A county health officer is very much like a primary care medical provider except that his or her patient is an entire community.
My patient is Fresno County. In comparison to other such patients in the state, mine is rather young, quite poor, not so well-educated, faces many obstacles to health care access, suffers excessively from obesity, diabetes, violence, mental health disorders and sexually transmitted diseases, breathes polluted air, and is at high risk of delivering preterm infants who have an unacceptably high risk of dying during their first year of life.
Every primary care medical provider knows that the best health of the patient comes when every body part, organ and tissue is functioning at optimal capacity.
Like any good provider, I routinely run the most up-to-date tests at my disposal, examining all the interrelated and interacting body parts.
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A recent analysis conducted by our health department compared Fresno County census tracts (CT) to others in California for the following measures:
▪ Pollution burden
▪ Years of potential life lost to preventable causes
▪ Mortality from chronic diseases
▪ Pre-term birth rate
Twenty six of our 199 CTs ranked in the highest 25th percentile statewide for three of these measures and three CTs ranked in the same percentile for all four measures. To further examine one of these three most highly impacted CTs and to observe the situation for myself, I decided to make a “house call.” Beforehand, I collected additional information on my patient and discovered that 2013 data in this CT indicated:
▪ An average age of 28 years, compared with 31 for Fresno County and 35 for California
▪ An average household income of $24,500, compared with $45,500 for Fresno County and $61,000 for California
▪ Fathers were absent in 26 percent of households, compared to 23.5 percent for Fresno County and 19 percent for California
▪ Thirty-three percent of people 18 to 24 years of age had less than a high school diploma or equivalent, compared with 20.4 percent for Fresno County and 15.7 percent for California
▪ Twenty-five percent of households had no available automobile, compared with 9 percent for Fresno County and 7.5 percent for California
▪ Investment in physical activity opportunities was 30 percent, compared with 50 percent for Fresno County and 72 percent for California
▪ The unemployment rate was 21 percent, compared with 14.5 percent for Fresno County and 11.5 percent for California. Newer unemployment data from 2014 is available for Fresno County as a whole at 9.5 percent and California at 6.2 percent. Although the 2014 data is not yet available for the CT, I suspect the disparity persists.
Observation of my patient during the “house call” showed: a significant number of industrial structures and lots, many of which were abandoned; major roadways in poor condition with many sidewalks missing or in disrepair; one large but unkempt grocery store; boarded-up houses; an individual wandering aimlessly in the middle of a heavily trafficked road; and two people gathering what looked like their possessions, which had been scattered across another major roadway.
However, I also saw: several productive individual farms; a vibrant primary medical care facility; an inviting community center with a variety of recreation options; a very well-kept middle school campus; a handsome charter school; no stray animals; very attractive churches; a comfortable-appearing senior living center; and several individuals taking advantage of the intact sidewalks around that center to engage in group walks.
What methods can be brought to bear to heal the vitality of this part of my patient? What can be done to enhance and expand what is healthy and improve what is not? What further tests should be done? What specialists should be called in for consultation? Answers to these questions must be found for all the areas of our county that suffer excessively from poor health and well-being outcomes.
Specialists in health care, education, child care, housing, business, law, community planning, transportation, and other fields are pulling together to determine how we can collectively impact those conditions in which we are born, live, learn, work, play, worship and age, that so affect our health, functioning and quality of life.
Will you join us? Visit www.fcdph.org/toyourhealth to find out how.
Ken Bird, M.D., M.P.H., is Fresno County health officer, Fresno County Department of Public Health.