Community/Organization of Interest: Health and medical services in Bella Vista, PA, a South Philadelphia neighborhood

The cultural perspective

Bella Vista, PA, a South Philadelphia neighborhood, is a largely Italian-American ethnic enclave dominated by white, working-class residents. Although recent scholarly literature has focused upon the deficit of healthcare knowledge and services in lower-income nonwhite populations, deficits in knowledge and willingness and ability to access vital resources to improve their health still persist across population groups. For example, one study of non-Hispanic and Hispanics found that there were high levels of systemic barriers to obtain colorectal screening, including: scheduling and financial barriers; fear of diagnosis and pain; and lack of motivation amongst all study participants (Green et al. 2008). Culturally and psychologically in many communities, there is often an unwillingness to seek medical treatment in the form of screening. Even though Bella Vista is not a poor community cultural attitudes towards healthcare can still be significant.

Politics and economy: Effects upon healthcare

Enhanced physical and economic access to healthcare is critical to enhancing residents' ability to fully enjoy healthcare services: "one of the most important community determinants of access is the magnitude of the geographic area's population that tends to rely on the health care safety net, such as community clinics, public hospitals and clinics, and teaching hospitals" (Brown et al. 2004). Bella Vista currently boasts access to a number of large community hospitals, including Greater Philadelphia Action which can enhance usage of critical services.

Institutional perspectives

One health topic which has received considerable scrutiny in recent years is the issue of obesity: once again, although a great deal of media attention has specifically been focused upon this issue in low-income nonwhite communities, it is still endemic within a wide number of communities suffering from a lack of access to healthy foods and a deficit of nearby places (and available time) to engage in physical activities. "In health research, there is a long history and supporting evidence for the influence of place...

2012:2). However, cultural factors such as a fixation on high-calorie traditional foods and skewed views of weight and health can also impact obesity rates. From an institutional perspective, beyond cultural attitudes towards food, factors such as physical access to supermarkets and affordable healthy foods may affect population shopping and buying patterns regardless of culture. Within the Italian-American community, for example, the emphasis on food as a source of bonding can counteract weight reduction efforts -- however, the higher levels of education within the community and transmission of critical knowledge regarding weight loss can counteract such influences.
Bureaucracy

Creating a more effective healthcare bureaucratic system to deal with healthcare needs is essential. The recently-passed Affordable Care Act (ACA) has tried to increase reimbursements to Medicare providers as well as Medicaid providers (Breen 2013). For elderly residents this can be a critical spur to take a more active approach to healthcare and self-care.

Organizational culture

One organization within the area dedicated to providing assistance to residents is Greater Philadelphia Action. GPHA advertises itself as a nonprofit organization offering a wide array of "primary, dental and behavioral healthcare" with a focus on preventative medicine (GPHA, 2014). The organizational culture and vision stresses the need to provide "compassionate and affordable healthcare for families" and is one of "the largest and most effective providers of primary healthcare in the area-serving over 85,000 patients" (GPHA, 2014). Comprehensive healthcare in a 'one-stop shopping' facility can enhance willingness to access primary care and encourage users to avail themselves of a wider array of healthcare resources.

Organizational structure

GPHA makes use of a…