I continue to be haunted by the words of America Bracho, MD, MPH at the 1999 STFM Annual Spring Conference. Her life has been about service to underserved communities in Orange County California. During her talk, she challenged academic medical centers to get involved more with the underserved. She noted that neighborhoods facing challenging circumstances often surrounded most of our academic medical centers. She asked why these neighborhoods were not doing better despite decades of geographic contact. - America Bracho, MD, MPH 1999 A very good question! Where is the economic benefit claimed by academic medical centers when defending their budgets at the state level if these benefits do not include those most in need and closest to them?
National Center for Children in Poverty - midwest children poverty up 29%
(43% of the increase in child poverty in the nation), greatest rise in families
without college education
The US could adopt UK methods that were stolen from the US in previous eras
Child Poverty: Faces Not to Be Seen in Medical School
Organized - who gets what they want and how do we get what people need?
Poorer Health in the Process
Poverty Locations and Physicians
Understanding Higher Education and Income
Medical School Admissions and Social Status
AAMC GQ 1995 Rural Interested Students 60 % interested in choosing underserved areas, but only admitted
Susan La Flesche Picotte - first native female physician, missionary, advocate, servant to all
|Kennedy and Crisis - dealing with the underserved is the best foreign policy in 1961 and today||Not For the Faint of Heart - New York City's finest torched, not the first time, terrorists extinguished by restoration|
|Poorer Health in the Process - 14 patient cases demonstrating that our health system is keeping patients in poverty||McLennan County FP Residency: a Model of Cooperation and Better Health|
|Assessing Community Orientation|
CENSUS in Haiti by Stu Embury
AAFP Special Resource Page for Underserved http://www.aafp.org/special/resource/
AFMO Document on FP community contribution at http://www.uams.edu/afpa/vol16_4.pdf
Improving Rural Health at the Federal, State, Local level
Immersion in the Underserved
What Is the Risk If We Train Too Many To Serve the Underserved
Studies show that an increase in insurance costs of 0.5 % above inflation results in another 200,000 without health care insurance - Blue Cross Blue Shield exec
"We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be inevitable in a free-market economy. But those disparities should not extend to essential services like education, clean water and air and protection from crime, all of which we already acknowledge are public responsibilities. The same should be true for medical care -- particularly since we can well afford to provide it for everyone if we end the waste and profiteering of our market-based system." The Forgotten Domestic Crisis, Marcia Angell, former editor in chief of the New England Journal of Medicine and senior lecturer in Social Medicine at Harvard Medical School She also states that health care would be the number one priority in the US, except for the war drums. http://www.nytimes.com/2002/10/13/opinion/13ANGE.html
The best way to keep people in poverty is to restrict education and health care. The train to freedom will always go through a narrow dangerous gorge before it gets to the promised land of milk and honey. You can delay the start of the train, but once started, it is most dangerous to try to derail it RCB 2003
FEATURED STORY from CCPH site. WHERE DOES IT HURT, DOC? WHERE THEY CUT OUT THE TRAINING Read the entire story athttp://futurehealth.ucsf.edu/pdf_files/PM092002.pdf
I forgot one most important concept that I have grown more aware of over the past weeks.
We are not called so much to
stamp out darkness. We are called to witness to the light!
Jesus did not spend time wandering about fighting all of the injustice in the country. He did the Father's bidding, and so must we. Fighting injustice is a fine balance between doing what you are called by God to do and over-reacting to what Satan can stir up to distract you and involve you in the world. Injustice reminds us that God is in control, not us. It is a balance that I will never fully have, but awareness of this is a start.
Physicians, if they really desire to understand their patients, will become aware of many of these problems. Many physicians have forgotten that this is a real privilege of the profession. If used correctly, physicians caring for the underserved can do much to help others understand what is going on, particularly those who might have the ability to change such situations. Physicians caught up in their own lives or agendas or situations will not be of much help.
Mark Twain understood the importance of a Christian's responsibility as a citizen. He wrote, "A Christian's first duty is to God. It then follows, as a matter of course, that it is his duty to carry his Christian code to the polls and vote them... If Christians should vote their duty to God at the polls, they would carry every election, and do it with ease... it would bring about a moral revolution that would be incalculably beneficent. It would save the country."
Research Topics and Methods in Underserved
Admissions and Minorities in California
High Educational Debt and choice of underserved - Pathman http://www.ahcpr.gov/research/dec00/1200ra.pdf
Research Methods and References in Underserved
The following are pages involving this critical area:
My first encounter with Dr. Fitzhugh Mullan's work was in 1971 when I read his editorial in the NYT in 1971( White Hands Clenched Fists). We had an opportunity to meet in Washington several years ago. Dr. Carmichael was there and I introduced them to each other. That conversation I will not long forget. For those who may not read the Washington Post here is the URL of his editorial. Bob, I thought you might be especially interested. Lawrence Silverberg
Fitzhugh Mullan's Washington Post Article about AHEC cuts http://www.washingtonpost.com/wp-dyn/articles/A29293-2002Aug17.html
Bibliographies of Note
Literature on Retention
Braden, J, & Beauregard, K. (1994, February). Health status and access to care of rural and urban populations (AHCPR Pub. No. 94-0031). Rockville, MD: National Medical Expenditure Survey Research Findings 18, Agency for Health Care Policy and Research, Public Health Service. Jill J. Braden and Karen Beauregard
Gessert, C., Blossom, J., Sommers, P., Canfield, M.D., and C. Jones. "Family Physicians for Underserved Areas: The Role of Residency Training." The Western Journal of Medicine. 150(2):226-230, February 1989.
National Association of Community Health Centers, National Rural Health Association. The National Health Service Corps: An Investment in Health Professionals for Underserved Communities, 2000.
Xu, G, et al. (1997). The relationship between the race/ethnicity of generalist physicians and their care for underserved populations. American Journal of Public Health, 87(5), 817-822.
Physician Workforce Studies