CIRS Blog about Rural California
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.
By Lynn Graebner
Counties all over California are cheering the state’s decision to expand Medi-Cal to more than 1.4 million low-income adults – and bracing for the $1.3 billion the state expects to take away from county health services over the next four years.
Counties should see savings on January 1, 2014, when Medi-Cal expands to include childless adults under the age of 65 with incomes less than 138 percent of the federal poverty level or $15,856 for an individual annually. The federal government will pay 100 percent of the costs for new enrollees from 2014-2016 and 90 percent in 2020 and beyond.
“On paper, you’d think there would be savings,” said David Luchini, Assistant Director of the Fresno County Department of Public Health. But the UCLA Center for Health Policy Research predicted in a Sept. 12, 2012 report that three to four million Californians would remain uninsured in 2019. Counties say it is way too early to count on savings from the ACA and to chop away at county health care safety nets.
By Leah Bartos
With all Americans required to enroll in health insurance under the Affordable Care Act, will the existing safety net clinics become a thing of the past?
For generations, grassroots-style community clinics have worked to fill the coverage gap. Their mandate: to treat any patient who walks in the door, regardless of ability to pay.
But by January of next year, all those patients should have health insurance. In theory.
Despite the requirement — and penalty fee for noncompliance — a projected 3 to 4 million Californians will remain uninsured through 2019, according to a UC Berkeley Labor Center study. Of the remaining uninsured, the report projects that nearly 40 percent still won’t be able to afford coverage, and that three-fourths will be U.S. citizens or lawfully present immigrants. More than half will include households with incomes at or below 200 percent of the federal poverty level.
For many, California’s safety net clinics will continue to be their best — or only — option for care.
Recovery in the Valley
California began to recover from the 2008-09 recession in 2012. Employment rose from 16.2 million in January 2012 to 16.5 million in November 2012, and the unemployment rate dropped from 11.3 to 9.8 percent.
In Fresno county, a bellwether for the San Joaquin Valley, the labor force was stable at 441,000 in 2012 but employment rose from 367,000 to 380,000. Fresno's unemployment rate dropped from 17 percent in January 2012 to 14 percent in October 2012.
The Great Valley Center released a report on the air, land and water in the San Joaquin Valley in July 2012 that emphasized the need to further improve air quality, preserve and enlarge water resources, and adopt green technologies to support sustainable San Joaquin Valley growth. San Joaquin Valley air quality is improving, but the "easy" or less costly reductions in emissions have already been made.
The report analyzed grant programs that subsidized the replacement of older cars and tractors with newer ones, but did not analyze whether subsidized replacement programs were the best way to use limited tax monies to improve San Joaquin Valley air quality.
Despite the most stringent regulations in the U.S., agricultural workers in California continue to die from heat related illness, a preventable outcome, and are at higher risk than other workers exposed to hot environments. The search for effective and feasible solutions must involve diverse approaches appropriate for hired farm workers.
A current research project titled, “Reducing the risk of heat-related illness in western agricultural workers” brings together investigators from medicine, epidemiology, public health, physiology, rural sociology and community outreach and education. The group’s goal is to obtain novel data on internal body temperature as it relates to crop type and geography, external heat, and internal metabolic loading.
This long-term collaborative research project between the University of California Western Center for Agricultural Worker Health and Safety and the California Institute for Rural Studies will gather behavioral, physiological and environmental data from California agricultural workers and environments that will allow us to assess vulnerability to heat related illness, provide the methodology to test potential strategies in the fields, and disseminate results to stakeholders. The project employs innovative techniques for both understanding and evaluating potential solutions to reduce the risk of heat related illness in varied agricultural settings.
According to the U.S. Department of Agriculture (USDA), nearly 100 California communities -- and more than 900 communities across the nation -- will lose their eligibility for USDA rural housing programs on October 1, 2012. Of the 97 California communities that will be impacted, 64 are cities and 33 are census-designated places in unincorporated areas. These communities are scattered throughout the state, but more than half (50) are located in the San Joaquin Valley (31) and Inland Empire (19). Not coincidentally, these two regions have been major magnets for population growth over the last several decades. A current list of communities can be accessed at http://ruralhousingcoalition.org/wp-content/uploads/2012/02/USDA-List-of-Impacted-Communities_06272012.pdf. The USDA could release a final list as early as August.
There are many issues related to California’s Central Valley that have been in the news recently. Topics such as social justice, farmworker health and labor conditions, immigration and its role in labor fluctuations/shortages, how pesticides are affecting drainwater and the health of people and animals living in the Valley and the ability of lawmakers to shift the future of agriculture in the country. This post is a collection of these issues. Hopefully this will be an opportunity to learn more about a topic you were unaware of, or a chance to learn more about issues currently influencing the region.