Hospitals are Abandoning the Poor – Give Us More Community Health Workers

Corruption Hospital Accountability Mexico Travel

Los Mochis     Driving across the Mexican state of Sinaloa, no matter you’re preconceived impressions, especially from Culiacan to Los Mochis, you feel like you’re in something close to the breadbasket of Mexico.  Hectares after hectares of corn, frijoles, and garbanzos.  Is this Bakersfield, California or is this Los Mochis, Sinaloa?  El Chapo and the cartel probably saw their fate in the fields from birth and decided to go after a money crop.  The farming operations are huge agribusiness giants, at least so it seems as the miles on the tollway stream by.  Relatively speaking, Sinaloa with a poverty rate of 30.9% is 21st in Mexico, which in US terms is terrible, but the southern Mexican states have rates two-times that level, making the northern states near the border seem richer.

Meanwhile north of the border there’s another kind of corruption that seems commonplace when it comes to the poor.  Yet another report, this time from the Wall Street Journal, looking at almost 500 transactions by tax-exempt, nonprofit hospitals, ostensibly receiving an estimated $8.8 billion in tax relief because they are charitable and serving the poor, found that these hospitals were closing more facilities in poor areas and expanding into wealthier areas.  Just a few of the examples included the fact that…

Since 2001, half the hospitals divested by CommonSpirit Health, a large Catholic system based in Chicago, were in communities where the poverty rate was above the medians for state hospital markets, compared with 30% of those it added.  At Bon Secours Mercy Health, formed by the 2018 merger of two growing regional nonprofits, about 42% of hospitals it divested were in areas with higher poverty, compared with 27% of hospitals it added.  Of hospitals divested or closed by St. Louis-based Ascension, about half were located in higher-poverty areas, compared with 40% of the Catholic system’s acquisitions.

My hair’s on fire.  This is disgusting and done in plain sight with impunity.

It’s no surprise that income, or the so-called social determinants of health, make it clear that your very life and time on earth is locked to your home address, your wealth, and of course your race.  In fact, reading Linda Villarosa’s Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation, it’s clear that it’s not just poverty and class – race trumps.  Villarosa is shrewd.  She personalizes her journey to this recognition, bringing the reader along with her in the dismantling of falsehoods and misconceptions, many that she had as well, until the conclusion that health is racialized is unavoidable.  Painfully, some of the horrific examples are from New Orleans-area tax-exempt, nonprofits like Ochsner and Touro.  On the high side, she props the New Orleans Doula Collective, which used to meet regularly in our community space at Fair Grinds Coffeehouse.  Of course, her overall recommendation is just stopping the discrimination that is killing people based on their race, gender, and poverty, but she also makes the case that the failure of doctors and hospitals to listen and heed the voices from their patients and the community could be alleviated with a wildly expanded program of community health workers (CHWs).  Part of the Biden federal Covid response funded expanded CHW programs and numbers, including in Louisiana, and that was a good thing.  These are the barefoot doctor equivalents that made the difference in China and Cuba decades ago and more recently in Ethiopia, Peru, and other countries.

Since our hospitals are all about the dollar, we can’t count on them without top to bottom reform, so having a small army of community health workers would save and extend lives at for pennies compared to what they are stealing.  How about we all start making that demand?