Over the Rhine Health Disparities & Crossroad Health Center

1. Over the RhineHealth Disparities & Crossroad Health Center Chuck Schubert MD Professor of Clinical Pediatrics Cincinnati Children’s Hospital University of Cincinnati

2. Over the Rhine • German immigrants • Beer production until prohibition • Old housing stock • Movement to the suburbs • Absentee landlords • Population shifts • Where did all the families go?

3. Poverty in the USA & Children • Federal Poverty level: $22,000 (family of 4) • 200% FPL: Minimum to ensure clothing, housing & food • 40% of children in families < 200%(children only 25% of population) • 6% of children < 50% • 400% of FPL = middle income

4. FPL= Federal Poverty Level • FPL based on “Thrifty Food Plan” • Assumes: • 1/3 spent on Food • 1/3 spent on Housing • 1/3 spent on basic necessities • Not updated (especially on cost of housing)

5. Poverty in Hamilton Cty, Ohio • 2.1 million people • 18% of families (22-27% of population) <FPL • 32% under age 18 • 15% over age 65 • National Average of cities >250,000 pop. • 13.3%

6. Poverty & Cincinnati • 36% of children live below the poverty line • 3rd in the nation • 82% live with a single mom • One of the fastest-growing rates of suburban poverty in the nation(Brookings Institution)

10. Social Security Act of 1935 • Economic assistance to the unemployed, the aged & low income widows & children • Social Security:Works: < 10% of elderly live in poverty • Old age survivor & disability insurance • Annual cost of living increase • Welfare:not worked so well for kids • AFDC now TANF: Temporary Assistance to Needy Families • Limitations including welfare to work • EITC: earned income tax credit • Minimize or eliminate federal income tax for those living in below FPL • Lifts more children out of poverty than any other program • Minimum wage: increased still less than 1960/80 real dollars

11. Food Insecurity / Safety Net • Food stamps • 49% of recipients are children • School lunch & Breakfast • WIC(Women’s Infants & Children) • Discretionary: only enough funds to serve 55% of eligible • Private Sector: • Food Banks, soup kitchens

12. What Controls Access to Health Care • Financial access (i.e.. insurance) • Geographic distribution of physicians • Willingness to see the poor • Availability: transportation, office hours, etc.

13. Why doctors don’t see the poor • Low reimbursement • Medically and socially complex patients • Negative perceptions • non-compliant, ungrateful, risk of law suit • Difficult to refer

14. Why is Access Important? • Essential to prevent disease & promote health • If access is limited or denied for any reason there will be repercussions • as opposed to being a sudden tragedy, the problems will be insidious • Personal tragedies • Unfulfilled potential (Pb poisoning) • Health care becomes a privilege for the wealthy • Cost of health care as a nation will be an issue

15. Health disparities & How poverty affects child health? • Risk of decreased brain development • Poor living conditions • Inadequate housing • Emotional stress of unstable environment • Lack of nurturing • Why? Life priorities? Justice issues? • Minimum wage, housing, nutrition, education

16. Health disparities & How poverty affects child health? • Decreased access to health care • PB poisoning & anemia • Developmental delays • Decreased exposure to reading • Speech & school readiness • Asthma • Story of 6 yr old • ADHD • Fewer options

17. Health disparities & How poverty affects child health? • Safety issues • Prescription drugs ingestions • CO poisoning (space heaters) • Falls (from windows) • Violence exposure

18. How does poverty affect child health? • Low birth weight: doubled • Lead poisoning: tripled • Delayed immunizations: tripled • Death due to disease: 3 – 4 times • Death due to accidents: 2 – 3 times • Severe iron deficiency: doubled

19. What is Required for Child Health • By health care providers • Access • Comprehensive & preventive care • Supportive to parents • Of parents • Ability to pay for services • Stability • Of the community • Freedom from conditions which increase risk • Pb, violence, vaccine preventable diseases, air & water quality, • Dealing with poverty

20. Adult Health Disparities • Obesity • Diabetes • Hypertension • Mental Health treatment

21. My Journey • Medical career melded with my faith • 17 years in Cincinnati’s inner city • Founded Crossroad Health • Treat all with dignity and respect • More importantly lived in the same neighborhood as my patients • Time in Zambia • Value to my family

22. Residency • September 1983: Relocated to OTR • Worshiped there • Shopped there • Kids went to school there • Built relationships • Plugged into projects • Identified with the community

23. A real job 1988 • Work in clinics in low income areas • Getting serious about health ministry • Performed community assessment • Explored other models of health care • Explored funding options • Looked for community partners • All built on years of relationship building

24. Health Clinics • FQHC: Federally Qualified Health Centers • 330 funds • Cost based reimbursement • But costs are never covered • Free Clinics • Faith-based health centers (CCHF) • Chicago, Memphis, Washington D.C., Cincinnati

25. Planning Begins • 1990: Christian Community Health Services Incorporated • 1990-1992 Secured Funds • Greater Cincinnati Foundation • Robert Wood Johnson FoundationLocal Initiative Partners • Churches, Individuals

26. Early Years 1992 • Opened Part-time, evening hours, 24-hour on-call coverage • Staffing • Part-time staff physician, nurse, social worker • Volunteer physicians • Full-time office administrator • 200 visits in 6 months

27. Crossroad Vision & Mission • Show video

28. Crossroad Stats • Provided almost 20,000 visits • 64% of patients are African American • 15% are Hispanic/Latino • 15% are Caucasian • 83% of patients have incomes < FPL • 39% of patients are uninsured • 76% of uninsured patients are adults.

29. Crossroad Stats • National Diabetes Collaborative • Mental health counseling • Patients w/ hypertension • significantly better control of BP compared to the national average: 60% are under control compared to 25% nationally.

30. Crossroad Stats • 96% of children screened for lead by age 2. • 94% who were treated for lead achieved safer levels in 6 months. • 96% of 3-year-old children were up to date with their immunizations. • 83% of female patients had PAP smears, meeting state and national recognized standards

31. Our Present Location

32. Natalie’s story • Natalie • Eric showed up on our doorstep • The rest of the story…

33. Conclusion:An abridged parable from the New Testament The parable is about a master intrusting his wealth to his servants. He went away for a time and on his return those servants who were faithful in using his wealth were rewarded. Another similar parable end with a message to a faithful servant (Luke 12:48) To the person who much is given, Much is required…

35. But who is covered by what? • 60% employer sponsored insurance • Down from 72% in 1979 • 9% individually purchased insurance • 3.5% Military insurance • 14% Medicare • 12.5% Medicaid • 15.5 % uninsured

36. Medicaid • 67% SSI (Supplemental Security Income) • Cash assistance for aged, blind and / or disabled • 19% for Non-disabled children • 333 Billion • 57% Federal dollars • 43% State dollars