Top 10 Issues
Valley Children’s Healthcare is guided by our mission to continuously improve the health and well-being of children.
With that commitment in mind, in 2023, Valley Children’s Healthcare and the Guilds Center for Community Health continued to track and trend our annual list of the most critical issues adversely impacting child health and well-being in our region. These issues do not exist in their own “silos,” but rather are interconnected and often interdependent. With our community partners, we continue to understand and equitably address these issues and measure our progress.
Top 10 Issues Facing Our Kids
Continuous healthcare access is essential for children. In the Central Valley, many children miss out on critical physical and mental health services due to inadequate resources and are often sicker by the time their families are able to access care.
Childhood adversity – such as child abuse, exposure to violence, family alcohol or drug abuse and poverty – can have negative, long-term impacts on health and well-being.1 Challenges children face in school, life and ultimately with their health, are often the symptoms of Adverse Childhood Experiences (ACEs) and toxic stress. In our region, ACEs affect almost 20% of children, increasing their risk for long-term health and behavioral issues.
Program Highlight: Adverse Childhood Experiences Screening
Valley Children’s Olivewood Pediatrics practice in Merced received close to $622,000 in grant funding to address ACEs through increased community partnerships, expanded education and broadened screening and referrals.
Through the grant, Valley Children’s is helping to identify patients and families at risk for poor health outcomes because of ACEs and toxic stress; educate providers, staff and community members about ACEs and toxic stress and how to intervene; connect families to needed resources; and build resilience to break the cycle.
From Oct. 1, 2022, through Sept. 30, 2023, the Olivewood Pediatrics practice screened 1,615 children for ACEs, 48 of whom screened positive and for whom intervention services were provided to disrupt toxic stress.
ABUSE
Physical
Emotional
Sexual
NEGLECT
Physical
Emotional
HOUSEHOLD DYSFUNCTION
Mental Illness
Mother Treated Violently
Divorce
Incarcerated Relative
Substance Abuse
1 Centers for Disease Control and Prevention. (2020). Preventing adverse childhood experiences. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html
Asthma is the most common chronic condition among children. It is also one of the leading causes of school absenteeism. In Kings County, over 25% of children have been diagnosed with asthma. Low-income populations, minorities and children living in underserved communities experience more emergency department visits, hospitalizations and deaths due to asthma than the general population.2
2 American Lung Association. Asthma Trends and Burden.
Child abuse can cause serious physical injuries and even death, and can lead to lifelong physical, emotional and behavioral problems, which can impact families across generations. Children who are abused or neglected are more likely to have problems such as anxiety, depression, delinquency and difficulty in school. Kern and Stanislaus counties have the highest rates of substantiated cases of child abuse and neglect in the region, much higher than the California state average. It is important to remember that child abuse and neglect are preventable.
In recent decades, the national childhood obesity rate has more than tripled, with persistent disparities by race/ethnicity and socioeconomic status.3 This is a troubling trend and a reality for the Central Valley; across our 12-county region, almost half (45%) of all fifth graders are overweight or obese. Compared with children at a healthy weight, children with obesity are at higher risk for a range of health problems, including asthma, high blood pressure, high cholesterol and Type 2 diabetes. They also are more likely to become obese as adults.4
Program Highlight: Schools for Healthy & Thriving Students
In 2023, Valley Children’s and the Guilds Center for Community Health, in partnership with the Center for Wellness and Nutrition and No Kid Hungry, completed Phase II of Schools for Healthy and Thriving Students, which supported school districts in their efforts to update and fully leverage school wellness policies, including policies addressing physical activity and nutrition. The framework for the work was the Centers for Disease Control and Prevention’s Whole School, Whole Community, Whole Child (WSCC) model, a student-centered tool for addressing health in schools. Of the 17 participating school districts, four updated their school district wellness policies and 14 updated a WSCC-related policy.
3 Fryar, C. D., et al. (2020). Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2-19 years: United States, 1963-1965 through 2017-2018. National Center for Health Statistics.
4 Centers for Disease Control and Prevention. (2021). Childhood obesity causes and consequences.
Approximately one in four Central Valley children is food insecure and lives in a household with limited or uncertain access to adequate food.
Program Highlight: Partnership with the Central California Food Bank
Through a partnership with the Central California Food Bank, Valley Children’s Home Care staff, as part of their regular home visits, are bringing qualifying families a specially assembled food box every month that aligns with the family’s cultural preferences. In the partnership’s first year, we distributed 8,492 pounds of food (the equivalent of 7,076 meals) to 35 families including 90 children.
Through the same partnership, Valley Children’s is supporting a food distribution at West Fresno Elementary School and West Fresno Middle School. During its first year, 23,055 pounds of food was distributed (the equivalent of 19,213 meals) to 377 families including 1,382 children.
Improving the well-being of mothers, infants and children is critical to the health of the next generation and impacts the overall health of communities. Unfortunately, Central Valley counties have some of the highest rates in California of babies born prematurely, babies born at low birth weight and infants who die before the age of 1. In addition, there are racial and ethnic disparities with Black children dying at much higher rates than any other ethnicity.
Program Highlight: Central Valley Safe Sleep Coalition
In 2023, the Guilds Center for Community Health continued to support the Central Valley Safe Sleep Coalition that represents more than 50 members in nine counties across the Central Valley. The Coalition – currently co-chaired by Valley Children’s and First 5 Fresno – has a vision that every parent and caregiver of an infant will have access to culturally appropriate risk reduction education and resources on infant sleep, keeping all Central Valley infants safe from preventable causes of death.
Coalition members include representatives from local public health departments, County First 5 offices, the California Health Collaborative, county offices of education, county community action partnerships (CAPs), the Black Wellness and Prosperity Center, and Cultural Brokers, Inc. The Coalition held its first learning collaborative in October 2023 that focused on safe sleep education for licensed and non-licensed childcare providers, friends, families, and neighbors. Over 300 registrants from all nine counties attended the October collaborative, and all spoken words and chat were simultaneously translated into Spanish.
Valley Children’s, as part of its safe sleep work, is also partnering with the Fresno Community Health Improvement Partnership and its community health worker program to distribute safe sleep environments and sleep sacks to parents in need.
Mental health is critical to overall health and well-being. Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems. Counties in the Central Valley have some of the highest rates of students experiencing depression-related feelings; more than a third of ninth graders in Kern, Merced and Stanislaus counties reported having these feelings in the previous year.
Program Highlight: Preventing Youth Suicide
In September 2022, Valley Children’s Healthcare was selected to participate with 15 other children’s hospitals in a national collaborative aimed at preventing youth suicide through improved hospital screening, internal systems of care and regional community collaborations aimed at reducing youth suicide to ZERO. As the collaborative leaders—Cardinal Health Foundation and the Zero Suicide Initiative—have said, “zero suicide is the only goal to strive towards.”
Across California, approximately 16% of children are living in poverty – but in the Central Valley, more than one in four children live in poverty. Poverty is an important social determinant of health and contributes to child health disparities. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and throughout a person’s lifetime, negatively affecting physical health, socioemotional development and educational achievement.5
5 American Academy of Pediatrics Council on Community Pediatrics. (2021). Poverty and child health in the United States. Pediatrics, 137(4), e20160339.
Unintentional injuries represent one of the leading causes of death in children nationally and in California. Within the Central Valley, Fresno County and Kern County have the highest number of children discharged from hospitals for non-fatal unintentional injuries.
County Health Rankings (The higher the number, the worse the ranking)
| 2019 | 2020 | 2021 | 2022 | 2023 | |
|---|---|---|---|---|---|
| Fresno | 50 | 48 | 46 | 45 | 46 |
| Kern | 52 | 52 | 53 | 53 | 53 |
| Kings | 30 | 32 | 33 | 32 | 29 |
| Madera | 36 | 38 | 36 | 37 | 44 |
| Mariposa | 42 | 44 | 30 | 31 | 31 |
| Merced | 47 | 39 | 38 | 38 | 39 |
| Sacramento | 29 | 28 | 26 | 26 | 26 |
| San Joaquin | 44 | 34 | 39 | 42 | 41 |
| San Luis Obispo | 15 | 14 | 16 | 13 | 14 |
| Santa Barbara | 19 | 19 | 18 | 19 | 21 |
| Stanislaus | 33 | 37 | 34 | 36 | 36 |
| Tulare | 51 | 53 | 47 | 47 | 42 |