If there's one thing everyone can agree on, it's that something needs to be done to improve children's health in the Bay Area.

The problem is, no one seems to agree on how.

But initiatives are underway large and small that seek to address the health struggles children and their families face.

Obesity, asthma and tooth decay are epidemic problems among Bay Area children.

And many children who need help with these three chronic health conditions don't have access to care.

Of the 1.1 million children in California who are uninsured, about half don't qualify for public insurance programs such as Medi-Cal and Healthy Families. The other half do qualify but aren't enrolled.

Last October, Alameda County launched Healthy Kids, which offers low-cost medical and dental insurance to children of families that don't qualify for other insurance. All children are eligible regardless of immigration status. Eligible children can have a household income of up to 300 percent of the federal poverty level, or $60,000 for a family of four.

So far, more than 1,200 children, up to age 18, have been enrolled in the program, and the Alameda Alliance for Health, which runs the service, is seeking more funding so it can add more slots.

On a state level, 2006 could be the year that California decides to fund health insurance for all children.

A coalition that includes the Lung Association of California and the

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California Hospital Association is collecting signatures for a November ballot initiative that would raise the price of a pack of cigarettes by $2.60.

The estimated $2.1 billion raised annually would be used to fund health insurance for children under age 19, as well as hospital emergency care, nursing education and other health programs.

Efforts led by Assemblywoman Wilma Chan, D-Oakland, to pass legislation that would provide health insurance to all children have been vetoed by Gov. Arnold Schwarzenegger in recent years.

The governor has instead proposed his own solution: spending $72 million to enroll the state's estimated 400,000 eligible children in existing health insurance programs.

The governor's proposal includes $20 million in grants to counties for outreach and enrollment initiatives. He also wants to make Medi-Cal and Healthy Family forms more accessible and easier to fill out.

The plan is included in his next fiscal year's budget proposal.

Clinics expanding

The number of children living in the East Bay suburbs in the Tri-Valley and in Contra Costa County is expected to grow as families move away from more urban areas in search of cheaper housing and open spaces.

Children's Hospital and Research Center of Oakland recently announced it would soon expand outpatient clinics in Pleasanton, Walnut Creek and Brentwood to serve those growing communities.

The hospital also plans to build a second state-of-the-art facility in Contra Costa County and is looking for a site, possibly near Mount Diablo.

Frank Tiedemann, CEO of Children's Hospital Oakland, said the hospital's inpatient volume rose by 7 percent in 2005 and outpatient volume grew by 9 percent.

The hospital is also reassessing its care for 11- to 15-year-olds, a fast-growing segment of its patients from around the region. The two biggest health problems facing preteens and teens are obesity and asthma.

Forty percent of all children treated at the hospital have health issues related to being overweight or obese — twice the national average, Tiedemann said. And asthma is the No. 1 cause of hospitalization at Children's Hospital Oakland.

The hospital's newly expanded Healthy Eating Active Living (HEAL) clinic offers a multidisciplinary approach to obesity, including self-esteem and eating habits. Children are treated by a physician, nurse, exercise physiologist, dietitian and psychologist, and other hospitals nationwide are looking at the program as a national model for treating obesity in children.

Almost two-thirds of California children have dental disease, making it a more pervasive problem than obesity or asthma, according to several recent studies.

In Alameda County, for instance, half of all children have untreated tooth decay by the time they reach kindergarten. By the third grade, 69 percent have untreated tooth decay. And nearly 1 in 10 have tooth abscesses, according to the county's Public Health Department.

Many California children have poor dental health, according to a survey of 21,000 kindergarteners and third-graders throughout the state conducted by the Dental Health Foundation. Of 25 states surveyed, only Arkansas ranked below California in children's oral health.

Studies have shown that tooth decay is related to behavioral problems and poor school performance.

Several area pilot projects are trying to fight the problem. One educates dentists on treating children from birth to 5. Another funds tooth sealants for elementary school children. Sealants cost about $100 to $200 per child and can greatly reduce the incidence of tooth decay.

"This is a quiet, unspoken health reality that doesn't get the attention it deserves," said Alameda County Health Officer Dr. Tony Iton.

Contact Rebecca Vesely at rvesely@angnewspapers.com.