HEALTH EQUITY
Achieving Health Equity Takes Work
by MIRANDA COOLE , MD & MELISSA MATHER , MPH
When Dr . Julia Richerson , a pediatrician at the Family Health Centers Iroquois , learned that her infant patient needed surgery at a specialty unit in Cincinnati , she immediately called into action the case worker and patient navigator at her site . “ The mother , Sarah ,* didn ’ t speak English very well , had mobility issues , didn ’ t have reliable transportation and had other small children . Now she needed to find a way to get to Cincinnati and back multiple times or her baby would be physically compromised for life ,” Dr . Richerson said of the situation . “ It can feel insurmountable .”
While Family Health Center staff were able to step in to help find transportation arrangements for the family and Sarah ’ s infant was able to receive the procedure needed , the family ’ s problems didn ’ t stop there . “ The more we met with the family , the more layers we peeled back . We learned that the utilities were often turned off , they were behind on their rent and were losing their housing . The deeper you get into it , the more complicated it gets ,” said Director of Behavioral Health , Samantha Davis , LCSW . “ We have staff who can help patients , but we also have to triage them , to focus on those who are facing situations that put them most at risk . The problems are never as simple as they appear .”
As a family physician and Chief Medical Officer for the Family
Health Centers , I ’ ve spent my career working in federally qualified health centers ( FQHC ) and community-based settings . The complexity of our patients ’ lives is not new to me , but in the conversation around health equity , it is still confounding . Family Health Centers , Inc . is Louisville ’ s largest FQHC , with nine locations and serving approximately 40,000 patients annually . The majority of our patients have trouble accessing the traditional health care system because they live in poverty ( 89 %), are uninsured ( 24 %), are homeless ( 11 %) or face other barriers to care such as limited English proficiency ( 40 %). Family Health Centers builds bridges to care through our sliding-fee discounts and enabling services that help families receive the essential health care they need and deserve . Is that enough to move the dial on health equity issues ? Sadly , not always .
Community Health Centers like Family Health Centers were first created in the 1960s as part of the social-justice , anti-poverty movements of that time . The idea behind them was to remove financial and geographic barriers to care for impoverished communities . When Family Health Centers first began in 1976 , the biggest health system barrier was the cost of care if you didn ’ t have insurance . While being uninsured remains a significant barrier for a quarter of our patients , other pressing issues like unstable housing , food insecurity , unreliable transportation and ongoing addiction are everyday occurrences for our patients , which our staff must help them to navigate . Our sliding-fee scale was once the safety net that people needed . Now , before we can address health issues , we often have to try and figure out the other , more pressing social impediments . Our approach is to meet patients where they are : literally and figuratively .
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