Sunday, May 23, 2010

It Will Take Community Action To Improve Health For All

I've been traveling a lot recently, both a faculty development workshop focusing on working with underserved communities and to the world conference of family doctors (WONCA) conference.  As a result, I have a number of ideas bouncing around in my head as to how I can act to improve medical students' willingness and ability to provide care to marginalized communities but also how to work to provide care to all who need it--in the US and abroad.  Realizing that my direct impact will never be as great as I might like, it's still necessary to keep trying. 

As a result, I'm posting 2 links here that will probably influencing a lot of my thinking over the next few weeks:

--The first link shows the interplay of individual factors that affect health with social and community impacts and broader socioeconomic factors.  Each circle/level is acted upon by the levels outside of it, meaning that one can never fully address the health of the individual without also addressing the broader societal factors that lead to poor health outcomes.  How can we effectively target diabetes or high blood pressure when patients live in communities with poor access to nutritious foods, regular exercise, good education and jobs that provide for their individual and family health and well-being?

--This second link opens a table describing a new way to conceive of health care, as a social justice issue, not a market based issue.  If we agree with this new description of health (which really doesn't seem new at all, but rather a return to essential precepts of health and health care), then it would call for significant changes in our health care system: more primary care, more wellness and preventive care, but also more action on the broader societal determinants of health referenced above.

2 thought-provoking ideas.   I hope that they take hold, as I feel our patients, our nation, and our world will be better off if these became our standard-operating procedure.

Sunday, May 2, 2010

A Corollary

A few days ago, I wrote a post about the need to reinvigorate primary care.

This study shows the critical stage of primary care as of 2008--prior to the new health care reform that will expand health care availability.  Pretty sad to think that over 1/4 of physicians interviewed would choose non-medical careers if given a chance to do things over.

Saturday, May 1, 2010

Letter to the Editor, Virginia Free Press

Just a quick note that I had a letter published in the Virginia Free Press.  No surprise, it's about health care reform.  The content probably won't surprise you, either:


With all the noise, hot air and controversy concerning the health care debate over the last year, it is no surprise that folks might not know what the recently passed health care legislation actually includes.

As a physician, I am concerned that many people believe the “sky is falling” scenarios that they are hearing about the health care bill. My primary concern is the health of my patients, and making sure they understand their health care options are of key importance. My job is not helped by the misinformation that abounds concerning the recently passed legislation.

As I tell my patients, in the next six to nine months the health care law will have immediate benefits
that may directly affect their access to health care. The law will allow access to insurance for uninsured patients with pre-existing conditions and will eliminate pre-existing condition restrictions for children. Small business tax credits will be made available for purchase of health insurance. There will be $250 rebates for seniors caught n the Medicare Part D doughnut hole. The bill will immediately end cancellations of coverage and eliminate lifetime limits. Adult children can stay on parents’ insurance plans until they turn 26, making insurance available as they begin their professional careers or extend their education. Insurance plans will be required to provide key preventive and
wellness services. Finally, this bill will strengthen public health and community health centers to improve care to many of the most vulnerable Americans and will start addressing
the looming shortage in primary care physicians to care for the newly insured.

Once you get through the misinformation, it is honestly not a bad six to nine months’ work.