Doctor's stories

The Social Context and Vulnerabilities that Challenge Health Care in the San Joaquin Valley of California

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Estimated percentage of children under 18 living in households with limited or uncertain access to adequate food, 2014

The overall pollution burden, which represents the potential exposures to pollutants and adverse environmental conditions caused by pollutants, is the greater than 8 to 10% in the Valley. Not surprisingly, asthma and lung diseases in SJV districts are highest in central California.  

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Percentage of children diagnosed with asthma

Scientific literature now highlights Adverse Childhood Experience (ACE) in which the number of exposures of toxic stress and trauma: child abuse, neglect, domestic violence, parental drug/ alcohol exposure, incarceration, separation, and or stress, is scored.  The greater number of ACE’s, the greater degree of maladaptive physiological, neuro-architectural, immunological, and epigenetic effects on the fetal and developing children.  The effect of ACE’s on mental health and chronic medical conditions, (asthma, diabetes, Cancer, heart disease, obesity, etc.) correlates exponentially with the number of ACE exposures. Such that, if a child has more than 4 ACE exposures the risk of developing COPD (Chronic Obstructive Pulmonary disease) as an adult increase by 260%; for depression it increases by 460%. In California the prevalence of the number of ACE with 2 or more toxic level stress exposures early in the child’s life is at 16.7%. Per, a Population Reference Bureau, analysis of data from the National Survey of Children’s Health and the American Community Survey (Mar. 2018) the incidence of parent reported of ACE scores >2 for the SJV counties is even higher: Fresno, Tulare, Madera, and Merced cities range from 17.9 to 19.3% of the population. Such that 1 out of 5 children are exposed to toxic level stress.  The consequences of that same child becoming an adult with a chronic medical and or mental condition cannot be discounted.

Health vulnerabilities in the valley are extreme and burden the limited health care systems servicing the community in SJV. The current California governor’s administration has acknowledged this fact.  Support to implement and maintain medical education and training programs with retention of providers in SJV is necessary. Specific funding allotments for improving mental health, air quality, homelessness among many other SDH’s  in the region is vital. 

Dr Nadine Burke-Harris, California first female Surgeon General, who recently visited the Valley, announced an ACEs Aware campaign. The ACEs Aware initiative is a first-in-the-nation statewide effort to screen for childhood trauma and treat the impacts of toxic stress. The bold goal of this state-wide initiative is to reduce Adverse Childhood Experiences and toxic stress by half in a single generation, and to launch a national movement to ensure everyone is ACEs Aware. ACE’s Aware is not only a complete program with training and readily available tools to implement screening, it is fully reimbursed in preventative pediatric care setting.  

Starting early, as pediatricians we can Identify kids exposed to ACEs through routine screenings and establish prevention programs in healthcare, schools and youth-serving organizations. In their critical and early developmental stages, resources allocation of health services can be provided. It is also imperative to know and stay engaged with our region’s leaders, telling our stories in health care, enlist our community partners, schools, regulatory agencies, and empower our patients and families to advocate for social and health equity.

By Dr Alya Ahmad MD FAAP

Pediatric Hospitalist

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