The California Health Report 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 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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By Marty Graham

The 14-acre certified organic farm at the south edge of the San Pasqual Academy is surrounded by commercial farms, orange and grape trees on three sides.

It’s a rich metaphor for the academy itself, an organic local effort that’s meant to anchor its community to healthy food, one that’s grown jobs and centered the way the students live.

And it has been more than a farm. According to San Diego organic farmer Scott Murray, who helped launch the farm, it is a hands on part of what the academy tries to teach its residents, teenagers in the county foster care system who have run out of housing options and are within a few years of aging out of the system.

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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.

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By Leslie Griffy

Agricultural businesses and the insurance companies that serve them are scrambling to prepare for the changes that health care reform will bring over the next few years.

Many smaller farmers struggle with the details of the Affordable Care Act, such as how to count seasonal farmworkers to determine who they must insure. Employers of more than 50 will face fines if they don’t insure eligible workers.

Meanwhile, three of California’s agricultural-focused health insurance providers required waivers from ACA rules to continue operation. Those waivers expire next year.

“There is a lot of confusion,” said Norm Groot, president of Monterey County Farm Bureau. “I think everyone is really put off with the amount of complexity, particularly for agriculture.”

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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.

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By Hannah Guzik

Demetria Martinez is sitting in a state funded children’s center in Oxnard, wrapping her baby daughter in a shawl, when worry invades her face. Her daughter is sick, she says. Something about her heart. The doctors told her, but she didn’t understand.

Martinez is speaking Mixteco—an indigenous Mexican language full of clicks and tones not used in English or Spanish—but she conveys her emotion without words too. Twisting the ends of her rebozo, frayed from all the baby wearing and worrying, she says what she does understand is that she’s still making payments on a $1,700 hospital bill for the tests doctors did on her 5-month-old daughter.

“I can’t afford it,” she says, speaking through an interpreter. “I’m worried too much about it, and I don’t know what to do. They said her heart isn’t working right. They said her heart is not OK.”

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By Daniel Weintraub

Nearly one in every four California kids lives in poverty – a familiar but still-stunning statistic in a land as plentiful as ours.

You would think this would be the top focus of the state’s policymakers – on the left and the right. Either by increasing public assistance, or increasing economic opportunity, or both, California must do something to lift the next generation out of this condition or risk supporting a permanent underclass for decades to come.

That’s why a recent report card on the wellbeing of children from kidscount.org, a project of the Annie E. Casey Foundation, is worth reviewing.

California, a state with an income per person ranked 15th highest among the states, finished 41st on the foundation’s broad-based measure of the condition of America’s children.

On 16 measures of economics, education, health and family and community characteristics, California kids rank near the bottom nationally.

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By Minerva Perez
California Health Report

Central Valley communities have the highest percentage of youth in the state who are not working and not in school, according to a recent report. Advocates in the afflicted counties say there is a way to help these so-called “disconnected youth” by building a council specifically aimed to address their needs.

The report, compiled by kidsdata.org and derived from the 2010 Census’s American Community Survey, cited Merced County as having the highest percentage of disconnected youth ages 16-19 with 13.5 percent, the highest percentage in all of California.

“Merced already has a reputation of ‘there is nothing to do around here’ so it’s not very surprising,” Michelle Xiong, the youth coordinator for the Merced’s Building Healthy Communities initiative, said of the indicators. “It’s still sad that this is what we are known for.”

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By Kate Moser
California Health Report

California has some of the nation’s toughest laws meant to ensure equal health care services for people who aren’t fluent in English.

But many limited English-speaking patients still lack the interpreters necessary to have meaningful communication with medical providers, particularly in emergency scenarios. The problem is acute for the communities of indigenous Mexican immigrants in California, advocates and practitioners say.

“The root of the problem is that until fairly recently, the huge indigenous population in California was under the radar,” said Sandra Young, a family nurse practitioner at a clinic in Oxnard and the president of the Mixteco/Indigena Community Organizing Project.

Many indigenous Mexican immigrants are farmworkers, the most recent arrivals in the state’s agricultural labor market, according to the Indigenous Farmworker Study, a California Endowment-funded study completed in 2010.

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By Daniel Weintraub

It’s fair to say that California is the richest state in the nation. We have more millionaires than any other state, and mansions dot our coastal bluffs and inland canyons.

But California is also, arguably, the poorest state in the nation. We have more people in poverty — 6.1 million — and more children in poverty than any other state.

Even more ominously, a new measure of poverty shows that California has the highest percentage of its population living below the poverty line.

By the traditional measure, California’s poverty rate is 16.6 percent, 20th in the nation. But the new, supplemental measure released last year by the Census Bureau puts California at the top of the list with a poverty rate of 23.5 percent.

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By Leslie Griffy
California Health Report

When students start school in the Salinas Valley town of Bradley, they bring with them with pens, paper and notebooks. The school district provides their water bottles.

That is because tap water in this south Monterey County school is undrinkable. It’s contaminated with dangerously high levels nitrates.

Bradley’s approximately 49 students, kindergarten through 8th grade, aren’t alone in their lack of tap water.

Officials at schools in San Lucas, a little less than a half hour north of Bradley, discovered about two years ago that the water from their taps isn’t safe. Filling the gap, first with county emergency funds and now with water provided by a bottled water company, was a juggling act at first.

“It was a bit of surprise and sudden scramble to think that ‘uh oh, we have to do something,’” said Principal Nicole Hester.

The Washington Union School District, off Highway 68 between Salinas and Monterey, is also without potable water.

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By Leah Bartos
California Health Report

In the coming year, millions of currently uninsured Californians will gain coverage under the federal Affordable Care Act — but that does not necessarily mean it will be any easier for them to see a doctor.

As the state prepares for the expected onslaught of newly insured patients, health-care professionals are warning there may not be enough doctors — particularly, those practicing primary care — to meet the increased demand. Some say that the problem will be even more amplified in rural California, which already suffers a physician shortage and dwindling workforce, as the majority of rural physicians nears retirement and recruitment of new doctors lags in replacing them.

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By Rosa Ramirez
California Health Report

OXNARD— The stories that Dario Gutierrez, a native of Mexico City, would hear before arriving in Oxnard two years ago prompted him to make the dangerous trek to the United States illegally. People here, he recalls hearing, earn enough to live comfortably. “Dicen que aquí se barre el dinero en la calle.”—They say here, people can sweep money off the streets.

The saying has prompted flows of people from Mexico and other parts of Latin America to migrate north for work in California’s bountiful agriculture industry. They hope for upward mobility. But the reality for many toiling in the $44.3 billion industry is different. Poor pay, which characterizes the farmworker labor force, has left many struggling to find adequate and safe housing.

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