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LHCC >> Health Issues
This page is still in progress, so there are many health issues listed without any information. We are in the process of compiling information on each of these topics. To give input into this process, please go to Contact Us. Thank you!
With a culturally and linguistically diverse population in a Valley with poor air quality and high poverty due to high unemployment, seasonal employment, and low wages, there are many challenging issues related to health care access, community health, and health status. Two of Fresno County's largest job sectors, agriculture and services, often provide neither health insurance nor paid sick leave for their employees. Medi-Cal and Medicare reimbursement rates to health care providers are among the lowest in the nation. Rural hospitals are especially struggling for survival.
The large undocumented population, ineligible for most government health programs, can depend only upon emergency room health care treatment, and then will usually be billed for an expense they can never repay. By extending hours to evenings and weekends for a short time, a local clinic discovered that those who came were primarily those for whom there was no reimbursement for the health services provided. Cultural and linguistic appropriateness is too often missing from health and social services. Some low-income seniors have had to choose between food and medicine. Transportation is a major issue. Fresno County does not have a full-time Public Health Officer to lead in public-private planning and implementation. The former Board of Supervisors did not designate any of the Tobacco Settlement funds for health care. Below are descriptions of some of the health care issues affecting the Fresno area.
The topics are clustered into categories in alphabetical order. If you would like to notify us of additional information or discuss these and other issues, please Contact Us.
Topics:
- African American Health
The Local Health Care Coalition recognizes the many disparities that exist in health and health care. For African Americans, there are many indicators of this disparity, such as higher rates of infant mortality, childhood asthma, cancer mortality, AIDS/HIV, and total life expectancy. In addition, many communities of color do not have the resources available to improve health outcomes. More needs to be done to improve the quantity and quality of health care resources and the access to health care in these communities. Please visit Roundtables to download the Notes and Evaluations from the April 2000 Roundtable on African American Health in the Central Valley.
- Consumer Involvement & Advocacy
The voices of those who utilize government services needs to be heard but oftentimes is not. There are many barriers, such as transportation and language, which keep consumers from becoming involved in expressing their concerns and advocating for their rights. Fresno Metro Ministry has received a grant from Kaiser Permanente Fresno Medical Center to be used for increasing consumer involvement in discussion and action related to health care issues in the Fresno area. In addition to opportunities such as this, consumers who would like assistance with advocating for their rights can call local legal services agencies, such as the Fresno Health Consumer Center at 1 (800) 300-1277, Central California Legal Services at (559) 441-1611 or California Rural Legal Assistance at (559) 441-8721.
- Fresno County Contract with Community Medical Centers
Ceasing its administration of the county hospital, Fresno County contracted with Community Medical Centers in 1996 for indigent care, jail health care, clinic services, and construction of a new Level 1 trauma center and burn unit.
Community Medical Centers (CMC) is a not-for-profit corporation owning several hospitals and skilled nursing facilities in the Fresno area, including University Medical Center (formerly Valley Medical Center -VMC) and Community Hospitals in Fresno and Clovis. Fresno County has contracted for 30 years with Community Medical Centers to provide the contracted services listed above.
- Downtown Regional Medical Center
CMC is planning to construct the Regional Medical Center on and around the site of the current Community Hospital in downtown Fresno. This center will house a Level 1 trauma and burn unit (the only one in Central California), the UCSF Medical Education Program, ambulatory clinics and a Medical Education Research Center. There has been community concern over delays in this project, which was originally scheduled to be completed by 2001. This date has been extended several times, and the new projected date for completion is now 2004.
- For-Profit Health Care Entities
In 1999, CMC partnered with several cardiologists to plan development of a for-profit Heart Hospital in north Fresno. There is public concern over this for-profit venture in regards to its effects on plans for development of the Regional Medical Center and effects on the general health care service delivery in Fresno. Proponents reason that the for-profit entities will enhance the non-profit sector. Opponents reason that the new for-profit will divert needed resources from downtown Fresno to the northern parts of town.
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- Environmental Health
As the primary agricultural center of the country, there are many unique environmental health issues in the Central San Joaquin Valley. Many agricultural practices increase the levels of air, water and ground pollution. These factors take a toll on the health of the farmworkers and others living in the Valley.
- Pesticide Exposure
Pesticide use in the Valley threatens the health of farmworkers and community members living near fields, as well as the general population. Unfortunately, the effects pesticide exposure are disproportionately experienced by children either directly or through reproductive effects.
- Air Quality
Fresno has some of the highest rates of childhood asthma in the country. This is no doubt at least partially due to the poor air quality in the San Joaquin Valley, second only to Los Angeles in air pollution rates. At the end of 2001, the Valley was classified as a severe non-attainment air basin, with the main pollutants being ozone and particulate matter (PM10).
- Fresno County Human Services System
The Fresno County Human Service System is a new branch of the county government that formed after the merging of the Social Services and Health Departments.
- Reorganization
The Social Services and Health Departments of the Fresno County government were merged during the 1990's into the Human Services System with the intent of streamlining and increasing continuity of services, as well as cutting costs.
- One-Stop Centers
In 1999, Fresno County opened a multi-service clinic in Selma that combines medical, social and mental health services. This center has been very successful in providing convenient and efficient services in the Selma region of the Valley and serves as a model for other counties in California. The Local Health Care Coalition supports the Fresno County Health Department's plans to replicate this center in other rural areas of the Valley.
- Cultural & Linguistic Appropriateness/Competence
A situation arose in 1999 whereby a Laotian woman with tuberculosis (TB) was placed in the Fresno County jail for 10 months for failure to comply with directions regarding treatment for her TB. This incident points to a lack of cultural competence and linguistic appropriateness, which jeopardizes access to public health services and therefore the health of the entire community. Efforts to increase and improve in-service training for county employees in cultural and linguistic competence is needed, as well as to hire more bilingual and bicultural employees.
- Employee Wages and Benefits
Unfortunately, Fresno County pays lower wages than many other counties throughout California. The employee benefits offered, especially health coverage, are minimal, with some employees paying significant out-of-pocket expenses. Employee recruitment and retention is an on-going problem that needs to be addressed as a priority.
- Public Health Officer
The Fresno County Board of Supervisors approved a decision in November of 1998 to consolidate the positions of coroner, public administrator and public guardian/health officer in the interest of efficiency and cost effectiveness. This consolidation was approved through January 2003. The Local Health Care Coalition would like to see a full-time qualified health officer who would be able to competently and efficiently take the lead in addressing public health issues for the county.
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- Health Care Access
- Language and Culture
Fresno County is one of the most culturally diverse areas in the State, with over 100 languages spoken. The Local Health Care Coalition has been involved in efforts to provide training and education programs in health care interpretation for health care providers so as to improve accessibility of health care services to everyone in our diverse Valley. Many providers simply hire bilingual staff to serve as interpreters; however, the Coalition realizes that these people must also be trained in medical terminology, interpreting skills, and rights and responsibilities as an interpreter. The Coalition further advocates continued cultural sensitivity and understanding through cultural competence training for health care providers in order to break down this barrier to health care access.
- Transportation
For those who cannot or do not wish to drive or own a vehicle, the public transportation system in the Fresno area and outlying rural areas provides limited service that doesn't always meet the needs of community members. Fresno Area Express, the city's transit system, has made improvements in the hours and frequency of service, but they struggle with an insufficient pool of resources. In the rural areas, there are stories of some people paying their neighbors and relatives unreasonable fees to get a ride into the Fresno for health appointments. The Local Health Care Coalition feels that the lack of affordable and appropriate transportation and the lack of knowledge of the transportation services available are major barriers to accessing health care services.
- Public Charge
Public charge has been a major barrier to health care access for immigrants. This is a term used in immigration law and describes persons who depend on government benefits that provide cash for their income to support their family, like CalWORKs or SSI. In 1999, the term 'public charge' was clarified by the Federal government. Those who use health care benefits, food programs, and other programs that do not give cash will not be considered a public charge. The Coalition has made efforts to inform the community, especially those who are concerned regarding their immigration status, about the new clarifications.
- Health Policy
- State Legislation
A state legislative update has traditionally been a part of the Local Health Care Coalition's Community Health Care Roundtables. To read about past health related California legislation with a focus on health access and public health, please go to Roundtables to download Notes and Evaluations from each monthly Roundtable. In addition, there are excellent web resources to research and track legislation for both the Assembly at www.assembly.ca.gov and the Senate at www.senate.ca.gov. The state budget is also important in regards to health and health care. The California Budget Project (CBP) is an organization that conducts independent fiscal and policy analysis and public education to improve public policies that affect the economic and social well-being of low- and middle-income Californians. Their website is a valuable resource at www.cbp.org. For official analysis of state legislation from the Legislative Analyst's Office, visit www.lao.ca.gov.
- Fresno County Policies
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- Managed Care
- Mental Health
- Children's Services
- Latino Mental Health Task Force - MAPPS study
- Case Management Concept
- Services for Children of Adult Clients
- Mental Health Advisory Board
- Medi-Cal (Medicaid)
- Managed Care - Blue Cross and HealthNet
- Outreach
- Effects of Welfare Reform
- Proposition 10
- The State Commission
- Children and Families Commission of Fresno County
- Public-Private Collaboration
- Rural Health
- Public Transportation
- Childcare
- Public Health
- Health Promotion
- Communicable Diseases
- Immunizations
- Teen Pregnancy
- Infant Mortality
- Health Officer Position
- Violence Prevention
- AIDS/HIV
- Hepatitis C
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- 'Safety Net' Problems
- Child Health Coverage
- Universal Coverage
- Outreach & Enrollment
- Immigration- Public Charge, INS Issues
- Paperwork Reduction
- Reduction of Forms for Government Programs
- Senior Health Care
- Home Health Nursing
- Nursing Home Reform
- Medicare - Reimbursement
- Free Health Programs
- Southeast Asian Health
- Cultural Competence
- Spiritual Beliefs
- Access to Services
- Education
- Substance Abuse
- Effective Treatment Models
- Services & Programs
- Needle Exchange
- Proposition 36
- Tobacco Settlement Funds
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