The United Nations and UNESCO have defined an overlapping set of major issues that represent the most serious issues for the global community. These common and inextricably linked issues, including health, poverty, education, and environmental and cultural sustainability, are highly visible and acute in the SJV. This region has a diverse population, narrow economic base, low levels of educational attainment and abundant health issues. It is an eight-county region of 27,280 square miles, home to 3.87 million people, or >10% of California’s total population (2006).
Although much of the SJV is rural, it does contain several urban cities and suburbs. Through the year 2030, the growth rate of the region is projected to be 65% higher than the state average. By 2050, a projected 14.5 percent of the state’s population will reside in SJV. Almost 60% of the SJV’s growth since 2000 has been due to migration, with the remainder attributable to natural increase (the excess of births over deaths). Like California as a whole, the SJV lacks an ethnic majority, but Hispanics now are the largest group, constituting 45%.
The SJV trails the rest of California in most socioeconomic and environmental indicators, with some of the highest poverty rates and poorest air quality in the state, indeed in the nation. Poverty is deeply engrained throughout the region. The region is dominated by low-wage farm and service-related jobs and lags behind the rest of the state in average job earnings. In 2008, 13% of its population was unemployed (State of California, Labor Market Information Division 2008); however, that rate has increased and currently exceeds 20% in several cities and counties. In 2005, the average income was $24,244. Almost one-fifth of the region’s residents (18%) are 14 years of age or younger, compared to 7% for the United States. More than one in four children live below the poverty level in the SJV and many are without health insurance.
The poor quality of the region’s natural environment also has an impact on the health of SJV residents. In 2003, the American Lung Association ranked five of the SJV’s eight counties among the top ten most polluted in the nation. Agricultural pesticides further deteriorate the quality of the environment in the SJV. In 2002, the California Department of Pesticide Regulation reported that half of the pesticides used in California (68 million pounds) were applied in the SJV, where they pollute both air and water.
These problems undermine the health of the SJV population, which ranks high statewide in the prevalence of several diseases and low in health care access. Although the eight counties in the SJV vary widely in disease prevalence and health status, the region has a higher prevalence of almost every disease and health threat.
For example, Madera County ranks 10th best in the state for fewest deaths due to all cancers, while San Joaquin County ranks 8th worst, with a rate that is 25 percent higher than the statewide average. All counties in the SJV have a higher percentage of obese children than the California average; the difference is even more pronounced in specific groups. This indicator portends the development of several chronic diseases. Health disparities in diabetes, childhood immunizations, asthma, coronary heart disease, chlamydia, cancer, and teenage pregnancy signal the need for research in these areas for improved prevention, diagnosis, and treatment of illness.
The region also includes numerous communities that are designated as a Health Professional Shortage Area (HPSA) by the U.S. Health Resources and Services Administration. The lack of access to routine preventative care contributes to the much higher than average prevalence of chronic diseases in the SJV. The large number of youth and high poverty rates in the region, less access to medical care, environmental threats, low levels of education, and high numbers of farm workers all contribute to a significant “At Risk” population in this region. There is a critical need to train and educate individuals who are knowledgeable about health disparities in the socioeconomic and cultural contexts of our region and to develop the future generation of researchers who will begin to find solutions to these disparities.