Study Examines Changing Picture of Health Coverage for Children

Children living in Santa Barbara County are four times as likely to lack health insurance and nearly three times as likely to lack dental coverage as those in Northern California’s Solano County, according to a new statewide report that found wide regional disparities in children’s well-being.

California Report Card 2003, released today by the research and advocacy group Children Now, also found that the state’s children have among the highest rates of asthma in the nation and that just one-fourth of youngsters meet standards for physical fitness.

The report this year focused on infant health, health insurance and access to care, oral and mental health, nutrition and physical fitness. It draws on state and federal statistics and UCLA’s 2001 California Health Interview Survey of more than 50,000 respondents.

The study’s authors suggest that although poor health care saddles many children with little opportunity for advancement, others fare much better, in part because some counties have aggressive outreach programs that enroll children in state and federal health-care programs.

Children Now released the report at a news conference in Sacramento and urged newly installed Gov. Arnold Schwarzenegger not to sacrifice children’s health care when making tough budget decisions

The report found that Santa Barbara, San Diego and Riverside counties rank lowest in children’s medical and dental coverage and prenatal care. Alameda, San Francisco and Sacramento rank in the top 10 in such indicators.

A third of low-income parents report that they find it consistently hard to provide food for their children, even those who say they live in some of the wealthiest counties. Nearly 42% of low-income parents in Sonoma County and 41% in Marin County, for example, said that their children sometimes go hungry, exceeding the statewide average of 34% of low-income parents who report the same need.

San Francisco and Los Angeles, with 36.7% and 34.6% respectively of low-income mothers reporting hunger, also exceeded the average.

Immigration has changed the population of suburban and rural counties, experts say.

“The regions where we see some of the biggest challenges are regions where more kids are living in low-income families,” said Children Now Vice President Amy Dominguez-Arms. “And they now include places like Santa Barbara and Orange County, where we weren’t used to seeing such a high prevalence of kids lacking health coverage. It’s important for communities where there are changing demographics to look at what they can do to address these problems.”

Other findings documented widely divergent outcomes for children of different ethnic backgrounds. For example, Korean American children (32.8% uninsured) are five times as likely as Chinese American children (5.8% uninsured) to lack health insurance. Overall, nearly 24% of Latino children lack health insurance, compared with 16.8% of Native American children, 9.1% of Asian children, 8.2% of white children and 6.1% of African American children.

Gabrielle Lessard, an attorney with the National Immigration Law Center, said some of the disparities correlate to poverty and lack of English proficiency.

Lack of insurance is high among Korean Americans because of the large number of family-owned businesses and the self-employed, she said.

And some Latino and Asian families are concerned that enrolling children in health programs may jeopardize their immigration status, particularly if they are undocumented.

“As a result, these parents are placed in the agonizing position of whether to take their sick children to the doctor or pay the bills,” she said. “It’s sad because they can do both.”

The report found some overall progress: California’s rate of uninsured children has dropped by one-third in the past 10 years. But one in seven children -- 1.3 million -- remain uninsured and the state ranks 45th among other states for children with health insurance, a position unchanged in a decade.

The number of uninsured children in California could further be reduced by two-thirds if all children eligible for public insurance programs like Medi-Cal and Healthy Families were enrolled, according to the report.

At the county level, the rates of children lacking health insurance range from 4.3% in Solano County to 19% in Santa Barbara County. In the Central Valley, seven of eight counties have rates of uninsured children above the state average with Kern County, at 18.7%, the highest. Southern California county rates of uninsured youngsters are: San Bernardino, 14.3%; Orange, 15.6%; Los Angeles, 16.9 %; Riverside, 17.9%; Ventura, 18.4%.

Almost one in four children statewide (23.3%) lacks dental insurance and 18% of children ages 2 to 11 have never visited a dentist.

Roger Heroux, Santa Barbara County’s director of public health, offered a number of reasons for the county’s low health indicators. In tourist-dominated communities like Santa Barbara and Carpinteria, many people work in low-wage service jobs that provide no health insurance, he said. The same is true in the primarily agricultural northern part of the county, dominated low-wage field workers.

Health officials have established a network of clinics to tend to the needs of the uninsured, and are trying to do more outreach to get children enrolled in state and federally funded health programs.

“Certainly some of these kids probably do miss school because of health issues, and we are concerned about the lack of exercise and diet that affect many children,” Heroux said. “We’re also seeing a growing incidence of Type 2 diabetes among children. It’s a problem.”

According to studies, the No. 1 reason for missed school and hospitalizations among the nation’s children is asthma. In California, 1.2 million children (13.6%) have been diagnosed with the illness, compared with a national average of 7.3%.

Asthma rates vary by region and race, ranging from one in 10 children (9.5%) in Siskiyou, Lassen and Trinity counties to one in five children in Fresno (21%) and Solano (21.3%) counties.

African American children (22.1%) and Native American children (26.8%) are diagnosed with asthma at the highest rates, compared with 10.3% of Latino, 12.5% of Asian American and 15% of white children.

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Insurance disparity

Percentage of California children lacking continous health insurance over a 12-month period, by county:

*--* 12% and lower 12.1% to 14.6% 14.7% to 16.5% 16.6% and higher Alameda Alpine Butte El Dorado Contra Costa Amador Colusa Imperial Del Norte Calaveras Glenn Kern Fresno Inyo Lassen Kings Humboldt Mariposa Merced Lake Marin Mono Modoc Los Angeles Napa Nevada Orange Madera Placer Plumas Siskiyou Mendocino San Francisco San Bernardino Sonoma Monterey San Joaquin Shasta Stanislaus Riverside San Luis Obispo Sierra Tehama San Benito San Mateo Sutter Trinity Santa Barbara* Santa Clara Tuolumne Tulare Santa Cruz Yuba Ventura Solano* Yolo

*--*

2003 county data are available at www.childrennow.org

* Solano was lowest at 4.3%. Santa Barbara was highest at 19%.

Sources: Children Now analysis of data from UCLA Center for Health Policy Research