Health problems that have long plagued the Third World are becoming such serious threats to public health in California that health care officials in the state are seeking advice from experts on developing countries such as Indonesia, Sri Lanka and Ethiopia.
High infant death rates, inadequate immunization of young children, poor prenatal care for pregnant women, and the growing AIDS epidemic are among the problems shared by Californians and the Third World.
"The problems of most developing countries are not dissimilar to the problems we're facing here" in California, said Dr. Robert Benjamin, past president of Northern California Public Health Assn.
"The reality is that in California . . . we're such a multiethnic, such a polyglot population, we have to deal with international health issues within our own border," he said.
Benjamin and others are so concerned about California's plight that they have invited dozens of Third World health care experts to address a three-day conference in San Francisco to help the state find solutions to its health care problems. The symposium, which starts Tuesday, is expected to attract about 400 health officials from across the state.
Health care advocates have warned for several years that California is falling further behind in meeting the health needs of a growing number of its citizens. The problem, they charge, stems from lack of funds and shortsighted health policies, compounded by a burgeoning multiethnic population and record numbers of people without medical insurance. Growing numbers of Californians have come to depend upon overcrowded and understaffed public hospitals and health clinics that are often facing budget cuts.
State health department statistics show that increasing numbers of toddlers in California--more than half of all 2-year-olds--are not adequately immunized against infectious diseases. This helped fuel the measles epidemic that struck 12,000 children in California last year and killed 55.
In California, about nine babies in every thousand die during their first year. Thousands of pregnant women statewide, especially in poverty-stricken urban areas, are receiving late or no prenatal care.
The infant mortality rate in Los Angeles County jumped 17% overall and 29% for black babies from 1987 to 1988, according to the latest county health department statistics.
"It's such an appalling fact that South-Central Los Angeles has problems similar to those in Third World countries that I think this conference is helpful to focus on just how bad the situation is here," said Wendy Lazarus, vice president of Children Now, a statewide advocacy group that is campaigning for better health care and services for children.
Russell Morgan, president of National Council for International Health, which is co-sponsoring the San Francisco conference, said: "Contrary to what most Americans may believe, the United States can learn some lessons from the Third World on how to deliver health care, especially under the constraints of limited funding and resources." He added that any state with large numbers of "under-served" people could be helped.
Dr. Gururaj Mutalik, an NCIH adviser who will speak at the conference, said California health officials will hear wide-ranging "success stories" recounted from all parts of the developing world:
In Costa Rica, the infant mortality rate has been drastically reduced to where it is now lower than in the District of Columbia or in Watts, NCIH officials said.
In Latin America, innovative community outreach campaigns have virtually wiped out polio and substantially improved maternal and child health care, said Dr. Carlos Serrano, a native of Colombia now advising the Pan American Health Organization. He is also scheduled to address the conference.
In Indonesia and Sri Lanka, special outreach campaigns have led to widespread acceptance of family planning among Muslim women, said another conference speaker, Dr. Ranjit Atapattu, former minister of health of Sri Lanka, now working for the United Nations Children's Fund.
In Ethiopia, Thailand and Kenya, the AIDS epidemic has been slowed by unique outreach programs that have increased the use of condoms among prostitutes, said Dr. Jonathan Mann, an international AIDS expert at Harvard University and former director of the World Health Organization's global program on AIDS.
In Thailand, similar programs have been so effective that researchers have snapped photographs of gutters outside brothels that were "literally clogged with condoms," said Dr. Donald Francis of Berkeley, an AIDS consultant to the Centers for Disease Control. Both Francis and Mann are scheduled to address the conference.
All these efforts, Morgan said, have relied heavily upon lay people trained as health care workers to educate their community about how to access the health care system to get prenatal care, nutritional advice, vaccinations, and take other precautions that will prevent illness.