Press Coverage Stanislaus receives poor health rating By Tim Moran Modesto Bee April 9, 2008 Babies in Stanislaus County still die too often, children and adults still weigh too much and there's too much diabetes and heart disease. The causes are a complicated mix of personal behavior, poverty, low education level and a lack of adequate medical care, according to the annual report of the Public Health Division of the Health Services Agency, presented to the Stanislaus County Board of Supervisors on Tuesday morning. The county's infant mortality rate is 7.3 per 1,000 births, compared with the statewide rate of 5.3 and the national rate of 6.9, according to the report. The causes include premature births, inadequate prenatal care, alcohol or drug use during pregnancy and lack of knowledge about recognizing problems with pregnancy. "Most of these concerns are regional, not just our county," said Dr. John Walker, the county's public health officer. But Stanislaus County ranks 57th of the 58 California counties for heart disease deaths and 47th for infant mortality, he said. "Clearly, these are significant issues," Walker said after the meeting. "As a local health department, we want to really focus on improving the outcomes." Among the recommendations in the report are countywide screening of pregnant women for substance abuse and sexually transmitted diseases, enhanced prenatal care services, community education and health care provider education. Chronic conditions such as diabetes, heart disease, high blood pressure and obesity are "the epidemic of the 21st century," Walker said. Obesity and physical inactivity are the major risk factors leading to most chronic diseases, the report says. It estimates that 60 percent of the adults in the county are overweight, and more than 34 percent of the middle school students are in an unhealthy fitness category. Heart disease, Type 2 diabetes and obesity are among the most preventable diseases and conditions through diet, exercise and avoiding tobacco, the report says. The infant mortality rate has improved a little -- the county was 53rd in the state the previous year, Walker said. "But it is still a high number. And heart disease is a significant concern to us," he said. Gum disease and cavities are another category of chronic ailments affecting the health of thousands of county residents, according to the report. Almost 1,100 children in the county, 11 percent of those screened, were found to have cavities severe enough to impair their ability to eat in adequate quantity or quality, according to a 2007 study by the Stanislaus County Women, Infants and Children program. Gum disease has been associated with premature labor, and 18 percent of premature births are attributable to poor oral health in the mothers, according to a 2007 Children Now Oral Health Policy Brief. Coalitions of groups including schools, employers and public agencies need to work together to educate the public, said Walker. Examples, he said, are policy changes such as banning smoking in restaurants and in public buildings that have made California the state with the lowest rate of smoking in the nation. The solutions to the problems are long term, Walker said. Improvements in the statistics may take a decade or a generation, as public behavior is changed. Methicillin-resistant staphylococcus aureas, the so-called "super bug" infections that are resistant to penicillin treatment, are an emerging challenge, Walker said. The infections come in two types, he said: health-care associated, which happen in hospitals and long-term care facilities to people who are chronically ill and vulnerable; and those that happen in the community to healthy people who are in close contact, such as child care and school settings, gyms, prisons and in military training. The community infections are rarely fatal, Walker said. The Public Health Division is distributing brochures to child care providers and schools, he said. Walker said a growing problem is that revenue from state and federal sources is earmarked for specific programs, which makes it difficult for the county to respond to emerging issues in the community. Less than 5 percent of the federal and state money for public health is for chronic disease, Walker said. With limited funds, the Public Health Division has chosen to focus on the next generation to alleviate chronic disease, with programs aimed at children. "We continue to beat the bushes looking for foundations that may assist us in these efforts," he said.