What Keeps Me Up At Night

As an advocate at Woodhull Medical Center for a nonprofit organization that strives to address social determinants of health, I find my work both riveting and frustrating. Each week, I call a number of my clients, most of whom do not speak English, and the others hardly answer the phone to begin with.
How does a public health professional become a catalyst for change and empower those they work with?
I feel like I fail week after week when I do get in touch with my clients and they tell me things like “Oh I did not have time to go an apply for health insurance” or “I do not see the value in going back to school and taking GED classes when I need to work.” How do you convince someone that these social needs are actually essential? It is nearly impossible to create a sense of agency for someone who finds a need like adult education undesirable or inaccessible…but that is why the field of public health captivates me. Each day I try to find unique ways to market to my clients value-value in their own health. It is one thing to exhaustively explain to someone that educational status is in fact a lead indicator for poor health, and it is not always clear to everyone the impact of their routine on their overall quality of life. When clients of mine fear even setting foot into a hospital, you know there needs to be a change.
New York City has an abundance of resources. If there is one city in the United States that can address some facet of health, this would be the place, and though I am going to make a rather broad generalization, I do not believe every organization makes the most of their potential to maximize resources. I should not have to explain to someone living in one borough that they are better off traveling into another borough to receive quality service, or that help with their need does not exist in their specific borough. This goes back to the notion of accessibility and acceptability.  Is it feasible to ask someone to travel for a class or to fill out an application? (I hope you agree with me that the previous question is rhetorical). If the resource landscape in New York City as a whole is so robust that every other major city in the US looks to us to inform their own public health agenda, then why shouldn’t that be the case in each borough? Would overall health increase by providing permanent solutions to address borough-specific social determinants? It is by no means a panacea, and I know I am not the first person to question the system, but it is just some food for thought. My mind continuously wonders about my role in the public health of our community, and so, why not think about your own?
Written by Pilar Mendez
Contact: pmendez@latinoaids.org

 

The 49th Anniversary of Medicaid and Medicare

This week marks the 49th Anniversary of Medicaid and Medicare. On July 30th, 1965 President Lyndon B. Johnson signed the Medicare Bill into Law at the Harry S. Truman Library in order to improve the state of health care in the United States. Forty-five years later the Affordable Care Act was signed into law, but the hopes for Americans have not changed much since 1965.  Back  then, President Johnson noted,

“No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.”[1]

 Today, after four years of the signage of the Affordable Care Act, we still have American families that are not accessing the medical care they need because of lack of health insurance and the means to do so. The Deep South States are especially impacted as health outcomes continue to worsen and health disparities and poverty continue to increase.  In part this problem continues to exist because there are still states that have not expanded Medicaid.

Increase in Number of People with Insurance if Deep South States Expands Medicaid[2]
States that have not Expanded Medicaid (July 2014) People with Insurance Coverage in 2016
Alabama 235,000
Florida 848,000
Georgia 478,000
Louisiana 265,000
Mississippi 165,000
North Carolina 377,000
South Carolina 198,000
Tennessee 234,000
Texas 1,208,000

 

We must set a goal in order to reach Johnson’s original vision.  It would be so grand for our health system and overall well-being if we were to have Medicaid expanded in the 24 remaining states.  It would be to our collective benefit to cover all 5.7 million Americans who would be eligible for Medicaid but are currently deprived of health care.  I hope that for the 50th Anniversary, we will be celebrating the expansion of Medicaid in our home states in the South.

[1] Lyndon B. Johnson: “Remarks With President Truman at the Signing in Independence of the Medicare Bill.,” July 30, 1965. Online by Gerhard Peters and John T. Woolley, The American Presidency Project. http://www.presidency.ucsb.edu/ws/?pid=27123.

[2] Excerpts taken from Buettgens M. Kenney GM, and Recht H. “Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States.” Washington, DC. Urban Institute, 2014, http://www.urban.org/uploadedpdf/413129-Eligibility-for-Assistance-and-Projected-Changes-in-Coverage-Under-the-ACA-Variation-Across-States.pdf

Written By: Judith Montenegro.

Where are We Headed? IAC 2014 theme of the day.

As the International AIDS Conference wraps up in Melbourne, Australia we are asked to ponder “Where are we headed?” Our CBA Specialists shine some light on where they believe the HIV field is moving henceforth… Use the comments section below to let us know where YOU think the HIV/AIDS field is going to!

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Stepping Up the Pace: IAC 2014 theme of the day.

In-Home HIV Test and an HIV Free Generation

Today’s theme at the IAC2014 is “Stepping up the Pace.” This theme seems to me like the perfect call to action that we all should heed to. The new biomedical interventions like PrEP and treatment as prevention have been making headlines all over the world. There is no denying that the science community has been active doing their share of the bargain. What about us, the general community? Continue reading

My First Step in “Stepping up the Pace”

When recently asked what we can do to step up the pace in our efforts to end the AIDS epidemic, I was instantly reminded of a recent email from the Student Global AIDS Campaign (SGAC). The email was urging us, as constituents, to plead with the senate and foreign operation subcommittee to move the $300 million dollars that are unable to be appropriated to the Global AIDS Fund into the President’s Emergency Plan For AIDS Relief (PEPFAR). Continue reading