Existing law establishes the State Department of Public Health and prescribes its duties related to public health, including the prevention of disease and the promotion of health. Among other duties, contingent on appropriation in the annual Budget Act, the department is required to analyze asthma morbidity and mortality data, periodically assess the burden of asthma on the states medical and economic resources, and identify those populations most seriously affected by the disease.

This bill would require the department to conduct a study of the pulmonary health of communities in the Salton Sea region. The bill would also make related findings and declarations.

Date of Hearing: May 3, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 827

Author:(Garcia) – As Introduced Ver:February 13, 2023

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Public Health (CDPH) to conduct a study of the pulmonary health of communities in the Salton Sea Region.

FISCAL EFFECT:

CDPH estimates costs of $4 million in fiscal year (FY) 2024-25, $2.5 million in FY 2025-26 and FY 2026-27, and $2.5 million annually thereafter (General Fund). The estimate includes funding for four full-time positions, purchasing and maintenance of specialized equipment (including air, water and soil testing equipment, and reagents and consumables) to collect data and study the environmental effects the Salton Sea on local communities. The funding also covers consulting contracts with laboratories to receive secondary confirmation of findings, retaining subject matter experts to review findings, and hosting town halls and events with the affected community.

CDPH states its experience with other environmental studies suggest this bill will require studies of asthma prevalence, respiratory health, clinical pathophysiology, and characterization of dust.

COMMENTS:

According to the author:

Residents of Imperial and Riverside counties living near the Salton Sea see a disproportionally high rate of asthma and other respiratory illness. These conditions are particularly prevalent in young children. The areas surrounding the Salton Sea are historically disadvantaged communities that suffer from a lack of access to health care. While our State has made significant progress in providing funding for Salton Sea mitigation efforts—including over $500 Million since 2016—a comprehensive health study on the impacts of Salton Sea dust on the residents will provide invaluable information on the unique health needs of the region. Additionally, this study will help guide future projects by identifying what mitigation efforts are the most effective in reducing resident dust exposure, and what locations are best suited for future projects.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 11, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 827

Author:((Garcia) – As Introduced Ver:February 13, 2023

SUBJECT: Public health: pulmonary health: Salton Sea region.

SUMMARY: Requires the Department of Public Health (DPH) to conduct a study of the pulmonary health of communities in the Salton Sea region.

EXISTING LAW: Establishes DPH and sets forth its powers and duties, including, but not limited to, disease prevention and health promotion. [Health and Safety Code §104100-106036]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, residents of Imperial and Riverside counties living near the Salton Sea see a disproportionally high rate of asthma and other respiratory illnesses. These conditions are particularly prevalent in young children. The areas surrounding the Salton Sea are historically disadvantaged communities that suffer from a lack of access to health care. The author states that while our state has made significant progress in providing funding for Salton Sea mitigation efforts, including over $500 Million since 2016, a comprehensive health study on the impacts of Salton Sea dust on the residents will provide invaluable information on the unique health needs of the region. The author concludes this study will help guide future projects by identifying what mitigation efforts are the most effective in reducing resident dust exposure and which locations are best suited for future projects.
2. BACKGROUND. The Salton Sea, the state’s largest lake, is a body of water in Southern California’s Coachella and Imperial Valleys. According to a February 25, 2023 New York Times article, the Salton Sea was created in 1905 when an engineer tried to divert some of the Colorado River’s flow into a canal. But the diversion was poorly designed and easily overwhelmed, and soon the entire volume of the Colorado River began pouring into what was then the Salton Sink, more than 200 feet below sea level. The water continued flowing for nearly two years. Today, the Salton Sea covers some 350 square miles, but keeping it full has been a losing battle in recent decades, as Imperial Valley farmers only undertook water conservation efforts after they agreed to transfer some of their water to San Diego and other cities. The efforts, which saved about 500,000 acre-feet a year, reduced inflows into the sea. It is twice as salty as seawater and only a handful of fish species, including tilapia and the endangered desert pupfish, remain. With fewer fish, bird populations along what is an important migratory flyway have declined. Human health has been affected, too. The retreating water has exposed huge expanses of lake bed, and with wind stirring up dust from them, air quality in the Imperial Valley is among the worst in the state. That’s led to a high incidence of childhood asthma and other respiratory illnesses among the valley’s 180,000 residents.
   
   1. Salton Sea Study. A University of California, Riverside, study indicated that along with high levels of dust, the communities surrounding the Salton Sea have high levels of childhood asthma. Currently, the asthma rate among children is estimated at 20-22.4%, which is among the highest in the state, and higher than the state average. Additionally, the communities surrounding the Salton Sea are among the top percentile for emergency department (ED) visits due to asthma, though it is unclear if this is due to more severe asthma, lack of access to healthcare, high asthma rates, or a combination of all those factors. The study opines that little is known about how the dust in the Salton Sea Basin may contribute to asthma and pulmonary disease.
   2. Asthma. Asthma is a chronic lung condition that makes it hard to breathe. Swelling in the airways can cause asthma symptoms such as wheezing, coughing, shortness of breath, and chest tightness. Asthma attacks or episodes can be caused by triggers. Triggers include pollution, pet dander, mold, pollen, exercise, tobacco, wood smoke, dust mites, or infections like the cold or flu. There is no cure for asthma, but it can be controlled.
      
      According to 2020 data published by the federal Centers for Disease Control and prevention, there are over 2.8 million (9.3%) adults with asthma in California. Let’s Get Healthy California (Let’s Get Healthy) states nearly 1.5 million children in California have asthma. Let’s Get Healthy also states that in California, asthma costs are estimated at $11.3 billion per year. This includes direct health care costs, work and school days lost, and productivity lost due to premature death. Charges for asthma hospitalizations alone in 2010 were over $1 billion and the average charge per asthma hospitalization increased by twofold since 1995 ($13,274 vs. $33,749, even after adjusting for inflation). Medicare and Medi-Cal cover 65% of asthma hospitalizations and 50% of asthma ED visits in California.
   3. Health Disparities. According to a 2021 article, “An Overview of Health Disparities in Asthma,” available on the National Institutes of Health website, in the US, the burden of asthma is disproportionately borne by racial and ethnic minority groups and the economically disadvantaged. The prevalence of asthma among Puerto Rican and non-Hispanic Black children (21.2% and 14.5%, respectively) is higher than among non-Hispanic white and Mexican American children (8.2% and 7.5%, respectively). Similarly, the prevalence of asthma is higher among individuals of low socioeconomic status (SES) compared with those of high SES. Although asthma mortality is trending down, asthma was responsible for the deaths of more than 3,000 Americans in 2019. Asthma mortality rates are highest for adults, women, and African Americans. African Americans have a mortality rate twice as high as white Americans (21.8 vs 9.5 death rate per million). The underlying factors contributing to these disparities are multiple and complex, but can be categorized in five domains: Biological, Behavioral, Sociocultural Environment, Built Environment, and Healthcare System.
      
      According to the California Health Benefits Review Program, in its analysis of AB 391 (Chiu and Gomez) of 2017, the prevalence and incidence of asthma varies between adults and children. In 2015, 15.6% of adults and 13.8% of children in California reported a lifetime asthma diagnosis; 8.6% of adults (2.5 million) and 9.2% of children (796,000) had current asthma. The lifetime and current prevalence of asthma in California is highest among children aged five to 17 years, about 30% higher than among adults. Young children (ages zero to four years) have the lowest prevalence of asthma owing to the high rate of respiratory infections in young children that may confound accurate diagnosis. In both Medi-Cal enrollees and the state population overall, children are twice as likely as adults to have poorly controlled asthma; however, a larger proportion of children in Medi-Cal (31.1%) reported asthma-related ED visits in 2015 as compared with Californians overall (20.1%). Among adults and children with poorly controlled asthma in California, 82% of children and 52% of adults are enrolled in Medi-Cal. Women are more likely to have asthma as adults, whereas men are more likely to have asthma as children. In California, adults account for over three-quarters of persons with current asthma; accordingly, in 2015, females were almost twice as likely to have current asthma in California as compared with males. In 2015, women in California overall and low-income women in Medi-Cal were more than 30% more likely to have poorly controlled asthma as compared with men. Among women with poorly controlled asthma in California, 63% (180,000) are enrolled in Medi-Cal.

Disparities in asthma prevalence and diagnosis by race and ethnicity are well-documented in California. Data from 2015 showed that, compared with the statewide average of 8.7%, African Americans and American Indians/Alaska Natives have the highest prevalence of current asthma (14.8% and 15.5%, respectively), almost twice the rate of whites (8.9%), whereas Asians and Hispanics have the lowest (6.2% and 8.2%). Although Hispanics have one of the lowest asthma prevalence rates of all ethnic groups, there are important differences in prevalence by Hispanic subgroup; when disaggregated, Puerto Ricans have the highest asthma prevalence (35%) of any ethnic group in California. Racial and ethnic disparities are also present in asthma symptom severity among Californians with current asthma. African Americans were more than four times as likely as whites to report asthma-related ED use in 2015, whereas Latinos and Asians were approximately two times as likely to report asthma-related ED use as compared with whites. When compared with the state, all racial/ethnic groups in Medi-Cal had higher than average prevalence of poorly controlled asthma. In 2015, Asian and African American Medi-Cal enrollees were most likely to report asthma-related ED use than whites or Latinos; however, Latinos represented 55% of poorly controlled asthma cases.

• 1. Federal funding for clean-up. As part of the Inflation Reduction Act, on November 28, 2022, the U.S. Department of Interior announced a $250 million funding over four years to clean up what remains of the Salton Sea. Most of the money is contingent on the Imperial irrigation district and Coachella Valley water district making good on their commitments to reduce their own use of river water.
     

1. SUPPORT. Supporters such as Desert Health Care District and Foundation, Loma Linda University Health, and Borrego Health state that as the state implements dust mitigation projects, this bill will provide invaluable information on the unique healthcare needs of the surrounding communities around the Salton Sea and inform the state about prioritizing future projects. Furthermore, a health study will help provide a benchmark for the state to gauge the effectiveness of dust mitigation and other Salton Sea restoration efforts. They state that the dynamic situation in communities around the Salton Sea deserves to be studied and mitigated.
2. POLICY COMMENTS. The author states the intent for this bill is to help guide future projects by identifying what mitigation efforts are the most effective in reducing resident dust exposure and which locations are best suited for future projects. The author may wish to include this in the bill language. Additionally, the author may wish to consider a timeline for when DPH should conduct the study, whether to engage with stakeholders, and for DPH to submit its findings to the Legislature and/or post the information on its website.

REGISTERED SUPPORT / OPPOSITION:

Support

None on file.

Opposition

None on file.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097