Integrating Academia with Community-Based Health Practices: The San Bernardino County Community-Based Pediatric Vision Outreach System

In humans, sight is the most powerful of the five senses. Recent research has demonstrated that preschoolers and school-age children are most at risk for developing visual problems.1,2 Regular school screenings, comprehensive eye examinations, and appropriate surgical interventions are all necessary to safeguard the integrity of the visual system. However, a child’s access to eye care services is largely dependent on the health insurance status of the family. The Census Bureau has calculated that 38.7 million people living in the United States lack health insurance.3 In California, 18.7% of the population was without health insurance in 2000, the seventh highest uninsured rate in the nation.4 Poor uninsured children in California are in far worse overall health than poor children on Medicaid or low-income children covered by health insurance.5 In California, many individual counties are faced with the growing problem of providing health care services for large uninsured populations. For instance, San Bernardino County is the largest county in the contiguous United States and home to approximately 185,000 children ages 0–5 years.6 It has been estimated that as many as 19% of children ages 0–18 years living in the county are uninsured.7 For poor families, accessing low-cost health care and preventive services can dramatically influence positive health outcomes, especially in children. However in San Bernardino County, geographic isolation, poverty, high exposure to violence, and impoverished residential environments have limited many residents’ access to preventive care services and have generated huge health disparities.8,9 Periodic physical examinations, routine dental care, vaccinations, and dilated eye examinations are among the preventive health services that are necessary for the health of our children.10 Yet in the area of comprehensive vision care, there are very few options for financial aid available to children without health insurance if they live in San Bernardino County. In the fall of 1999, four community activists living in the city of San Bernardino (including present author EH) became involved in creating a system whereby low-cost or no-cost vision services could be provided for needy children. An innovative approach to the problem clearly was necessary. A course for MPH students offered by the Department of Health Promotion and Education (DHPE), School of Public Health, Loma Linda University, gave the initial program planners a systematic method for gathering the necessary needs assessment data, planning a system of care, and implementing and evaluating the program in the target communities. The San Bernardino County CommunityBased Pediatric Vision Outreach System (PVOS) evolved out of these circumstances.