Community Health on the Frontlines

By Michelle Chen Mar 03, 2009

There’s a lot of hooplah these days about Obama’s political maneuvers on health policy, but health care reform is getting a more subtle, but no less systemic boost in the new stimulus package. The American Recovery and Reinvestment Act includes over $2 billion to build up the country’s system of community health centers—the clinics and facilities providing vital care to medically underserved areas. Overall, $1.5 billion for health center infrastructure investments, along with $500 million to fund operations. About $155 million in direct grants will go to community health centers across the country, to serve about 750,000 patients. The funding for the health centers, as they struggle to meet growing need, underscores the nexus of race, poverty, health care access, and the broader economic system. According to a 2007 analysis by the National Association of Community Health Centers, community health centers help bridge the gap between reliable primary care and the vast “medically disenfranchised population” concentrated in poor communities and communities of color:

Primary care characterized by enhanced accessibility, continuity, and interpersonal relationships with physicians is associated with better self-rated general and mental health, and is found to mitigate disparities related to income, race and ethnicity, and economic inequalities. Moreover, minorities living in poverty can make the most improvement through higher quality primary care.

Health centers fill a critical gap by providing medical, dental and mental health services regardless of the patient’s ability to pay. Within this infrastructure of “health care homes,” the NACHC explains, the centers:

• are required to be located in high-need areas identified by the federal government as having elevated poverty, higher than average infant mortality, few physicians in practice, or sufficient social and financial barriers to the existing healthcare infrastructure. • customize and tailor their services to meet the specific needs of their patients and communities. While nearly one-third of their patients are best served in languages other than English, 95% of patients report that their doctor speaks the same language as they do. • are committed to community health improvement and patient involvement in healthcare delivery. Community boards remain a key aspect of the health center model, ensuring that health center care prioritizes the particular needs of each community being served. This way of engaging communities to define their own health care needs and make care community-oriented is frequently an obstacle for communities that have no health centers and where care has traditionally been dictated by physicians and hospitals.

Clearly, simply supporting health centers won’t remedy the health care crisis, and the country is still a long way from a comprehensive, equitable national health system. But an expansion of locally rooted health facilities may go along way in alleviating unmet needs in marginalized communities–and also empower the communities themselves to achieve the wellness they deserve. Image: Patients line up outside Charlotte Community Health Clinic / T.Ortega Gaines, Charlotte Observer