The Issues

Liver disease is the eighth most common cause of death in California. It is the second most common cause of death related to a communicable disease in the state, after influenza.[1] Hepatitis B and hepatitis C are the leading causes of primary liver cancer, one of the most deadly cancers, with five-year survival rates of only 10%. While the incidence of many cancers is declining, rates of liver cancer are increasing.

Public health experts estimate that more than 600,000 Californians have been exposed to hepatitis C and that 450,000 remain chronically infected..[2] Experts estimate that 280,000 Californians are chronically infected with hepatitis B..[3], [4]
Communities of color and those living in rural sections of the state are particularly hard hit by viral hepatitis. Among Asian Pacific Islanders, the prevalence of hepatitis B ranges from 5% to 15%,[5] among African American men age 40 to 49, the prevalence of hepatitis C is approximately 9%; and for Latino men between 50 and 59, an estimated 6% have been exposed to hepatitis C. 
Hepatitis B and resultant liver cancer is the leading cause of cancer death among Asian Pacific Islander men. Liver disease related to hepatitis B and C is now a leading cause of death among people with HIV/AIDS.
The majority of those who are infected do not know it. Vast improvements have been made in treating viral hepatitis in recent years, yet the fatality rate doubled for hepatitis C in California in the last 10 years due to lack of public awareness and early detection.[6] The baby boomer population currently accounts for an estimated two out of every three cases of chronic hepatitis C. As this population continues to age, the consequences of undiagnosed infection will exact a heavy toll on the lives of this population and on the nation’s private and publicly funded health care systems. Experts estimate that this epidemic will impose billions of dollars in increased costs to private insurers and public systems of health care such as Medicare and Medicaid in addition to billions lost due to decreased productivity for the millions suffering from chronic hepatitis B and C.
Chronic hepatitis B is treatable when detected early and properly managed. In about 50% of cases, chronic hepatitis C can be cured.

Without screening, detection, and treatment, tens of thousands of the state’s citizens will die needlessly, leaving their families to suffer emotional pain and financial hardship, and their communities deprived of their participation.

By investing in prevention, education, screening, and treatment for viral hepatitis, California can begin to attack this leading cause of death.
  • Primary prevention needs to focus on community-based, culturally appropriate efforts to encourage Asian Pacific Islanders, African Americans, Latinos, Native Americans, gay men, and people with HIV, to be screened for the viruses. People who know they are infected with viral hepatitis are much less likely to infect others, as well as benefiting from medical management or treatment, as needed.
  • Screening, which costs only $16 to detect both viral hepatitis B and C, can prevent serious illness and procedures such as liver transplants, which cost more than $300,000 and typically fall to the state to pay. Yet today, still too little is being done to make sure Californians have access to affordable screening and treatment.
  • Vaccination against hepatitis A and B is urgently needed to prevent liver cancer among adults at elevated risk of infection, including sexual partners of people with hepatitis B, those who are already infected with any other form of hepatitis, and people who have multiple sexual partners.
  • To fight the rapid spread of hepatitis C, hepatitis B, and HIV among persons who inject drugs, as well as their sexual partners and offspring, legal barriers to safe access to sterile syringes should be removed. Not only should people be able to comply with the National Public Health Services recommendations that they use a new sterile syringe for each injection, they also should be able to legally possess those syringes until such time as they can dispose of them safely.
  • The state infrastructure exists. The adult viral hepatitis coordinator, working with the Office of Minority Health, the California Department of Corrections, the State Office of AIDS, and the STD Control Branch can make good use of existing programs to deliver prevention education, vaccination, and screening in a cost-effective manner.
California needs a fully funded, coordinated effort to stop this deadly epidemic. That’s why CalHEP is directing its efforts to make that a reality, raise awareness about the epidemic, and work to improve access to affordable services for every Californian who needs them.
We support efforts by the National Viral Hepatitis Roundtable and others to seek federal funding of a national plan to control viral hepatitis. CalHEP recognizes that the California budget is in collapse and is actively researching appropriate new revenue streams to pay for prevention, vaccination, screening, and treatment of viral hepatitis.
CalHEP supports the U.S. Congress in its efforts to pass meaningful reform that guarantees affordable health insurance and health care access to people with chronic hepatitis. CalHEP supports reforms to ensure that people with pre-existing conditions can get affordable health insurance and that there be no co-pays for screening, vaccination, and preventative services related to the control of viral hepatitis.
[1] California Department of Health Services. Trends in Leading Causes of Death: Gender Disparities by Race and Ethnicity, California 1990-2001. May 2004.
[2] "Centers for Disease Control and Prevention. Recommendations for Prevention and Control of Hepatitis C Virus (HCV) infection and HCV-related Chronic Disease." Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47(RR-19):1-39.
[3] McQuillan GM, Coleman PJ, Kruszon-Moran D, Moyer LA, Lambert SB, and Margolis HS. "Prevalence of Hepatitis B Virus Infection in the United States: The National Health and Nutrition Examination Surveys, 1976 Through 1994." Am J Public Health 1999;89(1):14-8.
[4] Estimates based on National Health and Nutrition Examination Survey III (NHANES) seroprevalence data and California population statistics.
[5] Asian Liver Center, Stanford University.
[6] Wise M. UCLA and Los Angeles Department of Health provided statistics and charts based on his work on 2008 article on national rates. California mortality rates are higher than the national average.