Tuesday, February 9, 2010

Creative Thinking About Community Health


Baylor Hospital is preparing to open its new Diabetes and Wellness Institute in a low-income section of Dallas. It has the potential to be an extremely valuable venture.

While it is diabetes and the issue of wellness in general is a critical issue in poor communities, narrow interpretations of what it means to fight the disease and the general lack of health, could mean limited effectiveness.

John McKnight, in his book, "The Careless Society: Community and its Counterfeits", has some interesting suggestions for how medical institutions can contribute to the overall well being of economically distressed neighborhoods.

"While it is true that the environment has always been a primary determinant of health status, medicine has offered a remedy without environmental change. It is the truth of our times that that offer is now failing. We are forced to seek improved health through improved environment because the medical alternative is steadily diminishing in efficacy. Nonetheless, Rene Dubos observes that "to ward off disease or recover health, men as a rule find it easier to depend on the healers than to attempt the more difficult task of living wisely.""

"A 1984 study determined the number of dollars provided by federal, state and county sources designated for the low income residents of Cook County - the county that incorporates the city of Chicago. The study found that a total of $4,851,113,300 was appropriated by these three governments to specifically benefit low-income people. This amount, divided equally among the Cook County residents with incomes below the official poverty line, would have provided a per capita income of $6200. Thus a family of three including a mother and two children would theoretically be the beneficiary of $18,600 on a capitation basis. This figure was, at the time, near the median income for a family of that size."

"Further analysis of the Cook County data indicated that 35 per cent of the total allocation was provided in direct cash benefits to Cook County's low-income people; 65 percent of the allocation for low-income people was provided in the form of services or vouchers for commodities. The medical care system received 38 percent of all the dollars allocated for the benefit of low-income people."

"Statistically, the data indicate that on a per capita basis, the family that might have received an $18,600 income would find $7,068 given to the medical system."

"As a matter of epidemiological policy, is it healthful to use over one-third of the public income of poor people for healers rather than for wise environments? What would the research of McKeown, Dubos, and Fuchs tell us about this form of public investment? Is it a health-filled policy choice? Does it create wise environments and build healthful communities?"

"Whatever the answer, it is clear that the medical system is a major, prosperous growth industry receiving heavy public investments that are appropriated for low-income people. While this industry consumes a considerable portion of the wealth of poor people, it also has the potential to reinvest that wealth in these same people. It is this reinvestment relationship that has created healthful community-building relationships between local medical systems and low-income citizens. "

"A reinvestment policy recognizes that strengthening the local community economy and income of individuals results, in part, from the economic decisions of the medical system.

1. Purchasing from local producers and suppliers of goods and services.

2. Hiring residents of the local area.

3. Targeting contracts for goods and services to support the creation of new businesses.

4. Investing institutional resources in local financial institutions such as credit unions, co-ops, and community development loan funds."

"As medical resources are reinvest in these ways, the economic status of the local community will be strengthened, with the resulting improvement in health status predicted by community-oriented epidemiologists."

Such comprehensive reinvestments overtime can have collateral dividends that benefit these neighborhoods and this city. Baylor should seriously consider these or some variation of them.

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