Tuesday, October 13, 2015

Adolescence, health, and rural California.

Some background:
In looking into what is a hidden problem in the state of California I relied heavily on the California Adolescent Health Collaborative. The Collaborative has a series of reports that tie together the issues many adolescent rural residents face in California. The reports draw on statistical data analysis that a variety of third parties assembled. Please note that I did not cover sexual health of adolescents, which is potentially an entire topic in and of itself.

California has the largest Latino community in the United States. In part because of the need for workers and in part because of its close border proximity. Roughly 53% of the rural California residents born outside of the U.S. are Latino. On average, there is one doctor for every 935 residents of a rural county. In contrast an urban county has 460 residents per doctor. Roughly 45% of the state's rural residents live in areas designated as, "primary care shortage," regions. Rural residents are more likely to list their health as poor, have a higher rate of asthma, and live in highly toxic and polluted areas, where funding does not exist to clean up the environmental waste.

In addition to the poor environmental and health options is the poverty. In the U.S. 47% of rural children born into poverty will be Latino. Roughly half of the mothers are undocumented workers, working in low paying jobs. Even if both parents are working fulltime they are likely to remain in poverty and be exposed to vermin, poisons, and assorted chemicals. Some children will be born within range of industrial strength pesticides.

Because of their rural location and possible immigration issues migrants have difficulty accessing even fundamental services. Rural residents in general have difficulty accessing basic services but undocumented immigrants are suffering far more.

The state of California should consider possible remedies, such as increasing incentives for doctors to go into rural areas, through tax incentives, research grants, or paying doctors a respectable wage to encourage medical professionals to enter the rural areas. In addition the state should strongly consider how to provide regions with the funding needed for environmental cleaning. This could include raising taxes on the industries that caused the pollution in the first place.

Adolescent health access:
In California there are 183 school health centers. 22 of those are in rural areas. In many areas there are small satellite clinics for health care emergencies, often within walking distance (refer to the previous link). However, rural residents often rely on cars for transport to proper healthcare facilities. Teenagers report discrimination, knowledge of health services but no way to access such services, and difficulties with their insurance being accepted. It's common for Imperial county residents to find transport and cross the border to Mexico, where healthcare is cheaper. Finally, there is a significant language barrier. Many facilities do not have interpreters or bilingual staff members. adolescent patients reported difficulty communicating what was wrong with their health that had driven them to a healthcare facility. This is particularly troublesome when an estimated one-third of Latino children in rural areas suffer from depression. Those suffering depression in rural areas are unlikely to seek help due to social and cultural pressures, the addition of a language barrier hardly helps.

Another concern with the lack of health access is asthma. In the Central Valley region roughly 72% of children ages 12-17 report asthma symptoms, with no proper medical care. In contrast, California children (including Central Valley residents and other polluted regions) has a rate of 56%. This is a symptom of the massive amounts of pollution that residents face.

Death and rural counties:
In the California rural adolescent residents face higher than average rates of homicide, suicide, vehicular death, assaults, and motor vehicle accidents, higher than in many other states. Due to poor road conditions, limited education on safe operation of a motor vehicle, and delays in receiving trauma care, motor vehicle injuries and deaths in some counties far surpass the national average (P. 2-3).

In terms of homicides, assault deaths are significantly higher among males in the 20-24 age bracket, in largely rural counties. Monterrey county leads the state in homicide deaths, with five other rural counties rounding out the top ten (Kern, Tulare, San Joaquin, Stanislaus, and Merced) (P. 3).

In general the 10-19 age bracket for California Latinos is depressing. 8.8 per 100,000 residents die per year. In contrast the California 10-19 overall average (including Latinos) is 6.6 per 100,000 (P. 4).

Possible actions:
The state needs to reconsider its financial priorities. Latinos account for over 40% of the state's population. A well known fact is that populations with high rates of health issues are a financial burden on the state as a whole. Further, the potential for crime waves increases with poverty, as young people look to improve their situation, with very little to lose and everything to gain. At present the state spends $49,000 dollars per prisoner in the state prisons. The state has spent 4 billion dollars on its death row inmates. Perhaps it's time to seriously consider how to differentiate between threats to society and alternative punishments, in order to shift funding to communities that desperately need resources. The state needs to ensure its populace has adequate healthcare, clean air, and is relatively free of environmental hazards. Resources needs to be reallocated to cover this or the long term effects have the potential to be disastrous.

Related links:
For more the following links are tangentially related. Please see here, here, here, and here.

1 comment:

Daniel Quinley said...

The numbers are shocking. I don't quite know what to say beyond that. The disproportionate location of health centers in schools is perhaps the thing that is most troubling to me (beyond the money spent in prisons instead spent on kids). Only 22 in rural areas. I understand that there is a cost benefit analysis that goes on, and that simply maintaining the infrastructure in rural areas dramatically increases costs, because rural California cannot support the economies of scale that its coastal cities maintain.

But still. We know the Central Valley is in constant non-attainment of CAA regulations. We know that agriculture and rural work has negative impacts on health; and yet the state is still content to not invest in providing adequate healthcare in those areas. A re-evaluation of state priorities would certainly be beneficial--along with some cost trimming from urban-centralized bureaucracy to allow more funding to reach the rural areas where it is needed more.