Clinicians, Health Organizers Challenge Feds
Community-level wellness programs fueled by public-health research and organizing bring great benefits to low- to moderate-income communities like Humboldt Park. But federal reform efforts are likely to produce limited gains, according to panelists who appeared Oct. 23 at a daylong forum at Association House, sponsored by the Greater Humboldt Park Community of Wellness.
“What’s in the [federal] bills is not comprehensive, and it doesn’t address communities,” said Dr. Jose E. Lopez, executive director of the Puerto Rican Cultural Center, who closed the event with a high-voltage speech that roused the several hundred health workers and activists in attendance. “We as a community can come together to address asthma, diabetes, I don’t care what it is.”
Lopez referred to a much-discussed, groundbreaking 2004 study of health disparities by theSinai Urban Health Institute in Chicago.
“You have to be able to harness resources. That’s what the Community of Wellness does,” he said. “For the issues addressed by the Sinai study, we’ve brought together $10 million [in grant money]. That’s an amazing feat for a poor community.”
During a panel discussion on the competing federal health care proposals, Juana Ballesteros, executive director of the Community of Wellness, said she tuned out of the debate months ago. “I saw no role for what I considered primary prevention. I saw no role for communities and those of us who worked in them,” she said. “There needs to be a role for a wellness approach.”
Dr. Lee Francis, president and CEO of Erie Family Health Center, referred to the likely outcome of federal reform as a “half-baked pie” and said those working at the community level will have to work creatively to gain eligibility for their clients.
For example, the 12 million or so “unauthorized” residents of the U.S. will not be eligible for federal subsidies and might not be eligible to buy into any government-subsidized plan, depending on which version of the bill passes, Francis said. “Immigration policy has become part of the health care debate,” he said. “That is not the right track for us to go on.”
In addition, many others will be left out through a “donut hole” of moderate-income people who can’t afford health care and won’t receive enough subsidy, Francis said. “Who would be covered? Probably not everyone. That’s the big tragedy,” he said. “Does this get us part of the way there? Yes. It is good? I don’t know yet.”
Dr. Anne Scheetz, a private physician who makes house calls to frail, elderly people who can’t leave home, gave a passionate endorsement of a single-payer plan, similar to Canada’s, which is not being seriously considered in the U.S.
“Now, you get health care according to what you can afford. If you can’t afford it, you don’t get it, or you go bankrupt,” said Scheetz, a member of Physicians for a National Health Program and Chicago co-chair of the Illinois Single Payer Coalition. “Health care as a human right makes it cheaper” without the huge administrative costs involved in multiple insurance companies determining eligibility case by case. “Everybody in; nobody out. One nation; one health plan.”
One audience member responding to the federal panel urged those in attendance to try to get community voices heard on Capitol Hill. “We have a great national model here,” the attendee said. “We should reshape the national agenda to talk about wellness communities. Creating communities of wellness is something we could disseminate throughout the nation.”
Dr. Molly Martin of Rush University cited the community health care worker movement, which has taken hold more quickly abroad than in the U.S., in which services are taken out of clinical settings and into neighborhoods. “In our current system, there is no motivation for prevention,” she said.
State and community level Two state legislators, Sen. Willie Delgado and Rep. Cynthia Soto, talked about what they and their colleagues in Springfield have done to address community health care.
Delgado spoke of the importance of codifying reforms in statutes rather than relying on one administration’s policies, which can be changed by the next one.
“The Puerto Rican Cultural Centers and the Vida/SIDAs of the world need to come together and say, ‘We need to shape existing policy,’ ” he said, the latter referring to a health clinic that treats HIV/AIDS patients. “I challenge you to be involved with our existing networks. When we talk about diabetes, when we talk about asthma, historically, in our communities we have to talk about working together.”
Chairman of the state senate’s public health committee, Delgado said he and his colleagues have worked issue by issue to address challenges ranging from access to mammograms, to adequate detoxification treatment for the scourge of heroin addiction. “This is like a pizza,” he said. “If you try to eat it all at once, it’s going to be very difficult. We have to take it slice by slice.”
Soto detailed initiatives that included expanding access to community dental clinics, treatment for veterans and others with brain injuries, and services for children with autism and other special education needs. “If you have any ideas, please reach out to me,” she asked those in attendance.
Dr. Steven Whitman, director of Sinai Urban Health Institute, reminded attendees of some of the stark realities uncovered by his agency’s five-year-old study – and summarized a few of the major grants that have flowed into the community since then.
Life expectancy in Humboldt Park is among the lowest in the city, at 71.5 years, nearly three years below the average, while smoking rates are double the U.S. average, diabetes rates for those of Puerto Rican descent triple the citywide averages, and one-third of Puerto Rican children have asthma, Whitman said.
Challenges addressed Such challenges have been addressed through programs like the “Helping Her Live,” breast cancer awareness and education program, which has brought $2 million over three years; a $500,000 grant over five years for the Co-Op Humboldt Park anti-obesity program; and another $275,000 for the La C.U.R.A. program to address pediatric asthma.
“These dollar amounts are numbers that are coming to Humboldt Park,” Whitman said. “This collaboration is built on the suffering of the community and the strength of the community. It’s your ability to be organized through the Community of Wellness.”v“This community did not just lay back and say, ‘We’re sick. We have high rates of asthma and diabetes.’ We took action,” Ballesteros said. “We work with public health researchers who see us as partners, not just subjects.”
Community partnerships are key for medical institutions, said Martin, who detailed a $600,000, two-year grant from the National Institutes for Health to address asthma in schools. Rush’s partners include the Greater Humboldt Park Community of Wellness, Puerto Rican Cultural Center and Near Northwest Neighborhood Network.
The resulting study will include 50 elementary school and 50 high school students who have uncontrolled asthma, half of whom will receive home visits and half mailed information, and all of whom will get home inspections. “We don’t do things without their approval,” Martin said of Rush’s partners in the effort. “There is no way I can recruit 100 Puerto Rican kids to be part of a study. They can.”