California’s Heartland, also known as the San Joaquin Valley, is considered to be the richest agricultural valley in the world. Yet, its residents experience some of the most severe health conditions in the state.

According to the most recent data available …

• One in 13 Valley residents age 18 and over has diabetes.

• One out of six people in the Central California region, or 478,000, has no health insurance.

• More than 17% of Fresno County residents have been diagnosed with asthma. Fresno County leads the Central California region and has the second-highest rate in the state.

Today, Joel Diringer, lead author of Health in the Heartland: The Crisis Continues, spoke about the Valley’s health status and why the Valley experiences such serious health conditions, during the 3rd Annua/ Central Ca/ifornia Health Conference at the Fresno Convention Center.

“Whatever progress that has been made in the health status of Valley residents in the past years has still fallen short of statewide improvements,” said Diringer.

The California Endowment funded the Health in the Heart/and project in partnership with the Central Valley Health Policy Institute at California State University, Fresno. Hea/th in the Heart/and is one of the Institute’s first publications and will be utilized to inform the San Joaquin Valley communities about the region’s current health, influence policy and promote systems.

Approximately 600 health professionals, policy makers and students from all over the Central California region attended this daylong conference as a “call to action” for healthier communities in the San Joaquin Valley. Participants of the conference had the opportunity to choose from 36 breakout sessions and 52 speakers covering the areas of: health policy, resources, public health promotion, cultural diversity, health disparities and health outcomes.

Diringer set the pace for the conference, by identifying his research and 50 health-related indicators from his recent book, Hea/th in the Heartland. Much like his 1996 report, Hurting in the Heartland, his current report focuses on the demographics of Valley residents, economic and environmental factors and health services. The report pays close attention to chronic diseases, health resources, immigrants, access to care, current health policy issues, health disparities and health outcomes. The executive summary of Health in the Heartland was released to all participants of the conference.

Over the past year, Diringer and co-authors of Health in the Heartland, Dr. Kathleen Curtis, Cheryl McKinney Paul and Danielle Deveau, studied the health conditions of the Valley’s eight counties (Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, Tulare) and the relationship among 61 community clusters in comparison to California’s health conditions as a whole.

Their report reveals that communities with poor health access are characterized by: high rates of poverty, low educational attainment, female-headed households, higher percentages of immigrants and higher percentages of non-English speaking individuals.

The report documented that…

• Children of immigrant parents are at a high risk of being uninsured.

• More than 40%, or 475,000 children, out of the total population of more than 1 million children in the San Joaquin Valley, had at least one immigrant parent.

“Evidence from a recent UCLA study shows that out of the 1 million children under 18 living in the San Joaquin Valley, an estimated 110,000 were uninsured at the time of the survey in 2001. An additional 50,000 children were uninsured at some point in the 12 months preceding the survey. Two out of three of these uninsured Valley children had at least one immigrant parent,” said Curtis.

Diringer and co-authors found that…

• In the year 2000, 27.5 % of Valley children or 287,750 lived at or below the federal poverty level, which is much higher than California’s statewide percentage of 19.5%.

• Three out of four, or approximately 80,000, Valley children were eligible for Medi-Cal or Healthy Families. Almost two out of three Valley children, or 50,000 who were eligible and not enrolled for these state and federally funded programs, had at least one immigrant parent.

Many of the parents of these children documented that they were fearful of jeopardizing their immigration/citizenship status, they were confused about eligibility criteria and simply did not know about these programs. Full enrollment of these 80,000 children could result in millions of additional dollars for the Valley’s local health economy.

Health in the Heartland revealed that 29.7% of households in the Valley spoke Spanish as a dominant language, indicating the need for medical interpreters to educate non-English speaking families about available health resources, health conditions and preventative services.

A short supply of Valley health providers already exists. During 2000-2001…

• Central California had 30% fewer physicians that the California average. There were 67.4 primary care physicians per 100,000 persons in California, compared to 47.9 physicians in the Valley.

• There were 20% fewer nurses in the Valley. Statewide there were 730 nurses per 100,000 residents, compared to 582 nurses in the Valley.

• The Valley had 40% fewer dentists than the state average. California had 80 dentists per 100,000 people, compared to 48 in the Valley.

• The Valley had 85% fewer psychiatrists, 70% fewer psychologists, 50% fewer licensed clinical social workers and 65% fewer marriage and family therapists per 100,000 persons than in California.

Between 1990 and 2000, the Valley’s population rose from 2.7 million to 3.3 million people, an increase of approximately 560,000 persons. With an increase in the number of youth, immigrants and baby boomers who are gradually coming out of the workforce, additional supportive services are desperately needed.

“Needs are increasing, fueled by our growing population, poor air quality and widespread

poverty, at the same time that resources to provide those needs are shrinking,” said Curtis.

Another challenge that Valley residents face is the daily exposure to toxic air pollutants. The San Joaquin Valley leads the nation in violations for eight-hour ozone standards. Children, parents and the elderly, who are most affected by the air, are forced to miss work and/or school. Lost productivity and increasing medical expenses are fueled by the economic impact of asthma and chronic pulmonary conditions.

In an effort to help improve the Valley’s health conditions, Dr. Philip R. Lee, consulting professor for the Program in Human Biology at Stanford University and former assistant secretary for health in the U.S. Department of Health and Human Services, delivered a keynote speech at the conference on “Health, Health Disparities, and Health Communities: From Problems to Solutions.” As an adviser to federal, state, and local health policy makers, he added a unique action-oriented approach to the conference. His key points focused on defining a health-related problem, its magnitude, actual measures of outcomes and the underfunding of healthcare infrastructure in the Valley.

Lee explained that a “paralysis state” of health care exists in the Valley and expressed the importance of community action as well as involving people affected by health problems to determine solutions.

“One thing that’s going to improve people’s health more than anything is to improve the level of education across the board,” said Dr. Lee

In an effort to initiate community action, Diringer will be presenting the findings of Health in the Heartland throughout the San Joaquin Valley at eight regional dissemination meetings, beginning February 2004. The meetings have been designed in a way so that key health professionals of each county will have the opportunity to review and discuss current health issues outlined in the book. This process is intended to create an ongoing flow of communication, initiate a response from decision makers and create policies for health care in the Valley.

“While millions of dollars have been invested in improving the health of the Valley, much more effort is needed to overcome the disparities among communities in the Valley, and its relative poor health compared to the rest of California,” said Diringer.

Dr. Benjamin Cuellar, Dean of the College of Health and Human Services at California State University, Fresno, echoed the need for a regional approach to address the serious health problems of the San Joaquin Valley. “The Central Valley Health Policy Institute exemplifies the university’s commitment and leadership role in addressing the health disparities of our region,” said Cuellar.

The Health in the Heartland report is available online at: Hard copies will be available in March 2004. For more information on how you can obtain the executive summary and full report of Hea/th in the Heart/and: The Crisis Continues, please contact the:

Central Valley Health Policy Institute

Attn: Cheryl Paul

2743 E. Shaw, Ste. 121

Fresno, CA 93710-8205

Tel:(559) 294-6097

Fax: (559) 291-7046

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