Panelists discuss history, challenges of local health care
In a packed auditorium last Friday, the Association of Black Students teamed up with Campus Progress to present a panel on the state of health care in St. Louis.
The city faces severe disparities in health care provision. This is shown most starkly by the decreased availability of health care in ZIP codes populated by people from lower socioeconomic positions.
“We have great health care in this city, great providers, but it’s fragmented,” said panelist Melba Moore, commissioner of health for the City of St. Louis Department of Health. “In fact, one of the comments [from a recent study on St. Louis health care] was that the health outcomes in the northern quarter…were Third World.”
The disparity in health care coverage is especially clear when comparing affluent white neighborhoods to the less wealthy neighborhoods inhabited mostly by minorities.
“Certain ZIP codes that are predominantly white have better health care than the poor ZIP codes of the areas which are predominantly black,” said junior Adam Abadir, ABS political affairs chair.
“We saw that other organizations on campus were dealing with the health care reform aspects of health care but without really dealing with St. Louis’ status,” Abadir said. “We think that it would be good for the student body to know more about these local issues as opposed to just focusing on the reform aspects nationwide.”
ABS approached the issue from a less partisan perspective than previous health care-related events on campus did.
“Health care isn’t a partisan issue necessarily. There are uninsured Democrats, and there are uninsured Republicans,” Abadir said. “We felt that our organization would be best to deal with the nonpartisan aspects of healthcare.”
History: Health care in St. Louis
The correlation between zip code of residence and access to health care was “ordained by those in the power structure,” according to panelist Will Ross, associate dean for diversity and associate professor of medicine in the Renal Division at Washington University School of Medicine.
According to Ross, St. Louis was a relatively wealthy, desegregated city until 1917, when race conflicts escalated. In response, zoning ordinances were established in the 1920s, and were in place until the 1950s.
“Zoning ordinances were acted upon until 1950, essentially segregating the city,” Ross said. “Those who were African Americans were actually zoned into the North Side. Those who were Germans were zoned to the county. Those who were Italians were zoned to an area we now call the Hill. They are as entrenched as ever in the city.”
These zones then had differing access to education, jobs, and health care, according to Ross. Since 1920, the regions have developed at different paces with respect to these issues, resulting in the current disparity.
“This is absolutely not an act of serendipity. This is a predestined act based on that history,” Ross said.
Students found Ross’s discussion of the historical roots to today’s problems to be particularly enlightening.
“I think he really brought in a historical aspect to what’s going on and that’s something that people don’t look at, how it was historically systematically shaped,” junior Maggie Parker said. “When you look at those maps, you can see how it is ingrained in our society. I think that really lets people think about it on a whole different level. That’s what I really enjoyed.”
Addressing the problem
There are a number of ways that students can help improve the state of health care in St. Louis. Ross claims “access, cost and quality” of health care must be addressed in order to reduce the disparities across St. Louis ZIP codes.
Moore believes access is the most crucial factor.
“African Americans within the community don’t access services for lack of access and availability,” she said.
On national health care, Ross argues the current legislation will have little impact on the health care situation because it fails to address adequately “access, cost and quality.”
“What we have won’t reduce costs that dramatically. It will not improve access that much. It will affect quality maybe 10 years down the road. The plan is deeply, deeply flawed,” he said.
Moore believes that public health is not as high a priority for the people or the government as it should be.
“We’re always fighting for every dime we can get. We’re in competition with Parks and Recreation. We’re public health,” Moore said. “We have to choose what we’re able to do in a public health agency because there’s not enough money.”
Moore advises students to contact their legislators to inform them of the need for greater public health funding.
Conversely, panelist Judy Bentley, head of the Community Health-in-Partnership Services (CHIPS), a nonprofit organization that provides health care and social services for the underserved, believes in the power of lower-level change.
“You need to look at health reform as not a top-down, but a bottom-up. I think that’s where change really happens,” Bentley said. “Policy is only good if you can make it work. I think the most effective way to make anything work is if you can get your community involved and you can get individual participation.”
Panelist Gregory Polites, assistant professor of emergency medicine and assistant director of the Emergency Medicine Residency Program, argued that both methods are effective.
“Be politically active. You might not think that your voice matters, but it really does,” Polites said.
Polites advised students looking to make a community-based change to develop ideas that involve a basic program that would have a huge impact. He said good ideas can get financial and political support.
“To take the effort and energy and put it into your own community here in St. Louis, to me, I think, is incredible,” he said.
Is the E.R. an option?
Although most use the emergency room as a last resort, many uninsured individuals use it as a first choice option, according to Polites.
“We can get a workup done that would require about three weeks in some cases or more in outpatient done in a matter of hours,” Polites said. “I can see a rationale for why people would come to the Emergency Room.”
The emergency and trauma facilities are “geared towards an incredibly rapid pace on very serious patients,” according to Polites. The problem, however, is that these facilities also must deal with preventable issues.
“What we do a lot of times in emergency medicine is stamp out fires,” Polites said. “[Emergency issues are] not the problem. Everyone is going to get emergency care. The problem is how to get to people before it turns into an emergency. That’s what we need to address.”
Ross noted that resources are misused when people wait for preventable issues to become severe and then choose to go to the ER.
“When a patient gets to an emergency room, that’s a failure of the system,” Ross said. “That’s an inappropriate use of our country’s resources.”
One possible solution Ross and others propose to this is the development of medical homes, which would provide primary care and prevent issues from becoming too severe.
“This is how we should be delivering care,” Ross said. “If we did this, if we had a country that could provide that level of basic care to everyone at a relatively low cost, then we wouldn’t see this excessive utilization of hospital and emergency care.”
Polites sees great benefits of this to individual patients.
“Patients deserve better than just having a person they can go to temporarily. They deserve a primary doctor who knows them. We need to put more emphasis into that,” Polites said.
What about Medicare and Medicaid?
Medicare and Medicaid, the federal- and state-funded programs that provide care to many low-income individuals, have received a mixture of criticism and praise since their inception. Ross believes that the programs themselves have great potential but are limited by the flaws of the basic healthcare system.
“Medicaid and Medicare are extraordinarily effective programs. They’ve been demonized. They’ve been called socialistic, but they work,” Ross said. “Medicare and Medicaid are functional. The system on which they are based is dysfunctional.”
According to the panel, emphasis in the current healthcare system is on healing critical illnesses rather than providing adequate primary care.
“As a consequence of the perverse system, we’ve utilized so much money that we now can’t pay for Medicaid and Medicare,” Ross said, although he claims these programs are less costly than private insurance systems.
Polites, too, sees the current system as backwards, and advocates a shift in focus to preventative care where possible.
“We have everything backwards. The way that we fund things, it’s totally backwards,” Polites said. “We spend so much money on folks that are acute, who have a life-threatening illness. That’s where the vast majority of resources go into. If we took those same resources and put them into preventative healthcare and do it early, at a young age…you would have the money to fund those.”