Presentation on theme: "Over the Rhine Health Disparities & Crossroad Health Center"— Presentation transcript:
1Over the Rhine Health Disparities & Crossroad Health Center Chuck Schubert MDProfessor of Clinical PediatricsCincinnati Children’s HospitalUniversity of Cincinnati
2Over the Rhine German immigrants Beer production until prohibition Old housing stockMovement to the suburbsAbsentee landlordsPopulation shiftsWhere did all the families go?
3Poverty in the USA & Children Federal Poverty level: $22,000 (family of 4)200% FPL: Minimum to ensure clothing, housing & food40% of children in families < 200% (children only 25% of population)6% of children < 50%400% of FPL = middle income
4FPL= Federal Poverty Level FPL based on “Thrifty Food Plan”Assumes:1/3 spent on Food1/3 spent on Housing1/3 spent on basic necessitiesNot updated (especially on cost of housing)
5Poverty in Hamilton Cty, Ohio 2.1 million people18% of families (22-27% of population) <FPL32% under age 1815% over age 65National Average of cities >250,000 pop.13.3%
6Poverty & Cincinnati 36% of children live below the poverty line 3rd in the nation82% live with a single momOne of the fastest-growing rates of suburban poverty in the nation (Brookings Institution)
10Social Security Act of 1935Economic assistance to the unemployed, the aged & low income widows & childrenSocial Security: Works: < 10% of elderly live in povertyOld age survivor & disability insuranceAnnual cost of living increaseWelfare: not worked so well for kidsAFDC now TANF: Temporary Assistance to Needy FamiliesLimitations including welfare to workEITC: earned income tax creditMinimize or eliminate federal income tax for those living in below FPLLifts more children out of poverty than any other programMinimum wage: increased still less than 1960/80 real dollars
11Food Insecurity / Safety Net Food stamps49% of recipients are childrenSchool lunch & BreakfastWIC (Women’s Infants & Children)Discretionary: only enough funds to serve 55% of eligiblePrivate Sector:Food Banks, soup kitchens
12What Controls Access to Health Care Financial access (i.e.. insurance)Geographic distribution of physiciansWillingness to see the poorAvailability: transportation, office hours, etc.
13Why doctors don’t see the poor Low reimbursementMedically and socially complex patientsNegative perceptionsnon-compliant, ungrateful, risk of law suitDifficult to refer
14Why is Access Important? Essential to prevent disease & promote healthIf access is limited or denied for any reason there will be repercussionsas opposed to being a sudden tragedy, the problems will be insidiousPersonal tragediesUnfulfilled potential (Pb poisoning)Health care becomes a privilege for the wealthyCost of health care as a nation will be an issue
15Health disparities & How poverty affects child health? Risk of decreased brain developmentPoor living conditionsInadequate housingEmotional stress of unstable environmentLack of nurturingWhy? Life priorities? Justice issues?Minimum wage, housing, nutrition, education
16Health disparities & How poverty affects child health? Decreased access to health carePB poisoning & anemiaDevelopmental delaysDecreased exposure to readingSpeech & school readinessAsthmaStory of 6 yr oldADHDFewer options
18How does poverty affect child health? Low birth weight: doubledLead poisoning: tripledDelayed immunizations: tripledDeath due to disease: 3 – 4 timesDeath due to accidents: 2 – 3 timesSevere iron deficiency: doubled
19What is Required for Child Health By health care providersAccessComprehensive & preventive careSupportive to parentsOf parentsAbility to pay for servicesStabilityOf the communityFreedom from conditions which increase riskPb, violence, vaccine preventable diseases, air & water quality,Dealing with poverty
20Adult Health Disparities ObesityDiabetesHypertensionMental Health treatment
21My Journey Medical career melded with my faith 17 years in Cincinnati’s inner cityFounded Crossroad HealthTreat all with dignity and respectMore importantly lived in the same neighborhood as my patientsTime in ZambiaValue to my family
22Residency September 1983: Relocated to OTR Built relationships Worshiped thereShopped thereKids went to school thereBuilt relationshipsPlugged into projectsIdentified with the communityReally Relocating:-Where we live-Where we worship-Where we shop-Where our kids go to schoolMuch of this is “intentional” and doesn’t just happenFears / ChallengesNegativesFamily would not visitFriends wanted us to come to their suburban homesSecurity / theftGreat and inspiring worship?PositivesCross cultural and cross socio-economic relationshipsOur view of God’s Kingdom much more inclusive and much more diverse … ArthurOur boys…A solidarity with the poor
23A real job 1988 Work in clinics in low income areas Getting serious about health ministryPerformed community assessmentExplored other models of health careExplored funding optionsLooked for community partnersAll built on years of relationship building
24Health Clinics FQHC: Federally Qualified Health Centers Free Clinics 330 fundsCost based reimbursementBut costs are never coveredFree ClinicsFaith-based health centers (CCHF)Chicago, Memphis, Washington D.C., Cincinnati
25Planning Begins 1990: Christian Community Health Services Incorporated Secured FundsGreater Cincinnati FoundationRobert Wood Johnson Foundation Local Initiative PartnersChurches, Individuals
26Early Years 1992Opened Part-time, evening hours, 24-hour on-call coverageStaffingPart-time staff physician, nurse, social workerVolunteer physiciansFull-time office administrator200 visits in 6 months
27Crossroad Vision & Mission Show videoCrossroad Mission and VisionProviding health care to the whole person---physically, mentally and spirituallyLiving this out…. Programming this is more challengingPraying with patients, seeing them in church and in the communityWorking with them through crisis
28Crossroad Stats Provided almost 20,000 visits 64% of patients are African American15% are Hispanic/Latino15% are Caucasian83% of patients have incomes < FPL39% of patients are uninsured76% of uninsured patients are adults.
29Crossroad Stats National Diabetes Collaborative Mental health counselingPatients w/ hypertensionsignificantly better control of BP compared to the national average: 60% are under control compared to 25% nationally.
30Crossroad Stats 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.83% of female patients had PAP smears, meeting state and national recognized standards
32Natalie’s story Natalie Eric showed up on our doorstep The rest of the story…A friend from our little inner city church showed up on our doorstep late one evening. I can still see them standing there on our steps as I opened the front door. Natalie with her worried look and this little bundle in her arms. It was Eric, who was only 3 months old but thin and wasted in appearance. This was a sight I rarely saw in America, Eric was essentially starving, because his mother (addicted on drugs) could not care for him. With some care at Children’s hospital, he recovered quickly and was eventually adopted by Natalie. He has been my patient for 15 years
33Conclusion: 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…
35But who is covered by what? 60% employer sponsored insuranceDown from 72% in 19799% individually purchased insurance3.5% Military insurance14% Medicare12.5% Medicaid15.5 % uninsuredThis is the at risk group and poverty plays a large role
36Medicaid 67% SSI (Supplemental Security Income) Cash assistance for aged, blind and / or disabled19% for Non-disabled children333 Billion57% Federal dollars43% State dollars