First the good news: Obesity among low-income youth in the county fell slightly last year, and more people who lacked health insurance got coverage from programs such as Medi-Cal and Healthy Families.
Now the bad: More Orange County young people qualified for free lunches, and more families signed up for food stamps in the last year.
These findings were among 40 in the 17th annual Report on the Conditions of Children in Orange County, which examines the health, education and safety of youth and families.
Mike Ruane, executive director of the Children and Families Commission of Orange County, is the man who can at least take some credit for the good news and bears at least some of the responsibility for the bad. Recently he answered a range of questions about the report and the state of children's health in the county.
Q: Were there any surprises in the report?
A: We're very concerned about low birth weight [which increased from 2000-09, but fell slightly in 2010.] That is a key index of preventative care and well-being, and it's a predictor of the medical care that an infant and family are going to require. Even a small percentage increase is noteworthy.
Q: So birth weight reveals more than just the infant's heath?
A: It's two things. It relates to the level of prenatal care and health of the mom, so it's representative of the conditions in which the family may be living, in terms of poverty, access to health care and other conditions that would put that child at risk. The infant is probably not only medically fragile but there are other conditions that have impacted the prenatal care.
Q: Such as drugs or smoking?
A: There are dozens of causes, but substance abuse and smoking increase the risk of low-weight births.
Q: What other bad news is revealed in the report?
A: I think the gang member increase [by 72 percent from 2001-10] is always of concern to the community. ... The other was the free and reduced lunch.
Q: That figure increased?
A: Yes, you're now at 45 percent of all students in public schools in Orange County. Anything above a third is a sizeable amount of children. [Nationally, the figure is 65 percent.]
Q: Should we be alarmed that increasing numbers of young Latinos are relying on the county's psychiatric services?
A: That indicator only measures children receiving publicly funded services from the Orange County Health Care Agency. It wouldn't include people getting private treatment.
Q: Can you give more information on the decline in vaccination rates?
A: What's going in Orange County, when you look at "opt out" rates where parents opt out of vaccination, it's much higher in south Orange County than central and north part of Orange County.
Q: Why is there a growing lack of faith in vaccines in these communities?
A: There's a lot of conflicting information regarding safety and side effects and a tremendous need for an objective and timely education campaign to make sure families and parents are aware of the importance of vaccines. Those efforts have started this year to make sure parents have that information. There's a wonderful program in Colorado called Immunize Colorado, which uses social media.
Q: Who is most at risk from decreasing vaccination rates?
A: It's going to be the most medically vulnerable people. The longer treatment is deferred, the more serious the symptoms can be. There was a pretty aggressive campaign here, and at least the one metric, zero fatalities, was commendable. [Ten children died of pertussis or whooping cough in California in 2010, prompting a requirement to get a booster vaccination.]
The most vulnerable are very small children. In the first six months, the vaccine doesn't fully immunize them. The focus with pertussis, the greatest area of concern, was babies — very small infants who have immature immune systems. Even with shots … it doesn't fully protect them.
Q: On another topic from the report, why is it good news that more people are signing up for public or subsidized insurance programs?
A: It's not an indicator of sickness. Those people are eligible due to income not being above a certain level, and it is a testament to the high level of outreach and enrollment efforts by clinics and community-based organizations to make sure people who are eligible for coverage are enrolled.
This is not about more people being sick. The evidence is much stronger that people enrolled in programs like Healthy Families [for children and adults up to 19] with preventative care are going to be not as likely to show up in the emergency room.
Q: The report shows that obesity among low-income Orange County children has decreased. Why is that?
A: There are three places where there's been increased effort. One is at the schools, not only on nutrition but renewed interest in physical fitness. Programs like PE4ME, where they've brought physical activity to the schools, play a major part. The second is I think there's a greater bridge between the medical community and public health. You may see better education and material and programs.
Ten years ago we didn't have Dr. [Patricia] Riba's program, an obesity clinic for low-income children. A lot of what's going on in the community is a push among pediatricians. Before, asthma and some of more traditional issues were the key areas of focus. Now obesity is something every pediatrician and school nurse is well-versed and trained in.
Q: On the national level, first lady Michelle Obama has gotten flak for placing more emphasis on exercise and less on food.
A: The fact is now there's a lot of consensus on physical activity. Nutrition got the early focus and attention.
Q: What is the relationship between the economy and health care?
A: There are two indicators of tough economic times. One is automobile maintenance and repair. Generally people will put off maintenance until they have to, because they don't have the money to do it. Unfortunately, people and families make a similar decision regarding health needs. People will go to the doctor or the emergency room when the child is sick, but copays and the like for preventative care and the cost of preventative care where there seems to be no urgency are the types of things that get deferred.
Q: By showing poverty on the rise, does the "Conditions of Children" report contradict the popular image of Orange County?
The national image of Orange County is out of step with this report.
— Interview by AMY DePAUL