e-Transition: Affordable Health Care Blog

Recommendations for the DOH

comments by Dr. Michael E. Zeilinger.  Download RecommendationforDOH.pdf

HIV/AIDS: Between Promises and Performance

for comments, attached.  Download hiv_aids.doc

DC's Teen Health Page

In the summer of 2006, DC Campaign to Prevent Teen Pregnancy launched our Teen Health Page, a comprehensive listing of medical clinics in Washington D.C. where teens can get health care. The Department of Health should be providing a link to the Teen Health page on their website shortly. We hope the Teen Health page can be a resource for teens and all who care about their well-being, including the new government leaders, in assuring access to medical care for every District teen. The Teen Health page can be viewed here , or you can visit our website at www.teenpregnancydc.org.

Health Pre-Transition Team Executive Summary

Download health_executive_summary.DOC

Pre-Transition Health Team Final Report

Download pretransition_health_final_report.DOC For Comment

Healthy Cities Require Smart People and Smart Governments

Potential Near-Term Actions (too late?)

1. The mayor should make it abundantly clear that health issues are directly related to educational deficits and the poverty that results, and that solutions will involve strong cross-agency efforts;

2. ...and call for greater regional cooperation in solving the region’s common health problems;

a. Necessary but Not Sufficient:

NARPAC is very impressed by the thoroughness of the Fenty health care plan, and agrees with virtually all the recommendations it understands We are also pleased to see the concept of a new National Capital Medical Center ignored.  But we still see room for improvement:

o We were sorry not to see any reference to the blot on our national image as the US capital city brought on by all the unfavorable health statistics. Some of them come much too close to Third World standards, and some of them are for the same reasons.

o We are always disappointed when we see no mention of the role of  “faith-based institutions” in helping “reach” some of those who are hardest to reach, and most in need medical attention and/or changes in their life-style. In a city where there are so many churches and so many pastors determined to insinuate themselves into local political processes, why shouldn’t they accept some responsibility for the physical health of their flocks, as well as  their spiritual and political health?

o NARPAC sees the same imbalance here as in the public education domain: too much emphasis on making better health care available (the teaching side) and too little emphasis on the patient-receptivity side (the learning side). Here, however, it is not just a simple matter of parental encouragement. While uninspired students are young, the chronically sick are most likely far older and far more likely to be on their own. Who, then, will push these needy toward their salvation?

o A few minutes of “googling” identifies any number of reports linking poor health and illiteracy. Fenty highlights the serious education problem associated with DC’s embarrassingly high number of “functionally illiterate”, frequently quoted at one-third of all DC adults. Those who cannot read about their illness, read about how to get help, fill out insurance forms, or read the instructions their doctors have provided are surely not likely to be highly motivated or capable of getting well.

o Poor health is evidently linked to poverty (and illiteracy), but it is also likely associated with living alone, being the only adult in a household, or having no concerned employer. There is probably no stronger interest in one’s health than his or her live-in partner, relative, or spouse. Here again, DC is at a strong relative disadvantage. DC has a far higher (and growing) share of lone householders than the rest of this metro area, and a larger share of one-parent family households as well. Finally, DC has over 90,000 people over 45 yrs old that are either “not in the work force” or “unemployed”. Almost two-thirds of them are women. These older generations are clearly at greater risk, with an increased likelihood of being both poorly educated and alone.

o The misuse of DC’s (rather inefficient) emergency medicine capabilities has also drawn our attention in the past. Like it or not, more attention needs to be paid to the budgetary impact of trying to provide health services to a large population that does not really understand its health problems, how it got them, how it can get rid of them, or who would pay for it. 

Based on the foregoing, NARPAC seriously doubts DC’s very serious health-related problems will be solved within 10 years, unless there is more emphasis on adult education and poverty alleviation (or re-distribution). It will not help much to build and fill a larger water trough if the horse can’t be lead to water or made to drink.   

b. developing a regional context:

As in our other blog inputs, we find it strange that there is virtually no reference to the possibility of developing greater regional approaches to many of these health problems. There is no place in DC further than three miles from a neighboring jurisdiction, and no neighboring jurisdiction that does not share the same health problems, albeit to a lesser degree. Someone in the extensive health care advocacy world should take on the basic issue of identifying specific opportunities for expanding regional health solutions for the benefit of the whole national capital metro area.    

c. free plugs for NARPAC:

o We dissected the DC FY00 Human Services budget several years ago at http://www.narpac.org/HSI.HTM#hsnewbud but have not returned to it since;
o We took a close look at the American College of Emergency Physicians (ACEP) “National Report Card” earlier this year at http://www.narpac.org/HSACEP.HTM and noted DC’s apparently inefficient application of emergency medicine;.
o and we expressed our disapproval of the NCMC at http://www.narpac.org/HSNCMC.HTM .

Health Care Safety Net Report

Download healthcare_safetynet.DOC for comments.

Fire & EMS Report

Download fireems.DOC  for comments

HIV & AiDS Report

Download hiv_aids.DOC for comments

Health Care Workforce Shortage Report

Download healthcare_workforce_shortage.DOC  for comments.