Essay is about Healthcare Access and how it contributed to health disparity in ward 7 & 8 of Southeast DC

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Healthcare Access and how it contributed to health disparity in ward 7 & 8 of Southeast DC

Access to highest quality healthcare services is a must for people of diverse cultures and races. In southeast DC, a huge part of the population consists of African Americans of which ward 7 and 8 has nearly 92% African Americans (“District of Columbia Health Systems Plan”, 2017). According to the D.C. Fiscal Policy Institute, ward 7 and 8 are deprived of quality healthcare facilities and has not seen much financial and infrastructural growth since the recession period. Having critical economic issues, it is very difficult for the African Americans living in that region to prosper in the future. The highest rate of infant mortality is observed in ward 7 and 8, and has an ever increasing teen pregnancy which further increases the IMR (Thebault, R., 2018 August 09). According to a report by Columbia Department of Health published in 2014, death rates of African Americans caused due to heart diseases was thrice to that of whites, which being one of the many health disparities. The life expectancy rate for African Americans states that they live 15 less years as compared to the white Americans. 

In District of Columbia, as per the 2017 Youth Risk Behaviour report, the consumption of tobacco amongst high school students has proven to have adverse effects on their grades. Tobacco is also one of the leading reasons for lung cancer mortality in southeast DC, almost for 80-90% of total lung cancer patients. Report shows that 43% of high school students consume marijuana, and 21.3% consumes alcohol before the age of 13. Mortality rates and cancer incidences in African Americans in the region is more by nearly % in comparison to their white counterparts. Homicide rates are found to be highest in ward 8 and also saw the highest rate of increase in the district from the year 2015-2016 (“District of Columbia Health Systems Plan”, 2017). Majority of the lowest income population and minority people stay in Wards 7 and 8 of DC. In spite of having an insurance cover, the type of cover and their Medicaid coverage status also prevents them from getting best treatments like radiation. Even though there may be a presence of sufficient number of physicians and specialist doctors in ward 7 and 8, not all of them accept Medicaid. 

There are various transportation issues for the people to reach cancer screening and treatment centres, apart from for reaching the hospitals. The average distance for people to reach hospitals is 3-5 miles in ward 7 and 8, which includes changing of buses, thereby increasing the time required to receive medical aid. For disabled people, it is an additional burden to travel long distances causing inconvenience in reaching hospitals. Also, in terms of affordability, the highest cost for hospital care is in DC as compared to other states. These factors along with absence of health insurance coverage, demotivate young adults to go for health check-ups, causing cancer in later stages. Continuous monitoring of health is very important to prevent critical diseases like cancer. The neighbourhoods of southeast DC are full of liquor stores and unhealthy food outlets. The percentage of deaths due to diabetes is maximum in ward 7 and 8, 21.4% and 20% respectively as of year 2010. Same goes for deaths due to HIV, accidents and assaults in these areas (District of Columbia Community Health Needs Assessment, 2014).  

As of 2011, lowest percentage of residents with a high school degree was found to be in ward 8 and that with a bachelor’s degree were in ward 7. The unemployment rate in ward 7 in December 2017 was 10% and in ward 8 it was 12.9% (“District of Columbia Health Systems Plan”, 2017). Also, due to relocation, the overall quality of life was even more affected in these regions for African Americans. Lack of adequate grocery stores in ward 7 and 8 shows food access in these areas is also not proper. Biases in providing efficient treatment to African Americans, based on cultural, racial and gender, adversely affects the overall standard of treatment received by them. Unfriendly attitude and feelings of dislike for African Americans are common in health care workers in southeast DC, resulting in inefficient care and reduced trust for physicians in the eyes of African American patients. 

Mental health services in ward 7 and 8 are not so great and people face multiple barriers for its access like lack of healthcare provider, stigma around mental illness treatment and trouble finding resources for treatment. The people there require family support regarding their mental health condition, the anxiety and stress amongst them further impact their individual productivity. Studies depict that African Americans have to encounter racial, cultural and ethnic abuse like focusing cigarette ads towards them and sending free samples to their low-income populations (“DC Public Health Case Challenge”, September 2018). Violent Psychological behaviours such as criminal activities, bad family relations and low socio-economic status add on to stress in the youth, ultimately increasing their urge to smoke. Although the practice to promote cigarette consumption by sending free samples is been banned, it will take a long time to observe a decent amount of reduction in smoking. The 2009 Tobacco Control Act requires the seller to verify the age of the buyer photographically. A policy to increase cigarette prices has been made to discourage young adults to smoke tobacco. Oral health issues like tooth decay are very common in southeast DC as a result of tobacco intake. 

Providence Health System is being told to shut down its northeast DC hospital, on grounds of shutting down many of its services without proper approvals from the health regulatory body (Gilgore, 2019 May 1). The law prohibits any hospital from denying to treat any patients with emergency medical needs. SHPDA had asked for a complete information on transition of patients to other hospitals and a complete closure plan in order to terminate such issues. In place of the hospital, a new centre known as ‘Healthy Village’ is planned, especially for providing healthcare services for low-income elderly people. An urgent care centre will treat all the inmates equally disregarding their socioeconomic and financial status. There is an indigenous disparity between the west and east parts of DC in health consequences (Jamison, P., 2019 March 12). 

Plans to close United Medical Centre, a public hospital in DC, is not seen as a favourable decision by protestors as the residents will not have a nearby access to a hospital. But due to its financial instability, it has no option but to seek assistance. In place of St. Elizabeth Hospital, the city’s psychiatric centre, budget for new hospital is to be allocated.  In recent months, crime rates and homicides in ward 7 and 8 rose, and a need for a full service public is necessary for the district’s people. All these hospital closures are in one side of the city, impacting mainly the poor African American public. The government needs to take adequate measures to facilitate its population with a proper healthcare facility amidst such hospital closures. Almost one-third of the districts population is in a health crisis like situation and the government need to consider it as a critical issue while allocating budget and plans for the new hospital facilities. Now, it’s the government’s responsibility to speed up its actions to provide its residents with a quick access to healthcare. The National Institute of Minority Health and Health Disparities (NCMHD) is focusing its research and efforts on abolishing such disparities by formulating programs such as “The Bridges to the Future”, providing students master’s level training (NIH Fact Sheets - Health Disparities, October 2010). Public and Private institutions in southeast DC need to collaborate in order to prevent violence and criminal actions by its youth. Policies to tackle unhealthy food places also need to be implemented efficiently to reduce obesity. By race, African Americans have 33% of obese people as compared to their white counterparts having 10% in the region of DC (“District of Columbia Health Systems Plan”, 2017). The lack of proper nutrition and poor physical fitness are the main reasons for obesity in people here. 

It is evident from all the above data and information that the people of southeast DC have to struggle for basic amenities and appropriate healthcare. Even though people are enrolled in Medicaid, the number of healthcare visits doesn’t seem to be rising. For ward 7 and 8, more than 20% of inpatients are for sensitive care conditions (Chandra, A., Blanchard, J. C., Ruder, & T. 2013). There need to be geographical coordination relating to healthcare centres in DC so that there is equal access for people spread across all its wards. Hospitals should provide better navigation services within the emergency department. The primary care givers need to understand the issues and problems of the patients disregarding their racial and economic backgrounds. The literacy rate also need to be increased in order to see an actual impact in reducing of crime rates, which ultimately can also improve health status. E-cigarette advertisements and use should be promoted and free samples should be distributed in most prone to smoking areas. Additionally, education about the harmful effects of smoking should be made mandatory from basic levels of schooling to reduce deaths and other illness caused by tobacco. 

The most relevant strategy to improve the healthcare conditions of the population of southeast DC is to increase the number of primary care physicians (PCP’s). If access to PCP’s can be made more convenient and frequent, a lot of critical illness occurrences among people of elderly age can be avoided. One way is to make PHP access available outside hospitals for locals. If more investment is done in setting up small PHP centres especially in ward 7 and 8, there can be a decent amount of increase in patient visits and preventive measures can be taken in time. Building up of trust in patient-doctor relationship is extremely necessary. Actions and events should be organised to eliminate the discriminatory attitude and bias that white Americans in southeast DC have towards African Americans, at least in the field of healthcare. 

The financial barriers of unemployment, transportation, medications and child care still pertain in spite of subsidized treatments. For homeless people, special healthcare camps should be organized. Non-English speaking population with financial instability should also be catered with access to PCP visits and public hospitals. The discharge and readmit rates are highest in ward 7 and 8 for heart diseases and mental health problems. Poor transition records and delays in transfer hampers patient’s treatment schedule and ultimately treatment outcome. Gentrification and scattering are altering the landscape of the city. Nearly 20% decrease in African American population is reported in DC as people are shifting towards more affordable locations (Browne, 2017 May 18). In order to see a significant reduction in this disparity, a collective approach involving the community members, national health advocates and government officials is needed towards improvement in sectors of education, socioeconomic factors and public safety. 

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