The growing number of New Yorkers lacking health insurance has been a persistent concern of government as well as the public. (309) In contrast, the distribution of health care resources came to the fore more recently. The New York State Commission on Health Care Facilities in the 21st Century, for example, recommended a series of hospital closures and downsizing, based primarily on financial considerations in 2006. (310) As described below, the State has consistently allowed hospitals and clinics to close with little regard for New Yorkers' health care needs. Particularly in New York City, the mismatch between health care resources and health care needs, violates all the elements of the state constitutional right to health care: universality, comprehensiveness, and equity. (311) The State has a clear obligation to address New Yorkers' health care needs more effectively and to ensure that comprehensive, quality health care is available and accessible to all New Yorkers. (Jenkins, and Ardalan 479)
Of course New York is not alone, as many urban and rural clinics and hospitals are being closed because the economy is failing and diversification of finances, and especially investment of the institutions in risky ventures, has created situations where even though there is a clear community need for the retention of the facilities they are being closed anyway, because they cannot pay operating costs. Another area of concern, specific to clinics and hospitals which run in part or completely on funding from non-profit and foundation grants, as such funding is clearly becoming scarce, as people and organizations tighten their belt during an economic slump and stop contributing.
Disparities are often specific to race and gender but in cities where there are unusually high concentrations of minorities healthcare disparity should be part of a universal program fro elimination. Thus far this is only true of the rhetoric, and not true of the reality, and even more so as clinics and hospitals close in these areas. These closures leave these already at risk individuals with even fewer, if any options as for how to receive adequate and equitable preventative care.
…statistics document significant disparities for minority populations in health outcomes, such as quality of life, as well as mortality, processes, quality, and appropriateness of care, and the prevalence of certain conditions or diseases. ("CAM at Minority or Health Disparities Research Centers" 46)
Preventative care is particularly hard hit when clinics and hospitals are not easily accessed, usually due to distance, requiring the individual to wait a longer period and go a longer distance to receive routine or preventative care. In many cases the option become null and the individual simply enters the system through the doors of the ER, when they have waited as long as they could to receive care. Serious disparities can be found in some of the more serious sets of human disease; "HIV / AIDS, cancer, cardiovascular diseases, diabetes, adult and childhood immunizations, and infant mortality -- " ("CAM at Minority or Health Disparities Research Centers" 46) Yet other disparities also exist, and in general minority populations often receive far less care, for fundamental access and personal reasons and therefore have lower quality of life and a higher mortality rate for serious and chronic disease as well as an overall lower longevity.
The economy seems to be making an already bad situation far worse as clinics and hospitals close in many areas of the country. These closures leave minorities even more vulnerable to slipping through the healthcare cracks, as these clinics and hospitals may have been the only ones they ever had access to. Resolution of this problem is long in coming, despite a relatively long period of social and institutional awareness of it. It now seems that action will take even longer than was expected as many without care die or get sicker waiting for disparities to be resolved.
An example would be the number of people in California, by race in all age groups who die of diabetes and other endocrine related diseases.
Center for Health Statistics
Vital Statistics Query System
DEATH BY RACE/ETHNICITY
AGE OF DECEDENT: ALL
RACE / ETHNICITY 1:...
Hispanic origin of decedents is determined first and includes any race group. Second, decedents of the Two or More Races group are determined and are not reported in single race groups. In order to remain consistent with the population data obtained from the Department of Finance, the single race groups are defined as follows:
a. "American Indian" race group includes Aleut, American Indian, and Eskimo;
b. "Asian" race group includes Asian Indian, Asian (specified/unspecified), Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotian, Thai, and Vietnamese;
c. "Pacific Islander" race group includes Guamanian, Hawaiian, Samoan, and Other Pacific Islander;
d. "White" race group includes White, Other (specified), Not Stated, and Unknown.
Death rates are per 100,000 population. Age-adjusted rates are calculated using the 2000 U.S. Standard Population.
Source: California Department of Public Health, Death Statistical Data.
Rates are per 100,000 population, age-adjusted to 2000 U.S. Population Standard.
California Department of Public Health: Death Records
State of California, Department of Finance, Race/Ethnic Population with Age and Sex Detail, 2000-2050. July 2007.
The development of a program such as this would build accessible resources in a challenged economy. The individuals this center serves are fundamentally challenged to begin with for a multitude of immigration related diseases and better health care options are essential to prevention and treatment referral, as well as access to publicly funded health insurance and food benefits.
Increasing the opportunity of individuals to seek low cost health alternatives in a challenged environment and economy will improve the community as well as the lives of those within it. The community where the center is located is predominantly populated with lower income immigrants. The expansion of the health fair system to include 12 fairs per year and an onsite clinic will better serve the community as it will ensure that many of the individuals in the community do not fall through the cracks and fall victim to rapidly growing health disparities. Screening for preventable diseases as well as immediate response for potential deadly disease can be the result of the situation. The health clinic, if supported and funded could even be expanded to include minimal site hours, during times other than health fairs as much of the high cost of setting up the system is infrastructural and equipment related. Implementation will include an expansion of commitment from the individual who already provide services for health fairs and will also include the inclusion of local university and college health professions students, local retirees (who retain health licensures) and former immigrants who have been aided by the center and have now obtained health related credentials in the U.S. The expansion of the health fair will require a few additional man hours, supporting additional planning activities but the fair is currently well connected and well received by the community so service expansion on this end would be minimal, excluding increased supplies. The health clinic itself would have a single operative, with one exam table, and various diagnostic tools. The center can dedicate a single private office to the cause and will dedicate several file cabinets in the records storage room to secure patient records, applying all pertinent laws. Patients with critical illnesses or seeking more advanced, long-term care will be referred out to larger free clinics, and follow up will be provided on an as needed basis by the volunteer provider on site during the hours of the following health fair or if needed through referral services. The clinic will be first come first served so scheduling staff will not be required. The clinic will have a voice mail single line phone line that will be checked by…
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