As Congress considered the bailout of Wall Street, there appears to have been little focus in the debate on the underlying causes of the larger economic situation that the United States is in. Our current predicament is not just about mortgages or the undercapitalization of the financial sector; it is also very much about the shift in priorities in this country over the last thirty years. We have come a long way from the idea of The Great Society, a productive national community that not only took care of itself, but grows consistently stronger for having done so. In the New York Times this past weekend, Ezekiel Emanuel, chair of bioethics at the National Institutes for Health, argues that in some ways, the current crisis is a symptom of "chronic problems," specifically the continued unfulfillment of our human right to health care:
[S]olving the deep problem of the economy cannot be done without solving the health care mess. Economic, tax and health care policy are inextricably linked. Middle-class incomes have hardly grown in 30 or more years (except for five years in the 1990s when health care costs were moderated), budget deficits are escalating and will only worsen and investment in education and other engines of long-term economic growth are declining.
These problems are all driven by health care. Rather than go to wage increases, almost all of the growth in workers' productivity has been swallowed up by rising health care costs.
Basic economic security cannot exist without good health, and without a foundation of economic security, our efforts to aspire to be a better nation--one that fulfills the interconnected promises of life, liberty and the pursuit of happiness--are in danger of proving futile. As President Franklin D. Roosevelt said in his 1944 State of the Union address, "we have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence."
If you've watched a news show, listened to the radio, picked up a newspaper or even just watched The Daily Show this week, you know that Wall Street is in trouble. Years of irresponsible speculation and reckless lending policies--including the targeting of subprime mortgages in America's most vulnerable communities--have contributed to the threat of bankruptcy of some of the biggest names in banking and insurance. Bear Sterns. Fannie Mae. Freddie Mac. Lehman Brothers. Merrill Lynch. AIG. You may not have heard of all of them before, but chances are that you've heard of one of them, and the chances are even bigger that they have, somewhere along the road, been involved in your own financial situation, whether it is as an investor in the bank that lent you your mortgage or as the manager of your 401(k) or pension. Long story short, this is really big news with potentially huge impacts on every sector of American life and the economy. And as big news, the reporters are covering it, just as they're also covering the fact that the Federal Reserve, an independent government agency entrusted with managing America's monetary policy (mainly through deciding interest rates), has bailed out a few of these large investment banks to the tune of over $300 billion.
I'm no economist, but the economists who are talking about these bailouts right now generally appear to believe that they are necessary. The fabric of the American economy is so interwoven that we cannot simply allow major segments of our community to fail without repercussions for the rest of us. Undoubtedly, there should be reprecussions for bad behavior, and the current critiques of the lack of accountability for these banks and their managers are very persuasive. Just as America cannot succeed without broad support of the common good, it cannot succeed without accountability, transparency, or justice. Responsibility in America cannot just be to ourselves (or our stockholders), it must be to each other as well.
Of course, this interconnectedness isn't only true for large investment banks; this is true for all of us, from the largest to the smallest. That's why it's disappointing to see that as the Federal Reserve takes action to keep our financial sector in one piece, our elected official in Congress and the Administration are not providing parallel support to American families and children. Apparently frozen until next year is consideration of expanding the State Children's Health Insurance Program, which provides access to health care for about 7 million children. One of the most successful government programs, the Children's Health Insurance Program has reduced the number of uninsured children by around 3 million, and, as I wrote a couple of weeks ago, is credited for helping with the reduction of the number and percentage of uninsured from 2006 to 2007. Similarly, we've yet to see a federal response to the
So my question is, what's AIG got that your child doesn't? True, this isn't exactly comparing apples to apples; the Federal Reserve's independence allows it to act in ways that are more difficult for Congress and the Administration. Nonetheless, the social contract of America which has made this country strong is one of mutual security, the guarantee that our elected officials will work to insure our ability to provide for the health, food, education and other basic needs of our families, neighborhoods, and communities. Almost a century ago, when financial crisis also created hardship for Americans across the country, the government responded not with bailouts, but with a program of hope and support, a set of policies that did not seek to provide for American's basic needs, but rather to assist us all, as families and as a national community, to get back on our feet. Legacies of those policies live on today, responding to high fuel prices with the Low Income Home Energy Assistance program and to skyrocketing food prices with the Women, Infants and Children nutrition program for mothers and their children, the Commodity Supplemental Food Program for senior citizens, and the Emergency Food Assistance Program that supports food banks. At only a fraction of the cost of the recent investment bank bailouts, there is an opportunity for our elected representatives to not only guarantee and uphold the core American value of economic and community security, but to help stimulate the economy as well.
The New York times ran a story on economic inequalities in access to treatment for obese children, of which there are nine million in the United States. While this figure has tripled since 1980, there is a dearth of comprehensive, effective, or affordable programs to address the issue. Summer weight loss programs are generally costly (some cost over $1,000 a week) as most seek to turn a profit. Furthermore, most insurance providers do not cover this cost. Dr. Walter J. Pories, a gastric bypass surgeon, calls the lack of insurance and government financing for such programs "the single most frustrating problem in dealing with childhood obesity."
The TriCaucus, comprised of the Congressional Asian Pacific American caucus, the Congressional Black Caucus and the Congressional Hispanic Caucus, sent House Speaker Pelosi a letter urging the inclusion of two provisions in the SCHIP reauthorization bill to improve health care access for immigrant children: one eliminating a five-year waiting period for documented immigrants to receive government benefits and another eliminating proof of citizenship as a requirement to receive these benefits. According to the TriCaucus, the proof of citizenship requirement has led to hundreds of thousands of U.S. citizens to be denied coverage because parents could not find the required documentation. The TriCaucus wrote to Pelosi, "We urge you to include provisions in this bill which address the needs of children in communities of color and respectfully request a meeting with you to discuss this critical issue."
A study released last Wednesday by the Pew Hispanic Center and the Robert Wood Johnson Foundation reported that 27% of Hispanic adults in the U.S. do not have regular health care providers, although many spoke English and 45% had health insurance. Hispanic men, younger adults, and those with little education or without health insurance were found most likely to not have regular health care providers, as reported in the Newark Star-Ledger. 41% of Hispanic adults without regular providers identified "seldom [being] sick" as the primary reason. Given that Hispanic adults actually have disproportionate rates of diabetes and obesity, this presents a unique challenge to providing Hispanics with access to health care that demands real solutions. The authors of the article wrote that the results of the study indicate a "need for providers to encourage Hispanic adults to seek routine health care."
According to a recent study published in the journal Cancer Epidemiology, Biomarkers and Prevention and reported in Reuters Health, members of minority groups who have felt discriminated against by their health care providers are less likely to be screened for breast or colon cancers. Of the 11,245 black, Hispanic, Asian and Native American adults aged 40-75 surveyed, 9% of women and 6% of men said they experienced discrimination from their health care providers in the last 5 years. These women were approximately half as likely to have had a mammogram and only two-thirds as likely to have a colorectal cancer screening. Men who had perceived discrimination were 70% less likely to have had a colorectal cancer screening.
This past week, two Kaiser Health Disparities Reports documented the effects of language and cultural barriers on medical outreach and diagnosis. The first report, on HIV/AIDS in the Texas Hispanic community, referenced a Dallas Morning News story which documented that HIV is being detected later in Texas Hispanics than in other ethnic groups. This increases the risk of spreading the virus and decreases possibilities for treatment. While 24% of the state's HIV-positive blacks and whites are diagnosed with AIDS within a month of testing positive for HIV, this number is 8% higher for Hispanics. Language barriers, limited access to health care, legal issues, and cultural differences are noted among the challenges at the root of this disparity. The second report points to language and cultural barriers as a reason many elderly Hispanics with Alzheimer's disease remain undiagnosed and untreated. According to the Alzheimer's Association, an estimated 200,000 Hispanics in the U.S have the disease, a figure expected to grow to 1.3 million by 2050. Experts point to a perception in the Hispanic community that symptoms of Alzheimer's are normal signs of aging, as well as a lack of health insurance and access to care as important factors in late diagnosis of the disease in Hispanics. Solutions include earlier screening, improved access, and "targeted awareness and treatment efforts."
The Health Care Blog reports that Howard County, Maryland will launch the "most ambitious local effort at universal coverage" since San Francisco in April 2007. The plan, known as the Healthy Howard Plan, will offer primary, specialty, and hospital care as well as prescription drugs to 2,200 of the county's 20,000 uninsured residents beginning next month, all for $85 or less a month. According to its designers, Healthy Howard is "built on the philosophy that health care is a right and a responsibility." This language of a human right to healthcare is echoed in the Opportunity Agenda's policy brief, Healthcare, Opportunity and Human Rights at Home. Each enrollee will have to complete a health assessment and work with an assigned health coach to reach specified goals. While the financing for the program, much of which comes from charity care from the local hospital, is not sustainable, the program will offer unprecedented insight into what does and doesn't work, valuable information for future health reformers. An initial evaluation of the program will be available within 6 months to a year.
An opinion piece in The New York Times evaluated the probability of universal health care reform in the upcoming years. It listed three hurdles to reform: the swing of political power in the upcoming election, the public's fear of change, and a loss of focus on the health care given such issues as a weak economy and foreign policy crises in the spotlight.
The Washington Post reported that health care costs are expected to rise 10% in 2009. Despite being the smallest increase in six years, the increase will make quality health care even more difficult to access. Particularly hard hit will be poor communities in the U.S. already struggling to pay steep premiums.
The public recently witnessed the lack of basic care that people are subjected to at Kings County Hospital Center in Brooklyn, New York. A woman was left for dead in the middle of the hospital's psychiatric ward waiting room as staff did nothing but walk away. The evidence in the New York Civil Liberties Union's lawsuit against the city proved that this was not an isolated incident (it just happened to be one of the only ones caught on tape). Unfortunately, New York City's government is not learning from this catastrophe and taking sufficient steps forward to examine their hospitals - Women's eNews is reporting that the city is refusing to participate in a state review of maternal deaths and racial disparities, despite the fact that New York City has the highest number of maternal deaths and one of the largest populations of African-American patients in the country.
The New York City Health and Hospitals Corporation (the same agency that is named in the NYCLU lawsuit as the agency that is responsible for the negligence at Kings County Hospital Center), has refused to participate in the review the Safe Motherhood Initiative is conducting. Pamela McDonnell, a spokesperson for Health and Hospitals Corporation (HHC) said:
We chose not to participate in the Safe Motherhood Initiative simply because we already participate in a number of established monitoring and review processes, measures and collaboratives.
However, one of the main points in the NYCLU's complaint was that the city had insufficient monitoring and oversight measures at its hospitals - it was this lack of oversight that led to last month's death at Kings County, and it could be part of the cause of numerous maternal deaths at city hospitals.
New York's American College of Obstetricians and Gynecologists, in conjunction with the New York State Department of Health, launched the Safe Motherhood Initiative in 2001. The Initiative was established to conduct reviews that facilitate responses to pregnancy-related deaths and eliminate racial disparities in maternal mortality in New York State. However, HHC's refusal to participate will lead to a great deal of information, particularly information on racial disparities among pregnant women in the hospitals, being left out of the review.
The first Safe Motherhood Initiative review that came out in 2005 interpreted 33 deaths over the course of 2 years - it found that 60% of those women who died were African American. The review examined the deaths of these women in detail and sought to determine what the cause of the racial disparity was. According to Women's eNews:
In 2004, black women were nearly four times as likely to die in childbirth as white women nationwide, and had a maternal death rate of 34.7 per 100,000 live births compared to 9.3 deaths per 100,000 live births for white women...
Designed to discover and interpret major risk factors, [director of New York's American College of Obstetricians and Gynecologists Donna] Montalto's State Maternal Mortality Review surveys--among many data--the deceased woman's occupation, primary language, education, insurance coverage, prenatal care, method of delivery and history of sexually transmitted diseases. It asks if the pregnancy was intended or unintended. It might also help explain why African American women represent a disproportionate amount of maternal deaths.
The Opportunity Agenda's report on New York City's health care system, Dangerous and Unlawful: Why Our Health Care System Is Failing New York Communities and How To Fix It, showed the unequal and inadequate access to health care that many communities, particularly communities of color, are faced with. This lack of access and poor quality was most evident in the absence of primary care for many New Yorkers. Incidentally, the last Safe Motherhood Initiative review found that inadequate prenatal care was one of the main causes of the racial disparity in maternal deaths in New York State. Prenatal care is something that many women get through their gynecologist as part of their primary care; thus, the lack of decent primary care can lead to many women in communities of color having at-risk pregnancies.
The problems in the city's health care system was exemplified by last month's disaster at Kings County Hospital. It is to the detriment of all New Yorkers that HHC is refusing to participate in the Safe Motherhood Initiative's review - it is crucial that we address health disparities and find real solutions to the problems in the state's health care system, but the city has to play a role in doing this. HHC says its mission is:
To extend equally to all New Yorkers, regardless of their ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity and respect.
The death of Esmin Green last month showed that HHC is not succeeding in its mission. Its decision not to participate in the Safe Motherhood Initiative review is another one that could lead to an unnecessary, preventable death at a city hospital. The city needs to work to address these problems - until it does, our communities will suffer.
• This past week there have been a number of news articles about the Black AIDS Institute study on the racial disparities among those living with HIV/AIDS in the United States. The New York Times pointed to the part of the study that said that if one only counted the African American population in the U.S., the country would have the 16th highest rate of people with AIDS:
Nearly 600,000 African-Americans are living with H.I.V., the virus that causes AIDS, and up to 30,000 are becoming infected each year. When adjusted for age, their death rate is two and a half times that of infected whites, the report said. Partly as a result, the hypothetical nation of black America would rank below 104 other countries in life expectancy.
The Washington Post's coverage of the study focused on the Institute's criticism of the federal government's approach to addressing the AIDS crisis in black communities:
African Americans with HIV -- at least 500,000 -- are more numerous than in seven of the 15 "target countries" in the Bush administration's global AIDS initiative, which has spent about $19 billion overseas in the past five years.
A DMI Blog posting last Thursday also discussed the study and questioned whether the next President would choose to focus on tackling racial disparities in the American HIV/AIDS population, or would continue to ignore the issue:
The bottom line is that the HIV epidemic in the US continues to spread, and at a rate greater than was previously thought. The real measure of political leaders and the American people is if this bad news spurs good action - the establishment of a comprehensive and accountable national AIDS strategy that will eliminate barriers to effective prevention, generate adequate resources, and hold the government accountable for ending this epidemic.
The Black AIDS Institute study can be accessed here. To learn more about the general prevalence of health disparities in the U.S., read The Opportunity Agenda fact sheet Healthcare and Opportunity.
• The Kaiser Health Disparities Report has pointed out that new data from the Centers for Disease Control and Prevention shows the presence of racial disparities in the current U.S. infant mortality rates. According to the new data, black infants are 2.4 times more likely to die before they turn one year old than white infants are:
CDC officials say the higher rates in large part can be attributed to low birthweights, shorter gestation periods and premature births. Experts say that it is difficult to identify a link between race and higher infant mortality but noted that higher rates of poverty, limited access to health care and dietary differences are possible contributors.
• An editorial in last week's Los Angeles Times discusses how rising food prices are actually likely to increase obesity rates in the U.S., not decrease them. In many other parts of the world, an increase in food prices leads to an increase in rates of hunger (not obesity). However, the article points out that obesity has a lot to do with the type of food people consume, not just the amount:
Obesity isn't simply about too much food. It's about the type of food, how it's prepared and the balance of calorie intake with physical activity. Stress and social conditions can also play a role.
Obesity rates have long been more prevalent in poor communities in the U.S. - the article also points out that the states that have the highest rates of obesity also have the highest proportion of families living in poverty. People living in poor communities, particularly poor communities of color, must have access to healthy food in order to prevent these health disparities from becoming more extreme. To learn more about inadequate health care access in communities of color, read the CERD report to the UN, Unequal Health Outcomes in the United States.
• An essay in The New York Times discusses how the American Medical Association's apology for its past racism towards black physicians and patients brought to light the historical split between the AMA and the National Medical Association, a group that represents black physicians. The essay pointed out that while last month's apology was an important step in bridging the gap between the two organizations, more needs to be done to overcome the inadequate representation of black physicians in the medical profession:
Yet reminders of this rancorous history persist, and the A.M.A.'s apology remains pertinent, if long overdue. Consider this statistic: In 1910, when Abraham Flexner published his report on medical education, African-Americans made up 2.5 percent of the number of physicians in the United States. Today, they make up 2.2 percent.
• In the past week, there have been numerous reports that call attention to the disparities among those living with HIV/AIDS in the U.S. The Kaiser Health Disparities Report has linked to a CBS Evening News story on the disproportionate number of African Americans that have HIV or AIDS. According to the story, blacks account for 49% of new HIV diagnoses, 69% of AIDS cases among ages 13 to 19 and 56% of AIDS cases among ages 20-24. Despite these high percentages, blacks only make up 13% of the population:
"No matter how you look at it through the lens of gender or sexual orientation or age or socioeconomic class or level of education or region of the country where you live, black folks bear the brunt of the AIDS epidemic in this country," Phill Wilson, founder of the Black AIDS Institute, said. Wilson added that early HIV/AIDS advocates did not send the right HIV prevention and education messages to the black community. "The mischaracterization of the epidemic in the early days ... made black folks think we didn't have to pay attention to the disease," Wilson said.
• Rates of HIV/AIDS are not only disproportionate in African American communities - The Washington Post is reporting that Hispanics represent 22% of new HIV/AIDS diagnoses, despite only making up 14% of the population. While the Post notes that HIV rates are highest among blacks, it also claims it is harder to target enough resources towards Latinos, particularly those who are immigrants, who have been diagnosed with HIV:
Blacks still have the highest HIV rates in the country, but language difficulties, cultural barriers and, in many cases, issues of legal status make the threat in the Hispanic community unique. For those who arrived illegally, in particular, fear of arrest and deportation presents a daunting obstacle to seeking diagnosis and treatment.
• On a more positive note, the Senate passed a bill that calls for a reauthorization of federal funding for a program that supports community health centers, the Deseret News reported last Tuesday. The bill, sponsored by Senator Ted Kennedy (D-Mass.) and Senator Orrin Hatch (R-Utah), allows for continued support for health centers that provide affordable and quality care for many Americans, particularly those with low income:
Hatch said that since 2001, increased funding has enabled community health centers to treat 4 million new patients in more than 750 communities across the nation. His bill reauthorizes funding for the program for five more years.
• State governments were also discussing implementing health care measures this past week - in Massachusetts, the Council on Racial and Ethnic Health Disparities, chaired by State Senator Dianne Wilkerson and State Representative Byron Rushing, met on July 21 to discuss the recommendations of the Special Legislative Commission on Health Disparities. According to A Healthy Blog, the Council discussed various successes and failures in the state's health care reform:
The presenters all pointed to the success of health care access expansion in Massachusetts as an important step in disparities elimination efforts, but also noted the need to continue working to address quality, cultural competence, and social context problems.
• According to The Health Care Blog, The Century Foundation has announced that it is creating a working group to establish a blueprint for Medicare reform. Maggie Mehar, author of HealthBeat Blog, will direct the group and plans to review issues such as:
Revising Medicare's physician fee schedule to pay more for primary care, palliative care, and co-ordination and management of chronic diseases.
Rethinking Medicare's fee-for-service system to reward doctors for quality, not volume.
Creating an independent Comparative Effectiveness Institute that reviews head-to-head testing of drugs, devices, and procedures to ensure that they are effective.
Identifying and rewarding hospitals that provide better outcomes and higher patient satisfaction at a lower cost while helping other hospitals meet benchmarks.
• The New York Times is reporting that a recent study of the American health care system, conducted by the Commonwealth Fund, has found that while the U.S. has the most expensive health system in the world, the quality it delivers is grossly inferior to other industrialized nations' health care. The report highlighted the fact that many of the improvements made in the U.S. health care system over the years, such as decreasing the number of preventable deaths, dwarfed in comparison to the greater achievements other countries made:
Other countries worked hard to improve, according to the Commonwealth Fund researchers. Britain, for example, focused on steps like improving the performance of individual hospitals that had been the least successful in treating heart disease. The success is related to "really making a government priority to get top-quality care," [Karen] Davis, [president of the Commonwealth Fund] said.
The report also emphasized the inefficiencies in the U.S. health care system and the role they play in diminishing quality:
The administrative costs of the medical insurance system consume much more of the current health care dollar, about 7.5 percent, than in other countries...
Bringing those administrative costs down to the level of 5 percent or so as in Germany and Switzerland, where private insurers play a significant role, would save an estimated $50 billion a year in the United States, Ms. Davis said.
• An article in Friday's Washington Post discusses the potential that community health providers have to save states millions of dollars in health care costs by shifting some of their health programs' emphasis to preventing illness. A recent Trust for America's Health report found that nonprofit community programs could have an enormous role in developing health initiatives such as anti-smoking laws, healthy eating and physical activity programs. However, despite the fact that many of these programs target at risk groups in impoverished areas, they face a serious lack of funding:
The researchers found that many such programs lack funding, a chronic problem for many preventive health initiatives.
"People think preventive health care pays off 20 or 30 years from now, but this shows you get the money back almost immediately, and then the savings grow bigger and bigger," [Senator Tom] Harkin [D-Iowa] said.
• An opinion piece in yesterday's Chicago Tribune calls attention to the health disparities among women with HIV. Black women have higher rates of HIV, despite the fact that studies have shown that they do not engage in "risky sex" any more than white women do:
A black woman in a poor neighborhood, for example, who engages in the lowest levels of risky behavior is dramatically more likely to acquire a sexually transmitted disease than higher-risk women in communities with low rates of infection, according to public health experts...
In short, who you are, and where you live and, consequently, the sexual partners you choose, matters when it comes to HIV prevention.
On June 18, 49-year-old Esmin Green was admitted to the Kings County Hospital Center psychiatric ward. After waiting to be seen for 24 hours, she fell to the floor, began to convulse and then passed out. Two security guards and one doctor walked into the waiting room, looked at her and then walked away. After one hour, a nurse finally came over, kicked Ms. Green, and then proceeded to get a stretcher. Shortly afterwards, Ms. Green was pronounced dead. The entire incident was documented on a security camera, and is now on YouTube, thanks to the Associated Press.
Hospital officials said they fired three of the workers and suspended another three, the New York Times reported on July 7. However, it is clear that Ms. Greene's death is far from an isolated incident at Kings County Hospital. The New York Civil Liberties Union, in conjunction with Mental Hygiene Legal Service and the law firm of Kirkland & Ellis LLP, filed suit against the New York City Health and Hospitals Corporation (the agency that runs Kings County Hospital) in May 2007. The plaintiffs claimed that patients at the hospital's psychiatric facilities were subject to conditions of squalor and filth, as well as abuse by hospital employees. A summary of the case can be found on the NYCLU website.
The evidence displayed in the lawsuit shows that Ms. Green's death is not solely the fault of the hospital employees who watched her die. The conditions in the hospital, particularly the psychiatric ward, and the treatment of the patients are the responsibility of the city agency that runs the hospital. It was not until over one year into the litigation, and after Ms. Green's death, that the city finally agreed to adopt a series of basic stop-gap measures, including:
* That every patient be checked every 15 minutes.
* That there be no more than 25 patients at any time in the psychiatric emergency ward.
* That detailed records on the ward be turned over every week to the advocates involved in the lawsuit.
* And that the advocates be active participants in the search for a new deputy executive director and emergency room director for Kings County Hospital's Behavioral Health department.
It is shocking that it took a lawsuit and the very public death of a woman to get New York City to agree to such basic levels of care for mental health patients. Donna Lieberman, executive director of the NYCLU, said:
What's happening in Kings County Hospital is an affront to human dignity...In 2008 in New York City, nobody should be subjected to this kind of treatment. It should not take the death of a patient to get the city to make changes that everyone knows are long overdue.
What is even more distressing about Ms. Green's death and the allegations of gross negligence of patients at Kings County Hospital is that many residents in Central Brooklyn do not have access to other hospitals. This is mainly due to the fact that the predominantly black, low-income areas of Central Brooklyn, particularly the neighborhoods Bedford-Stuyvesant, Brownsville, Canarsie, Crown Heights, East New York, and Flatbush have seen numerous hospital closures in the last few years.
The Opportunity Agenda has documented these hospital closures on its website Health Care That Works. Since 1985, Central Brooklyn has seen five local hospitals close their doors. Because of these closures, people in these minority communities have been forced to rely on Kings County Hospital even more. Local residents also begged the city to keep local clinics open - their requests can be seen in a video on The Opportunity Agenda's YouTube channel. At the same time all of these facilities were closing, allegations of mistreatment at Kings County were surfacing.
The fact that people of color have inferior access to health care in New York contributes greatly to the health disparities in the city. The Opportunity Agenda report Dangerous and Unlawful: Why Our Health Care System Is Failing New Yorkers and How to Fix It documents how areas with high concentrations of African Americans, Hispanics and Asian Americans are more likely to have shortages of primary care physicians than predominantly white communities are. The distribution of hospitals and other health care services has a significant discriminatory effect on these communities of color - their health care access is simply inadequate.
Ms. Green's death should do more than signify the need for improvement of existing hospitals like Kings County. It should also remind us that many people in New York, and across the country, lack basic primary care and access to emergency services. Changing this reality needs to be a part of health care reform discussions. If it isn't, we will continue to see needless deaths like Ms. Green's occur.
Last Thursday, the American Medical Association issued an official apology for its past racism toward African American patients and physicians. Along with the apology were the findings of a study conducted by the Commission to End Health Care Disparities, a group that the AMA and the National Medical Association (an organization representing black physicians) co-chair. The study has found that between 1846 and the 1960s, the AMA's past transgressions included:
substandard care for black patients or segregated them to black hospitals; a lack of support for black physicians and for the Civil Rights Act; and exclusion of blacks from medical schools, hospital staffs and residency programs.
The apology can be found here, and the study is available in the online version of the Journal of the American Medical Association. To learn more about the work of the Commission to End Health Care Disparities, go to the AMA website.
It is also worth noting that a number of doctors were opposed to the AMA's discriminatory policies in the 1960s. A group of physicians picketed the AMA convention in Atlantic City in 1963 in order to call attention to the AMA's racist acts. Among these physicians was Dr. Robert Smith, a leader of the Medical Committee for Human Rights in Mississippi (MCHR). The MCHR grew out of the Medical Committee for Civil Rights, and organized a number of volunteers to come down to Mississippi to provide care to black patients who were not being treated in their communities:
Though MCHR volunteers were not licensed to practice professionally in Mississippi, they could offer emergency first-aid anywhere and anytime to civil rights workers, community activists, and summer volunteers. Working without pay, they cared for wounded protesters and victims of police and Klan violence, assisted the ill, visited jailed demonstrators, and provided a medical presence in Black communities, some of which had never seen a doctor. They established and staffed health information and pre-natal programs in many Black communities. Appalled at the separate and unequal care provided to Blacks by Mississippi's segregated system, they soon involved themselves in political struggles to open up and improve Mississippi's health care system for all.
The Health Care Blog has a posting that discusses My Health Direct, the web-based solution to overcrowding in emergency departments. The idea of My Health Direct is for hospitals to use an online appointment system to re-route their Medicaid and uninsured patients to community and safety-net clinics. According to the blog posting, the program has been successful in increasing patients' access to primary care and improving the quality of care and treatment outcomes for those patients:
More than 12,000 health appointments have been made with the vast majority of these appointments for patients who are uninsured or enrolled in a Medicaid managed care plan. These appointments were made for patients who either presented for care with a non-emergent condition, or needed follow-up care in a primary care setting.
A utilization review of My Health Directs impact demonstrated that more than 92% of patients who received an appointment did not present to the ED again. Patients who obtained appointments were more than 4 times more likely to actually attend their appointment compared to previous referral efforts from the ED. Lastly, there was a 25% reduction in repeat non-emergent visits of those patients assisted by My Health Direct.
A recent Health Beat blog posting titled "The Realities of Rural Medicine" discusses the unequal access to health care for people who live in rural areas. The study on rural health care, conducted by the Center for Studying Health System Change, found that both patients and doctors feel significant strain in living in communities that do not have enough primary care options.
The Washington Post is reporting that Los Angeles City Councilwoman Jan Perry is trying to limit the prevalence of fast food restaurants in South Central Los Angeles by placing a moratorium on new fast food locations in the area. Perry is a representative for District 9, an overwhelmingly African American and Latino constituency that has significant health disparities in comparison to the wealthier West L.A. area:
Perry quoted research showing that although 16 percent of restaurants in prosperous West L.A. serve fast food, they account for 45 percent in South L.A. Experts see an obvious link to a health department study that found that 29 percent of South-Central children are obese, compared with 23 percent county-wide.
STATE BLOGS
