Health equity devolves to cities and states as the federal government cuts taxes for the wealthy
I have a bunch of pieces on equity planning and social urbanism, touched off by my experience on a DC Grand Jury. As one of the court reporters said "breaking the cycle--man, we're just cutting the grass." I figured that the city spends a couple billion dollars a year on the impoverished in DC, just to keep them in place.
-- "An outline for integrated equity planning: concepts and programs" (2017)
-- "Equity planning: an update" (2020)
-- "Social urbanism and equity planning as a way to address crime, violence, and persistent poverty: (not in) DC" (2022)
-- "Experiments in Social Urbanism"
-- "'Social urbanism' experiment breathes new life into Colombia's Medellin Toronto Globe & Mail
-- "Medellín's 'social urbanism' a model for city transformation," Mail & Guardian
-- "Medellín slum gets giant outdoor escalator," Telegraph
-- "Medellín, Colombia offers an unlikely model for urban renaissance," Toronto Star
United Way Greater Toronto for more than a decade has focused its program funding on languishing impoverished neighborhoods ("Guiding the United Way through the next decade," Toronto Star). From the article:
United Way Greater Toronto just launched an incredibly ambitious 10-year strategic plan. We’re going to sustain the 10 community hubs we have and create 10 more. Hubs are like a one-stop shop for social and healthcare services in neighbourhoods that need it most. So, it improves access to services. It improves quality. It pulls together organizations under one roof, so it increases collaboration across organizations.
Our second goal is a community real estate vision. Seventy per cent of the community organizations we support are at risk of losing their space, and they’re also at risk of then being, in essence, priced out of communities that need them the most. We have a real focus on supporting those organizations to ensure the stability of those physical sites being owned by community organizations and stewarded for generations to come.
At least with the cities, the programs tend to wax and wane as new administrations succeed previous ones more committed to poverty.
If we think that cities (and counties, see "Pontiac Michigan: a lagging African American city in one of the nation's wealthiest counties" and "East County, Montgomery County, Maryland: Council redistricting spurs ideas for revitalization | Part 1 -- Overview") should focus on addressing poverty with place-based solutions, I'm thinking it's the same with health equity. Programs like Medicaid expansion--run at the state level in most places--provide health care to people who are medically needy.
This op-ed in City & State by NYC's health commissioner, "I am New York City’s doctor. This is how we treat chronic disease" makes the point that as the federal government cuts health programs (and medical research) cities and states should step up and fill the gap.
[RFK Jr.] has fired at least 20,000 employees from the Department of Health and Human Services. Billions of dollars in lifesaving medical research have been cut. Tens of millions of Americans, including millions of New Yorkers, will lose their Medicaid, Medicare, and Supplemental Nutrition Assistance Program (SNAP) benefits because of Republicans’ “One Big Beautiful Bill.” The record-breaking government shutdown multiplied the confusion and loss.
... My job is to support all New Yorkers in leading their healthiest lives, no matter their income or neighborhood. We have the experience and expertise to improve outcomes and even prevent chronic disease entirely. We know what approaches are proven to make a lasting impact.
That’s why, at the New York City Health Department, we recently released a city-wide chronic disease prevention strategy, which outlines how local government can address the root causes of chronic disease.
The strategy recommends promoting healthy living through nutritious foods and physical activity. But we must also meet people’s material needs. Improving access to basic resources – with direct cash payments, grocery credits and more – has a proven impact on health. And informed conversations around marketing, product design and creative media approaches can increase consumer awareness of the health impacts of the products they buy.When people can afford the things they need – housing, health care, the ability to put healthy food on the table – they aren’t waiting to be treated in the ER once they’re in crisis.
This also comes up in Chicago, with multi-decade differences in life expectancy based on race, income, and neighborhood ("As they live Chicago's 'death gap,' a 3-generation family fights to end it," Chicago Sun-Times).
I have a series of articles about developing a comprehensive program at the bigger city scale on health equity, but I never termed it that way. City and county poverty amelioration programs need to focus on health equity as an element of equity planning, and these entries lay out a way forward.
-- "Revisiting East of the River medical care: United Medical Center" (2018)
-- "Update on DC's plans to build a new United Medical Center" (2018)
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital" (2018)
Labels: change-innovation-transformation, civic assets, crime, criminal justice system, equity planning, health and wellness planning, health equity, policing, public safety, social urbanism, urban design/placemaking
posted by Richard Layman @ 3:30 AM&Permanent Link
13 Comments:
https://unbiasthenews.org/dollar-stores-food-deserts-in-chicagos-frontline-communities-redlining/
Dollar stores, diesel fumes and food sovereignty in Chicago’s frontline communities
Understanding and Addressing Racial Disparities in Health Care
Health Care Financing Review, 2000
https://pmc.ncbi.nlm.nih.gov/articles/PMC4194634/
Racial disparities in medical care should be understood within the context of racial inequities in societal institutions. Systematic discrimination is not the aberrant behavior of a few but is often supported by institutional policies and unconscious bias based on negative stereotypes. Effectively addressing disparities in the quality of care requires improved data systems, increased regulatory vigilance, and new initiatives to appropriately train medical professionals and recruit more providers from disadvantaged minority backgrounds. Identifying and implementing effective strategies to eliminate racial inequities in health status and medical care should be made a national priority.
On the hook for uninsured residents, counties wonder now how they’ll pay
https://www.ocregister.com/2026/01/06/on-the-hook-for-uninsured-residents-counties-wonder-now-how-theyll-pay/
This is about Ontario, but still relevant to the US.
https://www.thestar.com/opinion/contributors/reducing-ontario-health-care-waits-six-solutions-avoiding-privatization-pitfalls/article_9db9be78-d44b-4bfe-8809-637452c5d0b9.html
Reducing Ontario health care waits: Six solutions avoiding privatization pitfalls
- need more beds, need more beds in nursing homes, rehab, and long term care
- Why do operating rooms close by 4 p.m. while patients are stuck on wait-lists? If Ontario can find billions to build private clinics, it can afford to run its own ORs past 4 p.m.
- more family doctors and a better system of preventative care
- wait times for certain specialties are worse than others. Single‑entry models put referrals into a single queue so patients get assigned to the first available specialist. This reduces wait times and prioritizes patients.
- lack of access to health records.
Actually in the US, with the use of Electronic Health Records this isn't an issue. It can be a problem if you are a patient in multiple systems, although most systems do provide a way to share, at least in Utah.
- better records for vaccines
Again, with good EHR systems, this isn't a problem in the US.
St. Francis Hospital, Wilmington, DE, Healthy Village concept
Healthy Villages are located in economically challenged neighborhoods and are designed to enhance the traditional safety net hospital model. The partners are typically organized and engaged according to investments in the Social Influencers of Health:
Economic stability (e.g., meaningful jobs and careers)
Safe neighborhoods (e.g., housing, transportation, parks, retail services)
Education (from literacy to higher education and everything in-between)
Food security (including good nutrition)
Social support (e.g., childcare, adult daycare)
Health care (e.g., emergency services, short-term stays including observation beds, post-acute care such as behavioral health and skilled nursing, primary care, care management and access to quality specialty care when needed)
======
https://delawarelive.com/saint-francis-hospital-sees-healthy-village-as-national-social-services-model-for-healthcare/
https://delawarelive.com/saint-francis-hospital-sees-healthy-village-as-national-social-services-model-for-healthcare/
Located in economically challenged neighborhoods, Healthy Villages are designed to enhance the traditional safety net hospital model.
“The goal is to create the ultimate one-stop care setting that promotes synergy, diversity, and equity,” said Lillian Schonewolf, executive director of the Healthy Village at Saint Francis, in a YouTube video.
According to Marlow Levy, who became president of Saint Francis Hospital and Mercy Fitzgerald Hospital in Darby, PA, in August, Saint Francis is the only hospital in the country with a Healthy Village.
======
Why St. Francis is making housing and community services priorities at the hospital
https://www.delawareonline.com/story/news/health/2022/09/02/st-francis-community-health-with-partners-within-hospital-healthy-village/65418073007/
To address these needs, Delaware's only Catholic hospital has announced plans to treat much more than medical conditions with the inception of its Healthy Village, an endeavor that intends to locate organizations offering community services inside the 98-year-old hospital.
"Taking care of someone's medical needs is really only 20% of their care," said Lillian Schonewolf, Trinity Health Mid-Atlantic's Vice President for Community Health and Well Being and Healthy Village's Executive Director. The other 80% includes addressing a person's behavioral, social and environmental well-being.
Based on research the hospital conducted that focused on Wilmington's west side, Schonewolf said they found the area's top concerns include trauma from gun violence, lack of healthy food options, housing issues, and behavioral and mental health treatment. Additional interviews with residents in the hospital's surrounding neighborhood also identified education, job training and senior care as desired services.
Through partnerships with community organizations, service providers will occupy whole floors or just an office inside the hospital to allow St. Francis' patients — many of whom do not own vehicles — a convenient one-stop shop of sorts for vital resources. Healthy Village partners will pay for their space inside the hospital, along with electricity and water. Administrators said they also anticipate increased usage of the hospital's cafeteria and environmental services.
Safety Net Barriers Add to Child Poverty in Immigrant Families
https://www.nytimes.com/2023/04/06/us/politics/child-poverty-immigrants.html
New research shows we pay doctors less to care for Black and Latino patients than white ones
We get what we pay for. In the U.S., doctors are paid very different sums for different patients, even when providing the same service.
https://www.inquirer.com/opinion/commentary/healthcare-doctor-pay-less-black-hispanic-patients-20260111.html
Our new research shows that practices receive 8.8% less for visits with Black patients and nearly 10% less for Hispanic patients than for their white peers. For children, the gaps are even wider. Physicians got 13.9% less for visits with Black children and 15% less for Hispanic children.
https://ldi.upenn.edu/our-work/research-updates/new-national-study-finds-doctors-paid-less-for-treating-black-and-hispanic-patients/
We get what we pay for. In the U.S., doctors are paid very different sums for different patients, even when providing the same service. Commercial insurance tends to pay the most. Medicare, which primarily serves older Americans, pays less. And in most states, Medicaid, which serves low-income Americans, pays the least.
What does this mean for a child on Medicaid? Many physicians refuse to treat anyone with Medicaid. When researchers posed as parents and called pediatrician offices seeking an asthma appointment, over half of callers with Medicaid were denied appointments.
Yet, when these same clinics received a call about a child with private insurance, every single one offered an appointment. Financial incentives matter.
This disparate pay will only worsen after the largest funding cut in Medicaid’s history. The recently passed “One Big Beautiful Bill Act” reduced federal Medicaid support by roughly $1 trillion over the next 10 years.
States now face three options: remove people from Medicaid, cut optional services, or further reduce what they pay providers. States like North Carolina have already moved to cut doctor pay, and others will likely follow suit.
Even among patients with similar coverage, like commercial insurance, Black and Hispanic patients still found themselves in plans that paid doctors less. These differences amount to a “tax” physicians face for treating patients whose health insurance pays less. This tax not only penalizes physicians in safety net roles but also shapes which patients ultimately get treated.
Physicians provide more care when they are paid higher prices. One frequently cited study showed that raising physician payment by 2% resulted in 3% more care provision. Based on this figure, we project that eliminating pay disparities would cut the gap in general checkup visits by more than half between white children and Black or Hispanic children.
As long as we provide less incentive to treat some patients, we will get what we pay for: a system that falls short for people with less, especially children. Reversing this trend will require strengthening Medicaid rather than gutting it. Raising Medicaid payments to doctors to be equal to Medicare rates would improve access, evidence suggests. But reforms like this require investment.
https://www.nejm.org/doi/full/10.1056/NEJMsa1413299
In Philly, Medicaid and SNAP cuts will be big — but not beautiful
Roughly a third of city residents rely on Medicaid and SNAP benefits. They are not abstract budget numbers. They are policy decisions that will impact the health and dignity of our neighbors.
https://www.inquirer.com/opinion/commentary/big-beautiful-bill-snap-medicaid-cuts-impact-philadelphia-20260526.html
According to the Pennsylvania Partnerships for Children, Philadelphia County is projected to lose $11.4 billion in Medicaid and SNAP funding between 2027 and 2034.
In our city, 34% of residents — including 68% of children — rely on Medicaid for healthcare coverage. In 2023, nearly 30% of Philadelphians received SNAP benefits to help put food on the table. As these cuts take effect, thousands of residents are expected to lose Medicaid coverage entirely, while many more households could lose some or all of their food assistance.
Behind every number is a family struggling to afford groceries, a child in need of medical care, or a senior depending on long-term support services. These are not abstract budget numbers. They are policy decisions that will directly impact the health, dignity, and well-being of our neighbors.
The impact will ripple throughout the city’s healthcare and social service systems. Hospitals, community health centers, nursing homes, behavioral health providers, and food assistance programs all will face increasing strain. Cuts of this magnitude threaten not only healthcare access, but also the stability of families already under economic pressure, seniors, and the disabled.
Thousands drop health insurance in Mass., and picture is expected to get worse, experts say
https://www.bostonglobe.com/2026/05/27/business/massachusetts-aca-health-connector-subsidies-expired-uninsured
Also left struggling were many noncitizen immigrants with legal status and incomes below the federal poverty level. About 66 percent of that group surveyed, who are not eligible for full Medicaid coverage, reported being uninsured.
Double-digit premium hikes push Michigan small businesses to reconsider health coverage
https://www.crainsdetroit.com/health-care/cgr-sbam-survey-20260526
More than 40% of Michigan small business owners say they may have to decide within three years whether to drop employee health coverage altogether, as years of double-digit premium increases push them to a breaking point.
Another 16% said they may have to consider dropping health benefits within four to six years because they cannot continue to absorb the rising costs, according to a Small Business Association of Michigan May member survey.
The survey results are “shocking numbers in terms of their scale and implications, but not surprising,” Small Business Association of Michigan CEO Brian Calley told Crain’s.
Employers for a decade have steadily adjusted health benefits to manage rising costs, and now “more and more are questioning their ability to continue, and the ramifications for that are enormous,” Calley said.
“We have reached a breaking point,” he said. “What they’re telling us is they can’t do it anymore.”
The high cost of employee health benefits “is like a built-in incentive to explore AI,” Calley said.
https://www.detroitnews.com/story/opinion/2026/05/27/investing-in-healthy-babies-can-grow-michigans-economy-hanna-opinion/90275046007/
At the Mackinac Policy Conference, Michigan leaders are gathering to discuss economic growth, workforce development and the future of our state. This year, that conversation also includes recognition that investing in healthy babies is investing in Michigan’s future.
The state has already begun to make that investment. Last year, Gov. Gretchen Whitmer signed a bipartisan budget that included a $250 million investment in Rx Kids, a first-in-the-nation maternal and infant health program that provides direct support to pregnant moms and babies.
This is one of the smartest investments Michigan has made in decades.
Rx Kids was built around a simple idea: if we want healthier babies and stronger communities, we must invest early. The program provides pregnant moms with $1,500 during pregnancy and $500 monthly during infancy. Launched in Flint in 2024, Rx Kids has now expanded to more than 40 communities across Michigan, from Detroit to the entire Upper Peninsula, because the results are hard to ignore ― families are more stable and moms and babies are healthier.
This week, new peer-reviewed findings published in The Lancet Public Health provide some of the strongest evidence yet that reducing financial stress during pregnancy improves birth outcomes at a population level — including lower rates of preterm birth and costly neonatal intensive care admissions. This adds to recently published research in JAMA Pediatrics showing a 32% reduction in child welfare investigations among infants.
These findings are a big deal. They show that when we address the social drivers of health early and at scale, we can improve outcomes not only for individual families, but for entire communities.
The returns extend far beyond health. Healthy babies help build healthy economies.
Rx Kids is not only reducing downstream medical and social costs, it is also strengthening local economies. The costs of infancy add up fast, and families spend this support quickly and locally at grocery stores, childcare centers and neighborhood businesses. An independent analysis by the W.E. Upjohn Institute for Employment Research found that this spending circulates and multiplies through communities, creating hundreds of jobs and generating broader economic activity.
When Profit-Driven Clinics Kick “Noncompliant” Patients off Dialysis, Is Anybody Watching?
https://www.motherjones.com/politics/2024/05/dialysis-davita-fresenius-involuntary-discharge/
Regular maintenance not only improves the appearance of a property but also helps prevent larger problems in the future. Whether it's repairing doors, installing fixtures, or performing seasonal maintenance, a trusted handyman service ensures that every task is completed safely and professionally.
Post a Comment
<< Home