Maybe we need a new Surgeon General’s warning: “Caution: Poverty Can Be Bad For Your Health.”
A much-reported recent study found that, in 2000, 523,000 deaths could be attributed to individual and area-level poverty. This is one of those fancy statistical analyses, with limits that even the lead researcher acknowledges.
But there’s no doubt that factors related to low income — limited access to health care, insufficient resources for a healthy diet, bad housing conditions, stress, etc. — can cause health problems and make existing health problems worse.
Back in 19
696, Rebecca Onie, then a bright undergraduate, got a very bright idea for linking health care to remedies for conditions like these. Today, it’s a nonprofit called Health Leads,* with projects in six cities, including the District of Columbia.
Health Leads recruits other bright college students as volunteers and places them in participating hospitals and clinics. Their job is to fill “prescriptions” ordered by doctors to create healthier living conditions for their patients, e.g., food and/or fuel assistance, job training, transportation, health insurance.
They do this by linking patients (or their parents) to government and nonprofit programs that can meet their specific needs — and providing the interface and followup to make sure they’re served.
This takes a combination of creativity and tenacity that good college students exercise all the time. “Really like a fancy Google search,” Onie says.
But, as anyone who’s dealt with an agency bureaucracy knows, finding the right resource is only the first step. You need a lot of tenacity to get to the right person — and to get that person to act.
I had thought that hospitals and major clinics had social workers to do what the Health Leads volunteers are doing. Turns out they do, but not nearly as many as needed. In some large urban hospitals, there’s one social worker for every 25,000 patient visits.
So volunteers do what social workers don’t have time for, freeing them to focus on what they’re trained to do — and on what the facility can get reimbursed for under Medicaid. Our health system, after all, still doesn’t recognize lack of food or shelter as a medical issue.
But that they change, thanks to efforts like Health Leads’.
The change begins with doctors, who, we’re told, start paying attention to patients’ social needs when they know there’s an in-house system to address them.
At Children’s Medical Center, for example, there’s been a 300% increase in doctors issuing “prescriptions” for Health Leads to fill through the hospital’s regular electronic records system.
And Health Leads is incubating future doctors who will bring to their practices what they’ve learned. “When I’m a doctor,” says one volunteer, “I will never prescribe antibiotics that say ‘take with food’ without making sure there’s food in the house.”
Yet Health Leads is a relatively small organization, dependent on charitable donations, volunteers and progressive health care providers.
As Onie says, we’ll need a major system-wide shift in focus from “care” to “health” — from managing diseases to solutions that address the social factors that cause and exacerbate them.
This isn’t a call for another broad-gauge war on poverty, much as I’d like to see one. Rather, It’s a sensible, cost-effective way to bend the rising health care cost curve that’s now straining both government and personal budgets.
It’s also a way of moving the system toward a more holistic view of patients, who are, after all, more than a collection of body parts and ailments addressed by our plethora of specialists.
And it’s empowering for both them and for health care practitioners, who know full well that they’ve got patients suffering and prematurely dying because they live in poverty.
* Health Leads used to be named Project HEALTH. It renamed itself in November 2010 to signify that it was more than a project now.