Health issues vary in low-income Imperial County

Elizabeth Varin wrote this story for The Imperial Valley Press as a 2011-12 California Endowment Health Journalism Fellow.

In Imperial Valley two in every five people are obese, nearly 13,000 people have been diagnosed with diabetes and 163 children were hospitalized in 2010 due to asthma.

The Valley leads the state with these factors, having the highest rates of diabetes, asthma hospitalizations and obesity. Because of these and other factors, Imperial County has an uncertain future, ranking as one of the worst counties in California for its health habits, though currently the area is not too far off with how healthy it is.

About one in three people reported having bad or only fair health, according to a report released earlier this month by the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. On average residents had about five days through a 30-day period that they considered to be poor physical health days, compared to the 3.7 in California and the 2.6 national average.

While there were health factors locally that did much better than the state average, like adult smoking, excessive drinking and the number of diabetic screenings done, overall factors that can lead to a healthy life here were bad.

About 24 percent of the population is reported uninsured, 66 of 1,000 teenage girls between the age of 15 and 19 have had a baby and 23 percent of people older than 20 reported no physical activity.

Socio-economic factors can also affect health, and Imperial County’s high unemployment rate and the number of children in poverty worked against the area in its health ranking.

The report shows that Imperial County ranked 35 out of 56 counties in California for how healthy it is, but the area did poorly — 52 out of 56 counties — with its factors that lead to a healthy life in the future, like obesity, insurance levels, socio-economic factors and the physical environment.

The report was geared not toward pitting counties against each other, but rather encouraging people to get involved, said Kate Konkle, outreach specialist with the County Health Report group. It gives people tools, like the Web site to try and better their community.

Any change is going to take not only health specialists, but also business owners, political leaders, educators, really everyone coming together to work on issues, she said. 

This report gives people the information and a roadmap for what they can do.

“We recognize health is local,” she said. “Where you live matters to your health.”

The group hopes that people use this as a call to action, to take control of their community’s health by bringing partners to the table and having an honest discussion on what can be done, she said. A lot of factors impact health, and it takes a shared community group coming together to make a significant change.

One of the big impacts in this area is asthma, with about 300 hospitalizations  in 2010. Among that group was Adriana Mendez, 18.

Mendez is one of many in her family who has asthma, including her mother, grandmother, sisters, brother and cousins. One of her cousins in Mexico even died after having an asthma attack.

The Brawley resident has made multiple trips to the hospital every year due to her asthma, which she has had for as long as she can remember. It’s been horrible to never feel 100 percent under control of it, she said.

It starts out as a feeling like someone is choking her, pressing down on her chest. She can feel her throat and lungs closing.

Now not only does Mendez have to take daily doses of medicine, but also her 5-month-old daughter Leea Ruiz takes doses every three hours from her blue-penguin decorated inhaler. Leea was just released from the hospital again after another few days stay there.

Mendez worries about her daughter, that she won’t be able to have fun or play soccer because she could have an asthma attack.

“I want her to have a normal life,” Mendez said. “Even if it’s (asthma) controlled, it’s not for that long.”

Whenever it gets windy or fields she passes start to be burned, she knows it’s not going to be a good day, she said. There are just so many things that can affect her family.

There are health issues that affect this area more than others like asthma, hypertension and obesity, but the general health awareness also isn’t there, said Dr. Vachas Palakodeti with the Imperial County Medical Society. For the more than 20 percent of the population that is on MediCal there’s no incentive or educational push toward getting healthier.

“You would think ‘I want to be healthy’ would be an incentive, but I see, and a lot of physicians see, that it’s not as much of an incentive as it should be,” he said.

Those programs don’t emphasize preventive care, he said. Even with the many people who get food stamps, there’s no incentive to buy fruits or vegetables, he said.

According to a study from the UCLA Center for Health Policy Research four in five Imperial County residents don’t have three or more servings of vegetables in a day.

For Palakodeti public health programs like MediCal need to have a “carrot-and-stick approach,” he said. If you have food stamps, you shouldn’t be able to buy junk food with it and if you lose weight maybe your co-pay goes down. But the way health insurance is done in California, none of these things happen.

Overall it’s hard in this area because while Imperial County has health clinics, hospitals and nutritionists, there’s a huge population that needs help, but limited resources, he said. There has to be some effort by the whole community to set something in place. Unless the patients are made part of the solution, it’s not going to work.

That hardship is something Lisa McKenzie knows about. She’s on MediCal, and she and her family have to deal with the financial impact of health problems.

It had started as emergency room visits for her son Mario Jeffrey Salazar. His knees were swelling, and he was in pain.

After five or so such visits, he was taken to Rady Children’s Hospital in San Diego to be diagnosed forrheumatoid arthritis when he was 13. Just more than a year later he was told he also had fibromyalgia. Now the 17-year-old is still working to find the right treatment, and it’s an experiment.

As a parent it’s hard to watch, because McKenzie said she doesn’t see that she can do much. He gets out of bed, and he’s hurting. He has trouble playing basketball with his friends, which he loves to do.

“He tries to be a tough guy, but I see how this lifelong battle really gets him down,” she said. “It takes the simple joys out of life. … I can’t always put a smile on his face.”

It’s difficult traveling to San Diego for appointments and hospital visits, especially with two other sons at home, she said. When the Children’s Hospital clinic in El Centro closed, it was a real blow because it’s something that’s really needed here.

Lisa herself has arthritis and has to go to Clinicas de Salud del Pueblo, though her son can’t go because they don’t have a juvenile arthritis doctor, she said. She made an appointment in November, but won’t get to see a doctor until September, almost a year later.

“That’s the choice we have,” she said.

There are similarities between what the Valley deals with now and what it has dealt with for years. Statistically, the county stood quite well in the early ’90s, though there was a high incident of foreign-born residents, low-income levels and high numbers of young pregnancy, said Dr. Kenneth M. Tittle.

Through the last few years Tittle has dealt with an older population, primarily Spanish-speaking at the Calexico Health Clinic, but between 1990 and 1992 he served as public health officer for Imperial County. He’s not seen the public health numbers since he’s been working with individuals, but in general people don’t get hung up on medical trends, but rather focuses on how they’re feeling, he said

Tittle himself has also dealt with his own health issues, being diagnosed with an inoperable brain tumor last month. He died April 19, but in an interview a week after he retired from the Calexico clinic he emphasized the importance of public health.

“The problem with public health is it’s crucially important, but it doesn’t immediately help any individual,” he said. “What people are concerned about is ‘am I going to be sick?’”

Staff Writer Elizabeth Varin can be reached at or 760-337-3441. 

This article was produced as a project for The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School for Communication & Journalism. 

This story was originally published in the Imperial Valley Press on April 28, 2012