COVID-19 reveals gaps in the Valley’s public health system, but improvement is possible
The COVID-19 pandemic has made visible the effects of years of divestment in essential public health infrastructure.
The accumulated divestment hits rural regions particularly hard. As the number of cases surges, our health systems struggle with a lack of the basic supplies needed to perform essential medical and public health functions.
Campaigns have been launched across the country encouraging people to sew face masks and protective gowns in response to hospitals desperate for personal protective equipment for health-care workers. The number of available ventilators is woefully inadequate to meet the expected need, as is the number of hospital beds, particularly in rural counties.
About 15% of the U.S. population, or about 46 million people, live in rural areas, according the U.S. Census Bureau. The San Joaquin Valley is home to more than 4 million rural dwellers, 41% of whom are covered by Medi-Cal. Of California’s 58 counties, three in the San Joaquin Valley rank near the bottom in health outcomes: Fresno (48th), Kern (52nd), and Tulare (53rd).
This means we have a high proportion of vulnerable people living in persistent poverty, with unstable or uncertain employment and without stable housing. Many of those who do have adequate housing worry about paying rent and mortgages. These kinds of circumstances drive differential exposure risk across social and, at times, geographic divides.
Reports across the country warn of overwhelmed health-care systems without enough hospital beds, specifically intensive care beds, to meet the surging need. In the San Joaquin Valley, we are faced with not only a dearth of hospital beds, but also medical providers. The 2017 workforce assessment commissioned by the University of California, San Francisco found that our region has the lowest ratios of licensed MDs, nurse practitioners and registered nurses, among other health-care professionals, in California, and the second lowest per-capita ratios of physician assistants, certified nurses, and psychologists.
Addressing these challenges requires not only resources, but a commitment to developing a health-care workforce — a key element of a robust public health infrastructure — that understands and has the necessary tools to address the needs of San Joaquin Valley residents. UC Merced and UCSF-Fresno are actively collaborating to create a medical education program that will bring medical students and residents to the Valley for primary training.
UC Merced, UCSF-Fresno, Fresno State, and Bakersfield College are working together as part of the Rural Health Equity And Learning Collaborative (HEAL) to address persistent poverty and its health effects in our region. The Public Health Ph.D. program at UC Merced is providing regionally relevant training to graduate students committed to improving health in the Valley. There are possibilities for linking nursing programs in the community colleges, California State University campuses and UC Merced to increase the health-care workforce pipeline.
In its 2003 report on the future of public health in the 21st century, the Institute of Medicine argued for the urgency of ensuring a “sound public health infrastructure,” and urged the federal government to plan for national and regional funding to accomplish this goal. In 2020, in the midst of the COVID-19 pandemic, this mandate is more urgent than ever, and the passage of the CARE Act is a step in the right direction. It is clear that we need to come out of the current crisis with re-imagined health care and public health systems that will not be vulnerable to this kind of pandemic.
A key element of this re-imagining, especially here in the San Joaquin Valley, is the strengthening of the health-care workforce. We are particularly well positioned to address this due to the strength of UC, CSU, and community college training programs with adequate investment.
As President Franklin Delano Roosevelt stated, “The success or failure of any government in the final analysis must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health; the state’s paramount concern should be the health of its people.”
This story was originally published April 10, 2020 at 5:00 AM with the headline "COVID-19 reveals gaps in the Valley’s public health system, but improvement is possible."