Healthcare disparities persist despite progress under Obamacare

With a recent national report indicating profound health disparities between Detroit residents and the rest of the county and state as the backdrop, Detroit's Wellness Plan Medical Center on Outer Drive, has announced an expansion of services. The services will include an onsite Urgent Care Center that accepts all insurances and is now open after hours and weekends at its Eastside location.

The move comes on the heels of this year's Robert Wood Johnson Foundation's 2016 County Health Rankings report indicating that Wayne County yet again, ranked last out of Michigan's 83 counties for both overall health outcomes and health factors.

The Foundation report not ed that in 2015, Detroit's infant mortality rate was 13.6%, compared to 6.1% in Wayne County (excluding Detroit) and 6.8% in Michigan. It's obesity rate was 37%, compared to 31% in Michigan. It's diabetes rate was 14.6%, compared to 10.4% in Michigan. And 18% of Detroiters reported poor mental health on at least 14 of the past 30 days, compared to 12.6% in Michigan.

Dr. Tiffany L. Sanford, the newly appointed Medical Director for The Wellness Plan Medical Center said the grim statistics are a reflection of the poor health outcomes that result from a high concentration of of poverty, intense racial segregation and the fact that many people in that situation often find themselves with facing social barriers to obtaining health care services in spite of now having health insurance under the Affordable Care Act.

"As a federally funded health center, we have to conduct routine assessments, and it soon became very clear that there was a need for Urgent Care services on the Eastside of Detroit," she said.

Sanford said her organization has four clinics serving the Metro Detroit area and Pontiac. But their internal assessments indicated the Eastside of Detroit had the greatest need for expanded services due to that section of the city being home to such a high density of poor people with chronic illnesses, inadequate transportation, inadequate access to healthy food sources and a lack of full service medical clinics to meet community needs - especially urgent care facilities.

Historically, the hospital emergency room has often been the first choice of many poor people for urgent care services she said.

However, a medical center's Urgent Care designation means if your doctor's office is closed or unable to accept appointments on that particular day and you have an urgent need to be seen due to a condition that requires an urgent evaluation by a medical professional, you can visit an Urgent Care Center without the cost and wait time of visiting a hospital emergency room.

The 2010 Affordable Care Act increased funding for community health centers, which provide comprehensive, high-quality preventive and primary health care. Health Center grantees in Michigan have received $208,926,298 under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces in medically underserved areas, to expand preventive and primary health care services.

Of that funding, more than $100 million went to the city of Detroit, according to a new report by the Center for Healthcare Research and Transformation at the University of Michigan.

Still, the website for the Detroit Department of Health and Wellness Promotion, as of September 2016 showed the city has only three public health centers servicing the city of Detroit. And the latest they stay open is till 6:30 pm - on Wednesdays.

There are however, independent privately run clinics like the Wellness Plan Medical Center that receive federal grants for some of their services. However, Sanford said they did not receive any funding from Detroit's $100 million under the ACA.

The Detroit Wellness Plan Medical Center was not the only East side health center shocked in to action by what the conditions they found on that side of the city. The Foundation reported that the Joy-Southfield Community Development Corporation (JSCDC) has operated in the neighborhood since 2001 and initially offered sorely needed, but basic, healthcare services to low-income, uninsured residents. However, it expanded its services in 2011 and developed what Dr. David Law, executive director of the JSCDC called an "ecological approach to promoting health equity," that addresses each of the four factors measured by the County Health Rankings: health behaviors, clinical care, social and economic factors and physical environment.

But Dr. Nancy Baum, director of Health Policy at the Center for Healthcare Research and Transformation, said the fact is, studies show that much of the gap that exists between communities of color and the general population in health too often stems from social determinants related to where they live. And as in the case of too many Eastside residents and other poor people around the state and country, in spite of new health insurance benefits many poor Michiganders must still contend with inadequate funding for local health departments, inadequate public transportation to get them to the clinics or medical specialists or support groups, pharmacies, grocery stores and most importantly, full service clinics in their communities.

"Everybody recognizes that healthcare is not the only thing that contributes to people's health," she said. "Living a stressful life, eating good food, transportation to get to places to buy good food do too."

"A healthcare system itself doesn't make up for all those things; health care makes people healthy, but it's one of only many things people need to be healthy," Baum said.