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