Central California Health Policy Institute Publications


Dentistry During and After the COVID-19 Pandemic: A Dental Providers’ PerspectiveDentistry During and After the Covid-19 Pandemic: A Dental Providers’ Perspective

As many dental providers and their staff prepare to re-open their practices, it is essential to understand their perspective on how the COVID-19 pandemic may have a long term impact on their practices and dentistry in general. Patients will certainly be affected by this impact. There is a need to understand the policies that dental providers would support that aim to ensure patients would be able to receive safe and affordable dental care after the COVID-19 pandemic. This report presents findings of a survey that the Central Valley Health Policy Institute sent to dental providers nationwide. As a timely response to the pandemic, this work aims to understand the dental providers’ perspective on how dentistry is and will be impacted by the COVID-19 pandemic and to know their suggested policy recommendations to support the dental community.

Click here to read the full report

Click here to read the one-pager


Oral Health Literacy

The American Dental Association (ADA) defines oral health literacy as the degree to which individualsOral Health Training
have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. To address low oral health literacy level, CVHPI prepared an oral health training suitable for Community Health Workers (CHWs) and Promotores. The training was delivered to 50 Community Health Workers (CHWs) who work with underserved communities. The training aimed to empower the CHWs with the knowledge needed about oral health and its related connection to general health across the life span. The main goal was to improve their oral health literacy and subsequently the communities they serve. A training evaluation was concluded in a detailed report.

Click here to read the full report 

Click here to read the one-pager

Oral Health Barriers for California's San Joaquin Valley Underserved and Vulnerable Populations

Oral Health BarriersOctober 2017 -- Oral health is recognized as an essential part of an individual’s overall health. The aim of this project is to understand how California’s San Joaquin Valley residents think about, feel about, and experience oral health services. This report presents findings from 659 surveys measuring healthy and unhealthy oral health knowledge, oral health needs and barriers.  Surveys were collected at clinic and non-clinic sites throughout the San Joaquin Valley, an area characterized by its large Latino and immigrant populations, as well as its low levels of education and high levels of poverty. The results indicate disparities by ethnicity and language, insurance coverage, and education. 

Click here to read the full report


Community Benefits Needs Assessment in South Fresno

African American Infant Mortality in Fresno CountyAugust 2017 -- In this report, the Central Valley Health Policy Institute at Fresno State share the findings of focused group interviews with residents of south Fresno neighborhoods. Based on these data, the report describes a number of potentially cost-effective, patient-centered and culturally responsive community benefit investments to further the health of Fresno residents.  

Community Benefits Needs Assessment in South Fresno Report (PDF)

Executive Summary in English (PDF)

Executive Summary in Spanish (PDF)


San Joaquin Valley Public Health Consortium: Report Series

African American Infant Mortality in Fresno County

African American Infant Mortality in Fresno CountyJanuary 2016 -- Much higher rates of infant mortality and other adverse birth outcomes have been noted for African Americans compared to whites nationwide and locally, even as overall rates of infant mortality have declined for many years. In response to a persistent increase in infant mortality among African Americans over the last few years, First 5 Fresno County and Fresno State’s Central Valley Health Policy Institute (CVHPI) conducted a mixed method assessment, between January 2015 and July 2015.


African American Infant Mortality in Fresno County (PDF)
African American Infant Mortality in Fresno County: Executive Summary (PDF)

Operational and Statutory Capacity of Local Health Departments in the San Joaquin Valley

cover of the report

Operational and Statutory Capacity of Local Health Departments in
the San Joaquin Valley – Released October 28, 2013.

Despite having some of the state’s highest levels of poverty and poor health outcomes, the San Joaquin Valley receives less public health funding from state and federal sources than other California counties with similar populations according to a new report from the San Joaquin Valley Public Health Consortium.

This report is the first to compare the operational capacity of local health departments in eight Valley counties to their peers in California.

Click here for full report

HEALTHY PEOPLE 2010: A 2010 Profile of Health Status in the San Joaquin Valley

Health People 2010 Cover
Healthy People 2010 – A 2010 Profile of Health Status in the San Joaquin Valley culminates a decade of biannual reports which document the severity of the Valley’s health crises. Following national objectives, established in 2000 by the U.S. Department of Health and Human Services, the report tracks health indicator progress in eight valley counties. Findings show that over the last 10 years, there was little to no improvement on key indicators. The reports also demonstrate the range of successful policies and programs that have been piloted around the region during this time. For the most part, however, these initiatives have been tested on a small scale, in isolated communities, and without the broad public engagement needed for coordinated county-wide or regional impact. The report recommends that Fresno and the region adopt a new strategy focused on primary prevention and improving quality of life in under-resourced urban and rural communities.

Click here for full 2010 report

Click here for project overview

Place Matters for Health in the San Joaquin Valley: Ensuring Opportunities for Good Health for All

Place Matters Cover
Place matters
for health, and it may be more important than access to health care and health-related behaviors. The Central Valley Health Policy Institute at Fresno State and Joint Center for Political and Economic Studies released a report Wednesday, Feb. 29, comprehensively analyzing links between social, economic and environmental conditions and health in the region. The study examines the relationships between place, race and ethnicity, and health in the San Joaquin Valley of California and attempts to address two specific questions raised by the San Joaquin Valley Place Matters researchers:

  • What is the relationship between social factors and premature mortality?
  • What is the relationship between social factors and exposure to environmental hazards?

The report demonstrates that neighborhood conditions and the quality of public schools, housing conditions, access to medical care and healthy foods, levels of violence, availability of exercise options, exposure to environmental degradation can powerfully predict who is healthy, who is sick, and who lives longer. And because of patterns of residential segregation, these differences are the fundamental causes of health inequities among different racial, ethnic and socioeconomic groups. This study examined the relationship between social conditions, environmental factors, and health outcomes in the context of the unique demographic characteristics of the area.

Click here to download full report

Executive Summary in English

Executive Summary in Spanish

Understanding Traditional Hmong Health and Prenatal Care traditional Hmong healthcare reportBeliefs, Practices, Utilization and Needs

The purpose of this project is to understand the health and prenatal care beliefs, practices, and needs of Hmong women age 18-35 and men age 18-45 in Central California where the largest share of the Hmongs have settled.

Although the displacement of people from their home countries is of growing concern, little attention has been paid to the health care experiences, utilization or outcomes of refugees in the U.S. health care literature. Experiences of refugees are more complex and difficult than those of voluntary immigrants because refugees often experienced trauma in their own country, as well as being forced to leave. Voluntary immigrants most often choose to immigrate willingly in search of a better life. Trauma may further complicate acculturation for refugees and their children as they learn practical skills for survival and construct an identity in the host country (Yakushko, Watson, & Thompson, 2008).

Click here to download the full report


air quality report cover The Impacts of Short-Term Changes in Air Quality on Emergency Room and Hospital Use in California's San Joaquin Valley

The findings of a recent CVHPI study for the San Joaquin Valley Air Pollution Control District provide important new regional evidence for the public health consequences of air pollution. This study offers the first local evidence of short-term population-level health effects associated with elevations in PM2.5 and ozone for the San Joaquin Valley, demonstrating linear increases in rates of asthma ER and hospital admissions with increasing levels of air pollution, with effects more pronounced for children.

Click here to download report snapshot

Click here to download the full report

Please add alternative text . Hospital Council of Northern and Central California

The Patient Protection and Affordable Care Act (PPACA) imposed new requirements on non-profit hospitals. Hospitals must comply with requirements regarding community health needs assessments, financial assistance policies, charges, billing and collections. The nonprofit hospital provisions of PPACA do not exempt any hospitals from its requirements. Thus, hospitals currently exempt from community benefit reporting pursuant to State law (SB 697) must now develop a community health needs assessment and report community benefits. This includes small and rural, children's charitable, public and other hospitals.

This project is the culmination of several years of collaboration between the Hospital Council of Northern and Central California (Community Benefits Managers from six hospitals--Adventist Health-Central Valley Network, Community Medical Centers, Children's Hospital Central California, Kaiser Permanente, Madera Community Hospital, Saint Agnes Medical Center) and the Central Valley Health Policy Institute (CVHPI) at California State University.

This report provides a health "snapshot" of four-county (Fresno, Madera, Kings, and Tulare) using secondary quantitative data and explores needs, strengths, challenges, and identifies priorities for action using primary qualitative data collected in 2 010-2011. In collaboration with the Hospital Council, we identified a set of community health indicators, drawing on the Healthy People 2010 and other national and state-level projects. The indicators focus on determinants of health (economic conditions, health care access, and health behaviors), prevalence of chronic conditions, and health outcomes (morbidityÑas measured by hospital use, and mortality) and were examined from both quantitative and qualitative perspectives.

Download Report (PDF)

Please add alternative text . Community Needs Assessment:
Arvin, Lamont, and Weedpatch, CA

The purpose of this community needs assessment was to identify the health and psychosocial service and access needs of residents who live in Arvin, Lamont, and Weedpatch, California. These three rural communities were targeted based on their high levels of poverty, environmental problems, and known health disparities.

Download (PDF)

Please add alternative text cause The Affordable Care Act and California's San Joaquin Valley:
A CAUSE Perspective

Steve Chooljian, M.D., John A. Capitman, Ph.D.,
Mohammad Rahman, Ph.D. , Kudzai Nyandoro, B.S.





Promotora The Effectiveness of a Promotora Health Education Model for Improving Latino Health Care Access in California's Central Valley (Full Report)Promotoras de salud, also referred to as lay health advisors or Community Health Workers (CHWs), have been used to target hard-to reach populations, traditionally excluded racial/ethnic groups, and other medically underserved communities. Promotoras serve as the cultural bridge between community-based organizations, health care agencies, and their respective communities. Our innovative effort uses CHWs as promoters of health care access. Promotoras focus on increasing enrollment in health insurance programs, receipt of preventive care services, establishing a usual source of care and improve self-efficacy.

(Download PDF)

Promotoras Promotoras: Lessons Learned on Improving Healthcare Access to Latinos (English) Executive Summary of "The Effectiveness of a Promotora Health Education Model for Improving Latino Health Care Access in California's Central Valley"

(Download PDF)



Promotoras Promotoras: Aprendiendo como mejorar acceso al sistema de salud para los Latinos (Spanish) Executive Summary of "The Effectiveness of a Promotora Health Education Model for Improving Latino Health Care Access in California's Central Valley"

(Download PDF)




This report is intended to support the ongoing planning efforts of The California Endowment Building Healthy Communities (BHC) sites in the San Joaquin Valley by beginning a regional conversation about currently available data and additional data needed to support planning and implementation of the BHC strategic initiatives.

(Download PDF)


Telemedicine in the San Joaquin Valley Telemedicine in the San Joaquin Valley:
Opportunities and Barriers in Adoption

Expansion of telemedicine in the San Joaquin Valley has been slower compared to California's coastal areas. This study explored possible barriers in the adoption of telemedicine in this region by conducting several in-depth interviews of healthcare managers and practitioners. Several factors were identified as major barriers to adoption of telemedicine. It was found that factors such as, uncertainty about the benefits of telemedicine, unclear profit prospects and lack of clarity in existing 'practice' and 'labor' regulations act as major disincentives to health care providers in adoption decisions. Another notable barrier tied to the region that dissipates telemedicine adoption is the unique contractual arrangement that exists between part-time specialist physicians and the management at some healthcare facilities. Along with the provision of financial assistance, the healthcare providers in this region need to be educated on telemedicine practice guidelines. Special emphasis needs to be put on developing telemedicine business models that cater to regional socio-economic and cultural realities.

Download Report (PDF)


Policy brief California Program on Access to Care
Undocumented Latinos in the San Joaquin Valley: Health Care Access and Impact on Safety Net Providers

John A. Capitman, Diana Traje, and Tania L. Pacheco

California has the largest number of undocumented immigrants nationwide. Out of the estimated 11.6 million undocumented immigrants living in the U.S., about one-quarter--2.7 million undocumented immigrants-- live in California. Furthermore, approximately 280,745 of these immigrants live in the San Joaquin Valley, which is the center of California's fertile agricultural region. This study explores how San Joaquin Valley safety net providers are impacted by serving undocumented Latinos and how immigrant populations, specifically Latinos and to a lesser extent Hmongs, are experiencing care access. Download Report (PDF)

Human Investment Human Investment Initiative: Mental Health Cluster
First year's Observations, Conclusions and Recommendations

(Fresno Business Coalition publication)

As demonstrated by the success of the Regional Jobs Initiative, our community is in the midst of a fundamental transformation. We are shifting from the expectation that government and single interest advocacy is the answer to our problems to a recognition that solutions will require new approaches, new partnerships and every individual stepping up to take responsibility for the success and well being of all residents. We, not government, are responsible for creating the world we want. In that spirit, the Human Investment Initiative ("HII") was launched in 2007 to address the destructive force of poverty in our neighborhoods and the lack of alignment of our community resources behind shared strategies. One HII task force of private citizens, the Mental Health Cluster ("MHC"), was formed in February 2008 to evaluate mental health services in Central California. At the outset of the effort, the members of the Mental Health Cluster agreed to act in accordance with the Community Values included at the end of this report. These will be important as we take the next steps. Download Report (PDF)


Oral health Survey Oral Health Survey of Federally Qualified Health Centers in the Central Valley

Low-income residents of the Central Valley face limited access to oral health care due to barriers, including a shortage of dental health professionals, a maldistribution of services, and a lack of providers willing to accept uninsured or publicly insured patients. Federally Qualified Health Centers (FQHCs) ease access barriers by providing oral care to underserved populations. In an effort to respond to regional concerns regarding the shortage of oral health professionals, a survey was conducted to evaluate the impact of these shortages in the Central Valley.
Download Report (PDF)


Please add alternative text MVA Place Matters:
Understanding Rural/Urban Differences in Motor Vehicles Fatalities in California's San Joaquin Valley

Motor vehicle accidents (MVAs) remain a leading cause of injury and death in Central California's San Joaquin Valley, especially for minority, low-income citizens of rural communities. Living in a rural location may contribute to one's risk of being in an MVA. A strong majority (65%) of fatal accidents in the six counties from 2001 to 2005 occurred on rural roads. Public health experts from six counties collaborated to identify the underlying social and environmental determinants behind the disparities in rural/urban MVAs. This collaboration was part of the Place Matters national demonstration program, a national initiative of the Joint Center for Political and Economic Studies, Health Policy Institute to reduce/eliminate health disparities by targeting upstream causes associated with social determinants of health.
Download Report (PDF)


Latino Health Assessing Mental Health Disparities
Among Latinos in the San Joaquin Valley

In 2000, at least 7.9 percent or 103,785 Latinos of all ages living in the eight counties of the San Joaquin Valley (Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare) experienced either serious emotional disturbance (SED) or serious mental illness (SMI). Because of limitations on mental health services and delivery system capacities, it is often hypothesized that a sizable proportion of the population in need of these services are not receiving them. Download Report (PDF)


Wood Burning Environmental Health Evaluation of Rule 4901:
Domestic Wood Burning

This report provides an evaluation of the regulatory and public health effectiveness of Rule 4901 as adopted by the San Joaquin Valley Air Pollution Control District on November 1, 2003. Rule 4901 set in place a 150 AQI-triggered ban on wood burning in areas of the San Joaquin Valley that have natural gas service and are below 3,000 ft elevation. (Download Report)


Aging in the San Joaquin Valley: Present Realities and Future Prospects

Aging Report cover

This report presents an overview of the demographic,
economic, health and social characteristics of the San
Joaquin Valley's aging population. This report is a first
step in describing the issues and concerns of the older
population. In order to meet current needs and future
demands, it is imperative that we understand the aging
population and lay the framework for developing policies
and programs to meet their needs. Download Report (PDF)


Healthy People 2010 report'Healthy People 2010' report examines status of Valley's health

(May 27, 2008) - Researchers from the Central Valley Health Policy Institute at California State University, Fresno released a report today that reveals the Valley is not making progress toward meeting the Healthy People 2010 objectives and is likely to not reach a majority of the target measures by the end of this decade.

Read the full news release
Read the full report (PDF)


cover of Air Quality ReportHealth Policy Institute report details challenges to Valley air quality policymaking

A report released by the Central Valley Health Policy Institute at California State University, Fresno documents the need for San Joaquin Valley residents to understand and be involved in the region's air quality policy landscape.

“The Long Road to Clean Air in the San Joaquin Valley: Facing the Challenge of Public Engagement” provides policymakers and residents with practical recommendations to enhance the public's engagement around air quality policy issues.

Read the full news release...
Read the full Air Quality Report (PDF)...


Policy Brief 2007 cover photoHealth Reform 2007: Impact on the Valley

The San Joaquin Valley now has a unique opportunity to influence health policy and health care reform by giving a voice to the health disparities experienced by its residents and influencing the negotiations that are ongoing as the health reform debate heats up.
Read the full report (PDF)...


Prenatal Care and Birth Outcomes: Challenges to Growing a More Nurturing San Joaquin Valley - Excecutive Summary

Bengiamin, M., Capitman, J.A., Mathilda R. (July 2007). Fresno, CA: California State University, Fresno. Available in MS Word or PDF

Home Garden Assessment cover

Home Garden Community Assessment

A. Gonzalez, M. Bengiamin, J. Capitman (May 2007). Download in MS Word format or PDF format


Growing a Healthier San Joaquin Valley: Recommendations for Improving the Public Health and Healthcare Infrastructure. Capitman, J.A., Riordan, D.G., Paul, C.M. (2007).

Health Professional Shortages in the San Joaquin Valley: The Impact on Federally Qualified Health Clinics. Riordan, D.G., Capitman, J.A. (2006). Fresno, CA: California State University, Fresno.

Healthy People 2010: A 2005 Profile of Health Status in the Central San Joaquin Valley. Bengiamin, M., Capitman, J.A., Paul, C.M., Riordan, D.G., and Curtis, K.A. (2005).

Medi-Cal Redesign: Implications for the San Joaquin Valley, Summary and Policy Brief. Capitman, J. A., Riordan, D., Bengiamin, M., Paul, C. M. (2005, June)

SB 2-Health Insurance Act of 2003: Expanding Employment Based Health Insurance in the San Joaquin Valley. Ingvaldson, G., Curtis, K.A., Capitman, J. A., Graham, E. (2004, August).

Health in the Heartland: The Crisis Continues, Health in the Heartland: The Crisis Continues (print and Web versions). Diringer, J., Curtis, K. A., Paul, C. M., Deveau, D. R. (2004). Fresno: California State University, Fresno.

Healthy People 2010: A 2003 Profile of Health Status in the Central San Joaquin Valley. Perez, M., Curtis, K.A. (2003)

Hurting in the Heartland:Access to Healthcare in the San Joaquin Valley - A Report and Recommendations. Diringer J, Ziolkowski C, Paramo, N (1996) Sacramento, CA; Rural Health Advocacy Institute and the California Rural Legal Assistance Foundation