Combating Healthcare Access Disparities

Combating Healthcare Access Disparities

Through Community Building and Organizing for Health and Wellness in the Low Socioeconomic Areas of the East Coachella Valley
The Foundations of Community Building and Organizing: Social Capital
The term “epistemological keys” means the study of acquiring knowledge, in which one individual or a group of people may end up questioning what, who, when, where, why and how we know a particular issue or subject in public health or anything for that matter. It also may potentially bring you to an understanding of how we perceive certain concepts that may either be basic in nature or complex and multi-layered in kind — as in most life circumstances — especially as it relates to making a difference in the health and wellness of the general public through community building and organizing. It may be a very tall task but the latter idea of the epistemological keys and the essence of understanding why things are the way they are. This concept of questioning can be applied to significantly assist and relieve particularly public health issues and problems in the local communities, especially in terms of the lack of health care access as illustrated in the East Coachella Valley residents living in the Riverside County in Southern California.

Another prominent topic in public health is social capital. What do we mean when we talk about social capital? In basic layman’s terms, it is essentially a “five-dollar” word for “networks,” “relationships,” or what sociologists may call “group participation” that may foster positive outcomes and advantages for an individual, group and communities. In the case of the East Coachella Valley residents, there may not be abundant resources and potential opportunities in education, employment, social support, and affordable health care services just to name a few. Therefore, having social capital through active participation, forming networks and lasting relationships, community building and organizing by public health advocates and concerned local constituents can create positive improvements in the access of community resources and help spawn a better outlook for the underserved and underprivileged communities of the East Coachella Valley area. Obviously, it should be noted that social capital must be utilized in a positive light, meaning some communities may be empowered for the wrong reasons as in gaining financial gains and other maladaptive motives, for instance, not intended to help out other people in much dire need of it.

Coachella Valley

However, the lack of social capital may mean poor standards of community building and organizing and could conceivably adopt some negative and “self-destructive” individual and/or community health behaviors. Whether we speak in terms of public health, economics, politics, sociology, cultural competency, philosophy, etc. social capital is the foundation that public health practitioners and advocates should stand on so that constructive and progressive social change can occur and, more importantly, so that healthy behaviors and wellness are erected in a particular community, principally where there is an evident stark divide between the underprivileged persons with limited health care access and most of the fortunate commercially insured ones who are able to afford the best and most accessible doctors including regular follow-up visits to their preferred healthcare providers and emergency services. In order to make a difference in the cause for any public health issue beginning in the local communities, public health advocates should attempt to practice social capital’s different variations of “bonding,” “bridging” and “linking” between diverse individuals and groups of different backgrounds and socioeconomic status. Thus, through development of durable networks and relationships in the local community, there is potential to create more resources and opportunities for the less fortunate ones.

However, the encompassing questions in this piece are really the following:

How do we get everyone – not just public health advocates and practitioners – to buy-in in order to get local communities such as the East Coachella Valley residents to create valuable health care and other resources for themselves?
How do we bring awareness to the important concept of the other communities to at least attempt to take care of or ease the burden of the underprivileged communities with much less resources in medical care and access?

The answers to these complicated public health issues are easier written and said than actually done. One notion is certain, community development efforts should be geared towards creating social change in the at-risk communities by questioning the status quo and even requesting changes in the social structure so that the at-risk communities may be brought out of their affliction of scarce health care resources.
Going Above Social Capital to Lessen the Healthcare Access Disparities
The California Institute for Rural Studies’ Policy Brief: East Coachella Valley Healthcare Access Disparities illustrates the social and health care access inequality within this particular low socioeconomic region in Southern California. The disadvantaged residents have lack of poor access to essential resources, such as basic healthcare needs. From this article, it is approximately 36% to 70% of the East Coachella Valley residents who cannot afford to have any commercial health care plans or even be considered for Medicaid and/or Medi-Cal due to the low employment rates in this area. In actuality, the healthcare injustice in this underprivileged area speaks to the number of patients per doctor in the region; it surpasses the federal government recommendation by 4 times. Specifically, the Coachella Valley Healthcare Initiative found that there are 8,407 residents of the East Coachella Valley for one doctor. As per some residents of the East Coachella Valley area, respectively the ones living in the Salton City, there are only two outpatient primary care clinics that are open twice a week (or even not at all if the healthcare provider has other duties and responsibilities in their respective field or practice of medicine).

More importantly, the lack of healthcare access within the East Coachella Valley region is closely tied to the social, economic, and/or environmental disadvantages of its constituents. According to the website HealthyPeople.gov, which is part of the Office of Disease Prevention and Health Promotion, health care differences are mostly connected with the groups of people who have had more of their share of social, economic, and/or environmental obstacles to healthcare access due to their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. For example, a myriad of East Coachella Valley residents in the unincorporated areas are employed as local farmers, which 70% of them have no health insurance plans whatsoever according to another research done by the California Institute for Rural Studies in a 2001 Baseline Report, Access to Healthcare for California’s Hired Farm Workers. Remarkably, the United States Department of Health and Human Services reported on September 2011 in another article, Overview of the Uninsured in the United States, that the national percentage of individuals who are uninsured was about 16% in 2015, startlingly revealing how the low socioeconomic areas of the East Coachella Valley have almost a threefold healthcare access injustice compared to others in America who can afford commercial health plans.

It should be emphasized again that creating solutions to public health issues may or may not be possible depending on multifactorial events that must be in place in order for successful answers to occur and change the social structure to benefit others that need medical resources. However, one of the most positive and significant ways to tackle the health care access shortage in the East Coachella Valley is to create enough social capital to get the community in question to come together. For instance, the local healthcare practitioners, powerful politicians, middle to higher class residents, small business owners, local media venues, and any persons of higher socioeconomic influence should assist in promoting, advertising and delivering affordable, low cost or even free health care access to those residents who do not have the economic means for a decent health plan coverage, especially those in the East Coachella Valley. In addition, other communities with ample health care resources should pull together to help the target at-risk communities who have scarce or even no health care access, which goes beyond just your networks and relationships built through social capital. Using the latter may spark the social change that can revolutionize the outlook of health care access in all underprivileged communities in the United States.

A prime example of social capital at its best and other groups coming together to help in the lack of health care access is the Coachella Valley Volunteers in Medicine clinic (CVVIM), which opened its doors in 2015, delivering free primary and specialty health care in the East Coachella Valley for very low-income residents. The CVVIM’s chief mission is to “provide a no-cost primary health care service to medically underserved adults residing in the Coachella Valley and is part of the national Volunteers in Medicine (VIM) Alliance. What is commendable about this free medical clinic is that it not only brings basic primary acute and preventative medical care, dental, and some specialty services but it was also created, in large part, because of a diverse and influential network of public health advocates (i.e., medical groups, physicians, legislative officials, prominent leaders in the community and caring volunteers) and especially affiliated hospital institutions (e.g., Riverside County Regional Medical Center in Moreno Valley, CA; Desert Regional Medical Center in Palm Springs, CA; Eisenhower Medical Center in Rancho Mirage, CA; and John F. Kennedy Community Hospital in Indio, CA just to name a few hospitals who have aided in providing free this type of free health care to the low income families).

All of these integral and vital networks and relationships pooled their respective resources together to generate a positive social change that transcended into a community-wide social capital and significantly benefits the underprivileged and low socioeconomic residents of the East Coachella Valley and other low-income individuals who need basic healthcare needs. What is more promising is the non-discriminatory eligibility criteria of CVVIM patients as all low-income persons are welcome regardless of race, gender, gender identity, class, religion, sexual orientation, disability, national origin or citizenship status as long as they are residents of the Coachella Valley, at least 18 years old or older, have no current healthcare coverage, and do not have a household income exceeding 200% of the current Federal Poverty Guidelines for their respective family size.

Yet, there are more ways to build on the “community-wide social capital” that brought CVVIM to the forefront of minimizing the health care disparities that faces the deprived residents of the East Coachella Valley. The Riverside County Mobile Clinic is another example of offering accessible health care to those in need by traveling to those areas of low socioeconomic and/or environmental disadvantages. Still, the Riverside County Mobile Clinic is only available once per month and so, public health cohorts should encourage funding for more mobile visits in order to support the shortage of health care inequality in the poorer regions of the Coachella Valley.  This initiative and promotion of increased traveling and reachable medical clinics should also apply to other public health organizations, such as the Los Medicos Voladores or The Flying Doctors (LVM), which also serve numerous low-income regions of the East Coachella Valley.

In cases of life threatening or near life-threatening medical emergencies, there are scarce ambulance services for residents of the East Coachella Valley, Salton City, and other unincorporated areas. This fact should be a warning sign due to the deficiency of first responders, who may take longer than the average seven to ten minutes to arrive to a scene in medical emergencies,  such as those persons with lethal cardiac arrests and acute hemorrhagic strokes. The latter life-threatening medical emergencies are one of many critical medical conditions that necessitate acute medical interventions and clinical therapy, as well as possible basic life support (BLS) such as cardiopulmonary resuscitation (CPR) and using an automated external defibrillators (AED) in addition to advance cardiac life support (ACLS). Adult, child, and infant residents of the East Coachella Valley area may also need to have access to advance airway and ventilation management with quantitative waveform capnography, intravenous therapy, arrhythmia control, pharmacological management and delivery, diagnosis and early treatment, especially for some of the catastrophic arrhythmias that have reversible causes.

By the same token, although there are emergency air ambulance services and medical flight transports that fly from one of the two locations in Thermal, CA to either John F. Kennedy (JFK) Community Hospital in Indio, CA, Level 2 Trauma Center at Desert Regional Medical Center in Palm Springs, CA, or University of California San Diego (UCSD) Regional Level 1 Trauma Center, the medical response time may be inappropriately prolonged that may not stop the deterioration and decompensation of critically ill and trauma patients. This is not to say the emergency ambulance services in this particular area lacks the clinical skills and competency to treat patients with life-threatening medical conditions as Palm Desert Resuscitation Education LLC (PDRE) as had excellent and capable flight doctors, nurses, respiratory therapists and paramedics needing their BLS, ACLS, and PALS certifications or recertifications by the American Heart Association (such as Mr. Henry Olson, EMT-P who work for Air Methods and Mercy Air based in Thermal, CA). However, there should be more development and expansion of fire stations and ambulance services like the American Medical Response (AMR), and feasible in-house first responders in the local health care settings to respond to emergency medical situations in the East Coachella Valley area. Yet, one of the most important questions to ask is who will finance and initiate the expansion and development of more medical responders in these less fortunate and geographically disadvantaged areas of the East Coachella Valley?

What is more alarming is that the nearest emergency department for the East Coachella Valley residents is located in Indio, CA at the JFK Community Hospital that maybe more than 25 miles or more for most geographically deprived residents who need emergency medical care. In addition, if the people who live in the East Coachella Valley area do not have any imminent and otherwise life-threatening medical and clinical emergencies but only need outpatient follow-up visits to their primary care physician and/or referral to healthcare specialist(s), some may need to frequently travel at least 70 miles to Moreno Valley, CA to receive their Medicaid-based health care services. Healthcare providers are more than ever encouraged to sign contracts and agreements with Medicaid and other Health Maintenance Organizations (HMOs) to lessen the health care disparities and burden of the low socioeconomic residents of the East Coachella Valley area.

Furthermore, public health supporters should also improve the community-wide social capital by supporting, encouraging, and/or funding of specific local groups, associations, and factions that assist in providing basic healthcare needs as well as life skills to help to create a positive difference in the lives of children and young adolescents, particularly the ones who have poor upbringings and come from disadvantaged families with little access to primary education, job opportunities and, most importantly, health care access and medical resources. For instance, the Adolescent Outpatient Substance Abuse Program by the Latino Commission is aiding young teenagers to reduce alcohol dependence and illicit drug use and abuse and also nurturing their lives holistically through social and family functioning interventions. Health care providers and adjunct allied health professionals in behavioral health should evaluate these young adults appropriately for their mental health issues. Everyone can make a significant impact in promoting this type of social change and, thus, help in the community development.

Specifically, the Latino Commission tries to deliver a concrete adolescent focused aftercare program, which resumes to adopt relapse prevention, aftercare plans, and follow-ups.  Furthermore, most of the children and teenagers who come from low socioeconomic families and backgrounds have alcohol and illicit drug abuse and dependence including undiagnosed psychiatric co-morbidities such as major depressive affective disorders (MDD), anxiety and panic disorders, bipolar disorders, schizoaffective disorders, schizophrenia, attention deficit hyperactive disorders (ADHD), other pervasive and developmental disorders, and suicidal and homicidal ideations.

Thus, health care access disparities in these types of underprivileged populations of the East Coachella Valley may need affordable psychiatric medical care along with cognitive behavioral therapy and other mind and body approaches to treat their co-occurring psychiatric illnesses that may stem from their poor social, economic, and/or environmental disadvantages. Therefore, it is imperative that behavioral health availability be a requirement and a need when it comes to providing health care access to the low-income children and their families. Again, how do our communities and, particularly, lawmakers pool their resources to accomplish this feat of providing behavioral health and other medical care to those with limited health care access?

Lastly, local small business owners should help in the enhancement of community-wide social capital by financially assisting, in every method possible, low-income families and individuals who cannot afford basic human essentials. Acting as a local paradigm for the latter endeavor to aid the underprivileged is Palm Desert Resuscitation Education LLC (PDRE) located in Palm Desert, CA and Redlands, CA in Southern California that offer high-quality and professional classroom-based, online, and out-of-site education and training in American Heart Association (AHA) Heartsaver Adult and Pediatric First Aid, CPR and AED, basic life support (BLS), advance cardiac life support (ACLS), pediatric advance life support (PALS), neonatal resuscitation program (NRP), ECG/EKG and pharmacology, acute stroke, Learn Rapid STEMI, Learn Pediatric Rhythm, Nonvalvular Atrial Fibrillation, and other HeartCode online courses for the certifications and/or re-certifications of healthcare professionals, allied health professionals and other non-healthcare providers or even novice beginners or laypersons.

As one of the leaders in advancing its mission of promoting healthier lives and assisting in reducing the morbidity and mortality of cardiovascular diseases and stroke through evidenced-based learning and professional education as per the most current guidelines and recommendations of the AHA, PDRE also strives to offer significant discounts to AHA volunteers, military personnel, business affiliates of PDRE and, most importantly, low-income families and individuals on course, supplementary, and product pricings and charges. At times, PDRE offers free First Aid, CPR and AED training courses for the local communities to not only help the AHA’s fundraising and relationships with the local medical institutions (i.e., Eisenhower Medical Center in Rancho Mirage, CA) and other businesses but also to help low-income residents of the East Coachella Valley, military personnel or veterans with their families, any volunteers, all non-profit organizations, and other business affiliates of PDRE.

A specific case that illustrates PDRE’s commitment is Mrs. Luprepia Ponce, an elderly Hispanic woman who comes from Latin American and is attempting to gain employment as a nurse in the Desert area. Her late husband, who had recently passed away a few years ago, use to help her take the local bus route to take her to and from her home and previous work. Mrs. Ponce is not able to afford an automobile and using a bicycle for transportation is not an option due to her senior age and the obvious scorching desert weather of the East Coachella Valley, especially in the hot summer months. What is very impressive and praiseworthy, though, about Mrs. Ponce is her diligent and dedicated missionary work, offering volunteer services a few times per year in the third world countries of Latin America, which she happily accomplishes with a passion and contented heart. Unfortunately, for Ms. Ponce’s initial job employment candidacy and further career progression in the healthcare field, she must make ends meet in order to finance her CPR certification.

Fortunately, PDRE gladly offered her affordable and discounted course pricing and charges for her BLS class and provided her with free course provider manuals, supplementary materials and other essential educational products for the completion and receipt of her electronic, up-to-date two year BLS certification by the AHA. The great news is that she ended up getting the job she wanted and thanked PDRE for helping her expenses so that she may be financially stable, continue to make a living in the health care field as an allied health professional and, most notably, continue to volunteer her time to help others in Latin America. Although this is a great example of charitable giving, it can be paralleled to how a community can help make a difference in the fight against health care access injustice and it leaves to the imagination a paradigm for others to follow to make a small, positive difference and social change.
A Constant Campaign in Community Building and Organizing: Community-Wide Social Capital
Whether one is part of a group in either side of the social, economic, and/or environmental spectrum of healthcare access and disparity, there should be a constant campaign by public health supporters of diverse influences and authorities to tap into more healthcare resources and opportunities for at-risk communities. Community-wide social capital through bonded, connected and non-discriminatory networks, the health and wellness of all persons who are part of these target at-risk communities — particularly the ones who come from underprivileged and poor neighborhoods, backgrounds, upbringing, and families with little to no access to primary education, job prospects, and specially basic healthcare needs — will be much better than it is now. It literally begins with an awareness and understanding to this important public health issue as stated in the meaning of the epistemological keys and then, possibly, inspiration from an individual, group, institution, and communities to begin the legislative process of social equality in health care access for everyone.

In general, the source of the social injustice of the healthcare access and disparities has to be confronted first and foremost. Yes, the reality of the low access to healthcare in these parts of the country, which have constituents and inhabitants who are in the low socioeconomic spectrum, is also perhaps due to the non-lucrative compensations for doctors and other healthcare providers working in the rural setting compared to the premium locum tenens, contracts, and other salaries of medical providers who are employed in the urban areas and larger medical groups and clinical institutions. In addition, the patient population may not be as health educated and may not be compliant with their current medication management and clinical therapy that may discourage their healthcare providers. Also, medical resources may be so scarce that even if a prescription or medical order is written, the patients do not have easy access to hospitals, outpatient clinics, pharmacies, and other medical facilities with top-of-the-line medications and imaging instruments, for example, to carry out the doctor’s instructions and medical advice. Nonetheless, these disturbing facts are the chief reasons why the public health obstacles of healthcare access and resource disparities in the underprivileged and poor regions of America is, again, very complex and multi-layered to tackle. The solutions to all of these public health challenges, however far-reaching, may require major community-wide social changes, understanding and even going above questioning of the current political nature and structure of medical care in the 21st century United States.

Our world will be a better and healthier place to live in if each and everyone contributed to the idea of this cause because we are all part of a community somehow, whether it is a small one or a larger network of communities. As an individual, one does not have to make significant lifestyle changes in in order to make an activist social change and enhance the community-wide social capital of the area one lives in. By just implementing a sense of involvement and participation in any public health cause in a particular community one can really make a significant, positive and optimistic difference in other people’s lives and well-being, especially ones who do not have much of the same basic and essential human needs that the majority of us have.  Just by reading this public health article by PDRE about community building and organizing, for instance, or just viewing a local newspaper editorial about any public health problem, it may constitute a transformation in the mind of the individual to spark interests and may end in positive, life-changing and health outcomes and behaviors. Everyone can make a difference in enhancing the community-wide social capital and participate in the campaign for community building and organizing, so please start now!