American workforces) were exempted from the 1935 National Labor Relations Act, leaving them without federal standards for overtime pay, basic union organizing rights and other worker protections.

“We work very hard and make little. … Why should we be treated differently?” Espinosa says.

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By Derek Walter

When Alexis Gonzalez tells her story about overcoming child abuse, she’s surprised by how many people it resonates with. At one event after another in the Central Valley, she’s approached by audience members who can relate.

“People would disclose their own abuse and that they had never told anybody,” said Gonzalez, now 21. “People are actually taking something away from these public speaking experiences, and it’s started to become a natural part of my healing process. At first it was something that was part of the process to help myself, but it’s also been inspiring to do this for other people.”

Gonzalez, who speaks on behalf of the Fresno County Council on Child Abuse Prevention, was molested by her paternal grandfather when she was a girl. For years she suffered in silence, but is now sharing her story in the hopes that it can prevent other Central Valley children from experiencing abuse.

Children in Fresno and Tulare counties, which make up a large portion of the valley, are more likely to experience abuse than most of those that live elsewhere in the state.

Child abuse can take many forms — including neglect through malnutrition, emotional trauma or sexual abuse. While they don’t inherently cause abuse, poverty, drug addiction and family dysfunction can create environments where problems are more likely to erupt, experts say. Thousands of Central Valley families struggle with this toxic mix, punishing the most vulnerable.

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By Derek Walter

The Central Valley has long been plagued with some of the dirtiest air in the nation. It usually hits those with the most vulnerable lungs the hardest, including elementary school-age kids with asthma.

While the Valley’s air is trending in the right direction, it’s still a challenge for schools to facilitate physical education and outdoor sports, especially with the pressure to fight childhood obesity by keeping kids active.

Schools are turning to a number of solutions that leverage a real-time air-quality monitoring network with creative ways to keep kids moving even when they need to head indoors. As we inch towards the summer months and the temperature rises, schools are working on their alternative physical education plans.

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By Fran Kritz

Since Jan. 1, thousands more kids in California have had improved access to breakfast and lunch at school for little or no cost.

That’s when a new law took effect requiring schools that serve subsidized federally funded meals and post the application forms online to have those applications available in multiple languages. The new law will make it easier for non-English speaking parents to apply for meals for eligible kids.

“It is simply unconscionable that there are children who go throughout the school day hungry due to something as simple as a language barrier…” said State Senator Tony Mendoza, the bill’s sponsor.

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By Matt Perry

As farmer’s markets explode all over California and people start to view food as a form of medicine, family farms are emerging as the backbone of a blossoming “shop local” movement and the desire to reconnect with both neighbors and nature.

Yet an aging California population also means that older adult farmers – “agrarian elders” – are retiring at a record rate and taking decades of irreplaceable wisdom with them.

A California farming organization is now on a mission to help keep these small farms in the hands of family members or trusted employees to retain this important heritage.

For the past 15 years, California FarmLink has been fostering farm succession using a team of advisors around the state and “toolkits” to help with the process.

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By Lily Dayton

Some days, Celia Díaz doesn’t want to get out of bed. But, since she’s the major wage earner in her household, she doesn’t have much choice. Six days a week, she drags herself to the Santa Cruz restaurant where she works 10- and 12-hour days as head prep cook. She rarely gets a break and often goes the entire shift without sitting down. She’s developed arthritis in her fingers.

“There are times I want to quit,” she says in Spanish, speaking while she eats tortillas and frijoles for breakfast in the dim light of her tiny kitchen. “But I can’t because many jobs pay less for more work.”

Díaz, whose name has been changed to protect her identity, has to work more than 60 hours a week in order to make ends meet on her $11.50-an-hour wages. Still, her paycheck—which never includes overtime pay (she’s paid in cash for anything above 40 hours)—doesn’t come close to covering the cost of living in this coastal California town. So she, her husband and their two small children share a cramped two-bedroom apartment with four other adults. Their living room is dominated by a metal-framed bunk bed. The other adults in the house earn less money per hour than Díaz.

They are all members of Santa Cruz county’s “working poor”—the population of low-wage earners that was the focus of a recent UC Santa Cruz study, “Working for Dignity,” led by sociology professor Steve McKay. Based on interviews with more than 1,300 people, the study looked at working conditions of the county’s lowest-paid workers, at the same time putting human faces on the unseen labor force that supports the base of the Central Coast’s economy. The final report was released in August.

“This was a ‘census of the invisible,’” says McKay, who directs the UC Santa Cruz Center for Labor Studies. “Our goal was to look at the numbers, but also tell the stories of low-wage workers in Santa Cruz County.”

The report’s release is timely. While the nation debates raising the federal minimum wage in response to the “Fight for 15” movement that has mobilized low-wage workers in cities throughout the U.S., the Santa Cruz City Council recently commissioned a study looking at the impacts of a local minimum wage increase. Other California cities have already began raising their local minimum wage incrementally, with San Francisco planning to reach $15 an hour by 2018 and Los Angeles planning to do the same by 2020.

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By Lily Dayton 

As summer wanes and students head back to school, farmers on the Central Coast are draping fields with plastic, preparing for fall fumigations that will sterilize soils before the next growing season. And if previous years’ trends continue, more than 35,000 Monterey County schoolchildren will attend schools near fields treated with high levels of potentially dangerous pesticides—including chemicals that are known to harm the brain and nervous system, cause genetic mutations and disrupt hormonal regulation.

“I’m really worried about our students and how it affects their developing bodies and brains,” says Karin Wanless, an intervention teacher who works with kindergarten and first-grade students in the Pajaro Valley school district, which straddles agricultural areas in both Monterey and Santa Cruz Counties. Some schools within the district are surrounded by fields ranked highest in the state for pounds of pesticides applied, yet application regulations differ between the two counties.

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By Lily Dayton

In the predawn hours of Oct. 3, 2012, two farm labor crews arrived at fields southeast of Salinas to harvest lettuce. A light breeze blew from the north across rows of head lettuce and romaine. As the sun rose higher in the sky, the workers started to smell an acrid odor that some described as paint, others as cilantro seeds or diesel fumes. The workers’ eyes began to burn and water; many complained of nausea, headache, dizziness and shortness of breath. No pesticides were being sprayed at the time, but still, the workers were displaying classic symptoms of pesticide illness.

The source of the odor was drift from a pre-plant strawberry field—a 25-acre barren plot of soil that had been fumigated the day before with a mixture of highly toxic and volatile chemicals 1,3-dichloropropene (also called 1,3-D and sold under the brand name Telone) and chloropicrin.

On the morning of Oct. 2, the fumigant had been injected into the soil through a drip irrigation system beneath high- barrier tarps. Eighteen hours later, 43 people—many of them working as far away as 2,000 feet south of the field—were sickened from poisonous gases that had escaped.

This case, like so many others listed in the state’s Pesticide Illness Surveillance Program, highlights a major problem with pesticides—they don’t necessarily go where they’re intended and, once applied, they don’t necessarily stay there.

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By Hannah Guzik

Although more than half of California’s children are enrolled in the state’s low-income health program, the state does not report how many of them are born at a low birth weight, receive a developmental screening in their first three years of life or have a suicide-risk assessment if they have a major depressive disorder.

These are just a few of the indicators that the federal government uses to assess the quality of the Medi-Cal program, which will cost the state about $18 billion this year.

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By Lynn Graebner

Thousands of residents in rural disadvantaged communities in the Salinas Valley may soon have help avoiding drinking water from domestic wells and small water systems contaminated with dangerous levels of nitrate.

A grass roots pilot project by the Environmental Justice Coalition for Water (EJCW) is helping rural low-income residents organize their communities so they can apply for grants for drilling new wells or for infrastructure to connect to municipal systems.

“We’re trying to connect people into a regional network,” said Vicente Lara, Central Coast program coordinator for the Coalition. “A lot of people think they’re the only ones experiencing this problem. This is a regional issue.”

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This is the second in a series of stories about how health care reform is affecting newly insured Medi-Cal patients.

By Robin Urevich

The Affordable Care Act, with its promise of health care for most Americans, represents a welcome step forward for physicians who have cared for the uninsured.

Michael Core, a primary care doctor at The USC Eisner Clinic, treats some of the city’s poorest people in a spare no-frills office just south of downtown Los Angeles. Core says it’s great that his previously uninsured patients have access to a range of specialists that they never did before—at least on paper.

Many of them are part of the ACA’s huge expansion of the state’s Medi-Cal program. State officials say the increase in recipients—3 million new enrollees in 2014— hasn’t affected the quality of service they receive, but both patients and physicians report potentially dangerous long waits for specialty care.

Many of the newly insured are baffled by insurance and have trouble navigating the health care system. Core now spends much of his time deciphering his patients’ paperwork and helping them cut through insurance company red tape.

Many of the clinic’s patients come from the communities just south of LA’s central core, where incomes are low and many people live in crowded conditions. The area suffers a severe shortage of primary care doctors and dentists and is considered medically underserved by the federal Department of Health and Human Services.

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By Hannah Guzik

A group of 13 women sit in a circle under a painting of ancient Mesoamerica featuring the first indigenous president of Mexico, Benito Juárez. Under the painting is a quote by Juárez, in Spanish. Translated, it reads, “Among individuals, as among nations, respect for the rights of others is peace.” The room is sparse, with folding chairs, incense burning on a small table and blocks in a corner for the toddlers who sometimes come with their mothers. The women, wearing the same jeans and T-shirts they wear to work in the fields, sip tea in paper cups. There’s a printout of a chrysalis and butterfly taped to the wall.

The women here at the Mixteco/Indigena Organizing Project in downtown Oxnard are part of a new support group and are learning how to manage stress and deal with difficulties in their lives, sometimes including domestic violence and mental illness. As indigenous people, they’ve felt their “outsider status” in both Mexico and the United States. They face other troubles every day as members of an often invisible minority group in California.

The support group is sponsored by the nonprofit Organizing Project, formed in 2001 to help indigenous immigrants in Ventura County and statewide. As the Affordable Care Act has expanded health care to much of California’s population, the nonprofit has stepped up the services it offers to those who have been largely left out of health reform: undocumented residents.

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By Fran Kritz

President Obama’s executive action on immigration, announced in November, could potentially come with a much sweeter — and healthier — deal for undocumented immigrants in California than in the rest of the country.

While undocumented immigrants in the U.S. do not qualify for coverage under the Affordable Care Act, California law allows “certain lawfully present immigrants” to be covered by Medi-Cal, the state’s low-income health program. Immigration experts say they expect that provision to apply to the new Deferred Action for Parental Accountability program announced by the president, which allows undocumented people who have a child who is a U.S. citizen or lawful, permanent-resident to apply for a work permit and deportation protection if the applicant has been in the U.S. since Jan. 1, 2010.

Over four million people in the U.S. are likely to qualify for the program beginning in 2015, and over a million of those live in California, according to the National Immigration Law Center in Los Angeles. That means more than a million Californians could be newly eligible for Medi-Cal, if their incomes are low enough to qualify.

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