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Over the Rhine Health Disparities & Crossroad Health Center Chuck Schubert MD Professor of Clinical Pediatrics Cincinnati Childrens Hospital University.

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Presentation on theme: "Over the Rhine Health Disparities & Crossroad Health Center Chuck Schubert MD Professor of Clinical Pediatrics Cincinnati Childrens Hospital University."— Presentation transcript:

1 Over the Rhine Health Disparities & Crossroad Health Center Chuck Schubert MD Professor of Clinical Pediatrics Cincinnati Childrens Hospital University of Cincinnati

2 Over the Rhine German immigrants German immigrants Beer production until prohibition Beer production until prohibition Old housing stock Old housing stock Movement to the suburbs Movement to the suburbs Absentee landlords Absentee landlords Population shifts Population shifts –Where did all the families go?

3 Poverty in the USA & Children Federal Poverty level: $22,000 (family of 4) Federal Poverty level: $22,000 (family of 4) 200% FPL: Minimum to ensure clothing, housing & food 200% FPL: Minimum to ensure clothing, housing & food –40% of children in families < 200% (children only 25% of population) –6% of children < 50% 400% of FPL = middle income 400% of FPL = middle income

4 FPL= Federal Poverty Level FPL based on Thrifty Food Plan FPL based on Thrifty Food Plan Assumes: Assumes: –1/3 spent on Food –1/3 spent on Housing –1/3 spent on basic necessities Not updated (especially on cost of housing) Not updated (especially on cost of housing)

5 Poverty in Hamilton Cty, Ohio 2.1 million people 2.1 million people 18% of families ( 22-27% of population ) 250,000 pop. National Average of cities >250,000 pop. –13.3%

6 Poverty & Cincinnati 36% of children live below the poverty line 36% of children live below the poverty line –3 rd in the nation –82% live with a single mom One of the fastest-growing rates of suburban poverty in the nation (Brookings Institution) One of the fastest-growing rates of suburban poverty in the nation (Brookings Institution)

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10 Social Security Act of 1935 Economic assistance to the unemployed, the aged & low income widows & children Economic assistance to the unemployed, the aged & low income widows & children –Social Security: Works: < 10% of elderly live in poverty Old age survivor & disability insurance Old age survivor & disability insurance Annual cost of living increase Annual cost of living increase –Welfare: not worked so well for kids AFDC now TANF: Temporary Assistance to Needy Families AFDC now TANF: Temporary Assistance to Needy Families Limitations including welfare to work Limitations including welfare to work –EITC: earned income tax credit Minimize or eliminate federal income tax for those living in below FPL Minimize or eliminate federal income tax for those living in below FPL Lifts more children out of poverty than any other program Lifts more children out of poverty than any other program –Minimum wage: increased still less than 1960/80 real dollars

11 Food Insecurity / Safety Net Food stamps Food stamps –49% of recipients are children School lunch & Breakfast School lunch & Breakfast WIC (Womens Infants & Children) WIC (Womens Infants & Children) –Discretionary: only enough funds to serve 55% of eligible Private Sector: Private Sector: –Food Banks, soup kitchens

12 What Controls Access to Health Care Financial access (i.e.. insurance) Financial access (i.e.. insurance) Geographic distribution of physicians Geographic distribution of physicians –Willingness to see the poor Availability: transportation, office hours, etc. Availability: transportation, office hours, etc.

13 Why doctors dont see the poor Low reimbursement Low reimbursement Medically and socially complex patients Medically and socially complex patients Negative perceptions Negative perceptions –non-compliant, ungrateful, risk of law suit Difficult to refer Difficult to refer

14 Why is Access Important? Essential to prevent disease & promote health Essential to prevent disease & promote health If access is limited or denied for any reason there will be repercussions If access is limited or denied for any reason there will be repercussions –as opposed to being a sudden tragedy, the problems will be insidious Personal tragedies Personal tragedies Unfulfilled potential (Pb poisoning) Unfulfilled potential (Pb poisoning) Health care becomes a privilege for the wealthy Health care becomes a privilege for the wealthy Cost of health care as a nation will be an issue Cost of health care as a nation will be an issue

15 Health disparities & How poverty affects child health? Risk of decreased brain development Risk of decreased brain development –Poor living conditions Inadequate housing Inadequate housing –Emotional stress of unstable environment –Lack of nurturing Why? Life priorities? Justice issues? Why? Life priorities? Justice issues? –Minimum wage, housing, nutrition, education

16 Health disparities & How poverty affects child health? Decreased access to health care Decreased access to health care PB poisoning & anemia PB poisoning & anemia –Developmental delays Decreased exposure to reading Decreased exposure to reading –Speech & school readiness Asthma Asthma –Story of 6 yr old ADHD ADHD –Fewer options

17 Health disparities & How poverty affects child health? Safety issues Safety issues –Prescription drugs ingestions –CO poisoning (space heaters) –Falls (from windows) –Violence exposure

18 How does poverty affect child health? Low birth weight: doubled Low birth weight: doubled Lead poisoning: tripled Lead poisoning: tripled Delayed immunizations: tripled Delayed immunizations: tripled Death due to disease: 3 – 4 times Death due to disease: 3 – 4 times Death due to accidents: 2 – 3 times Death due to accidents: 2 – 3 times Severe iron deficiency: doubled Severe iron deficiency: doubled

19 What is Required for Child Health By health care providers By health care providers –Access –Comprehensive & preventive care –Supportive to parents Of parents Of parents –Ability to pay for services –Stability Of the community Of the community –Freedom from conditions which increase risk Pb, violence, vaccine preventable diseases, air & water quality, Pb, violence, vaccine preventable diseases, air & water quality, Dealing with poverty Dealing with poverty

20 Adult Health Disparities Obesity Obesity Diabetes Diabetes Hypertension Hypertension Mental Health treatment Mental Health treatment

21 My Journey Medical career melded with my faith Medical career melded with my faith 17 years in Cincinnatis inner city 17 years in Cincinnatis inner city Founded Crossroad Health Founded Crossroad Health –Treat all with dignity and respect –More importantly lived in the same neighborhood as my patients Time in Zambia Time in Zambia –Value to my family

22 Residency September 1983: Relocated to OTR September 1983: Relocated to OTR –Worshiped there –Shopped there –Kids went to school there Built relationships Built relationships Plugged into projects Plugged into projects Identified with the community Identified with the community

23 A real job 1988 Work in clinics in low income areas Work in clinics in low income areas Getting serious about health ministry Getting serious about health ministry Performed community assessment Performed community assessment Explored other models of health care Explored other models of health care Explored funding options Explored funding options Looked for community partners Looked for community partners All built on years of relationship building All built on years of relationship building

24 Health Clinics FQHC: Federally Qualified Health Centers FQHC: Federally Qualified Health Centers –330 funds –Cost based reimbursement –But costs are never covered Free Clinics Free Clinics Faith-based health centers (CCHF) Faith-based health centers (CCHF) –Chicago, Memphis, Washington D.C., Cincinnati

25 Planning Begins 1990: Christian Community Health Services Incorporated 1990: Christian Community Health Services Incorporated Secured Funds Secured Funds Greater Cincinnati FoundationGreater Cincinnati Foundation Robert Wood Johnson Foundation Local Initiative PartnersRobert Wood Johnson Foundation Local Initiative Partners Churches, IndividualsChurches, Individuals

26 Early Years 1992 Opened Part-time, evening hours, 24-hour on-call coverage Opened Part-time, evening hours, 24-hour on-call coverage Staffing Staffing –Part-time staff physician, nurse, social worker –Volunteer physicians –Full-time office administrator 200 visits in 6 months 200 visits in 6 months

27 Crossroad Vision & Mission Show video Show video

28 Crossroad Stats Provided almost 20,000 visits Provided almost 20,000 visits 64% of patients are African American 64% of patients are African American 15% are Hispanic/Latino 15% are Hispanic/Latino 15% are Caucasian 15% are Caucasian 83% of patients have incomes < FPL 83% of patients have incomes < FPL 39% of patients are uninsured 39% of patients are uninsured –76% of uninsured patients are adults.

29 Crossroad Stats National Diabetes Collaborative National Diabetes Collaborative Mental health counseling Mental health counseling Patients w/ hypertension Patients w/ hypertension –significantly better control of BP compared to the national average: 60% are under control compared to 25% nationally.

30 Crossroad Stats 96% of children screened for lead by age 2. 96% of children screened for lead by age 2. –94% who were treated for lead achieved safer levels in 6 months. 96% of 3-year-old children were up to date with their immunizations. 96% of 3-year-old children were up to date with their immunizations. 83% of female patients had PAP smears, meeting state and national recognized standards 83% of female patients had PAP smears, meeting state and national recognized standards

31 Our Present Location

32 Natalies story Natalie Natalie Eric showed up on our doorstep Eric showed up on our doorstep The rest of the story… The rest of the story…

33 Conclusion: An abridged parable from the New Testament The parable is about a master intrusting his wealth to his servants. He went away for a time and on his return those servants who were faithful in using his wealth were rewarded. Another similar parable end with a message to a faithful servant (Luke 12:48) To the person who much is given, Much is required…

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35 But who is covered by what? 60% employer sponsored insurance 60% employer sponsored insurance –Down from 72% in % individually purchased insurance 9% individually purchased insurance 3.5% Military insurance 3.5% Military insurance 14% Medicare 14% Medicare 12.5% Medicaid 12.5% Medicaid 15.5 % uninsured 15.5 % uninsured

36 Medicaid 67% SSI (Supplemental Security Income) 67% SSI (Supplemental Security Income) –Cash assistance for aged, blind and / or disabled 19% for Non-disabled children 19% for Non-disabled children 333 Billion 333 Billion –57% Federal dollars –43% State dollars


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