A new report, ordered by the state Legislature, examines the causes of nitrate groundwater contamination and identifies potential solutions to the widespread issue.
254,00: People in California’s Tulare Lake Basin (the southern San Joaquín Valley) and Salinas Valley currently at risk of nitrate contamination of their drinking water
96: The percentage of nitrate pollution connected to cropland. This occurs when nitrogen is applied to crops, but not removed by harvest, air emission, or runoff, and then leaches from the root zone to groundwater.
57: The percentage of the current population in the study area that depend on a community public water system with untreated nitrate concentrations that have exceeded the maximum contaminant level for nitrate in drinking water between 2006 and 2010.
80: The percentage of the population that could be affected by 2050, if nitrate groundwater concentration trends continue.
$20 to $36 million: The estimated cost, per year, for short- and long-term safe drinking water solutions for the two regions.
Learn more about Valley residents’ fight for clean drinking water:
Last week, I participated in an environmental justice bus tour intended to introduce the Kern Environmental Enforcement Network to community members and agency officials.
The network is the latest example of residents taking environmental justice into their own hands. (Past examples include the Arvin Bucket Brigade, and community mapping projects.) The program, which is expected to launch next month, is designed to make it easier for residents to report local environmental hazards, and for agencies to identify and investigate these issues.
The program will include a monitoring website, where people can report their concerns. Residents can also call in or text their complaints. A taskforce of community members and agency representatives will then meet and encourage the responsible agencies to investigate the complaints, and enforce existing environmental laws.
For area residents, the network is an opportunity to take an active role in ensuring environmental health laws are enforced. During the kick-off meeting last Wednesday, Valley residents and advocates said they welcome this challenge.
“We are not supposed to leave situations,” said Susana De Anda, as she described how her doctor encouraged her to leave the San Joaquín Valley, since the region’s polluted air causes her to have asthma attacks. “We can’t just leave and pick up – we have to fix the problems where we live.”
“I learned that I had to start educating myself – because otherwise, nothing is going to change,” Teresa De Anda (pictured below) said, after describing how she tried to report an incident of pesticide use on a poor air quality day, but was instead referred from agency to agency, in an instance of bureaucratic hot potato.
The Kern network is based off a similar, successful program in Imperial County, called the Imperial Visions Action Network. Residents there were experiencing their own environmental justice concerns, like agricultural burning, and the network has allowed people to shine a light on the hazards in their communities, said Luís Olmedo, executive director of Comite Cívico del Valle, the Imperial network’s lead organization.
“These communities in the eastern part of the state are not getting enough attention – they are more agricultural communities, more desert communities, and probably less influential communities,” Olmedo said. “Giving them this tool gives them the ability to have greater and better access to government organizations.”
Does this sound like a great tool for your community? Groups throughout the region – including Fresno, Tulare, Kings and Madera counties – have expressed interest in establishing their own networks, and it appears the EPA supports the project.
Through the program, residents will become “the community environmental police,” regional EPA administrator Jared Blumenfeld said during the kick-off event. “That is your job – you are the eyes and ears for all of our agencies.”
“The future face of the environmental justice movement,” he said, “is you getting equity through accountability.”
Read more about the Kern Environmental Enforcement Network in this week’s edition of Vida en el Valle.
Consider these facts, from a new study out this week:
Life expectancy varies by as much as 21 years in the San Joaquín Valley depending on zip code. Zip codes with the lowest life expectancy tend to have a higher percentage of Latino and low-income residents.
Areas of the Valley with the highest levels of respiratory risk have the highest percentage of Latino residents, while areas with the lowest levels of respiratory risk have the lowest percentage of Latino residents.
The health status of first-generation Latino immigrants is similar to the white population, but on average health deteriorates for second and subsequent generations of Latinos, largely due to economic vulnerabilities, inadequate educational opportunities, and a lack of political power relative to whites.
The report underscores the strong correlation between income and educational attainment, and premature mortality. As the income level and educational attainment of an area decrease, premature mortality generally increases, according to the study.
This information is hardly surprising. You only need to spend time in some of the Valley’s poorest communities, talking to people about their health and environmental concerns, to know there is great inequity in our region.
What struck me about this report, though, is how it frames the Valley’s health disparities in a larger social context. The report describes how the Valely is bolstered by agribusiness; neighborhoods are shaped by waves of immigration and patterns of class and racial segregation; and the region has been the home of national movements for human rights.
The report concludes:
“In this context, this study adds to the growing and consistent literature showing how the region’s striking social class and racial/ethnic health inequalities are at least partly explained by historical forces and current policies that concentrate low-income people, people of color, and recent immigrants in urban neighborhoods and rural settlements that lack many of the most fundamental supports for health and well-being.”
Does rural healthcare have a future? And how can we ensure that rural California residents have access to decent healthcare, as doctors are becoming scarce?
From my community health reporting in the San Joaquín Valley, I’ve learned that rural healthcare is essential and thriving. But there are significant challenges, too.
Dr. Victor Silva’s experiences exemplify these challenges. Silva was raised in Orange Cove by farmworker parents, and is now a medical resident with UCSF Fresno, working at Adventist Medical Center in Selma.
Compared to when he was growing up, he believes residents of rural communities now have more access to medical care, as more clinics have opened. But, he said, “as far as patients taking advantage of it – who know how that’s going.”
Transportation – especially to receive specialty care – is one of the biggest barriers to care, Silva said. His facility responds to this by bringing some specialists – like cardiologists, urologists, and orthopedists – directly to Adventist Medical Center, at least once a month.
Still, he said, “when we have to send our patients to Fresno for specialty care, a large percentage of those visits – they never make it.”
Transportation becomes a huge issue in emergency situations – like pregnancy, he said. He told the story of a pregnant woman who called an ambulance to travel from San Joaquín to Selma – a trip of at least an hour – because she was having contractions. When he asked why she called the ambulance, she said she didn’t have a ride, and she was very scared.
Residents of rural communities also face challenges in managing chronic medical conditions, like diabetes, he said. “If people don’t see the physical manifestations on a daily basis, that makes it hard,” he said. “When they are not seeing physical manifestations, they tend not to come in for just maintenance care.”
But as we will discuss during the event, providing this care is becoming difficult – especially as budget cuts strain the safety net, at a time when clinics are also preparing for the influx of new patients who will gain health insurance through the Affordable Care Act.
What other challenges does rural healthcare face? To find out, and to add your voice to the discussion, join us on Feb. 28 at 6:30 p.m. at Café Revue, 620 E. Olive Ave. The event is sponsored by The California Wellness Foundation and Valley Public Radio.
Facing a medical professional shortage that threatened to close down the tiny Ashland Health Clinic, the facility’s CEO developed an innovative pitch: Medical candidates who joined the clinic could take eight weeks off each year to do missionary work overseas.
This quote, from CEO Benjamin Anderson, explains why a mission-focused provider would be attracted to working in a rural region of the country:
“When you recruit a mission-focused provider, they want to see the ghettos,” he says. “They want to know that there’s no Spanish-speaking provider in more than a one-hour drive. They want to see houses that are falling down, widows that are uncared for. They want to know that there’s need and that by them coming there, they would fill a disparity that would otherwise not be filled. So we reversed it.”
So, would this work arrangement work in the Valley? The region has fewer primary-care physicians and specialists than are recommended by nationally recognized benchmarks, according to the California Health Care Foundation. Of Valley physicians, just 6 percent are Latino.
It could certainly help fill positions at individual clinics in the region. But I suspect that pipeline programs like the high school Doctors Academy, medical school programs – like the new UC Merced San Joaquín Valley Program in Medical Education - that train doctors to address the region’s unique medical needs, and the proposed medical school at UC Merced, will more effectively fill the critical doctor and specialist shortage in the region, over the long term.
Above, Agustín Morales, a student in the UC Merced San Joaquín Valley PRIME program, rallies in support of health care. Below, Selma High School student Karen Vásquez shadows nurses. By Héctor Navejas and Daniel Cásarez.
On the second day of his two-day tour through the San Joaquín Valley, EPA regional administrator Jared Blumenfeld visited the east Tulare County communities of East Orosi and Seville.
Standing in the driveway of an East Orosi home, Blumenfeld listened to the personal stories of community residents like Berta Díaz, in pink, who has fought for more than a decade for clean drinking water.
“I have fought with mis compañeros for eleven years, and we have not seen any change in this very contaminated water,” Díaz said.
“We are not complaining, we’re simply telling you our reality,” said Jesus Quevedo, pictured at right, as he described the health struggles of family and friends who have been sickened by the poor water.
“I’ve been having to growing up not being able to drink my tap water, which I think is something that’s not really right,” said Jessica Mendoza, 16, pictured above, at left. “All I’m asking for is just a change, because it is not just for my generation, but generations that are yet to come.”
From there, Blumenfeld traveled to Stone Corral Elementary School, where he addressed residents, including Rebecca Quintana, pictured below.
“I really wanted him to visually see what really exists,” Quintana said after the short community forum. “There is a difference between hearing and seeing. I actually wanted him to see with his own eyes what communities and their infrastructure look like.”
Hearing about residents’ personal struggles to access clean drinking water, and seeing their determination to bring potable water to their communities, seemed to leave an impact on Blumenfeld, pictured below.
“You can read statistics,” he said. “But when you meet someone with a name and a face and a child and a house – it is definitely why we all do this job. Our job is to protect human health and the environment.”
“Anyone can read about the problem… but it is one thing to read it, and it is another thing to be able to come to the actual communities that are impacted by the issue and hear directly from residents,” she said. “That makes a huge difference.”
U.S. Environmental Protection Agency Regional Administrator Jared Blumenfeld (pictured above) is expected to make some major announcements regarding health and the environment tomorrow morning in Stockton.
The announcements will kick off a two-day tour through the San Joaquín Valley that will take him from Stockton, to UC Merced, and eventually to Seville, where he will speak with Tulare County residents who can’t drink their water.
The way I see it, it’s good news anytime a public official with clout comes to the Valley and speaks with residents about air and water quality, protection of public health, and environmental justice.
These visits give residents a voice, when they often feel their concerns are ignored. And for public officials, these visits can help put a human face on the Valley’s very serious health and environmental justice concerns.
“I feel calmer,” Magdalena Romero, whose daughter was born with birth defects and died, said after meeting with Blumenfeld in her home. “I feel like a weight within me has been lifted. I feel relieved, because we are going to have answers soon.”
And that was the case when Catarina de Albuquerque, the U.N. Special Rapporteur on the Human Right to Safe Drinking Water and Sanitation, visited Seville in 2011.
“The power that I have is to draw attention to issues, and to point my finger at problems that I see in the countries that I visit,” said de Albuquerque, pictured below.
I will be tweeting updates from the road over the next two days, and posting photos on the Harvesting Health Facebook page. Follow these updates, or check out next week’s edition of Vida en el Valle.
More from Harvesting Health on environmental justice:
The New York Times and Los Angeles Times both ran stories this week about the apparent stalling of the country’s obesity rate.
Here’s an excerpt from the New York Times’ Well blog:
After two decades of steady increases, obesity rates in adults and children in the United States have remained largely unchanged during the past 12 years, a finding that suggests national efforts at promoting healthful eating and exercise are having little effect on the overweight.
While it is good news that the ranks of the obese in America are not growing, the data also point to the intractable nature of weight gain and signal that the country will be dealing with the health consequences of obesity for years to come.
But, the stories caution, there are still disparities in obesity rates. Here’s an excerpt from the Los Angeles Times story:
But though obesity rates may be flattening overall, increases and disparities can still be found in specific racial and ethnic groups.
Rates have risen to 58.5% among non-Hispanic black women and to nearly 45% among Mexican American women since 2004, for example. And among children and teens, about 21% of Hispanics and 24% of blacks are obese compared with 14% of non-Hispanic whites.
It is encouraging to hear that the overall obesity rate has not continued to skyrocket. But from recent interviews with school nurses throughout the San Joaquín Valley, I’ve heard that obesity and diabetes remain huge health issues among students.
“We are seeing a lot more overweight kids,” said Sandy Dutch, a school nurse with the Tulare County Office of Education. “Kids are concerned about being overweight.”
Being overweight or obese is not only a health problem – it can take a toll on students’ education, said Aurora Licudine, chairperson of school nurses for Modesto City Schools.
“Students who are overweight have more absences, and students who are overweight are not as academically successful,” she said.
“Our goal is to make them independent, and have them make these lifeystle changes, and that takes time.”
If the state legislature approves cuts to CalWORKS proposed in Gov. Jerry Brown’s 2012-13 budget, low-income families could lose the child care they depend on. That could cause parents to quit their jobs to stay home with their kids, and sink back into poverty.
And it could cause Sharon Esquivel – who has transformed her southeast Fresno home into a colorful day care, complete with a cozy classroom (pictured below,) a small library, and a backyard garden (pictured above) – to be out of a job.
Under the governor’s proposal, “the folks who really need help, and the folks who are struggling to get out of poverty, are left behind,” said Mike Herald, legislative advocate for the Western Center on Law and Poverty. “It’s a much higher mountain to climb out of poverty under this proposal than current law.”
The proposed cuts are a personal blow to Esquivel, who grew up in Fresno as one of 14 kids born to a poor, single mom. She goes above and beyond to provide children in her day care with educational opportunities, entertainment, and food, even though she is paid just $29 per child, per day.
“When I see these little children with their beat-up little shoes and their moms bringing them in with their little second-hand sweaters and their second-hand shorts, I recognize it, I know it,” she said. “It is deep for me to do all these things for them because I didn’t have it, and I wanted it.”
As Esquivel waits for the state legislature to determine which CalWORKS cuts will go through, her only option is to keep doing what she has excelled at for 21 years: Caring for children.
“We’re just grinning and bearing it,” she said of the proposed cuts.
More from Harvesting Health on the 2012-13 budget:
Si eres como muchos estadounidenses, aun no entiendes todos los cambios y beneficios de la ley de la reforma de salud.
Pero es muy, muy importante que la comunidad latina comprenda todo lo que ofrece esta ley, la cual entra en vigor en el 2014. Aunque casi el 16 por ciento de la población del país es latina, los latinos representan el 31 por ciento de la gente no anciana que está sin seguro médico.
“Esta traducción es un ejemplo de nuestra obligación en educar miles de latinos y personas de bajos ingresos sobre cómo va a cambiar nuestro sistema de cuidado de salud, y cómo pueden aprovechar de las provisiones de la nueva ley,” dijo el Dr. Robert Ross, presidente y CEO de The Endowment.
Si quieres aprender más, The Greenlining Institute ofrecerá una reunión sobre la ley el 18 de enero, de las 6 p.m. a las 8 p.m., en el Chicano Youth Center, 1515 Divisadero Street.
