November 19, 2007

Access To Good Food, Drugs, And Medical Care

Recently, I gave a speech at the American Health Insurance Plans (AHIP) business conference in Chicago on the prerequisites for a workable solution to our health care cost crisis.

One of the main points I made is that convenient and affordable access to healthy foods, prescription and over-the-counter medications, and primary care physicians and nurses for preventive screenings, immunizations, and treatment of minor illnesses and injuries was a more important issue to attack than simply expanding coverage. The more I learn, the more convinced I am that I am right.

This morning, I was listening to an interview on WFAN-New York radio, and the interviewee, a founder of an organization trying to address the issue of hunger in America, referred to “food deserts,” a term I had not heard before. He defined the term as a geographic area in which many people live, but they do not have convenient access to a supermarket or any other food store that carries healthy foods. He said that the entire city of Detroit and major chunks of New York City have no supermarkets. As a result, residents of these communities eat fast food or they go to bodegas or convenience stores that stock inexpensive junk food and nothing else.

After researching this topic more, I discovered a collection of comprehensive studies on food deserts published byMari Gallagher Research & Consulting Group. I also found some relevant blog postings. An entry in the Daily Kos blog details one blogger’s personal experience with a food desert. In addition, the U.S. Food Policy blog presents a few arguments on why this phenomenon occurs.

Similarly, when I have spoken with my Corporate Medical Director about finding a walk-in clinic for many of our employees that live in New York outside Manhattan, he told me that the supermarkets and pharmacies that might house such a clinic do not exist in these communities. I was in a CVS in Greenwich, Connecticut, which has a Minute Clinic adjacent to the CVS pharmacy. It’s open seven days a week, and the pharmacy is open 24 hours a day. However, such a facility would not exist in a poorer community because the economics would not support it.

Community health centers are supposed to fill this particular gap, but they are of uneven quality, they are often under-funded, and they do not offer a consistent broad base of primary medical services. They end up being referral services for behavioral health and other serious issues, a vital service for a community, but not one that helps address the community’s need for basic medical services.

States consistently try to mandate better health coverage to regulate insurance companies and pharmaceutical companies more tightly, to squeeze doctors and hospitals to reduce what the states have to pay for Medicaid, SCHIP, and other state-run medical programs. They would help the state of health and health care if they redeployed their resources to address the following issues:

  • Working with major supermarkets and pharmacies to put convenient, affordable stores in areas under-served by them now. Years ago, I visited the Central Ward of Newark, New Jersey, to see what Monsignor William Linder and New Communities Corporation had done with Pathmark. New Communities had put a first-class supermarket and pharmacy in the middle of a very poor section of Newark. He had high-quality, healthy, affordable food offerings tailored to the needs of an ethnically and racially diverse neighborhood. People would take the bus or walk to the store, but to make shopping convenient, particularly for the elderly, he created a delivery service long before Webvan and Peapod got into business. He also had a pharmacy next door to the supermarket with affordable offerings for residents. Every state could work on this kind of program.
  • Working with medical providers to put walk-in clinics in convenient locations, or, at a minimum, to offer convenient, affordable access to screenings and immunizations. Perhaps the community health centers could be the access point for this care, but each community has a different focal point for its residents. For example, African-American communities are best served by making the church the center point for health-service delivery. States are closer to their citizens than is the federal government, so it makes sense for them to identify the best delivery point in their poorest areas.
  • Working with universities and community colleges to create more programs to train and certify nurse practitioners and nurses, and working with state medical societies to broaden the range of services that can be delivered by health care professionals other than physicians. There is a severe shortage of health care professionals, particularly nurses and nurse-practitioners. This is a problem that can be addressed at the state level. Colleges and universities, particularly community colleges, can help solve this problem. Nurse residency programs between hospitals and local universities are a good solution, as documented in this blog post that outlines the partnership between Wisconsin hospitals and Milwaukee-based Marquette University.
  • Working with pharmaceutical companies and health care technology providers to enable more self-management of health. To the degree that individuals can monitor their own health, take care of their own disease management tasks, and self-administer a wider range of medications and treatments, there is more ownership of health issues at the patient level, and less strain on an overworked health care system. States can be a catalyst to improve this situation. Pharmaceutical companies have programs for low-income individuals to get free or very low-cost access to drugs, but many eligible individuals do not take advantage of them. States should help take the lead in getting the word out to their citizens to make sure these programs are accessed. This topic is further examined and critiqued in the World Health Care Blog.

These opportunities are real and significant, and states can pursue many of these without spending significant public dollars.