UC Merced Magazine | Volume XIX, Issue VII

Bridging the Health Care Divide in California’s Central Valley

By Alyssa Johansen

Merced County Public Health Director Kristynn Sullivan, Ph.D.

A stark divide exists in the heart of California, where vast farmland stretches to the horizon. Many residents of these rural communities form the backbone of the agricultural industry that feeds the world. Yet, they face disproportionately high rates of chronic illnesses that often go untreated or undiagnosed. Researchers at UC Merced are working to understand the environmental and systemic factors contributing to this disparity. Meanwhile, UC Merced alumni in the health care industry are stepping up to address the gaps, and as the university expands its medical education programs, it aims to develop a new generation of providers — trained in the Valley, for the Valley. Barriers to Health Care “The hurdles for some patients in the Valley can seem insurmountable, and unfortunately they often are,” said public health Professor Nancy Burke, the John D. and Catherine T. MacArthur Foundation Endowed Chair and co-director of the UC-Cuba Multi-Campus Academic Initiative. Several factors prevent residents from seeking necessary care. These include a lack of translation services, fears about immigration status, the distance to medical providers and the financial burden of taking time off work.

Though community clinics exist, the nearest emergency rooms, primary care physicians, specialists or dentists may be more than an hour away. Without reliable transportation, visiting a doctor can mean spending an entire day navigating limited public transit. Burke and her colleagues at UC Merced are launching a study to examine the long-term health effects on farmworkers who, after years of exposure to pesticides, extreme heat and grueling physical labor, often face debilitating health issues. “We are not seeing great health outcomes as they age,” Burke said. “They have given their lives and bodies to ensure the rest of us have food on our tables.” Burke also pointed to a Valley fever study underway in partnership with UC San Francisco. She and her colleagues interview people who have been exposed to the disease and developed the most severe cases. It’s a perfect example of how poor access to health care can lead to untreated illness with dangerous consequences. If left untreated, Valley fever, a lung infection caused by inhaling fungal spores, can spread to the brain and become fatal. Burke said early research indicates that 46% of surveyed patients fell out of care because their cases were lost to follow-up.

“This is the kind of disease that requires continual monitoring and care,” she said. “These cases progressed because it took so long for these people to get diagnosed.” Hidden Cost of Delayed Care After earning a doctorate in 2015 from UC Merced, Kristynn Sullivan spent years working as a health professional in Merced County and saw first hand the patterns associated with health disparities. She was recently appointed head of the county’s Public Health Department. While Merced County reports lower chronic disease statistics than some comparable regions, she said, the data comes with a concerning caveat: higher mortality rates. “That indicates that people are not seeking preventive care,” said Sullivan. “When they are diagnosed with a chronic disease, it’s more advanced, harder to control and they’re more likely to die from it.” Burke agreed that accurate health data on rural populations is often lacking — not because these communities are “hard to reach” but because they are “hardly reached.” “There’s a preference for conducting research in areas where sample sizes are easier to measure,” Burke said. “You actually have to put forth a substantial effort.”

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