by Selen Ozturk

Ethnic Media Services

As humankind grows increasingly urban, planting trees and parks — far from merely beautifying cities — increasingly becomes a matter of life and death.

As humankind grows increasingly urban, planting trees and parks — far from merely beautifying cities — increasingly becomes a matter of life and death.

At a Friday, Dec. 1 Ethnic Media Services briefing, Los Angeles Forestry officials and urban greening experts discussed the city as a case study of the link between green space and human health, and explained how adding nearly a million years of life expectancy in LA County through urban greening could serve as a model for other cities.

Green space and life expectancy

The more parks and trees there are in a given neighborhood, the higher the area’s life expectancy, said Michael Jerrett, referring to a July 2023 UCLA study he co-authored, which found that bringing green space in LA County to median levels could add up to 908,800 years of collective life expectancy to residents in under-resourced communities.

While the study found that life expectancy in wealthy and verdant Beverly Hills was 90, the median in south LA communities less than 15 miles away was 77. The total expectancy ranged countywide from 68 years in poorer south-central areas to 93 in affluent places like Malibu, said Jerrett, a UCLA environmental health professor and Center for Healthy Climate Solutions co-director.

In already “very leafy areas, like Brentwood, or parts of West LA, there’s not a lot of impact in adding more green space,” he added, but in disproportionately less green areas in the east, south and far north — where two-third of LA County’s Black and Latino population resides — merely expanding parks to county medians would add 164,700 years of life expectancy to the region, with Black and Latino residents receiving 72 percent, or 118,000 of these years.

Healthy trees, healthy people

The health benefits that come from more parks and trees depend on more than just planting, said Rachel Malarich, the first City Forest Officer for the City of Los Angeles. “In order to achieve those benefits, we need to have healthy trees, regularly maintained to live their own full lifespan in the neighborhoods which most need them.”

The city’s Urban Forest Management Plan has four pillars, she continued: planting new trees, maintaining existing trees, preserving these trees amid new construction and development, and engaging the communities who live with these trees.

“When we talk to community members, there is often frustration because the trees haven’t been maintained,” Malarich explained. “The industry standard is to inspect trees and trim them as needed every five to seven years; the city’s current cycle is closer to 18 years … we’re now holding community engagement workshops and feedback surveys both to improve inequity of access to green spaces, and inequity in how these spaces are maintained.”

Greening on-the-ground

The most sustainable urban forests are planted and supported by members of their own communities, said Marcos Trinidad, Senior Director of Forestry at TreePeople.

Now in its 50th year, the urban greening nonprofit has been shifting from an all-volunteer model of planting, maintenance and community education to a hybrid model which includes “workforce development,” particularly training youth interested in environmental careers to work with community organizations to green “neighborhoods which need trees the most,” like northeast and southeast LA, he explained.

Though TreePeople is based in LA County, Trinidad said that its model of community investment in “what is needed to have sustainable, sustainable urban forests” — namely planting, maintenance, preservation and education — is meant to be shared well beyond LA: “We’re currently in the Inland Empire and Antelope Valley … and want to share our process with the rest of the world.”

Green equity as green stewardship

To invest in more green space for underserved communities means investing in those communities as caretakers of this space, said Bz Zhang, Project Manager of the Los Angeles Neighborhood Land Trust (LANLT) — which, since its inception in 2002, has created about 30 parks and gardens across 21 acres of green space for over half a million LA County residents.

Since majority non-white communities “have 64 percent less access to park space than those in white neighborhoods, and lower income communities have 66 percent less,” greening LA County best means “doing so explicitly from an equity lens,” Zhang explained. Most crucial to this equity is community-centered stewardship: LANLT maintains the parks they plant by “hiring part-time stewards from within the neighborhood they’re located.”

“In these communities we create stewardship training programs … particularly for youth, through our Garden Apprenticeship Program, which has worked with over 350 high school students in south LA since 2013 to arm the next generation with the skills to tend to these spaces which are so crucial to their health … We can always build parks, but we also have to make sure those most impacted by green inequity have access to them,” Zhang added.

‘A matter of life and death’

This access to urban greenery is ever-more crucial as humankind becomes an increasingly urban species, said Jon Christensen: “As of 2007, over half of us live in cities, and that’s expected to go up to 70 percent by 2050. Cities are our habitat and our resilience to climate change — the resilience of our own health as a species — requires that we invest in cities, which means remedying the inequities which have shaped our urban environment. It’s a matter of life and death.”

In its efforts to remedy green inequity, “Los Angeles is a model of global concern for understanding urban ecosystems,” said Christensen, adjunct assistant professor at the UCLA Institute of the Environment, Luskin Center for Innovation, and Laboratory for Environmental Narrative Strategies.

In California alone, he continued, “$100 billion dollars will be spent on green infrastructure, urban greening and climate resilience over the next several years — half of it from the federal government and half from the state.” As governments worldwide begin to implement similar measures, “We need to recognize that planting trees is not enough; we need to ensure that the communities which most need them can thrive with them.”

California, which has the highest Medicaid caseload in the U.S., is set to dramatically expand access even as it continues to review eligibility post-pandemic

by Selen Ozturk

Ethnic Media Services

As Medi-Cal expands next year to include all undocumented immigrants and new services well beyond the doctor’s office, California is on the national front lines of transforming public health care.

In a Wed., November 15 briefing co-hosted by Ethnic Media Services and the Department of Health Care Services, DHCS experts and ground-level community health workers discussed this expansion to include all immigrants and new services; the latest data on eligibility redetermination, and the transition to new care plans in 21 counties statewide.

Since the end of the federal COVID-19 emergency in May 2022, Medi-Cal has resumed its annual redetermination of enrollees’ eligibility. Giving an overview of the latest data on this yearlong process, Yingjia Huang said as of September 30, 15.2 million people “are on our case rolls” — over a third of California’s population. “I’m proud to report that, overall, we’re holding steady as a state.”

Because California has the highest Medicaid caseload in the U.S., Huang — the Assistant Deputy Director of Health Care Benefits and Eligibility for DHCS — said over one million people have faced redetermination each month since June, the first month of actual disenrollments. In September, about 1.7 million were up for renewal.

About 20 percent to 21 percent of these people are disenrolled each month, she continued — much lower than many other states like Texas, which saw a 73 percent disenrollment rate by the end of August.

Hispanic individuals, making up the highest percentage of Medi-Cal enrollees, also make up the highest percentage — 53 percent — of those disenrolled. However, Huang said, many of these disenrollments may owe to families who “no longer need this coverage,” having found employer insurance or surpassed income limits since the pandemic, when eligibility checks were paused.

Those in the 21 counties transitioning to new managed care plans come Jan. 1, 2024 will experience a change in the kind of health care they may be eligible for, said Michelle Retke, DHCS Chief of Managed Care Operations.

For many of these counties, managed care — which uses health insurance plans, like Kaiser or Anthem, to provide primary care doctors picked from a network of local health centers — is transitioning to a single-plan model where previously multiple plans were offered, Retke explained. For other affected counties, different plans will replace those currently there.

She emphasized that the main takeaway for Medi-Cal members in these counties, listed here, is “Pay attention to your mail; in October, November and December, you’ll get a notice that your plan is changing, and an enrollment choice packet that you can fill out on paper or online.”

As this redetermination and transition happens, Medi-Cal is also expanding to all undocumented immigrants come January 1; currently, those under 26 and over 49 are eligible.

Explaining the importance of this expansion to California’s hardest-to-reach residents, Dr. Sergio Aguilar-Gaxiola said “this is a tremendous need. Meeting it requires more than goodwill and wanting to do the right thing. In order to reach these populations, building trust is front and center.”

Many undocumented Californians are (or are related to) farmworkers, a population which Aguilar-Gaxiola — Professor of Internal Medicine at UC Davis and Director of its Center for Reducing Health Disparities — has worked with for decades. There are approximately 600,000 to 700,000 farmworkers in California, he said, with 900,000 dependents — a total of 1.5 million, “the vast majority of which are Mexican or Central American.”

In the 1990s, in Fresno County, “we did a study of those with Mexican origin, including farmworkers, which continues to be the most comprehensive mental health population-based survey today,” he said. “Among those who needed mental health services” — say, due to depression, anxiety or substance abuse — “one out of three of those U.S.-born were using them, one out of six (documented) immigrants were, and less than one in 10 of undocumented workers were. Almost half of them didn’t know where to go, or couldn’t go to clinic hours due to work. I believe that during the pandemic, this has gotten worse.”

The study illustrates a major challenge to Medi-Cal expansion, he continued: “Rather than ‘hard to reach’ populations, I prefer to think in terms of ‘hardly reached,’ because there isn’t enough engagement … You’re going to build this new health care like the Field of Dreams, but the question is: Will they come? They won’t take advantage of these services unless you know how to communicate them.”

Juan Avila, Chief Operating Officer of Bakersfield-based Garden Pathways, shared his experience of communicating health care newly offered under Medi-Cal to another hardly reached population: formerly incarcerated and “justice-involved youth and adults”; in serving about 400 to 500 a year through his nonprofit, he learned quickly that “if those we work with want to join the workforce again, they have to be healthy, and providing that care — preventative, mental health, dental, substance abuse — requires trust.”

Since 2017, Avila said he and his colleagues have built this trust by “going inside the detention centers, the county jail, to enroll individuals in Medi-Cal before they’re released back into their communities, as many reentry people won’t have the same address and so won’t get mail notices. This is the strength of community work, reaching them where they are — whether in the institutions or on the streets as peacekeepers — and building trust to get them the care they need, because they wouldn’t otherwise come to the government to seek it out.”

This care, too, is expanding: come Jan. 1, Medi-Cal will include new, community-based health services like reentry-related tattoo removal, housing aid “for those at risk of becoming homeless,” community violence intervention, aftercare for violence victims, and “intensive care management for higher-risk populations,” e.g. substance abuse and home health care, he explained.

In expanding to include these services, Avila said Medi-Cal is expanding the possibilities of health care itself: “California is understanding now that health involves services that haven’t traditionally been part of the old model of ‘go to the doctor, get your medicine, go home.’ Health is quality of life, and good healthcare treats barriers to it at the source.”