1 / 36

Over the Rhine Health Disparities & Crossroad Health Center

Over the Rhine Health Disparities & Crossroad Health Center. Chuck Schubert MD Professor of Clinical Pediatrics Cincinnati Children’s Hospital University of Cincinnati. Over the Rhine. German immigrants Beer production until prohibition Old housing stock Movement to the suburbs

zytka
Download Presentation

Over the Rhine Health Disparities & Crossroad Health Center

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Over the RhineHealth 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)

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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

  13. 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

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

  15. 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

  16. 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

  17. Adult Health Disparities • Obesity • Diabetes • Hypertension • Mental Health treatment

  18. 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

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

  20. 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

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

  22. Planning Begins • 1990: Christian Community Health Services Incorporated • 1990-1992 Secured Funds • Greater Cincinnati Foundation • Robert Wood Johnson FoundationLocal Initiative Partners • Churches, Individuals

  23. 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

  24. Crossroad Vision & Mission • Show video

  25. 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.

  26. 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.

  27. 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

  28. Our Present Location

  29. Natalie’s story • Natalie • Eric showed up on our doorstep • The rest of the story…

  30. 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…

  31. 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

  32. 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

More Related