Ka-POW!

"Senior citizens in California's Central Valley region have the worst health in the state and may provide a snapshot of the challenges California faces over the next two decades -- a time in which the elderly population is projected to double.

"Diabetes, obesity, falls, as well as low mammography rates and sedentary lifestyles among older adults are all more acute in the San Joaquin Valley ..."

Those are the first two sentences in a press release from a new study by the UCLA Center for Health Policy Research, "Trends in the Health of Older Californians."

Findings sound nasty. The governments representing people living in -- Fresno, Madera, Kings, Tulare, Merced, San Joaquin, Stanislaus and Kern -- "need to strengthen the public health infrastructure ... to better prevent chronic conditions before residents in the region reach their older years."

The survey is drawn from data gathered in 2001, 2003 and 2005. In other words, "the Good Old Days." Before the fiscal waterboarding that started a few months ago and which seems sure to worsen for years.

Now governments are cutting preventative and surveillance services. As this report was being issued, AARP was issuing a study saying that unpaid caregivers delivered $375 billion in aid to family and friends in 2007 -- again in the Good Old Days. A Wall Street Journal story quotes an AARP official as saying: "We need policies that support these family members who are sacrificing not only time but dollars."

The same issue of the Journal reports that at least 15 states are planning to cut services provided to shut-ins among the elderly and disabled. Waiting lists for community-based services are also growing.

If you need another dozen of so citations of bleakness, Beacon Economics just issued, "An Economic Backdrop for Fiscal Reform in California." That's a nicey-nice title for an assessment that three times in its first two pages says California is going off a cliff -- in just those words.

Enough. I've worked with enough do-gooders -- clergy, community activists -- to recall something they told me repeatedly. Sometimes things have to break so you can fix them. Not an easy chat to have with the people who panhandled me this week in River Park and near the downtown Fresno federal courthouse.

To put it in the ruffles and flourishes language of the Beacon report: "One theory of long-run change is that the best opportunity to overhaul a system is during a time of crisis when bureaucratic forces that might stifle change are reduced."

Or, as a poster from the Sixties, showing a cat clinging to a bar, said, "Hang in there."

(For more information, go to http://www.healthpolicy.ucla.edu/news_11202008.html

and

http://media.sacbee.com/smedia/2008/11/19/16/Fiscal_Reform_Econ_Backdrop_Beacon_11-081.source.prod_affiliate.4.pdf )