Staying close: California's housing crisis sickens families

"When you start superimposing economic inequality – that is you don’t have sufficient economic resources to maintain yourself while you’re here – it will impact you," Cuevas said. "We break down. Our body begins to get sick. If you don’t have access to healthcare, you get sicker until that disease process runs its course."

People living in overcrowded homes may have to deal with vermin and pests, as it can prove more challenging to keep the home clean when too many people are living there.

Communicable diseases also love overcrowding. Viruses, fungal infections and head lice thrive in these environments, where germs travel in the air from coughs, on commonly touched items, and more. 

Diseases that thrive

The county health department doesn't track individual cases of norovirus or influenza, save for outbreaks or death. However, during the 2018-2019 flu season in California, 588 people died from the flu, according to the state health department. 

Doctors like Cuevas said overcrowded housing, which has increased as the housing crisis deepened, also raises vulnerable peoples' risk of contracting these illnesses.

Viruses such as norovirus or influenza can be passed through contact with contaminated surfaces such as door handles, hands or food, but other diseases such as whooping cough or tuberculosis requires people to breathe in the bacteria.

"We’ve had instances (of tuberculosis) in the southern part of the county because of overcrowding: that is more than two people living in a room or more than one family living in a house," said Cuevas. "We’re seeing a lot of that right now. For people to afford the rent of a house, you’ve got five, even 10 to 12 families living in a house."

"If you've got multiple families living in one home, it's going to be very difficult to isolate someone with tuberculosis, with norovirus, with influenza," said Dr. Edward Moreno, the director of the Monterey County Public Health Department. "Especially if you have one bathroom.

"If you've got a one-bedroom home or a studio, you can't isolate someone. That's how overcrowding contributes to making people sick, because you can't isolate the person."

Based on 2011-2015 data from the Healthy Communities Data and Indicators Project, the California Department of Public Health found that in California, 8.2% of households are considered overcrowded.

In Monterey County, the rate of overcrowded households is 55% higher than the state average: It stands at 12.7%. 

Latino households in California experience the highest rate of overcrowding at 20.1%, followed by Native Hawaiian/Other Pacific Islanders. In contrast, white households are the least likely to be overcrowded at 1.7%.

Tuberculosis is more commonly found among those who live doubled and tripled up, said Cuevas, as the proximity of people to one another can make it easier to pass on bacterial diseases or viruses.

In countries with fewer resources, a bacterial disease like tuberculosis is often considered a death sentence, said Moreno. Mexico, South America, Southeast Asia and Central Europe all grapple with this fear, said Moreno.

"If you want to stay in the family, you want to keep your job, you don't talk about your tuberculosis, even though you're probably infecting other people," said Moreno.

"That's something we deal with as we're doing our investigations, so we don't always get all their other family members or people at work they've exposed," he said.

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A line of Salinas residents await their chance to get food benefits from members of The Celebration Church. The members offer clothes, eggs, canned food and restroom supplies on Jan. 18, 2020. (Photo: David Rodriguez/The Salinas Californian)

Doctors with the Monterey County Department of Public Health noted that tuberculosis infections increased in the second half of the decade but dropped from 29 cases in 2018 to just 12 cases in 2019, said Kristy Michie, the assistant director of public health.

"That's in a county with more than 440,000 people," said Moreno.

Asked what factors led or contributed to the decline in tuberculosis in the county, officials from the public health department are stymied. 

"The Health department does not have any data or evidence to support theories about why the incidence declined last year," said Michie. As such, she said, officials are closely monitoring cases.

"Last year was unusual for us, so we do expect to see at least this number or more this year," said Michie. "If that's influenced by overcrowding, we can't say for sure; there's a lot of things at play there."

Another bacterial disease, pertussis, also known as whooping cough, can pass more easily among the vulnerable in overcrowded conditions. More individuals became ill with whooping cough in 2019 than in previous years, but Michie said that was expected due to its cyclical pattern that peaks every three to five years.

"It looks like a radio wave across time," she said.

Local, low-cost or no-cost healthcare

In certain parts of Monterey County, overcrowding and unhealthy living conditions are common, thanks to a lack of affordable housing. That can leave the area's tens of thousands of farmworkers squeezed into garages and living rooms.

According to a 2015 fact sheet by researchers at San Diego State University and the Center for Immigrant Integration at the University of Southern California, an estimated 18%, or just under 9,000, of the 49,000 people who live in East Salinas are undocumented immigrants.

The researchers estimate only about 23% of undocumented immigrants have health insurance, compared with 63% of the U.S.-born population, excluding documented immigrants. 

"The group that's going to face difficulty (getting treatment) are the uninsured," said Moreno. Specifically, he said, those who didn't sign up for Covered California, don't have Medi-Cal or Medicare.

Going without health coverage can leave people choosing between a bill and a doctor's visit.

Children under 18 years of age and adults under 25 are guaranteed medical benefits by the Golden State, regardless of citizenship. However, that could still leave millions of residents without health insurance.

In 2014, between 2.35 million and 2.6 million undocumented immigrants called California home, research by the Public Policy Institute of California showed. Those numbers account for nearly a quarter of the nation's undocumented population and 6% of the state's total population.

Resources

For those without insurance, there are options available for medical care. Hospitals may have sliding scale payments for treatment, and the state's Department of Health Care Services offers lists of healthcare providers and insurers on its website.

Small federally qualified health centers or clinic systems across the state, such as the Clinica de Salud del Valle de Salinas clinics, offer healthcare to patients in English or Spanish at low or no cost.

These community-based health care providers receive federal funds to provide primary care services in underserved areas and must meet certain requirements, such as providing care on a sliding fee scale based on ability to pay.

The Salinas Valley Memorial Hospital System also operates a mobile clinic four days a week in Salinas, Castroville and Greenfield. It offers free healthcare in English or in Spanish.

• Monday,  11 a.m. - 2 p.m. 
  • Greenfield Family Resource Center
  • 439 El Camino Real, Greenfield
• Tuesday, 12 p.m. - 3 p.m.
  • Salinas Valley Community Church
  • 368 San Juan Grade Rd., Salinas
• Tuesday, 4 p.m. - 8 p.m.
  • Castro Plaza Family Resource Center
  • 10601 Mcdougall St., Castroville
• Wednesday, 12 p.m. - 8 p.m.
  • Alisal Family Resource Center
  • 1141 Del Monte Ave., Salinas
• Thursday 12 p.m. - 8 p.m.
  • MLK Family Resource Center
  • 925 N. Sanborn Rd, Salinas

Kate Cimini reported this story with support from the 2019 Impact Fund, a program of the USC Annenberg Center for Health Journalism. This work was also produced in part through a collaboration with the Bay Area visual storytelling nonprofit Catchlight. She is a multimedia journalist for The Californian. Call her at (831) 776-5137 or email kcimini@thecalifornian.com. Subscribe to support local journalism.

[This article was originally published by The Californian.]