The new report, “Rural Poverty and Its Health Impacts: A Look at Poverty in the Redwood Coast Region,” acknowledges that sweeping coverage is “probably a long way off.”
But it underscores that preschool and early school age children are at the highest risk of poverty-related ill health: Close to 28 percent of children under five live in poverty in the four county region of Del Norte, Humboldt, Trinity and Mendocino. The report shows that the prevalence of childhood poverty in the region rose between 1990 and 2000 and that poverty rates are highest among single women with children, as well as children in general.
Jessica Van Arsdale, M.D., M.P.H., Director of CCRP’s Health Research, said, “It is very concerning that nearly one of every three children under the age of five in our communities is living in poverty. This puts these children at risk for numerous poor health outcomes, including problems with growth and development, asthma, lead poisoning, poor oral health and malnutrition.”
At the other end of the spectrum, Redwood Coast elderly—those 65 and older—suffer a poverty rate of 7.5 percent, slightly below California’s 8.1 percent and the nation’s 9.9 percent. Rates among the elderly in Humboldt and Trinity Counties did not change significantly between 1990 and 2000, according to the report, but they rose fractionally in Del Norte and Mendocino Counties.
The center’s latest report recommends hiking Medi-Cal payments, allowing rural hospitals to operate medical practices, increasing area enrollment in existing public programs, such as nutrition and public insurance, and widening broadband access.
On the Medi-Cal front, the CCRP found that recipients overuse emergency services because only a limited number of health care providers will accept such patients. Yet, emergency treatment is more expensive than preventive care and the burden on society is heavier. The study found that Medi-Cal recipients were significantly less likely than those with private insurance to have received recommended screenings for breast cancer, colorectal cancer and diabetes.
Last August, a federal court reversed a 10 percent cut in Medi-Cal payment rates imposed by the Department of Health Care Services in July, saying it would “irreparably harm” access to health care for almost seven million Californians. “The struggle is likely to continue, as the state has appealed the ruling,” the report notes.
The CCRP recommends rethinking California’s statutory ban on hospital-run medical practices. The ban is rare nationwide and lifting it “would allow hospitals to provide primary care as well as specialty care,” the report says. This would allow health care providers to serve in rural areas without the set-up costs of private practices. The study points to a national trend showing doctors are opting for salaried positions.
Del Norte County is weighing a pilot project to equip Sutter Coast Hospital with a medical practice, but it is subject to legislative approval. The CCRP concluded that medical practice flexibility would buttress recruitment and retention of health care providers in under-served locales.
Concerning improved enrollment, the study pinpointed under-utilized public programs like nutrition. By one estimate, the Redwood Coast loses more than 32 million federal dollars annually in under-used school lunch, food stamp and summer food aid.
Ease of access is essential. The report highlights Humboldt County’s nascent efforts to enroll children in Health Kids Humboldt via a single web-based system named One-e-App. Currently the number of public sector health programs available on One-e-App is limited, but it has potential to provide eligibility determination for Food Stamps, WIC, CHDP and others.
Regarding broadband, the report says the GIS maps derived from the CCRP’s recent Rural Health Information Survey can be used to identify areas with low access, both to health care and the Internet. Telemedicine access points could be created, extending services to people who are geographically isolated.
Finally, the CCRP proposals embrace broad steps to assist the four-county poor: a higher minimum wage, an expanded earned income tax credit, increased education and job training and a focus on sustainable employment.