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What’s Happening in Health

  • 4 Aug 2022 1:45 PM | Jamila Jabulani (Administrator)

    By Rhonda Smith

    July was National Minority Mental Health Awareness Month, intended to bring awareness to the unique struggles that racial and ethnic minority communities face regarding mental illness in the United States. We wanted to take this opportunity to raise awareness of Tardive Dyskinesia (TD), an involuntary movement disorder associated with taking certain medications that treat bipolar disorder, depression, schizophrenia, or schizoaffective disorder, which disproportionately affect racial and ethnic minorities. National Minority Mental Health Awareness Month also focuses on breaking the stigma about mental health among racial and ethnic minority populations. The involuntary movements associated with TD carry a heavy stigma and are particularly harmful to Black communities. Some facts:

    TD is characterized by uncontrollable, abnormal, and repetitive movements of the face, torso, and/or other body parts. This can include lip puckering; jaw biting, clenching, or side-to-side movements; tongue darting, sticking out, or pushing inside; twisting and twitching hands and feet; and torso and hip shifting, among other symptoms. Untreated, TD can cause great distress for patients and negatively impact their overall quality of life.

    With nearly 6 million Californians living with mental illness, TD is no minor issue. Research suggests the overall prevalence of TD following prolonged treatment with first- generation antipsychotics is up to 30%, and it is estimated that 600,000 people in the U.S. are affected by TD, but many go undiagnosed.

    We encourage policy makers, medical professionals, health care advocates, and patients to learn more about TD and its impact on our community. This is especially important as we are in the endemic phase of the COVID crisis, during which patients may not have had regular, in-person contact with health care practitioners so that conditions like TD can be diagnosed and treated.

  • 17 May 2021 11:36 AM | Rhonda Smith (Administrator)

    By Richard H Carmona • May 17, 2021

    A public basketball game at Venice Beach Recreation Center in Los Angeles. Photo by iStock.

    The past year has taken a toll on the physical and mental health of millions of Californians. While we were rightly focused on slowing the spread of the pandemic, widespread shutdowns brought about a more sedentary, inactive lifestyle, which has led to increased weight gain and worsened mental health for many. As Californians look ahead and as more people receive the vaccine, it is time for policymakers and citizens to start reprioritizing physical activity and placing much needed attention on the health equity crisis in our state.

    There is a direct correlation between obesity and developing serious COVID-19 complications and chronic diseases. In fact, about 78 percent of people who have been hospitalized, needed a ventilator, or died from COVID-19 have been overweight or obese, according to the Centers for Disease Control and Prevention (CDC). And once the scourge of COVID has passed, the leading causes of death will continue to be heart disease and cancers — all exacerbated by physical inactivity and overweight. 

    This correlation is heightened by the fact that communities that were disproportionately impacted by COVID-19 were also already disproportionately impacted by inactivity and obesity. Data has shown that Black and Latinx communities suffered higher rates of COVID-19. Meanwhile in California, physical inactivity is the highest among Black and Latinx residents, at 23 percent and 27 percent, respectively. 

    The obesity rate in California is 25.8 percent, but that number jumps to 33 percent for Latinx residents, and 40 percent for Black residents. That figure is expected to be higher now as the pandemic has led to a 32 percent reduction in physical activity among individuals who were physically active. 

    These correlations can be attributed to the fact that many of our Black and brown communities exist in food deserts, experience a shortage of healthy food options and often have lower access to green space and safe outdoor spaces in which to recreate, among other reasons.

    Two recent studies show just how acute the COVID weight gain issue has become. A study in the Journal of American Medicine reported that during the first five months of closures, the average American gained nearly two pounds per month. And an even more concerning report by the American Physiological Association indicated that during the lockdown, 50 percent of millennials had gained weight during the lockdown, averaging an astounding 41 pounds.

    Separately, research from the Kaiser Family Foundation showed about four in 10adults in the United States have reported symptoms of anxiety or depressive disorder throughout the pandemic. That’s up from one in 10 during the first six months of 2019. Kaiser also found that many adults have suffered negative impacts on their mental health and well-being —  including difficulty sleeping (36 percent) or eating (32 percent), increases in alcohol consumption or substance use (12 percent) and worsening chronic conditions (12 percent) — due to worry and stress over the coronavirus.

    Fortunately, a healthy weight can be achieved through a regimen of healthful eating and physical activity. However, even before the pandemic, only about 23 percent of adults met or exceeded the federal physical activity guidelines of at least 150 minutes of moderate or 75 minutes of vigorous exercise each week. Even if an individual can’t meet the full recommended amount of exercise, researchers have found that as little as 20 minutes of physical activity a day can have anti-inflammatory effects that boost your immune system. And the pandemic has given us a new understanding of the value of maintaining a strong immune system.

    Fitness centers are committed to being part of the solution. They continue to work closely with local, state and federal public health officials as they reopen — implementing capacity restrictions and proven safety protocols like physical distancing, increased sanitization and air filtration. These policies are key to ensuring Californians have access to exercise while also mitigating the risk of COVID-19 transmission.

    I encourage policymakers to go beyond the current conversation and continue to discuss the underlying reasons for the health disparities in our state. We must pursue health equity by identifying solutions for food deserts, finding ways to ensure healthy food options regardless of zip code and, importantly, ensuring that every community has adequate and safe spaces for exercise, whether that be in a gym, park or on a walking trail. 

    Whether you are continuing your personal fitness routine or heading back to your fitness center, the important thing is to get your body active. Staying safe in a post-pandemic world means maintaining a healthy immune system, becoming physically active, eating well and maintaining a healthy body weight.  These lifestyle changes will allow you to live longer and happier!

    Dr. Richard Carmona served as the 17th U.S. Surgeon General and currently sits on the Chancellor’s Board of Advisors at UC Davis. 

  • 10 May 2021 11:37 AM | Rhonda Smith (Administrator)

    By Brett Walton Circle of Blue • May 10, 2021

    A monitoring program tracks toxic cyanobacteria and influences change.

    This piece is part of a collaboration that includes the Institute for Nonprofit News, California Health Report, Center for Collaborative Investigative Journalism, Circle of Blue, Columbia Insight, Ensia, High Country News, New Mexico In Depth and SJV Water. It was made possible by a grant from The Water Desk, with support from Ensia and INN’s Amplify News Project.

    LAKEPORT, California — Seven years ago, after the fish died, Sarah Ryan decided she couldn’t wait any longer for help.

    California at the time was in the depths of its worst drought in the last millennium and its ecosystems were gasping. For Ryan, the fish kill in Clear Lake, the state’s second largest and the centerpiece of Lake County, was the last straw.

    Ryan is the environmental director for Big Valley Rancheria, a territory of the Big Valley Band of Pomo Indians that sits on the ancient lake’s western shore. She and others raised alarms for several years about increasingly dire blooms of toxic cyanobacteria. But Lake County officials and state agencies were not gathering the data on toxin levels that Ryan thought was necessary to adequately communicate the health risks to tribe members or to anyone else using Clear Lake to swim, fish, drink — or walk their dog. 

    A year earlier a dog had died after drinking lake water. Fishing tournaments were cancelled due to the noxious scum, and the lake was starting to smell rotten in the warm months. It was time to act, she thought.

    Along with Karola Kennedy, then the environmental director at Elem Indian Colony, another area tribe, Ryan developed a plan. In the summer of 2014 Ryan and Kennedy laid out a map on a table — “our war room,” as Ryan described it — and chose several shoreline sites to collect water samples. They sent the samples to the lab and waited.

    The first results came back in early September, well after midnight on a Friday. Ryan was still awake. She looked at the readout on her screen. A sample taken about 100 feet from a drinking water intake showed more than 17,000 micrograms per liter of microcystins, a liver toxin produced by the microcystis species of cyanobacteria. The U.S. Environmental Protection Agency health guideline for microcystins in waters where people swim and boat is 8 micrograms per liter. California suggests posting warnings at beaches when levels reach 0.8 micrograms per liter.

    “Oh my gosh,” Ryan recalled thinking. “We have a problem here.”

    In the summer and fall, mats of toxic cyanobacteria can clog the perimeter of Clear Lake. In this photo from June 23, 2020, a bloom forms in Soda Bay, on the lake’s southern shore. Photo courtesy of Micah Swann.

    A Lake Out Of Balance

    The sample results, and the work Ryan and Kennedy have done to promote and explain the implications for public health and the recreational economy, prompted local and state responses that distinguish Clear Lake as a test bed for understanding and solving a worsening global water pollution challenge. 

    Neither California nor the federal government regulate cyanotoxins in drinking water. Two-thirds of Lake County’s 65,000 residents are served by utilities that use Clear Lake as a water source. What government officials want is more data. Starting this summer, the State Water Resources Control Board ordered the 18 public water systems that draw from Clear Lake to test their treated and untreated water every two weeks for microcystins. In addition, the Water Board asked the state Office of Environmental Health Hazard Assessment in February to evaluate scientific information on four cyanotoxins and recommend whether the state should establish notification levels, which are health-based thresholds that require utilities to tell customers when the toxins are present.

    Sometimes called blue-green algae and a constituent of harmful algal blooms, cyanobacteria are single-celled organisms that turn sunlight into energy. Alive on the planet for more than 2 billion years, they were the first species to produce oxygen as a by-product of respiration. You and I can be thankful for that. But because they’ve endured the eons — outlasting ice ages as well as hothouse conditions — they are adaptable survivors. 

    “In a way, their playbook is very deep,” Hans Paerl, a professor at the UNC Chapel Hill Institute of Marine Sciences and one of the country’s foremost researchers of cyanobacteria, told Circle of Blue. “Evolution has served them for a long period of time.”

    Today, however, a deep playbook is less and less necessary. Humans are making it easier on cyanobacteria. The organisms live everywhere, but they prefer warm, stagnant waters that are saturated with nutrients. As they see it, a planet blanketed by heat-trapping greenhouse gases, loaded with nitrogen and phosphorus, and saturated with slack water and rivers impeded by dams is a cozy and welcoming home. 

    “Almost every modification we’ve gone through — in terms of creating more nutrients or altering the flow of water in natural systems — seems to benefit their ability to form blooms and proliferate in those blooms,” Paerl explained. The blooms, in other words, are living in a boom time.

    Clear Lake, about 100 miles north of San Francisco, is relatively shallow, warm and, by its nature, biologically productive. That’s why it’s known as one of the best bass fishing spots in the country. It’s also considered the oldest lake in North America, which means that algae have probably been present for some portion of its 2 million years. Indigenous groups have lived along the lake’s clean waters and fertile shores for some 12,000 years. 

    But over the last century and a half, Clear Lake’s ecological balance has come undone. White settlers planted orchards, dug mercury mines, and built homes and towns. In the process an estimated 85 percent of the lake’s nutrient-absorbing wetlands were destroyed. 

    Unimpeded flows of nitrogen and phosphorus tipped Clear Lake into hyperproductivity, or eutrophication. Algae and cyanobacteria blooms worsened in the 1970s, started improving through the 1990s, and now are as extensive as any in generations. While the middle of the lake can be scum-free, the blooms paint the nearshore waters in the summer and fall in whorls of green and white. They emit terrible odors, described by various locals as like kimchi, dog poop, baby’s diaper, sewage, and “not as pungent as skunk, but on its way there.”

    An elder of the Big Valley Band of Pomo Indians, Ron Montez, Sr. has spent a lifetime around Clear Lake. The lake is central to the tribe’s culture, he said while at his office. Members collect tule reeds around its shores for making baskets and canoes and they immerse themselves in the water before dances and ceremonies. Photo by Brett Walton, Circle of Blue.

    Ron Montez Sr., an elder of the Big Valley Band of Pomo Indians, has witnessed those changes. He grew up around the lake, but his family had no running water. Instead they used buckets to gather from the lake what they needed at home. If algae were present, they would filter the water by pouring it through a cloth. To bathe, he would jump in the lake. Sometimes he would hold bread in his hands until the fish nibbled.

    Montez, who is 71, told Circle of Blue that the lake is central to his cultural identity and for his community’s livelihood. It’s where they collect tule reeds for weaving baskets and making boats, where they caught catfish, hitch, and perch for sustenance and income, where they splished and splashed. The lake is also where tribe members congregate for ceremonies, like the annual Big Head dances held in the spring. 

    “Before any dance we have to enter into the water, have our heads under the water,” Montez explained. The tribe members dance also for healing if someone is sick. “It’s cleansing before that time [of the dance], which is sacred.”

    Montez continued. “The water is very important,” he said. “It’s tied to us spiritually, physically. That has all been reduced because of the algae and other contaminants out there.”

    The environmental director for the Big Valley Band of Pomo Indians since 2006, Sarah Ryan has been instrumental in bringing attention to the harmful algal blooms and toxic cyanobacteria that blanket the shores of Clear Lake in the warm months. Photo by Brett Walton, Circle of Blue.

    Recognition and Response

    Sarah Ryan is not indigenous, but she has worked for Big Valley’s environmental department since 2001, becoming director in 2006. She notes that tribal governments in California, especially those along the Klamath River, have taken the lead on responding to toxic cyanobacteria.

    Ryan said the initial goal of the cyanobacteria monitoring program was to protect the health of Montez and other Big Valley Band members as they took part in the traditional cultural practices. The program costs Big Valley about $70,000 a year to operate for staff time, sample analysis, and equipment, Ryan estimates. Two or three Big Valley EPA staff members collaborate on the field work, sample collection, data entry, and public outreach. The funds come from state and federal grants, and they’re needed. Clear Lake has 100 miles of shoreline. 

    Monitoring sites were selected because of their importance to the tribes. Sampling more than 20 sites every two weeks in the summer and monthly in the winter is not a simple task. Ryan expects to be particularly active this year. The lake is at its lowest level since 2014, and the state is coming off its third-driest winter on record. In these conditions, blooms are likely to be very bad, she said.

    Around Clear Lake the influence of the monitoring program keeps growing. The data informs warning signs that the county posts at parks and boat launches. Ryan tallies the results on the Big Valley website, too. There have been follow-on studies of toxins in fish tissue and in private drinking water intakes. Public drinking water providers check the data for toxin levels around their intakes. 

    The monitoring program aligns with Ryan’s world view. Her father worked for the U.S. Environmental Protection Agency and she got her bachelor’s degree in government from the College of William and Mary. Science on one hand and policy on the other. Her mission is to ensure that the two stay connected. 

    “Government should be translating science into actionable items,” she said. “Otherwise, what are you doing?”

    Micah Swann, a third-year Ph.D. student at the University of California, Davis, displays equipment for monitoring water quality in Clear Lake. Photo by Brett Walton, Circle of Blue.

    Hazardous Conditions

    Though poisonings from drinking water are rare, simply being at the lakeshore when blooms are present is a risk. Touching certain cyanotoxins can cause rashes and allergic reactions. That’s why the U.S. Environmental Protection Agency published its guidelines for recreational water. It’s also why the tribes wanted more information about what their members might be exposed to during their ceremonies.

    Health hazards do not end with skin contact. In a peer-reviewed study published in April, researchers found that a harmful algal bloom on Nantucket Island, Massachusetts, was releasing anatoxin-a, a neurotoxin, into the air. The researchers speculate that sharp winds sent the toxin airborne, but it is unclear what effect inhaled toxins might have on human health. 

    The risk of aerosolized toxins is high enough that the Centers for Disease Control and Prevention will begin a study this year to assess airborne exposure in Florida residents who live or work on Lake Okeechobee, St. Lucie River, Caloosahatchee River, and Cape Coral canals — all places with a recent history of severe blooms. Results are expected in 2023.

    Though most attention is directed at phosphorus, Paerl says that nitrogen should not be neglected, either. Nitrogen is more manageable, Paerl told Circle of Blue. It can be cut more easily by restricting polluted runoff from streets, farm fields, septic systems, and wastewater treatment plants, while also minimizing erosion. Paerl has studied harmful algal blooms in large lakes worldwide, from Lake Erie to Lake Taihu, in China. 

    “That’s one thing we are prescribing for many of the large lakes that Clear Lake fits into: not only to reduce phosphorus inputs because it takes so long for the system to clear itself of phosphorus,” Paerl said. “But also deal with nitrogen.”

    There is an official process in this country for these nutrient diets. It’s called a total maximum daily load, or TMDL. Written into the federal Clean Water Act, TMDLs are a regulatory tool for reducing pollution in a waterbody. Some TMDLs apply to stream segments of fewer than a dozen miles; others, like the one for the Chesapeake Bay, encompass entire watersheds.

    Clear Lake has a nutrient TMDL that was put in place in 2007, but for phosphorus only. It identifies forest roads, country and federal lands, and irrigated agriculture as primary sources of sediment erosion.

    Nearly a decade ago, Ryan warned state officials that the TMDL was not effective.

    “It is obvious that the measures being taken by the communities in the Clear Lake Basin are not reducing nuisance algal blooms,” Ryan wrote to the State Water Resources Control Board on August 20, 2012.

    Karola Kennedy, her partner in developing the cyanobacteria program, also notified the Water Board of concerns about the TMDL. She said that projects to control erosion were not being monitored to assess whether they lived up to their promises. Kennedy did not want the state to extend compliance dates for reducing nutrient flows, which it is still considering.

    “The Elem Indian Colony Tribal community does not want to wait another generation for compliance on the nutrient TMDL,” Kennedy wrote on October 3, 2017. “Water quality issues have exponentially worsened in the past decade. We are fearful of what is to come if the responsible parties are given a pass for another generation.” 

    Kennedy, now the water resources manager for Robinson Rancheria, another Clear Lake tribe, told Circle of Blue that the lack of monitoring for erosion control is still a problem today. “It’s hard to say if those best management practices are truly that. If you don’t monitor them, you can’t manage it.”

    The Central Valley Regional Water Quality Control Board is the state agency that oversees the TMDL. Adam Laputz, the board’s assistant executive officer, told Circle of Blue that the board is reviewing the TMDL to see if it should be extended or revised. Laputz said that any revisions would take into account new research in the last 15 years on the causes of harmful algal blooms and could include nitrogen limits or changes to the amount of phosphorus allowed into the lake. But given all the factors that feed the blooms — nutrients, water temperature, wind and water currents — determining whether the TMDL has been effective “is a very difficult question to answer,” Laputz said.

    One major project that aims to prevent more nutrient-laden sediments from flowing into the lake and to reverse the loss of wetlands is the restoration of a marsh ecosystem downstream of Middle Creek and Scotts Creek. Located at the northern end of the lake, the site contributes about 70 percent of the sediment and phosphorus that flow into the lake. By one estimate, restoring 1,400 acres of marsh where there are now fields and levees could increase the lake’s wetland coverage by 70 percent and reduce phosphorus inputs for the lake’s upper basin by 28 percent. Those reductions are only on paper right now. The county is still acquiring land for the project and has not started construction.

    The Middle Creek restoration is an important step, but larger schemes could be on the horizon. In 2017, an act of the Legislature established a 15-member Blue Ribbon Committee to discuss the restoration of Clear Lake. The act also funded an in-depth research program that is being led by the University of California, Davis. The goal of the program is to observe how water and nutrients move throughout the watershed.

    The California Natural Resources Agency said it is working on a grant that will extend funding for the program, which needs more data before it can fine-tune a working model of the watershed and lake dynamics. According to Geoff Schladow, the research program’s principal investigator, the model will provide glimpses of the future. Once the model is running, researchers can tweak variables like nutrient inputs, wind speed, and air temperature to test their effect on the blooms, which tend to concentrate in two of the lake’s sub-basins, the Oaks Arm and Lower Arm. That way, local agencies could issue cyanobacteria forecasts, directing swimmers and boaters away from hazardous areas and warning tourists coming up from San Francisco for the weekend about which beaches to avoid. The tribes, though, cannot simply change the location of their ceremonies.

    One theory is that blooms proliferate in the Oaks and Lower arms because the lake is deeper there and phosphorus in the lakebed sediment becomes unbound when oxygen is depleted. This “internal loading,” a legacy of centuries of erosion, is actually the largest source of phosphorus available to fuel cyanobacteria growth in the lake. Schladow said a potential remedy is to inject oxygen in these areas when levels reach critical thresholds. But researchers won’t know whether that’s the case until their model is complete and they can run tests. The results matter not just for scientific discovery but also for fiscal responsibility.

    “The truth of the matter is lake remediation costs a lot of money and you can’t afford to get it wrong,” Schladow told Circle of Blue.

    Angela De Palma-Dow, the invasive species coordinator for the Lake County Water Resources Department, reiterated that point. Lake County is one of the poorest in California, and there is not a lot of spare cash to throw at false solutions. 

    “It’s hard for us to put money into a project and have it have a negligible impact on water quality,” De Palma-Dow told Circle of Blue. She hopes the UC Davis study will provide recommendations that are “targeted and relevant.”

    Researchers who study Clear Lake are full of praise for the program that Ryan and Kennedy started. It’s hard to imagine so much legislative and scientific attention directed at the lake if not for the work of the tribal governments.

    “The fact they’ve been collecting data has raised the awareness in the whole community,” Schladow said. “We would be a long way further back if it wasn’t for those efforts.”

    Local officials acknowledge that the tribes are providing a public service that they are not able to fulfill.

    “Frankly, there’s no way our county would be able to do that work and we rely heavily on them and what they do,” De Palma-Dow said. “They’re great partners.”

    Ryan said that it took many years of cajoling before those partnerships took root and bore fruit. She’ll keep pushing colleagues in county and state agencies, because after all, science without government action to back it up is just not enough.

    Brett writes about agriculture, energy, infrastructure, and the politics and economics of water in the United States for Circle of Blue. He also writes the Federal Water Tap, Circle of Blue’s weekly digest of U.S. government water news.

  • 5 May 2021 10:38 AM | Rhonda Smith (Administrator)

    By Claudia Boyd-Barrett

    Some rural California communities have waited nearly a decade for state regulators to repair their tainted drinking-water systems.

    This article, produced jointly by the California Health Report and High Country News, is part of a collaboration that also includes the Institute for Nonprofit News, Center for Collaborative Investigative Journalism, Circle of Blue, Columbia Insight, Ensia, New Mexico In Depth and SJV Water. It was made possible by a grant from The Water Desk, with support from Ensia and INN’s Amplify News Project.

    When Ramona Hernandez turns on her kitchen faucet in El Adobe, an unincorporated town just a few miles southeast of Bakersfield, the water that splashes out looks clean and inviting. But she doesn’t dare drink it.  

    “You worry about your health,” she said in Spanish as she sat in her tranquil front yard one morning early this spring, her elderly mother-in-law working in the garden behind her.

    “I’m scared,” Hernandez said, “of getting sick from the water.” Drinking the tap water in this tiny community of dusty ranches and unpaved roads could expose Hernandez to arsenic. So, for years, she and her husband, Gerardo, have shuttled twice a week to the nearby town of Lamont to load up on bottled water. At a cost of about $80 a month, it’s enough for drinking and cooking. If they had the money, Hernandez, 55, would buy bottled water to shower with and use for her chickens. But given her husband’s salary as a farmworker, she says, that’s not a realistic option.

    Like more than 300 communities across California, El Adobe lacks safe drinking water. Since 2008, the arsenic levels in one of its two wells have regularly exceeded the safety standards set by federal and state authorities, often by more than double. Long-term exposure to arsenic in drinking water is linked to diabetes, high blood pressure and cancer.

    Contaminated drinking water affects an estimated 1 million people in California, many of whom rely on private wells or small community water systems like El Adobe’s. A majority of these residents live in the Central and Salinas valleys. These are largely low-income, rural and Latino communities, where lack of access to clean water exacerbates the health disparities that already exist due to structural inequities. Since 2012, California law has recognized that access to safe and affordable water is a human right, but action has lagged behind the language.

    Ramona Hernandez in her garden in El Adobe. Hernandez worries that contaminated tap water in the community could make her sick. 

    Arsenic levels in El Adobe’s other well are currently deemed safe, but the well can’t provide enough water to meet year-round demand. That means that many residents of the unincorporated town, including the Hernandezes, continue to pay for water they can’t drink. The El Adobe Property Owners Association charges households $125 a month for tap water, money that also covers streetlights and road maintenance (although only one road is paved). Most residents also buy bottled water at the store. Others take their chances and drink the tap water despite the risks. Many townspeople are low-income farmworkers and retirees, and buying bottled water is a significant expense.

    “I can’t afford bottled water all the time,” said Kyle Wilkerson, 40, a father of three who lives on a fixed disability income. He’s also president of the El Adobe Property Owners Association, a small cadre of community members who manage the town’s water infrastructure almost entirely as volunteers.

    Wilkerson said he worries about his own health as well as that of his family. “But what am I going to do?” he said. “You get to the point of, it is what it is.”

    And indeed, residents in towns like El Adobe have few options. Arsenic can be removed from water, but it’s prohibitively expensive for most small towns. An arsenic treatment facility requires millions of dollars to build and another $100,000 or more per year to operate, said Chad Fischer, an engineer who works at the California Division of Drinking Water’s district office in Visalia, which regulates water in the region.

    Kyle Wilkerson, President of the El Adobe Property Owners’ Association at the Well #1 in El Adobe, Kern County. The well is one of two in the community, and was built in 1967. 

    El Adobe is so small — just 83 homes — that if community residents split the cost of a treatment system, they’d spend tens of thousands of dollars each and face dramatically increased water rates. “The math is awful,” Fischer said. “It ends up being unaffordable.”

    It’s possible for individual users to install an advanced filtration system, such as reverse osmosis, in their homes, usually under the sink, to remove arsenic. But these systems can cost hundreds of dollars to install and maintain. Some small water systems do install these in people’s homes, passing on the cost to consumers, but the state considers this a temporary fix. Inexpensive pitcher-type filters do not remove arsenic.

    A permanent solution was supposed to be coming for El Adobe. In 2013, with funding from the California State Water Resources Control Board, El Adobe commissioned a report that concluded that the best option for the community was to connect with the larger water system in Lamont. According to Scott Taylor, general manager of the Lamont Public Utility District, the state promised to grant Lamont enough money to build the connecting pipeline, service lines and new wells needed to accommodate the increase in users and replace aging infrastructure.

    “Eight years, it still hasn’t happened,” said Taylor. “I think it’s bureaucracy. For example, when we submit any kind of a document, a cost estimate, an engineering report … for whatever reason, it takes them two to three months to review it. If it took any of my staff a month to review a document, I don’t care if it’s 100 pages, I’d fire them.”

    Scott Taylor, General Manager of the Lamont Public Utility District at Well #13 in Lamont, which recently broke down after installation of a $1 million treatment system for 123-TCP.  

    Blair Robertson, a spokesman for the California State Water Resources Control Board, said the state is still waiting for Lamont to purchase land for the new wells and drill test wells to see if water at the proposed sites is contaminated. There is currently no start date for the project, which is estimated to cost between $13 and 22 million and will likely be split into several construction phases. Formal state approval of the project will likely be in 2022, Robertson said, but there’s currently no timeframe for when El Adobe residents will have clean drinking water.

    Planning and implementing a water system consolidation takes time, Fischer said, especially when the community, like El Adobe, is small and lacks a team of engineers and other professionals to manage the water supply. Lamont has its own water problems with contaminants and aging wells, which have added to the difficulties of the project, he said. Projects usually take five or more years to accomplish, he said, depending on their complexity. But it has already been eight years, and construction has yet to begin.

    More than 100 others

    Beyond those delays, dozens of other communities in California are also waiting on construction projects for clean water. Approximately 110 other out-of-compliance water systems in the state are planning or considering consolidation with another system. Sometimes, the larger communities resist appeals to absorb the smaller systems because they fear it will increase costs and strain their own water supply, particularly as droughts continue. The state often offers financial incentives to encourage consolidation, and can mandate it, if necessary. Other times consolidation isn’t even an option because a community is too remote.

    In 2019, California passed a law that established a program called Safe and Affordable Funding for Equity and Resilience (SAFER), designed to help fund water improvements for communities that struggle to provide clean water to their residents. The state water board is working to complete a needs assessment to determine which water systems need help and to what extent, according to a recent report by the state’s Legislative Analyst’s Office. However, the state is still “in the very early stages of implementation,” and “much work remains to be accomplished” before all Californians have access to safe and affordable drinking water, the report stated.

    Cheryl Blackhawk, 67, and her husband Edward, 69, are fed up with not having safe water in El Adobe. They moved to the town four years ago from nearby Greenfield, seeing it as a quiet and affordable place to retire. At the time, the seller assured them the water connection to Lamont would happen within a year. They’re still buying water bottles by the caseload from Walmart.

    Cheryl and Edward Blackhawk outside their home in El Adobe. When they moved to the community four years ago, they thought the drinking water would be fixed within a year. 

    “You can’t go to the faucet to get water to drink,” said Edward Blackhawk. “You can’t cook.”

    Contaminants aren’t the only problem. Like innumerable systems across California and the country, El Adobe’s wells, pipes, pumps and other water infrastructure are showing their age. El Adobe’s most critical well, the one without arsenic, was built in 1967, the same year Ronald Reagan became governor of California and labor activist Cesar Chavez initiated a nationwide boycott of the state’s table grapes. The community’s arsenic-laced well was built in 1985.

    The life of a well depends on the chemicals in the local soil and water, and the quality of the well materials and construction, said Dave Warner, community development manager at Self-Help Enterprises in Visalia, which helps low-income communities access funding for water projects. But a well as old as 1967 “is really pushing it,” he said. Over time, the casing inside the well corrodes, and sand and other contaminants can get into the pump, causing it to fail. Still, drilling a new well costs more than $1 million, according to water officials. Securing state funding for it can take more than a decade, Warner said.

    The precariousness of the situation is not lost on Edward Blackhawk. Without functioning wells and pumps, people’s faucets would run dry. Toilets wouldn’t flush.

    “If these wells go down, we’re out of luck,” he said. “We’re out of water.”

    Defunct well water pipes stacked at the Lamont Public Utility District Well #13, which recently broke because of age. The district is waiting on funding to fix several of its wells so it can consolidate with nearby El Adobe.

    Widespread water woes

    Three miles down the road, Lamont has its own water struggles. Five of the town’s eight wells are contaminated with a highly toxic chemical called 1,2,3-trichloropropane, or 1,2,3-TCP. The chemical was added to soil fumigants used in agriculture during the 1940s through the 1980s. It persists in the environment indefinitely and is recognized as a carcinogen by the state of California. The state started regulating the chemical in drinking water in 2017, which meant communities like Lamont had to find a way to remove it.

    Just like arsenic, 1,2,3-TCP is expensive to get rid of. A treatment system costs over $1 million per well, plus about $100,000 a year to change the filter, said Taylor. Lamont has installed treatment on four wells, using money from a settlement with Dow Chemical and Shell Oil, the companies allegedly responsible for the contamination. But two of the treatment systems are leased, and the utility district still doesn’t know how it will pay for them long-term. Two other wells still need 1,2,3-TCP and arsenic treatment systems, respectively.  

    Lamont’s population of 15,000 is almost entirely Latino, and many residents are farmworkers. The average per capita income is just over $13,000 a year. Plans to raise water rates last year to help cover some of the district’s expenses were delayed because of the pandemic. Even so, dozens of accounts fell into delinquency as people lost jobs and struggled to pay bills. The district is now short about $70,000 from delinquent accounts, Taylor said.

    View of a farm in the agricultural community of El Adobe, in Kern County. 

    Lamont’s wells are also nearing the end of their lifespan. Last year, shortly after the district installed a $1 million filtration system for 1,2,3-TCP on a 60-year-old well, the well collapsed. Taylor said he “raised holy hell” with the state water board and obtained emergency funding to build a new well, which is now under construction. Another three wells need replacing, he said. Those new wells may also need treatment systems. Funding for that is supposed to be included in the consolidation project with El Adobe.

    So far, Lamont has managed to provide clean water to residents, but that could change if another well breaks or demand increases enough to require making a contaminated well operational, said Taylor.

    “It’s a little discouraging,” said district board member, Miguel Sanchez. “You’re trying to comply with all these regulations and the system is crumbling.”

    Miguel Sanchez, member of the board of directors of the Lamont Public Utility District at the now-defunct Well #13 in Lamont. It’s one of several aging water wells in the city and in nearby El Adobe. 

    A reason for hope?

    But Californians now have a reason to be optimistic: A $2 trillion proposal by President Joe Biden to fund infrastructure improvements across the nation, including for clean water, could provide their state with more money for these types of projects. Biden’s plan — if approved by Congress — would include $111 billion dollars in clean water investments. The proposal seeks $10 billion to monitor and remediate new drinking-water contaminants and to invest in small rural water systems like El Adobe’s. The plan also requests $56 billion in grants and loans to upgrade and modernize America’s aging drinking water, wastewater and stormwater systems. Support for low-income communities and communities of color is a big focus of the proposal.

    It’s not yet clear how much of the money would go to California. However, Gov. Gavin Newsom has called Biden’s plan “a game changer.”

    And Warner, with Self-Help Enterprises, agreed. Right now, there’s not enough state and federal money available to efficiently tackle all of California’s water contamination and infrastructure problems, he said. Biden’s plan “gave me a lot of hope,” he said. “But it’s got to get approved.”

    Meanwhile, Susana De Anda, co-founder of the Community Water Center, an environmental justice organization based in Visalia, applauded California’s SAFER program, but said communities need help faster. A short-term solution would be for the state to implement a rate-assistance program for low-income residents who are struggling to pay their water bills, including those who pay for water twice because their tap water is contaminated, she said.

    “We want solutions now,” she said. “It’s a huge problem, and we have generations that have been condemned to this reality.”

    A home in El Adobe, CA in Kern County. 

    In El Adobe, Hernandez worries that she may be inhaling contaminants or absorbing them through her skin when she showers. The concentration of arsenic in the water is still safe for bathing, according to state regulators, and arsenic does not evaporate into the air, but Hernandez remains distrustful, particularly since she and her husband both have lung problems.

    If only officials in Sacramento could spend a day in her shoes, she said. “How would they like it?” she asked. “They don’t have to worry about having a shower, about drinking the water.”

    At the edge of the community, Cheryl and Edward Blackhawk checked on El Adobe’s second well, the arsenic-laden one, and its water tank, which sits inside a small enclosure littered with tumbleweeds. Cheryl Blackhawk, who serves as financial secretary for the property owner’s association, said she fears that drought conditions this year will lead to falling water levels that result in higher arsenic concentrations in the well.

    Her husband, standing quietly beside the aging pump, confessed he’s beginning to doubt the connection to Lamont will actually happen.

    “There’s a lot of people out here who think it’s dead in the water,” he said softly. “And it’s not just us. There are hundreds (of communities) like us in the state.”

    This story was supported by a grant from The Water Desk, with support from Ensia and the Institute for Nonprofit News’s Amplify News Project.

  • 10 Mar 2021 10:49 AM | Rhonda Smith (Administrator)

    By Manuel Pastor 

    A nurse gives a COVID-19 vaccination at The Forum in Los Angeles in January.A nurse gives a COVID-19 vaccination at The Forum in Los Angeles in January. Photo by iStock/M-C-C.

    California and so many other states initially launched an inequitable vaccine distribution system.

    Consider that once we got beyond vaccinating health care workers, the emphasis was on inoculating those over age 65. That makes sense in terms of the risk of death, but a simple glance at California’s demographics reveals a major shortcoming: 56 percent of California seniors are white, but two-thirds of those of prime working age — those most likely to be exposed to COVID-19 — are people of color.

    Add to that a vaccination enrollment system that privileged people who were eligible by age or occupation and happened to have a computer, high-speed internet, the tech savvy to automate the refresh function, a job that allowed time off when appointments opened, and a car to drive to a vaccination site. 

    Efficient? Sure. Fair? Not close

    Both state and local authorities have begun to address the racial disparities that are inevitable under such a system. For example, California has now set aside 40 percent of available vaccine for residents in areas facing the biggest economic and health challenges. 

    Locally, counties and cities have recruited community organizations and others to do outreach, and have been distributing more vaccines through local clinics, mobile pop-ups, and vaccine events in low-income neighborhoods of color. While there are concerns that these local approaches may get displaced by the state’s new contracts with Blue Shield of California and Kaiser Permanente, community activists will likely demand good monitoring and accountability.

    While this more inclusive approach is welcome, let’s not repeat the mistakes of the first wave. That means putting equity first as we begin to prepare for the post-vaccine world.

    When we emerge from this crisis, it will be a bit like the end of a movie about an imagined apocalypse: Many people will be crawling out of their homes with their savings demolished, health shattered, jobs lost and education interrupted — and they will be suffering from trauma. Expecting everyone to just bounce back is a bit like thinking a computer-based vaccination system will give everyone an equal shot at a vaccine.

    California needs to make major investments in stabilizing housing, restoring employment, and making up for educational and digital inequality. And it must help communities deal with the trauma and loss that has wracked families and neighborhoods.

    So let’s think ahead. We are going to need a “healing surge” that will match our vaccine surge — and health equity must guide how we allocate those resources.

    The California Health Report has already pointed out that funding for mental health care for low-income residents has gone unused even as COVID-19 drives up anxiety and depression. We need to mobilize those untapped funds and start thinking of new ways to assist communities at scale.

    We have learned the lesson in this crisis that public health is critical to our individual health — we all do better when we protect those who are most vulnerable. We also understand that mental health is not just an individual condition but a collective challenge in communities that were stressed by racist policing, economic inequality and deportation threats long before COVID-19 appeared on the scene.

    Making things right post-pandemic will mean addressing the systems that left so many at risk. It will also require a process of personal, familial and collective healing. Let’s hope we plan for this with equity and inclusion as our north stars.

    Manuel Pastor is director of the Equity Research Institute at the University of Southern California and co-author of No Going Back: Together for an Equitable and Inclusive Los Angeles.

  • 9 Feb 2021 10:41 AM | Rhonda Smith (Administrator)

    By Claudia Boyd-Barrett

    The need for mental health services has surged during the COVID-19 pandemic, increasing pressure on California’s already beset mental health care system.

    Yet one source of funding that could potentially help counties meet the demand for mental health care remains underused more than a year after the California Health Report first drew attention to the issue.

    Counties can be reimbursed for providing mental health services to low-income residents through several state and federal programs. One is called Mental Health Medi-Cal Administrative Activities, or MH MAA, which provides funds for people enrolled in Medi-Cal, the state’s low-income health insurance program. 

    More than a third of Californians are enrolled in Medi-Cal. Claiming more administrative funding could increase counties’ mental health budgets by millions of dollars, freeing up other money for direct mental health care, said Alex Briscoe, a former director of Alameda County’s health agency who now works as a consultant to counties interested in increasing their administrative claims. 

    But very few counties participate in the program, state data shows, and those who do mostly claim only small amounts. 

    Out of California’s 58 counties, only 15 claimed MH MAA funds for the 2019-20 fiscal year. Among those who did, most received a tiny fraction of the total statewide reimbursement of $41.7 million. A few, including Fresno, San Mateo and Santa Clara counties, did claim substantially more compared to four years ago, but most counties increased their reimbursements only modestly. Some, such as Sonoma, San Diego, Orange and Los Angeles counties — actually claimed less in 2019-20 than they did four years prior.

    One notable exception is Alameda County, which has a history of maximizing MH MAA funding. The county, including the city of Berkeley, increased its claims from about $4 million in the 2016-17 fiscal year to over $24 million in 2019-20, accounting for more than half of statewide reimbursements last year. 

    Each year, counties can opt to claim back some of the money they or their contractors spend on certain administrative work for mental health care by applying for the federal reimbursement. Counties can claim these funds for program administration, planning, referring people experiencing a mental health crisis to services, and helping people apply for Medi-Cal benefits.

    Some county officials contacted by the California Health Report said that applying for the reimbursements is too complex and time consuming. They were also concerned about an increased risk of auditing from the state. Others considered the program inapplicable or irrelevant for their counties, because they can claim most of their administrative costs through another, simpler reimbursement program.

    “Not only is it very burdensome to claim … but the state has tightened rules around claiming, increasing the burden around claiming and the audit risk,” said Jeffrey Nagel, Orange County’s deputy agency director of Behavioral Health Services, in an email. “There are other strategies to increase revenues that result in greater revenue with less administrative burden and less audit risk.”

    Orange County’s strategies include claiming reimbursement for administrative costs as part of the county’s overall Medi-Cal mental health spending. This is an easier process that allows counties to claim up to 15 percent of the amount spent on mental health for administrative expenses (this increased to 30 percent during the pandemic). 

    Riverside County has historically operated well under this 15 percent administrative claim maximum, which is why it hasn’t applied for MH MAA funds, said Thomas Peterson, county spokesperson. 

    “Our understanding is that the MH MAA reimbursement program may be utilized when a county exceeds the administrative reimbursement cap and not all costs are eligible for reimbursement as a result,” Peterson wrote in an email.

    Patrick Sutton, a long-time consultant on MH MAA funding who now works with Briscoe, said he’s looked at cost reports from across the state and most counties could take advantage of the program even if their immediate administrative costs don’t go above 15 percent. That’s because community-based organizations that contract with counties to provide mental health services are entitled to claim MH MAA money, he said. That requires time-keeping measures and staff training so that organizations can submit these claims through the county. It takes effort, but it’s doable, as Alameda County has demonstrated. 

    “If the ultimate goal is to maximize your federal dollar, then it’s hard to imagine why many counties wouldn’t do mental health MAA,” he said. “I have yet to see a large county where it wouldn’t have been advantageous for them.”

    Sutton and Briscoe worked with Los Angeles County in 2019 to increase its administrative reimbursement claims for the previous year. The county’s MH MAA claims soared to $15.6 million in the 2018-19 fiscal year, up from $5.4 million in 2017-18. However, last year, their claims dropped to $4 million. 

    L.A. County did not respond to multiple requests for comment before the publication deadline. Sutton said the county had concerns about whether their timekeeping surveys met state and federal requirements, but he did not know the full story.

    Briscoe said he’s in conversation with San Francisco and Sacramento counties about helping them claim MH MAA money, which they currently don’t. He has also urged the state Department of Health Care Services, which oversees Medi-Cal, to make the claiming process more accessible. A spokesperson for the San Francisco Department of Public Health said the county is conducting an analysis to determine whether to pursue the claiming procedure.

    COVID-19 has also complicated county efforts to seek more funding, said Orange County’s Nagel.  

    “While it may be possible to increase the MAA revenue source (with added costs of claiming, reporting and audit risk), we must also keep in mind that operations during 2020 had to be responsive to a global pandemic,” he wrote. “The COVID-19 pandemic strained the resources of staffing that would be necessary for training, tracking and reporting related to an increase in MAA claiming.”

    To Briscoe, the budget pressures wrought by the pandemic make pursuing the funding even more important. In fact, he said he’s received calls from several counties asking for help obtaining the administrative funds. 

    There’s a dire need for mental health services, and local governments must do everything in their power to meet it, Briscoe said.  A report by the Centers for Disease Control and Prevention in August found that symptoms for anxiety and depressive disorders among adults had increased between three and four-fold during the pandemic compared to 2019. Mental-health related emergency department visits among children have also soared.

    “At the heart of it is a culture of public service,” he said.

    Carol Sloan, a spokesperson for the state Health Care Services agency, meanwhile, said the department offers technical assistance to counties interested in the MH MAA program. Sloan said the state can’t change the application rules because it’s a federal program.

    “While DHCS makes every attempt to remove unnecessary administrative burdens, the Department is required to comply with all statutes and regulations, which are prerequisites for counties to enroll in the program and receive federal funds,” Sloan wrote.

  • 10 Dec 2020 10:43 AM | Rhonda Smith (Administrator)

    By Claudia Boyd-Barrett

    The first time Cat Brooks sought help from the police to deal with her violent husband was also the last.

    She was a 19-year-old college student, married to a man 10 years her senior. One night, after he beat her severely, her husband called police to their Las Vegas home. 

    Brooks was bruised, scratched and bleeding, and assumed officers would take her side. But her unscathed husband insisted Brooks had attacked him, a victim-blaming tactic not uncommon among domestic abusers. The officers, all of whom were white like her husband, whisked Brooks, who is Black, to jail. They released her back to her abuser the following day.

    “The message that (was) communicated to me was, ‘The police aren’t here to help me,’” said Brooks, now 45 and living in Oakland. “I never called them again.” 

    Brooks’ experience isn’t unusual. A 2015 survey by the National Domestic Violence Hotline found that about 75 percent of survivors who called the police on their abusers later concluded that police involvement was unhelpful at best, and at worst made them feel less safe. 

    A quarter of those surveyed said they were arrested or threatened with arrest when reporting partner abuse or sexual assault to police. About half of survivors never called the police at all, citing fear of discrimination by police, invasion of privacy, wanting to protect their children, not wanting their partner arrested, or concern that involving the authorities would exacerbate the violence. 

    “[I am afraid] of making the situation worse,” one survivor who did not call police told the hotline. “They might arrest my abuser, and when he is out, he will hurt me like he has threatened.”

    Another survivor who did call the police said, “I felt the police were buddy-buddy with my partner and ignored what I had to say and the reality of the situation. I was scared, and they ignored me.”

    At 19, Brooks was severely beaten by her husband. When police intervened, Brooks was taken to jail rather than her husband.

    Faced with findings and experiences like these, researchers and survivor advocates are increasingly searching for alternative ways to address domestic violence. More and more, they are beginning to question: If involving the police and criminal justice system isn’t a safe, reliable option for most survivors, why is it offered as the main pathway for seeking help? The conversation has gained new urgency amidst the rise of the Black Lives Matter movement and calls to reevaluate the scope of police funding and responsibilities.

    “For decades, survivors have told us that it’s not safe for them to call law enforcement, that they don’t want to be ushered into a criminal justice system,” said Colsaria Henderson, board president for the California Partnership to End Domestic Violence. “What they want is the ability to be safe in their homes and in their families. They want the violence to stop.

    “It’s really time that we re-center on what the survivors are telling us.”

    Indigenous and LGTBQ perspectives

    Immigrant victims of domestic violence can face additional hurdles. Some avoid calling the police out of fear that they or their family members will be deported, said Dulce Vargas, who coordinates a domestic violence intervention and prevention program for the Mixteco/Indígena Community Organizing Project in Oxnard, which serves Ventura County’s indigenous immigrant population. Survivors and their children may also be reliant financially on their abusers and have no family in the country they can turn to for support. If an abusive partner is arrested or deported, survivors worry they’ll be left destitute, Vargas explained. Additionally, police officers rarely speak indigenous languages or understand the cultural dynamics within the community, which further deters survivors from calling.

    Mistrust of law enforcement is also pervasive within the LGBTQ community, said Terra Russell-Slavin, deputy director of policy and community building at the Los Angeles LGBT Center. That’s partly because the legal system historically criminalized gay and transgender people. LGBTQ survivors are still subject to higher rates of wrongful arrest, Russell-Slavin said.

    “Much of the (police) assumption and assessment is based on (traditional) gender roles, and that just doesn’t hold true for LGBT survivors,” she said. “That can lead to survivors being deemed perpetrators because maybe they’re more masculine presenting or they’re relying on size differentials and other factors.”

    Survivors of sexual violence sometimes also find police intervention ineffective. After suffering a sexual assault seven years ago, Laura Heraldez, 41, of Bakersfield sought help at a hospital, where the staff called the police. But when officers arrived, they dismissed her story, according to Heraldez, and refused to authorize a rape kit because she had been drinking. 

    “They told me that I was drunk, that I was not raped,” she said. “It caused me to numb everything and not get the help I needed. I didn’t seek therapy. I got absolutely no help. I was in complete denial of what happened to me, because you get told something and you start believing it.” 

    Laura Heraldez sits in Jastro Park in Bakersfield.

    ‘We’ve informally done it for centuries’

    The search for more effective interventions has become even more important during the COVID-19 pandemic. Reports of domestic violence have soared while survivors are confined at home with their abusers, and families face additional economic and emotional pressures. 

    So far, there is no broad agreement on the best or most effective alternative solutions to address domestic violence, but some ideas are coming into focus. They include creating trained networks of community volunteers to intervene in domestic disputes, engaging survivors and their partners in restorative justice proceedings removed from the criminal legal system, and establishing programs that encourage men to embrace healthy definitions of masculinity.  

    Brooks, who is now executive director of Justice Teams Network, a coalition of organizations dedicated to eradicating state violence, is a leader in the effort to identify alternatives. Over the past year, her organization has been working on a toolkit that lays out principles and strategies communities can use to create their own responses to inter-partner abuse. The work is based on conversations with community members and organizations around the country who are working to address domestic violence and police overreach, mainly in communities of color, she said. It also draws from a program she helped launch this summer in Oakland called Mental Health First, that offers a hotline people can call instead of 911 for help de-escalating psychiatric crises.

    Statistics show people of color are more likely than white people to be incarcerated and face police violence.  One study estimated that Black men are 2.5 times more likely to be killed by law enforcement than white men. Women of color and those living in poverty also face disproportionate rates of criminalization and are more likely than white women to be criminalized and punished for surviving violence, according to a report from PolicyLink.

    While the toolkit is still a work in progress, Brooks said there are some main principles that can help inform the dialogue around solutions. First, advocates agree that responses should be localized to individual communities or even neighborhood blocks, be culturally sensitive, and have broad community oversight. 

    Such responses should also allow survivors to make decisions about how they want the violence addressed, and incorporate interventions that help the entire family (including children and the perpetrator). Although law enforcement should be a last resort, there must be a plan for when calling police is appropriate to ensure safety, she added. Brooks said she envisions small crisis intervention teams run out of churches, mosques or community centers, likely staffed by volunteers and funded through local philanthropy. 

    One solution might be similar to the Mental Health First hotline in Oakland, which responds to mental health crises, including those involving domestic violence. A survivor or person concerned about a domestic violence incident would call a hotline staffed by trained volunteers such as doctors, nurses, mental health professionals and community members. A team of volunteers would then respond in-person to the incident, work to deescalate the situation and connect the parties involved with community resources such as shelters, mental health treatment or financial assistance.  

    Colsaria Henderson, board president for the California Partnership to End Domestic Violence, in Newark, Calif.

    Some organizations have also attempted to resolve domestic violence disputes through a process called restorative or transformative justice. The process varies, but in general it involves a mediated discussion between the survivor, perpetrator and community members. They discuss the violence and its impact then agree on a safety and reparations plan — including ongoing accountability for the perpetrator. 

    Alternative approaches to handling domestic violence have long existed informally in communities of color, where mistrust of law enforcement runs deep, said Henderson. They are people or groups that survivors turn to for help, such as local pastors, attorneys, friends, relatives or even hair stylists, she said. 

    “We’ve informally done it for centuries,” said Henderson. “But it didn’t have a dedicated number to call. It didn’t have a true, regular avenue to flourish.”

    Optimizing these alternatives and making them widely available will require funding for pilot projects in different communities, she and others agreed. But Anita Raj, director of the Center on Gender Equity and Health at the UC San Diego School of Medicine, said significant investment from government at all levels is needed to fund these projects, but budgets are slow to shift in that direction.

    One attempt at the state level to fund alternative responses to domestic violence was vetoed by Gov. Gavin Newsom in September. Assembly bill 2054 would have provided grants of at least $250,000 to help community-based organizations establish pilot programs that address emergency situations such as domestic violence without involving the police. In his veto letter, Newsom disagreed with the bill’s proposal to house the pilot program under the California Office of Emergency Services. Instead, he wanted it assigned to the Board of State and Community Corrections. But supporters of the bill felt this was antithetical to its purpose, arguing that alternatives should be separate from the criminal legal system. 

    It’s important to acknowledge that some survivors do find police help effective and they want access to law enforcement, Russell-Slavin said. Police intervention is one tool for addressing domestic violence, Russell-Slavin explained, but may not be the best tool for every situation.

    A society that has allowed violence and racism to flourish

    Whatever solutions eventually emerge, most advocates agree they need to involve the perpetrators of domestic violence. Statistically, most often, that means men, although women and nonbinary people can be abusive too. An estimated one in four women and one in 10 men in the U.S. experience sexual or physical violence or stalking by an intimate partner in their lifetimes, according to the National Coalition Against Domestic Violence, although incidents are likely underreported. African Americans, Native Americans and multiracial people are at highest risk for domestic violence, according to a report by the Blue Shield of California Foundation

    Marc Philpart is principal coordinator of the Alliance for Boys and Men of Color at PolicyLink, a national network of community-based organizations seeking policies that better support the wellbeing of boys and men of color, and their families. That includes policy shifts in responses to inter-partner violence. The organization argues, domestic violence should be treated as a public health problem arising from societal norms and structures that have allowed violence, racism and misogyny to flourish. Embroiling perpetrators in the criminal legal system only exacerbates that violence, Philpart said. Men need a chance to learn new patterns of behavior, heal from their own traumatic experiences, and become positive agents of change in their relationships and communities, he said. 

    Marc Philpart, principal coordinator of the Alliance for Boys and Men of Color at PolicyLink, stands outside the Critical Resistance offices in the Temescal neighborhood of Oakland.

    “We’ve found ourselves in this situation where men aren’t involved in solution making and in safety planning and in stabilizing relationships,” said Philpart. “That one-sided approach has done nothing but deepen male involvement in the carceral state and in the criminal legal system and it also has led to significantly more destabilization in families and hasn’t helped to break the cycle of violence in a way that has been productive.”

    Currently, the only widely funded education programs targeting perpetrators of domestic violence are so-called “batterer intervention programs.” These programs are typically overseen by county probation departments, and men attend because they’re required to by court order. 

    The forced nature of the programs and the association with the legal system mean that men who attend feel stigmatized, Philpart said. There is little evidence that these programs work to change men’s behavior or keep victims safe, and it’s been shown that many men fail to complete the program because there is so little accountability.

    To reach more men, programs like these should be overseen by agencies like public health departments, not probation agencies, said Philpart. They should be promoted as open to anyone who wants to participate, not just those convicted of a crime. And they need to reflect the culture of the community they’re serving, Philpart added.

    The San Jose-based National Compadres Network has offered programs like this for years, although they are run by community-based organizations rather than local governments. The nonprofit has developed a concept called “men’s circles” where men come together to assess their own misguided ideas about manhood; explore those within the context of their experiences with systemic racism, oppression and childhood trauma; and develop a new understanding of what it means to be honorable based on their cultural heritage. The circles mostly serve men of color — largely those who are Latinx, Native American and Black. They also welcome people who are gay, lesbian, bisexual, queer/questioning and transgender. Some of the participants are referred by probation departments, but the programs welcome all men or people who identify as male who are seeking to be better fathers, partners, brothers, grandfathers and community members and to improve their relationships, said Jerry Tello, who founded the nonprofit.

    Jerry Tello, founder of the National Compadres Network, sits in the garden of the Los Angeles chapter of the network.

    Dozens of men’s circles exist in California and across the country. The Compadres Network also offers nonviolence programs that target specific groups of men and boys, such as fathers, teenagers and gang members. Additionally, they run circles for women and mothers on how to improve family relationships and raise healthy boys. 

    “Really this is a process and a movement and a re-grounding of manhood, a re-grounding of what it means to develop in a healthy way,” Tello said.

    Mixteco/Indígena Community Organizing Project also runs a domestic violence intervention and prevention program for both men and women. Living With Love is a series of workshops held in Spanish and the indigenous language Mixteco, that focuses on how to have healthy relationships, the impact of domestic violence on families and children and what to do if someone is experiencing domestic violence. The program, which is funded by the California Department of Public Health, encourages participants to explore the reasons for their own violent behavior, such as childhood trauma, said Vargas, the coordinator. Promotional materials for the program emphasize healthy relationships and self-care, rather than domestic violence specifically, which she said reduces stigma and encourages more people to participate.

    Dulce Vargas, coordinator of a domestic violence intervention and prevention program for the Mixteco/Indígena Community Organizing Project (MICOP), photographed at the MICOP offices in Oxnard.

    To make interventions like this more widely available, the Alliance for Boys and Men of Color recommended in a policy paper last year that California create a statewide office focused on violence prevention and intervention, increase violence prevention programs and services in schools, and increase funding for community-based solutions to end domestic violence. 

    Brooks left her abusive husband in 1994, but she wonders what difference the alternative intervention strategies now being proposed would have made for both her and her ex-partner if they’d had access to them. 

    “I could have gotten the help I needed, the healing I needed,” she said. “Maybe he could have too.” 

    This story was produced in partnership with Resolve Magazine and YES! Magazine.

  • 12 Apr 2020 10:48 AM | Rhonda Smith (Administrator)

    By Denzel Tongue 

    Photo by iStock/Marcos Elihu Castillo Ramirez

    For Sarah Dar, the success of California’s Health4All Campaign is a “life-or-death issue” for the state’s undocumented seniors.  If the expansion to cover undocumented seniors is legislated, it would be the first time in California’s history, says the public benefits director at California Immigrant Policy Center.  

    While President Barack Obama’s 2010 health reform bill, the Affordable Care Act, greatly expanded insurance access, it excluded undocumented immigrants across the country. This likely contributed to COVID-19’s disproportionate impact on undocumented Californians—an example of how institutional inequity can have life-altering consequences.

    Health equity and immigrant rights advocates have been urging California leaders to broaden health coverage for nearly a decade. Health4All began in earnest in 2013 when advocates first introduced legislation designed to expand Medi-Cal coverage to undocumented immigrants in California. Medi-Cal is California’s low-income health insurance program. Then in 2015, Gov. Jerry Brown signed SB 75 into law, expanding Medi-Cal access to undocumented children under 18 in the Golden State. And in 2019, Gov. Gavin Newsom expanded Medi-Cal coverage further to young adults up to age 25, regardless of immigration status.

    But that hasn’t helped older adults like Pedro Montes Vargas, a former farmworker. Montes Vargas, 76, has been in California’s Central Valley since 1975. He worked in the fields as a repairman for decades, fixing irrigation systems and farm equipment, along with other related tasks. In recent years, Montes Vargas has been forced to slow down because of his age and health challenges. He has high blood pressure, diabetes, and high cholesterol, which have made it difficult for him to use his hands and continue to work.

    Montes Vargas, who shared his story through an interpreter, now relies primarily on recycling to gain a modicum of income to support himself and his elderly wife. Because he is undocumented, he doesn’t qualify for Medi-Cal. He receives limited medical care from a local community clinic but is often unwilling to go because he has to pay out of pocket. Montes Vargas has already accumulated medical debt and receives regular calls from debt collectors. 

    Pedro Montes Vargas. Photo from Central Valley Immigrant Integration Collaborative (CVIIC).

    California has hundreds of thousands of other immigrants like Montes Vargas. If the state expanded Medi-Cal to all undocumented immigrants, they would be eligible to receive potentially life-saving health care.

    Undocumented immigrants make up the single largest group of uninsured people in the state. Projections show that, if nothing changes, by 2022, undocumented Californians will comprise roughly 38% of California’s uninsured population. The lack of access to health care has likely contributed to higher mortality rates in occupations that undocumented Californians tend to hold, especially during the COVID-19 pandemic. For example, agricultural workers died at a 55% higher rate during the pandemic compared to pre-pandemic times. Mortality rates among California’s construction laborers and cooks soared by 49 and 60%  respectively. In comparison, Californians in general ages 18 to 65 experienced a 22% increase in mortality between March and October 2020. 

    Undocumented immigrants have been instrumental in keeping California running during the pandemic. Not only do we rely on their work, but also their contributions to the economy and tax system. In 2018, undocumented Californians paid an estimated $3.7 billion in state and local taxes, and $7 billion in federal taxes. Ironically, some of their tax dollars fund Medi-Cal, the very program they’re excluded from. 

    Health4All coalition members are now calling for the state to expand full Medi-Cal coverage to undocumented elders like Montes Vargas. They see this as the next critical step toward eventually expanding coverage to all undocumented adults.

    Newsom included funding for undocumented seniors ages 65 and older in his January budget proposal for fiscal year 2020-21, but state leaders failed to include the expansion in the final budget, citing the economic downturn created by the COVID-19 pandemic. 

    Beginning in 2018, I served as a campaign coordinator for the Health4All campaign for two years. I saw firsthand how determined residents in the Inland Empire were to find health care for their elderly relatives and neighbors. I remember community members from TODEC Legal Center passionately advocating for immediate coverage of undocumented elders in their community during a legislative visit to state Sen. Richard Roth’s office. After years of organizing and storytelling, their work was so powerful that it led Roth to agree to co-sponsor the senate bill for Health4All Seniors in 2019. Moments like these remind me that the stakes of organizing for health equity are not theoretical—they are life-altering.

    Newsom has shown a willingness to lead on the defining issues of our era. He’s taken concrete steps to make health care more affordable and accessible. It’s time for the governor to prioritize expanding health care to one of our state’s most vulnerable groups. 

    The momentum is present, the economic rationale is clear, and the moral reasons are indisputable. It is now up to our state leaders to decide whether or not community elders who have sacrificed their working lives to support California’s economy deserve to live and age with dignity.

    This story was produced in partnership with Yes! Magazine.

  • 21 Jan 2020 11:35 AM | Rhonda Smith (Administrator)

    By Laurine Lassalle • Jan 21, 2020

    Photo credit: iStock. 

    When President Barack Obama enacted the Affordable Care Act a nearly decade ago, the broad aim was to improve health care access. One of the pieces of that legislation: requiring doctors to use electronic health records. 

    Electronic health records, which include health histories, prescriptions and test results, are now commonplace—but not everyone has access to them.

    Apple users are the only ones who can access their health records on their phones. CommonHealth, a new app for Android users, wants to change that and tackle health disparities in the process.

    “Android users tend to earn lower incomes, so medical centers using the Apple app are cutting out (a large fraction of patients),” said Ida Sim, a professor of medicine at UC San Francisco, where she leads the team piloting the app. 

    Sim and UCSF colleagues collaborated with Cornell Tech, the nonprofit Commons Project, and two other nonprofits to develop CommonHealth, which will be available to download for free in the coming months. 

    The app will allow patients with Android phones to safely store their health records on their devices and tell them how other apps are treating their stored health informationExperts also say it’s a step toward addressing the health-information access gap between Android and Apple users, because it will make medical records universally available—no matter the users’ smartphone brand. 

    Apple launched Apple Health Records two years ago, in January 2018, as part of the Apple Health app. The app allows users to access their immunization records, prescriptions, test results, documented allergies and other health information collected through their doctor’s patient portal. 

    The Office of the National Coordinator Health Information Technology reportedthat from January to May 2018, about 60 percent of the people who were offered access to online medical records viewed their records at least once on their smartphone or tablet.

    Elaine Khoong, an associate professor at UCSF and primary care research fellow at Zuckerberg San Francisco General Hospital, said that most of her patients express interest in accessing their health information online. But she said that even with apps for both Apple and Android users, there will still be barriers in the way. 

    “Our patient population is overwhelmingly a lot of patients with limited health literacy, who are low-income insured on Medicaid, racial-ethnic minority groups, and there’s a certain number of limited English proficient patients as well,” she said. 

    Khoong, who is conducting patient interviews on usability, testing and perceptions about CommonHealth, said she is preparing to test the app with Spanish and Chinese speaking patients in the future. 

    Accessing test results requires some level of health knowledge to understand what their results mean, said Adrian Aguilera, associate professor at UC Berkeley’s School of Social Welfare who conducts research on mobile health technology. This can discourage “patients from looking at their electronic health records,” Aguilera said. 

    Studies have shown that the smartphone market is almost equally divided between Apple and Android, but iPhone users are more likely to earn higher incomes than Android users. 

    A 2013 Pew Research Center study showed that 40 percent of cellphone owners who earned $75,000 or more annually had an iPhone, while 31 percent had an Android. Only 13 percent of those who earned less than $30,000 owned an iPhone, compared with 28 percent at this income level who owned an Android. 

    Because Android phones are cheaper, they are the only brand available through the “Obama phone” or Lifeline Assistant program, which gives free smartphones to low-income Americans.

    Moreover, while Hispanics and non-Hispanic whites were as likely to own an Android as an iPhone, 42 percent of African American cellphone owners said they had an Android.

    Apple phones, said Khoong, serve “a really specific segment of the population.” 

    About 400 health care centers in the United States already use Apple Health Records—and the number keeps growing. Apple and the US Department of Veterans Affairs, the largest medical system in the country, which provides service to more than 9 million veterans throughout more than 1,000 facilities, announced last month that veterans can now access their health records on their iPhones. But those who have an Android will still have to wait for CommonHealth. 

    For some, apps that allow medical information to be stored on phones, whether Apple or Android, raise privacy and security concerns, especially whether the tech giants can see and use this medical information. Recent data breaches make those personal data even more vulnerable. 

    JP Pollack, co-founder of the Commons Project and a CommonHealth project collaborator, said that the CommonHealth app would ask third-party apps to disclose their policies. The app will evaluate and inform users about their safety to help them make their own decisions. CommonHealth will also use encryption to secure health records. 

    But “once the data goes to another application, you no longer have control over it,” Pollak said. “It could be sold anywhere.” 

    That’s because the Health Insurance Portability and Accountability Act (HIPAA), which makes health care providers and insurers keep medical information private, doesn’t protect a patient’s information once it is stored on their phone.  

    Pollak said that patients, privacy experts, researchers and developers would work together during a workshop in February to finalize the CommonHealth app and address final issues regarding data privacy and information sharing.

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