The Health Center Movement From Its Roots Featured in the American Journal of Public Health

H. Jack Geiger, MD, and John Hatch during the construction of the Tufts-Delta Health Center

H. Jack Geiger, MD, and John Hatch during the construction of the Tufts-Delta Health Center

If you haven’t done so yet, take a moment for yourself and read the special article penned by H. Jack Geiger, MD in the American Journal of Public Health, “The First Community Health Center in Mississippi: Community Health Centers Empowering Themselves.”  One of the founders of the Community Health Center Movement, Dr. Geiger walks us back to rural Mississippi in 1965, when a Community Health Center was envisioned and proposed as a way to “intervene in the cycle of extreme poverty, ill health, unemployment and illiteracy.” To help readers fully appreciate the noble and enormous task of such a proposition, Geiger vividly describes the living conditions of residents living in Bolivar County, Mississippi during that time:

“Black people in poverty, particularly the isolated, rural Black ex-sharecroppers and ex-plantation workers who constituted the vast and silent majority of the Black community, lived an unceasing and often losing, struggle against disaster.  They were hungry; there was no food. They were unemployed; their skills had been made obsolete by the mechanical cotton picker, the herbicide-spraying crop duster, and the ironies of the cotton and other national crop-subsidy acreage restriction policies.  The median family income was $900.  They lived in crumbling, patchwork shacks with leaky roofs, rotting floors, buckling walls, gaping windows, newspapers for insulation, and crude stoves for heating and cooking– when there was firewood. Many drank contaminated water from drainage ditches and used dilapidated surface privies for sanitation  Infants under such circumstances often ingested their own excrement; children lacked the shoes to walk to school, the clothes to wear to school, or given these, the food to sustain learning…”

Dr. Geiger recounts how until the 1960s Americans had not looked to community health services as a means to address population health problems and implement social change in access to food, housing, clothing, water, sanitation, education and economic opportunity. Everyone understood that intervention was needed to fight poverty, but starting a program, and a host of community-based organizations that would address these social ills over the long term was daunting. Yet, it was done.

Community organization at the then-called Tufts-Delta Health Center began in 1966, followed by training that took place in an abandoned movie theater. Clinical health services were launched a year later in a church parsonage. Not long after, 10 local community health associations linked with the health center began to flourish, run by the people, for the people.  Soon there was  modern health center facility employing more than 200 people from the surrounding area. The North Bolivar Farm Cooperative (related to the health center but independent of it, Geiger explains), produced vegetables to be distributed to worker members. Dr. Geiger explains:

“These institutions served the community, and they were staffed by the community: every Black household in the poverty population in all of northern Bolivar County had at least one (and often more than one) adult member actively participating in decision-making, program-planning and program operation through a local health association… Together with Medicare, Medicaid, food stamps and other programs, the health center’s work improved the health status of its roughly 12,000 Black residents of North Bolivar County. Incidences of fetal losses, infant mortality rates, infectious disease and chronic illnesses such as heart disease, hypertension and diabetes all went down.”

It’s hard to imagine what health care would look like today were it not for the daring experiment undertaken by Dr. Geiger and fellow community organizer John Hatch, and many other dedicated foot soldiers.  Today, the health center movement is made up of more than 1,300 health centers, serving 25 million Americans, a phenomenal trajectory.  Yet, don’t be fooled into thinking this is an outsized health care program that has moved away from community   The heartbeat of such growth has come about because it is in fact driven by community, or as Geiger himself notes, “There is no other part of the American health care system in which patients themselves have such a powerful voice.”

 

D.C. Outreach and Enrollment Event Puts the Focus on Covering Kids

Dr. Lekeisha Terrell, Medical Director of Unity’s School-Based Health Centers, Secretary Sylvia Burwell, and Vincent A. Keane, President and CEO of Unity Health Care

Dr. Lekeisha Terrell, Medical Director of Unity’s School-Based Health Centers, Secretary Sylvia Burwell, and Vincent A. Keane, President and CEO of Unity Health Care

District of Columbia Community Health Center Unity Health Care recently received a visit from the U.S. Department of Health and Human Services Secretary Sylvia Burwell and Education Secretary John B. King, Jr.  The two visited Unity’s school based health center on the historic Cardozo Education Campus, which is a combined middle and high school in the Columbia Heights neighborhood, a diverse enclave of the nation’s capital.   The visit and roundtable discussion, featuring participants from the Children’s Defense Fund and the AASA, Schools Superintendents Association, was part of an effort to encourage schools and districts to enroll students in health care coverage through school registration.

“As a nation, there is more we can do to help children access the care they need to stay healthy and to be ready to learn. Enrolling or linking students to coverage through school registration processes is just one of many ways that education and health stakeholders and agencies can partner to ensure all students are healthy and ready to learn,” said Sec. John B. King in a press release.

Children who have health coverage are more likely to graduate from both high school and college than those who are uninsured, according to the Department of Education.  Despite progress in efforts to expand coverage for children, about one in 17 under the age of 18 remain uninsured. There are also about 2.8 million uninsured children who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

“Children do better in the classroom when they are healthy and ready for learning. As we gear up for Open Enrollment’s start on Nov. 1, we want to make sure more kids have access to quality care that will keep them healthy, active, and prepared to learn through the year,” said Secretary Burwell.

Unity is just one of many health centers across the nation that work hard to connect people with the information and services they need to get covered. Because of fluctuations in income and employment that impact health coverage—known as churn—health centers are proactive about keeping adults and children covered throughout the year, not just during open enrollment. In fact, health centers have been integral to national enrollment effort and have assisted over 15 million people with enrollment since July 2013.

If you’re a health center looking for tools to help you get children covered check out the two resources below.

Back-To-School Toolkit 

Insure All Children

 

One Health Center Doctor’s Perspective from Boston

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Today’s guest blog post is by Yhu-Hsiung (“Henry”) Lee, MD.  Dr. Lee  recently retired as an emergency medicine physician at East Boston Neighborhood Health Center, where he served patients for over four decades. He was also on the staff at Boston Medical Center, Massachusetts General Hospital, and South Shore Hospital, and on the faculty of Harvard Medical School.

I never set out to become an emergency medicine physician, let alone to see patients in East Boston’s first emergency room.  Nor did I set out to settle in for nearly a half century, serving the diverse medical needs of the people living in a vibrant neighborhood where, not long ago, health care was difficult to access.  My path to East Boston started in  in Taiwan, where I was born, raised and educated.  I came to the United States to gain access to broader educational and professional opportunities as a physician. While trained as an Ear, Nose and Throat specialist, I found my options to enter an ENT residency limited, with few positions for foreign-born doctors.

After pediatrics training, I began an infectious disease fellowship at Boston City Hospital – today’s Boston Medical Center. During my fellowship, I met Dr. James Taylor, who was also in the program and had undertaken a study of hypertension in East Boston.  When Jim Taylor got to East Boston in the early 1970s, the need for a full-service health center was manifest. At the time, East Boston was a largely working-class Italian neighborhood, geographically isolated from the rest of the city and medically underserved.  Lacking a hospital, and separated from vital treatment by lengthy rides on public transit, this five square miles of the city was a veritable medical desert.  When East Boston Neighborhood Health Center (EBNHC) began, its two exam rooms had diagnostic tools that seem primitive compared to what exists today: a small lab, simple X-ray machine and an EKG.

Today, EBNHC has come a long way.  It is equipped with nearly all of the diagnostic equipment found in a hospital.  There are 15 exam rooms, surgical rooms, a slit lamp for eye exams, ultrasound, a negative pressure isolation room to treat patients with infectious diseases, a full-service, on-site lab with rapid diagnosis capability, and mental health services.   The health center’s emergency department is open 24 hours a day, 7 days a week.   It is the only health center in New England, and one of the few in the country, to provide around-the-clock care.  The change in East Boston, its health center, and the field of medicine over the course of my career have been dramatic. The one constant has been my love for the profession.  Medicine has been richly rewarding to me.  It has allowed me to give back to a community in need, to improve the public health, while providing me with a meaningful and deep connection to my adopted homeland.

 

 

 

The NACHC CHI Is Underway in Chicago

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Acting Assistant HHS Secretary for Health, Karen DeSalvo addresses the NACHC CHI.

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Former Surgeon General Regina Benjamin and Grace Wang, MD, Vice Speaker, NACHC Executive Board

The NACHC Community Health Institute and Expo in Chicago has officially opened and it’s the usual swirl of events and inspiring speakers.   During the General Session NACHC Board Chair J. Ricardo Guzman underscored the accomplishments of health centers in responding to emerging public health issues, saying, “Whether it is Zika, opioids, floods, fires or contaminated water systems, these are community health problems that demand a long-term integrated community response.  And, as frontline responders, we have a vital role in meeting these crises.”  Guzman also described the work of health centers in reaching beyond the walls of the exam room to address the social determinants of health, and expressed hope that health centers should be viewed as an asset to be “preserved and expanded.”   Indeed, there is now a call underway for health centers to serve 50 million people by the year 2026, and the key question being asked at the gathering is: do health centers have the workforce, the technology, and the resources to be ready and tackle population health?

Karen DeSalvo, Acting Assistant Secretary for the Department of Health and Human Services, focused on the topic of population health in her remarks, noting the work that health centers are already doing in building healthy communities and addressing the social determinants of health (these two tasks go hand in hand in the health center world).  Asserting that “health is more than health care,”  DeSalvo also described research in health outcomes that has found that “Social determinants like your zip code determine your health far more than your DNA.  The richest Americans outlive the poorest by 10 to 15 years. For the poorest Americans this gap in life expectancy can be wider or narrower depending on where they live.”  DeSalvo went on to talk about the importance of achieving “health equity” in our system and that health centers continue to partner with local and public health entities to optimize health for all.

Former Surgeon General Regina Benjamin,  who practiced medicine at a health center, also reminded us about what patients need beyond clinical care. “I learned my patients had problems that my prescription pad wasn’t enough to solve, problems such as housing, or nutrition.”  Dr. Benjamin also shared a story about a patient who sought her help for severe back pain due to a slipped disc.  Dr. Benjamin prescribed pain medicine but when the patient returned to her office — in such pain that she was unable to sit — she learned the patient had not picked up the medicine because she could not afford the co-pay.  She was waiting until she received her paycheck in a few days.  Dr. Benjamin sent a nurse to pick up the prescription and when she handed the medicine to the patient her eyes welled up with tears of embarrassment.  “I realized then that I had taken away her dignity.”  Benjamin added that this was an important lesson.

“Cultural compentancy has nothing to do with the color of your skin, it has to do with allowing a patient to maintain their dignity,” she told the audience.

Aside from the General Sessions, there have also been a host of cutting edge education sessions that deal directly with the frontline work health centers are doing now  — addressing the Zika virus, opioid addiction, and caring for victims of human trafficking.  These sessions demonstrate that even though the world around us seems more complicated and perilous than ever, there is a vigilant safety net ready to respond.

The future remains a centerpiece topic for this conference, yet there was also a nod to the past.  NACHC Board Chair-Elect Jim Luisi reflected on the recent loss of health center leaders Wilford Payne, Elizabeth Swain, and Merle Cunningham, all of whom helped blaze new trails in the early days of the Community Health Center Movement.

Stay tuned while we keep you posted on developments at the NACHC CHI.

 

We’re Getting Ready for the CHI in Chicago!

August-28-30Chicago-ILWe’re getting ready for the NACHC Community Health Institute (CHI) and EXPO which kicks off in Chicago from August 28th to the 30th. The conference draws thousands of health center clinicians, board members, executives from across the country to gather under one roof [read media advisory]. Speakers from the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and the U.S. Department of Veterans Affairs are scheduled to speak. There are nearly 140 exhibiters at the EXPO exhibition, not to mention the NACHC games in the exhibit hall. But the real meat and potatoes of the conference will be addressing the issues that health centers are confronting in their daily work.  As a recent article about the CHI in Modern Healthcare Magazine noted, attracting and utilizing the primary care workforce will be a central theme.  Speakers such as Dr. Karen DeSalvo, the Acting Assistant Secretary of Health for the Department of Health and Human Services will discuss how innovative care models such as patient-centered medical homes will drive which types of healthcare professionals are most needed to serve the clinics’ low-income patients.

In addition to exciting speakers during the CHI, there will also be a host of education sessions, including ones that focus on emerging public health issues that have made headlines, such as the Zika virus and the nationwide epidemic on opioid addiction. Health centers are among the responders to these crises, which makes these cutting edge sessions all the more vital. The recent work health centers are doing in addressing addiction is an issue NACHC President and CEO Tom Van Coverden wrote about in this op-ed, also published in Modern Healthcare. There is also a session focused on the prevention, screening, care and prevention of the Zika virus. We will be live streaming that session on Facebook starting at 8:30 am on Tuesday, August 20th.

Stay tuned to this blog for more developments and features as we report from the NACHC CHI. Follow @NACHC and #2016CHI.