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Over the Rhine Health Disparities & Crossroad Health Center

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Presentation on theme: "Over the Rhine Health Disparities & Crossroad Health Center"— Presentation transcript:

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

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

3 Poverty in the USA & Children
Federal Poverty level: $22,000 (family of 4) 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

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

5 Poverty in Hamilton Cty, Ohio
2.1 million people 18% of families (22-27% of population) <FPL 32% under age 18 15% over age 65 National Average of cities >250,000 pop. 13.3%

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




10 Social Security Act of 1935 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 Annual cost of living increase Welfare: not worked so well for kids AFDC now TANF: Temporary Assistance to Needy Families Limitations including welfare to work EITC: earned income tax credit Minimize or eliminate federal income tax for those living in below FPL 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 49% of recipients are children School lunch & Breakfast WIC (Women’s Infants & Children) Discretionary: only enough funds to serve 55% of eligible Private Sector: Food Banks, soup kitchens

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

13 Why doctors don’t see the poor
Low reimbursement Medically and socially complex patients Negative perceptions non-compliant, ungrateful, risk of law suit Difficult to refer

14 Why is Access Important?
Essential to prevent disease & promote health 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 Unfulfilled potential (Pb poisoning) Health care becomes a privilege for the wealthy Cost of health care as a nation will be an issue

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

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

17 Health disparities & How poverty affects child health?
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 Lead poisoning: tripled Delayed immunizations: tripled Death due to disease: 3 – 4 times Death due to accidents: 2 – 3 times Severe iron deficiency: doubled

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

20 Adult Health Disparities
Obesity Diabetes Hypertension Mental Health treatment

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

22 Residency September 1983: Relocated to OTR Built relationships
Worshiped there Shopped there Kids went to school there Built relationships Plugged into projects Identified with the community Really Relocating: -Where we live -Where we worship -Where we shop -Where our kids go to school Much of this is “intentional” and doesn’t just happen Fears / Challenges Negatives Family would not visit Friends wanted us to come to their suburban homes Security / theft Great and inspiring worship? Positives Cross cultural and cross socio-economic relationships Our view of God’s Kingdom much more inclusive and much more diverse … Arthur Our boys… A solidarity with the poor

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

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

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

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

27 Crossroad Vision & Mission
Show video Crossroad Mission and Vision Providing health care to the whole person---physically, mentally and spiritually Living this out…. Programming this is more challenging Praying with patients, seeing them in church and in the community Working with them through crisis

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

29 Crossroad Stats National Diabetes Collaborative
Mental health counseling 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.
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

31 Our Present Location

32 Natalie’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

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…


35 But who is covered by what?
60% employer sponsored insurance Down from 72% in 1979 9% individually purchased insurance 3.5% Military insurance 14% Medicare 12.5% Medicaid 15.5 % uninsured This is the at risk group and poverty plays a large role

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

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