A philosophical question: How much medical training is needed to treat patients? Some say it’s the full course as proscribed by existing medical, nursing or dental schools. But when the shortages of doctors, nurses and dentists are ginormous, does the need require a different answer?
Consider oral health. “Shortages of dental practitioners and affordable dental care are hurting the health of millions of Americans, many of whom live with pain, miss school or work, and, in extreme cases, face life-threatening medical emergencies that result from dental infections. The situation is particularly severe for poor children and families and in communities of color,” writes Burton L. Edelstein, DDS, MPH Columbia University and Children’s Dental Health Project in a Dec. 2009 report for the W.W. Kellogg Foundation.
And, like most health issues, the data shows that Indian Country is at the low end of the spectrum. One study described it this way: “The American Indian / Alaska Native “population has the highest tooth decay rate of anypopulation cohort in the United States: 5 times the US averagefor children 2–4 years of age. Seventy-nine percent ofAIAN children, aged 2–5 years, have tooth decay, with60% of these children having severe early childhood caries (babybottle tooth decay). Eighty-seven percent of these children,aged 6–14 years, have a history of decay—twice therate of dental caries experienced by the general population.”
Has the Indian Health Service been an effective, government-run delivery system?
Consider this from a White House memo: “While there has been improvements in health status of Indians in the past 15 years, a loss of momentum can further slow the already sluggish rate of approach to parity. Increased momentum in health delivery and sanitation as insured by this bill speed the rate of closing the existing gap in age at death.”
In other words progress is slow. But Dr. Ted Marrs wrote the memo on April 26, 1976, and the subject was about the original Indian Health Care Improvement Act. “In 1974 the average age at death of Indians and Alaskan natives was 48.3. For white U.S. citizens the average age of death was 72.3. For others, the average age was 62.7.”
Dr. Marrs wrote that the “bottom line” was an unavoidable connection between “equity and morality” when there is a more than twenty year differential in age at death between Indians and non-Indians.
So what do the numbers look like now?
The most recent Indian Health Service data on general mortality statistics is about a decade old now. But it showed that the twenty-year differential has been reduced to a difference of less than five years. “The American Indian Alaska Native life expectancy at birth (both sexes) for the IHS service area population was 72.3 years,” according to the recent IHS report:“Regional Differences in Indian Health, 2002-2003 edition.” Compare that with the average life expectancy for all U.S. races, 76.9 years.
DETROIT – It’s hard to communicate the failure of public policy in this great American city (especially in a few hundred words). A drive around town highlights the consequences from decades of neglect: Abandoned and burned out homes, office buildings as ruins (and dangerous playgrounds), near-permanent unemployment, and thousands of empty lots capped with mounds. These mounds are burial sites of sorts because when a building was destroyed the rubble was left in a pile until time and grass shaped each into a small hill.
Yet the geography of despair includes many seeds of hope.
One east side neighborhood is transformed by inspiring folk art that brings humor and zest to several city blocks through The Heidelberg Project. Or there is the Community Health Awareness Group’s efforts to exchange needles so that drug users on the streets won’t as easily share disease. The program resulted in a drop of HIV infections from drug users from 33 percent to 17 percent. (And that, too, is the paradox because while an exchange is effective, it’s also difficult to fund). Then there’s the Earthworks Urban Farm. Detroit is a city without large chain grocery stores – only discount stores and “party stores,” or neighborhood enterprises that sell more liquor than protein. Access to fresh fruit and vegetables is a regular barrier for a family trying to eat healthier. But at Earthworks more people – at least in this one neighborhood – are growing their own access to healthy foods.
Congress passed the health care reform legislation – and President Barack Obama signed the bill into law. The Indian Health Care Improvement Act was included – and now we can put this debate to rest. Right?
Actually no. There are many more debates about health care reform to come – probably for years – and much work remains before this law can be implemented.
“Opponents will continue, and probably intensify,their opposition. They have promised legal challenges and arelikely to seek repeal of all or part of the legislation. Moreover,formidable implementation hurdles must be surmounted if healthcare reform is to achieve its goals,” Henry J. Aaron, Ph.D., and Robert D. Reischauer, Ph.D., recently wrote in the New England Journal of Medicine’s Health Care Reform Center blog. “On the political front, Republicans unanimously opposed thefinal bill in both the House and the Senate. They have expressedoutrage at the Democratic leadership’s decision to “ram through”reform using budget reconciliation to modify the Senate-passedbill sufficiently to make it acceptable to the House. The outrageis baseless, but the fury is real and will poison future debate.”
On top of that fury there are thousands of pages of federal regulations – words that will define complicated ideas like “quality” in the legislation – that still must be written and debated in draft form, before they can be implemented. And, as I’ve written before, this bill is only authorizing legislation. The appropriations process is on a different track that requires congressional action before some of the new ideas can be implemented.
How does a health care agency listen to patient complaints in the era of social media? Well, the easiest thing to do is to ignore complaints or to explain them away. The best practice: Treat complaints as critical nuggets of information.
Let’s start with a bit of context. The U.S. Department of Health and Human Services and the Indian Health Service have an extensive process for tribal consultation. There is a formula for listening to tribal leaders about its operation, priorities and budgets. There’s also an open line for internal IHS reform. The IHS collects data about best practices, ranging from treatments for cardiovascular disease to partnerships with traditional healers. This is a simple, but important, way to share ideas about programs or treatments that work.
So the context is that the Indian Health Service has an extensive practice collecting information – complaints – from tribal and community leaders. In general the Indian Health Service does a better job of listening to its constituents than most health care agencies. But that system was designed for another time.
So back to the question: How does a health agency listen to patient complaints in the era of social media? Each unit, clinic or hospital has a formal process, but most complaints aren’t filed, they are spoken between family members or said in the waiting room? How does a modern health care agency learn from those?
Three Sheets Northwest is an online boating magazine that has explored the delicate — and often perturbed — balance between environmental and economic interests during the all-hands-on-deck cleanup of Puget Sound.
Reporter Deborah Bach has been delving into the conflict between the bottom line and the health of the Sound by chronicling conflicts between the Puget Soundkeeper Alliance and five boatyards that the environmental watchdog group has threatened to sue for alleged violations of the federal Clean Water Act.
Sailors and reporters Marty McOmber and Deborah Bach, formerly of The Seattle Times and the Seattle Post-Intelligencer, launched Three Sheets Northwest to focus their reporting chops on boating in the Puget Sound region.
A Seattle program to rescue teenage prostitutes from the streets was going the way of budget cuts until private citizens stepped in with donations, ranging from checks of $5 to $100,000. Those contributions will help the city keep a pilot program designed to provide about 20 teenage prostitutes a year with emergency shelter, transitional housing and social services.
“People don’t want to overanalyze it. They hear it, they know it’s out there, they think it’s wrong and they want to do something about it,” said Terri Kimball of the Seattle Human Services Department.
Things got rolling in the fall, when a Seattle investment advisor pledged $100,000 to help launch the program. He then challenged others to match his donation, and those who did included the Gates Foundation and and Pearl Jam’s Stone Gossard and Mike McCready.
The investment advisor, who wishes to remain anonymous, has three daughters, and was moved to become involved after reading that there are between 300 and 500 teen prostitutes on the streets of King County at any given time. He and his wife usually donate to poorest Africa, he told Green in an interview, but decided to donate to this cause after reading of the need, and learning that there are only a few other residential rehab programs for teen prostitutes in the U.S. – in San Francisco, Los Angeles , New York and Atlanta.
While unemployment remains high and the economy down, folks are not looking inward and holding tight to their wallets. They’re passing school levies. They are thinking about the importance of the next generation of kids, other peoples’ kids, for the most part.
And the words school officials were using were “stellar” and “stupendous.” The support in many cases was well over the 60 percent mark. In Seattle, it was more than 71 percent in favor of two measures worth more than $700 million to pay for improved classroom offerings and construction projects.
So legislators, listen up. See that you take this lesson to heart. Your constituents are willing to open their wallets and hearts because they know the value of education to restart the economy and build futures. When it comes to funding K-12 and higher education in the state budget, see that you do the same.
President Barack Obama answered an important philosophical question last week: How will the federal government fully fund a starved Indian health system?
The answer is budget by budget: The administration boosted spending by 13 percent in fiscal year 2010 and is proposing another 9 percent increase for 2011. But this budget does not resolve the contradiction between “historic underfunding” and the larger reality about federal spending. The proposed budget calls for $5.4 billion in spending for Indian health care, ranging from clinical services to facility maintenance and construction. (The bulk of that money, $4.4 billion would be from appropriations, the rest comes from health insurance collections and special grants.)
HHS Secretary Kathleen Sebelius said: “Our budget also contains a significant increase in funds for the Indian Health Service as we continue to work to eliminate health disparities. It is the principle that we are trying to establish in our healthcare system – that regardless of race, ethnicity, gender or geography every American deserves high quality and affordable care.”
But while spending on Indian health is increasing – is it growing fast enough to catch up? There remains a significant gap between what is spent on an American Indian/Alaska Native patient than a federal prisoner, $2,130 per person versus $3,985. One measure used by the federal government is a benchmark based on spending for federal employees. The Indian Health Service is currently appropriated about 55 percent of that standard on per person basis.
Indeed, last April a tribal task force recommended a $2.1 billion increase in the budget authority for IHS in fy 2011. The tribal leaders called for a ten-year phase in of $21.2 billion to reach spending parity.
Sitting before a Senate subcommittee is a young mother. She is slim, pretty, intelligent . . . and full of dangerous chemicals.
Molly Jones Gray of Seattle testified this week in Washington, D.C., regarding human exposure to toxic chemicals. After participating in a study conducted by the Washington Toxics Coalition, a pregnant Gray was horrified to learn that her body contained a variety of dangerous chemicals. Gray said she was testifying not only on her own behalf, but also for her 7-month-old son Paxton. She told the Senate Subcommittee on Superfund, Toxics and Environmental Health:
On behalf of my son Paxton and all other children, I am asking for your help to lower our body burdens of chemicals that come between us and our health.