November 26, 2007

The Five Health Deserts

In my last posting, I referred to parts of America that have been described as “food deserts,” meaning that residents living in those areas do not have access to supermarkets or other food stores or restaurants from which they can purchase affordable healthy food. One of my Pitney Bowes colleagues referred me to a satirical YouTube posting called The Bronx Bodega, which powerfully illustrates what I have noted in a few postings: in many poorer communities with less healthy people, not only is healthy food unavailable at affordable prices, if it is available at all, but the unhealthy food is exceptionally inexpensive and attractively packaged.

But I have learned that the absence of healthy food is just one form of deprivation for low-income communities. They lack four other prerequisites for healthy living:

  • Safe outdoor play areas, like parks, to get exercise;
  • Primary care clinics for treatment of minor illnesses and injuries, preventive screenings, and immunizations, as well as referral to medical specialists;
  • Pharmacies; and
  • Information sources.

In effect, the “desert” label could be applied to all five of these areas. We incur more than $4 million in emergency room care in NY, although our employees have excellent coverage. We believe that the NY City health care system, while of high quality, is lacking in after-hours coverage for treatment of minor illnesses and injuries

Community health centers were funded back in the 1960’s to fill the gap in primary care. However, they have not been a strong solution. There are too few primary care physicians, and there is also a shortage of nurse practitioners and nurses. Dr. Richard Reese details some reasons for the physician shortage in his MedInnovation blog.

Too many of the centers have moved more into crisis counseling and counseling to assist people with behavioral health problems, all desperately needed services, but not ones that will help individuals who need basic physiologically directed health care. They are also unevenly funded, and, in many instances, are not open at the hours when people need the care.

An August 2007 report entitled “Access Granted” published by the National Association of Community Health Centers, reviews the impact community health centers can have on individual communities and the economy.

When individuals with health coverage live in these deserts, as is the case with many of our front-line employees, their primary caregiver tends to be the hospital emergency room. There are three fundamental problems with the emergency room care:

  • It is a ridiculously inefficient and costly way to deliver primary care for minor illnesses and injuries;
  • Emergency rooms are not set up for high-volume screenings and immunizations, so people whose care is rendered in emergency rooms tend not to get screenings and immunizations; and
  • Because of the unpleasantness and long waiting times for emergency room care, people tend to hold off going there until they are seriously ill, which means that we miss an opportunity to get them treated earlier in the progression of a disease, an illness, or an injury, which means that the treatment is far more expensive and complicated than it needed to have been.

Not surprisingly, emergency room care is also not designed for the critical follow-up care needed for chronic disease patients.

Amy Ridenour’s National Center blog explains how a federal law adopted in 1986 further hinders emergency room care, particularly for the uninsured.

This “desert” is the most fundamental health care issue we have. I believe it is at the root cause of why coverage costs keep skyrocketing, why businesses discontinue providing coverage for their employees, and, therefore, why the uninsured population keeps growing. If we do not solve this problem, trying to extend coverage to more people will either be ineffective in containing costs, or it will contribute to more costs and make the health care system even more dysfunctional than it is today.

State and local governments can do something about this:

  • They can be the catalysts for getting supermarkets, pharmacies, parks, and primary care facilities into these desert areas.
  • They can fund more training and development for nurses and nurse-practitioners. They can also increase the population of primary care physicians, but that problem will take much longer to solve.
  • They can help community health centers and other institutions provide basic screenings and immunizations at low costs, and can be a major factor in community outreach to get as many people in for screenings and immunizations as possible.

As I have said before, the current political debate on health care is misdirected. We have to attack the health and the access issues along with the coverage issue.