CIRS Blog about Rural California

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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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 Anna Challet

 

The safety net for uninsured Californians is full of holes – and those holes are much bigger for the state’s undocumented people.

 

That’s one of the main findings of a new study by the statewide health care advocacy coalition Health Access. The organization’s executive director Anthony Wright says the "uneven safety net" puts the state’s remaining uninsured in a position to “live sicker, die younger, and be one emergency away from financial ruin.”

 

“Counties should maintain strong safety nets for the remaining uninsured, through the county-led programs that provide primary and preventative care,” Wright said on a press call. “Counties that do not serve the undocumented should reconsider this policy, and focus their indigent care programs on the remaining uninsured population that actually has the most need for a safety net.”

 

Over a year into the full implementation of the Affordable Care Act, some 3 million Californians still lack health insurance. For many, that’s because coverage is still unaffordable. And almost half of the 3 million are undocumented, and thus shut out from federal health programs.

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By Daniel Weintraub

California is a land of health extremes, and to see what that means, you need only travel a few miles from the state Capitol.

Placer and Yuba counties border each other about a half hour’s drive north of downtown Sacramento. Both places are largely rural. But the similarities end there.

Placer’s residents are, on average, much healthier than their neighbors across the county line. A person living in Yuba County is much more likely to suffer from chronic disease and die at an early age than someone living in Placer. In fact, Placer’s residents are among the healthiest in California, while Yuba’s are among the sickest by many measures.

The easiest explanation for the difference is wealth. Health and wealth are connected, here and almost everywhere in California and across the country. No one is sure exactly why they go together, but the answer is more complicated than the fact that people with higher incomes also tend to have better access to medical care. Even when access to care is the same, health disparities remain, because a large share of a person’s health is determined by things outside a doctor’s office or hospital room.

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