Type 2 diabetes (DM2) results when the pancreas produces insulin, but the cells Diabetes prevalence in California is greater among certain racial/ethnic groups, …
INFORMATIONAL HEARING
The State of our Childrens Health
February 22, 2005
1:30 pm
State Capitol, Room 437
This hearing will examine critical areas of childrens health, including
asthma, dental disease, mental health, diabetes, and rates of health
insurance coverage
Background
The health of children in the United States has improved in many ways over
the past several years, including lower births rates for adolescents and
higher immunization rates However, increases in obesity, infant
mortality, and low birth weight present major challenges According to the
Federal Interagency Forum on Child and Family Statistics FIFCFS, between
1976 and 1980, 6 of children were overweight By 1988-1994, this
proportion rose to 11, and to 15 in 1999-2000 Black, non-Latino girls
and Mexican-American boys are at an even higher risk of being overweight
In 1999-2000, 24 of Black, non-Latino girls and 29 of Mexican-American
boys were overweight A California Center for Public Health Advocacy
CCPHA study found that approximately 27 of California
children are
overweight and 40 are unfit
Infant mortality has increased for the first time in decades, from a rate
of 68 infant deaths per 1,000 live births in 2001 to seven per 1,000 live
births in 2002 The Centers for Disease Control and Prevention CDC
attributes the increase to deaths among neonates infants less than 28 days
old, particularly infants who died within the first week of life One of
the most significant risk factors for infant mortality is low birth weight
babies weighing 55 pounds or less Low birth weight rates rose from 7
in 1990 to 78 in 2002 The rate of low birth weight babies among Black,
non-Latino infants 134 exceeds the rate for any other racial or ethnic
group Growth in multiple births largely due to increasing use of
fertility treatments partially explains the low birth weight increase,
even though there have been increases among singleton infants
California has come a long way in improving the health status of its
children However, despite great steps towards increasing access to health
care, disparities among racial/ethnic lines, socioeconomic status,
language, and geographic regions persist Along with increases in the
numbers of overweight
children, asthma and type 2 diabetes rates are on the
rise There is great opportunity for improvement in all areas of pediatric
health This hearing will examine opportunities in five major areas
Asthma
Asthma is one of the most common chronic conditions for all age groups
According to the 2001 California Health Interview Survey CHIS, 39
million Californians have asthma equaling 119 of the population; the
national prevalence is 101 Those living in rural areas experience the
highest rates of frequent asthma symptoms up to 15, while urban
counties prevalence rates reach up to 9 Asthma disproportionately
affects children and young adults Approximately 600,000 California
children are afflicted with asthma, an increase of 160 since 1980 Asthma
prevalence is highest among children ages six to 11 137 and adolescents
ages 12 to 17 163 Children of low-income families and children of
color are more likely to have had an asthma attack in the past 12 months
Finally, childhood asthma is considered to be a leading cause of school
absenteeism According to CHIS, of the approximately 667,000 school-aged
children who experienced asthma symptoms, 20 missed one or more days of
school and 24
were limited in their ability to participate in physical
activities
Asthma is a chronic disease that cannot be cured, but its symptoms can be
controlled People with asthma are symptomatic when exposed to certain
environmental triggers such as tobacco smoke, air pollutants, chemicals,
mold, cockroaches, dust mites, pollen, and animal dander Effective
control of asthma requires timely access to comprehensive health care and
educational services Independent analyses by the RAND Corporation, the
federal Health and Human Services Office of Disease Prevention and Health
Promotion, and CHIS all call for comprehensive asthma education services
for those afflicted with asthma and their family members RAND also
recommends the development of a model benefits package for people with
asthma needs Specifically, their 2001 report Improving Childhood Asthma
Outcomes in the United States: A Blueprint for Policy Action calls for a
set of basic benefits for all children with asthma to ensure that all
private and public health insurance plans cover all services essential for
the proper management of the disease
Dental Disease
According to the CDC, the oral health of children has
improved
significantly over the past few decades However, tooth decay remains one
of the most common diseases of childhood: five times as common as asthma
and seven times as common as hay fever More than half of children age
five to nine have had at least one cavity or filling and 78 of 17-year-
olds have experienced tooth decay By age 17, more than 7 of children
have lost at least one permanent tooth to decay
The most advanced dental disease is found among children living in poverty
This risk group is enormous as one quarter of American children are born
into families that live below the federal poverty line annual income of
17,000 or less for a family of four Children living in poverty
experience twice as much tooth decay as other children, and their disease
is more likely to go untreated Advanced disease is also frequently found
among some racial/ethnic minority populations, disabled children, and
children with HIV-AIDS
According to the CDC, children without health insurance are less than half
as likely as insured children to receive dental care, and children without
dental insurance are three times more likely than insured children to have
unmet dental needs Children
with untreated oral disease often are in
persistent pain, unable to eat comfortably or chew well, embarrassed over
discolored and damaged teeth, and distracted from play and learning More
than 51 million school hours are lost each year because of dental-related
illness
Mental Health
According to the National Institute of Mental Health NIMH, one in ten
children in the United States suffers from a mental disorder severe enough
to cause some level of impairment Common mental disorders affecting
children and adolescents include attention deficit hyperactivity disorder
ADHD, autism spectrum disorders, bipolar disorder, borderline personality
disorder, depression, eating disorders, and childhood-onset Schizophrenia
The treatment of mental health disorders in children can be complicated
There have been numerous reports of public concern over young children
being prescribed psychotropic medications According to the NIMH, studies
are needed to determine the best treatments for children with emotional and
behavioral disturbances because children are in a state of rapid change and
growth during their developmental years Mental health professionals must
take this into consideration
during diagnosis and treatment of mental
disorders While it had been previously believed that disorders such as
anxiety, depression, and bipolar disease began only after childhood, it is
now known that they commonly begin at an early age While some problems
are short-lived and do not require treatment, others are persistent and
very serious, and require professional intervention Of the children that
have mental disorders, fewer than one in five receive treatment Even the
childhood-onset mental disorder that has been studied, diagnosed, and
treated most frequently ADHD has a significant amount of further research
necessary in very young children
Diabetes
Type 1 diabetes mellitus DM1 results when the pancreas produces
insufficient amounts of insulin to meet the bodys needs Type 2 diabetes
DM2 results when the pancreas produces insulin, but the cells are unable
to use it efficiently, also known as insulin resistance DM2, which used
to be commonly referred to as adult-onset diabetes, is far more common
than DM1, making up approximately 90 of all diabetes cases To manage the
disease, diabetics must keep their blood sugar as close to normal as
possible to reduce the risk of
long-term complications If not treated
properly, both types of diabetes can lead to kidney failure, blindness,
cardiovascular disease, stroke, and renal failure
According to CCPHA, diabetes affects as many as 182 million people in the
US, including an estimated 52 million people that have not been
diagnosed DM2 affects a growing number of children, and accounts for
almost 50 of new diabetes cases in some communities If current trends
continue, approximately 33 of boys and 39 of girls born in 2000 will
develop diabetes sometime in their lives Ninety-four percent of the
nations children and adolescents with DM2 are from communities of color
and it is estimated that close to half of African American and Latino
children born in the year 2000 will develop diabetes sometime in their
lives More than 12,000 adolescents in California were diagnosed with the
disease in 2001 Diabetes prevalence in California is greater among
certain racial/ethnic groups, with 103 of African Americans having been
diagnosed with diabetes, 93 of American Indians and Alaska Natives, and
60 of Latinos, compared to 56 of Whites and 47 of Asians and Pacific
Islanders
Genetics play a large role in DM2, and
family history is a risk factor
Environmental factors such as a low activity level and poor diet can also
increase the risk for DM2 The American Diabetes Association ADA
recommends screening for children starting at age ten if they are over-
weight and have two other risk factors, such as a parent with DM2, signs of
insulin resistance, or if they are American Indian, Latino, or African
American Yet, outside of large clinical obesity programs, screening for
diabetes in children is rare, despite the fact that DM2 diagnoses have
reached alarming rates in children
Rates of Insurance
According to the California Health Interview Survey CHIS, more than 11
million California children under age 19 more than the populations of nine
states were uninsured for all or part of the year in 2003 This is a
decline from the 15 million children who were uninsured for all or part of
2001 This decline resulted from increased enrollments in Medi-Cal,
Healthy Families, and county health initiatives These public programs
enrolled 600,000 more children over the two-year period, and more than
overcame the drop in employment-based coverage of children
The disappointing trend in the coverage of
California children is the
decline of employment based coverage Two hundred thousand fewer children
were covered in 2003 through their parents employment than were covered in
2001 This drop in employment-based coverage reflects a weak labor market
which may be cyclical and rapidly rising health insurance costs,
including a 79 increase in employee share of premiums for family coverage
which are likely not reversible The following chart summarizes the
health insurance status of California children in 2003:
|INSURANCE STATUS |2003 |PERCENTAGE |
| | |POINT CHANGE |
| | |FROM 2001 |
|Uninsured All Year|51 508,000 |-24 |
|Uninsured Part |62 626,000 |-11 |
|Year | | |
|Employment-based |508 |-43 |
|Insurance All Year|5,102,000 | |
|Medi-Cal or |293 |52 |
|Healthy Families |2,942,000 | |
|All Year | | |
|Other Insurance |87 873,000 |27 |
|All Year | | |
|Population in
2003|100 | — |
| |10,050,000 | |
Source: CHIS, UCLA Center for Health Policy Research, December
2004
Based on insurance status at the time of the CHIS interview, 55 of all
uninsured children were eligible for enrollment in either Medi-Cal or
Healthy Families 227,000 for Medi-Cal; 224,000 for Healthy Families
Another 6 44,000 children were eligible for insurance through county-
based insurance programs Although children eligible for county-based
programs had grown to over 100,000 by December 2004, limited funding
resulted in enrollment caps in many county programs Thirty-nine percent
of uninsured children were not eligible for public programs because of
family income level 159,000 children or immigration status 148,000
children
Conclusion
The state of health of California children impacts childrens lives in many
ways, including their school performance, their family relationships and
their future wellbeing In addition, unhealthy children mean higher overall
health care costs for all Californians In 2002, the Select Committee on
California Childrens School Readiness and Health held a series of
hearings
and reported that healthy children attend school more regularly and
students absenteeism rates have a direct correlation with their academic
performance Children must start school healthy and be ready to learn
Children who have insurance have better access to care, including
prevention and treatment Many children begin their lives with preventable
health risks, but do not have access to preventive care services These
same students are expected to perform at grade level by age nine and
ultimately pass an exit exam to graduate from high school Without proper
intervention and attention to health needs, many students needlessly face
extreme challenges in meeting academic standards and moving on to
successful adult lives
Source:graniteschools.org
