Rebuilding Place in the Urban Space

"A community’s physical form, rather than its land uses, is its most intrinsic and enduring characteristic." [Katz, EPA] This blog focuses on place and placemaking and all that makes it work--historic preservation, urban design, transportation, asset-based community development, arts & cultural development, commercial district revitalization, tourism & destination development, and quality of life advocacy--along with doses of civic engagement and good governance watchdogging.

Thursday, May 21, 2020

Blaming the victim vs. blaming the system: Federal officials blame pandemic deaths on poor health practices of individuals

Yes, I have covered this issue a bunch already:

a couple pieces in response to the pandemic

-- "More communities need to integrate health care and public health programming: Prince George's County, DC, etc."
-- "Rush Medical Center (Chicago) clues us into a gap in state and regional health care planning: planning for disaster and epidemic response"

and a 2018 series outlining how a rebuild of United Medical Center in Ward 7/East of the River could be transformational both in terms of health care and public health outcomes as well as an economic development initiative, by marrying it with the simultaneous development of an advanced medical education and research program next door at the St. Elizabeths Campus, which the city has been trying to redevelop for more than a decade, with little to show for it.

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus"
-- "Part three: the potential for donations around an expanded program"
-- "Update on DC's plans to build a new United Medical Center"
-- "Community Health Improvement Planning"
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital"

But the issue isn't going away.  Whether or not we deal with it is another matter entirely ("Why we can’t build: America’s inability to act is killing people," Vox).

Collective versus the individual. Maybe because I had a "tragic childhood" which put me into the social welfare system, I've had empathy for people in need and a predilection to understand the value of the "collective" and the idea of public and social goods and community welfare.

Shockingly, there is a "politics" to the response to the pandemic, and two countries doing the worst in dealing with it, the US and the UK, are marked by a strong adherence to a neoliberal ideology and approach to government, one that aims to minimize the collective response and functioning of government to the maximum extent possible.

Blaming the victim versus...
The Guardian has an article, "All the psychoses of US history': how America is victim-blaming the coronavirus dead," about how top federal officials are "blaming the victims" of the coronavirus because they have "bad health" and pre-existing health conditions that make them more susceptible to illness and death.

...Recognizing structural failures and responding appropriately.
Equally, this fact--that people with pre-existing health conditions, those experiencing long term poverty, racism ("Racism and Covid-19 Are a Lethal Combination," The Nation) and the aged are more susceptible to the coronavirus--could equally be used to call attention to failures in the provision of health care in terms of maximizing health and wellness and inadequate investments in public health.

That was the response in the UK during World War II, when the country's elected officials couldn't ignore the relatively poor health of military recruits, and people who migrated from cities to rural areas. The response was to create the National Health Service, which provides health care to "everyone," in part organized through a network of family physician practices covering every part of the country.

By contrast, while "Obamacare" provides the opportunity for insurance for all, it didn't ensure that everyone covered would have access to a network of family physicians or community clinics. This is why the Affordable Care Act hasn't resulted in a decline in the use of emergency services--the hospital ER is still treated as the community clinic and doctor's practice for people who don't have a "family doctor."

And without resources directed "beyond the hospital" and the fact is that the ACA is focused on providing acute care in the hospital setting, ongoing population health problems leading to chronic conditions such as diabetes, obesity, heart disease, and cancer and not addressed in substantive ways either.

So it should not be a surprise that kinds of positive health outcomes expected from expanding the access to health insurance haven't come about.

Hospital and physician practice funding.  Another problem of the current system that has come up as a result of the postponement of elective procedures and other health care programming is that hospitals ("261 hospitals furloughing workers in response to COVID-19," Becker's Hospital Review) and physician practices ("Small medical practices struggle to survive amid coronavirus pandemic," Washington Post) are running out of money and are furloughing employees.

Health care provision needs standby capacity and should be moved somewhat outside of marketization.

Creating a public health extension system. And how the persistent defunding of public health both nationally ("Reform the CDC to fight the next pandemic," Washington Post) and at the state and local levels calls for rearticulation of these systems.

While there is long standing connections and integration between the CDC and other federal agencies, state and local public health agencies, and schools of public health and medicine, I argue that they need to be even more strongly intertwined into a more defined and active network modeled on the agricultural extension system, which links the US Department of Agriculture and its research stations to colleges of agriculture and a network of extension agents operating at the county level in most places in the country.

Conclusion.  Both the provision of health care and the organization of public health systems ought to change as a result of the pandemic.  They probably won't.

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