We don't just cover the North Bay. We live here.
Did You Know? In the first 10 days of the North Bay fire, nearly 1.5 million people used their mobile devices to visit our sites.
Already a subscriber?
Wow! You read a lot!
Reading enhances confidence, empathy, decision-making, and overall life satisfaction. Keep it up! Subscribe.
Already a subscriber?
Oops, you're out of free articles.
Until next month, you can always look over someone's shoulder at the coffee shop.
Already a subscriber?
We don't just cover the North Bay. We live here.
Did You Know? In the first 10 days of the North Bay fire, we posted 390 stories about the fire. And they were shared nearly 137,000 times.
Already a subscriber?
Supporting the community that supports us.
Obviously you value quality local journalism. Thank you.
Already a subscriber?
Oops, you're out of free articles.
We miss you already! (Subscriptions start at just 99 cents.)
Already a subscriber?

The "Follow This Story" feature will notify you when any articles related to this story are posted.

When you follow a story, the next time a related article is published — it could be days, weeks or months — you'll receive an email informing you of the update.

If you no longer want to follow a story, click the "Unfollow" link on that story. There's also an "Unfollow" link in every email notification we send you.

This tool is available only to subscribers; please make sure you're logged in if you want to follow a story.


Please note: This feature is available only to subscribers; make sure you're logged in if you want to follow a story.

By the numbers, the outlook seems bleak for many of those who call Lake County home, thanks to an often toxic mix of disease, poor nutrition, unhealthy habits and barriers to obtaining health care.

The average death rate in Lake County is about twice the state average, at 1,234 per 100,000 people, according to a report by the state Department of Public Health. Lake County ranked dead last of the state's 58 counties.

The reasons — cancer, stroke, drug abuse, accidents, heart disease, liver failure, suicide, guns — reveal a constellation of ills at rates disproportionate to the rest of the state, reflecting the county's rural culture and geography, as well social determinants like poverty, unemployment and substance abuse.

"It really is overwhelming," says Lake County Public Health Officer Karen Tait.

But rather than be intimidated, policy makers and service providers are taking a methodical approach to distill priorities and improve the wellness of the county's 64,000 residents. It is resulting in new programs that focus on better eating, exercise, smoking cessation, and mental and emotional well-being — underpinnings of good health with the potential to impact a broad range of medical problems.

There's a special effort to target children through families and schools, the incubators of healthy life choices; to take advantage of locally-grown fruits and vegetables as part of a nutritious diet; to move employers to support healthier, happier workforces; and to create public help centers to streamline access to health care and assistance in communities where need is high and availability limited.

The goal is to make it easier for people to make changes — even by taking baby steps — that will result in healthier, longer lives.

"We can't make all this right; it's just not something government can do," Tait said. "It takes individual motivation and choices and actions that people do on a daily basis to really make a difference."

But the obstacles are numerous, encompassing high rates of illness and the kinds of behaviors that lead to disease, like smoking and excessive drinking, as well as social ills that correlate to poor health, both physical and mental.

Rates of death by heart disease, stroke, lung and prostate cancers in Lake County are about twice the state average, according to the state's annual County Health Status Profile, which examined death rates in each county over a three-year period from 2009 to 2011.

Deaths by liver disease, lower respiratory disease and firearms in Lake County run at rates about 2 1/2 times the state average.

Suicides, traffic fatalities and accidental deaths are at least triple the state average.

Drug-induced deaths occur at a rate about 4 1/2 times the average rate for all counties in California.

Nearly a quarter of the adult population in Lake County smokes, according to the Robert Wood Johnson Foundation, whose own national health rankings put Lake County last in the state.

The foundation found 22 percent of Lake County residents drink excessively, while about one-third of the population has what's considered a "healthy weight."

But Tait and others say health measures reflect underlying socio-economic conditions that have many local residents living on the margins.


; The U.S. Census Bureau reports an average median household income of $39,525 in Lake County for the years 2007 to 2011, compared to $61,632 for California.

; About 71 percent of the county's children qualify for free or reduced-price lunches, compared to 56 percent statewide, according to 2011-12 figures from the state Department of Education.

; The 2010 Lake County Health Needs Assessment found that four in 10 household incomes fell below the federal standards for "bare bones" self-sufficiency. Basic transportation is often a problem, especially for those in far-flung areas of the isolated and rugged region.

; Unemployment tops 12 percent in Lake County — though it's vastly improved from the 2010 peak of 19.1 percent, according to the state Employment Development Department.

; Lake County's growing senior population, aged 65 and older, accounts for more than one in five of the county's residents, many of them dependent on Medicare and Medi-Cal, according to the health needs assessment.

; There's a shortage of doctors, dentists and, especially, medical specialists in the county, and many of them do not serve Medi-Cal patients.

"When you look at the numbers on paper for Lake County, you're seeing lot of frightening numbers, and it's been that way for years," said Shelly Mascari, director of communications for the Lake County Office of Education. "But there's a tremendous spirit of collaboration among the agencies in Lake County. ... We want to improve those numbers."

A "cabinet" of county health leaders assembled in the wake of the 2010 assessment has prioritized fundamentals like diet, exercise, smoke-free lifestyles and emotional well-being. They've launched a countywide, grant-funded campaign emphasizing "small steps" and "big rewards" that breaks down how individuals, parents, schools, employers and community groups can make a difference.

Newer initiatives include a wellness center coming together at Lower Lake High School, in partnership between the Konocti School District and St. Helena Hospital Clearlake/Adventist Health. It combines features of a health club with those of a medical clinic. In one spot, visitors can receive medical exams, nutrition counseling, smoking cessation classes and other programming aimed at improving the health of district students and staff, as well as spin cycles, yoga mats, free weights and other fitness equipment.

District Nurse Susan Salmina said students requested nutrition and exercise opportunities during planning for the facility, which was built largely through a federal grant for school-based health services.

"Really, what we're trying to create is an attitude of wellness," Salmina said.

School food service directors from districts around the county have been meeting to share recipes and menu ideas that, in part, extend an approach launched in Kelseyville schools more than a decade ago.

Kelseyville Schools Food Service Director Michelle Malm sought the job in 2001 because she was "completely sick" about what kids were eating at school. And it's proved so successful, officials are trying to replicate it in districts around the county.

This year, Malm's cooks, who include student aides, will be making from scratch 1,200 lunches and 1,100 breakfasts every day. Many utilize local produce from her farms-to-school program, and some incorporate canned and pickled foods she and the students put up over summer.

"We're teaching the kids where the foods come from and how it's made," Malm said. "We even had sauteed collard greens one day, and the kids just loved it."

In Upper Lake, a cluster of public agencies has collaborated on "The Hub," a pilot project opened last month on the high school campus. Families can seek referrals and linkage to a variety of medical, dental, behavioral health, counseling, social service and other forms of assistance.

County schools Superintendent Wally Holbrook, whose oversight of public schools has put him on the front lines of the battle for better health, said families who don't know where to turn often gravitate toward schools for information. The goal of The Hub is, in part, to demystify the process, helping clients identify what type of services they need, who provides it and how to get it, organizers said. Holbrook envisions building a model that can be duplicated in other areas of the county.

North Coast Opportunities, which serves up to 500 families a week through its Clearlake Food Pantry, lets clients choose their own foods in an open-air, market-style setting and has added an on-site garden to increase the selection of fresh produce. Through the agency's new "backpack program," 120 kids in the Konocti Unified School district take home about 10 pounds of healthy food a week.

Mascari, at the office of education, is developing a countywide program designed to prepare new parents to serve as their children's first and best teachers, in part by simplifying the exchange of health and parenting information. Ideas include home visits, monthly packets of parenting tips, parents clubs and other methods of engaging parents in the effort to create a healthier generation.

A little more than 700 babies are born each year in the county. "We could possibly impact, in a very personal way, all 600 or 700 of those new parents," Mascari said.

Dawn Jacobson, a public health expert with the RAND Corporation and lead researcher for the Robert Wood Johnson Foundation's county health rankings, said rankings are worthwhile when they inspire change by enabling people to see the connections between personal behaviors, social and economic forces — "all of these things that influence health."

"When the timing's right, a group of people can look at this data and think, 'This is alarming, and we've got to do something,'" she said.

Lake County leaders intend to keep chipping away at the problem, striving for "critical mass, a tipping point" that will yield tangible improvements in the lives of the region's residents, said Tom Jordan, executive director of First Five Lake County, part of a statewide program serving children ages 5 and under.

"We're patient people," he said.

(You can reach Staff Writer Mary Callahan at 521-5249 or mary.callahan@pressdemocrat.com.)

Show Comment