Our Quote of the Week is from 1967 but it highlights a problem that continues to be true today: that our for-profit health care system virtually shuts out the poor, making it impossible for all of us to have equal access to care.
Sargent Shriver spoke these words at the first American Medical Association National Conference on Health Care for the Poor. He was speaking in his capacity as Director of the Office of Economic Opportunity (OEO), the entity that created and managed the programs of the War on Poverty. In his speech, he outlined the many ways in which being poor impacts one's health in the United States. He mentions, among other issues:
- that poor children go without medical and dental care and are much more likely to die before the age of one
- that the poor are disproportionately affected, and have a higher mortality rate, by certain diseases
- that poor communities suffer from being what we would refer to today as "medical deserts," i.e., areas that have no health care providers or facilities at all
- that poor women using public hospitals have little or no access to pre-natal care
- that African American pregnant women in particular have a startlingly higher mortality rate than white women
In short, to use Sargent Shriver's own words: "for a poor person in America, poverty is not something you just feel in your pocketbook or wallet. You feel it in your body."
To address the issue of health care, as Sargent Shriver describes, the OEO created Neighborhood Health Centers (now known as the National Association of Community Health Centers), which expanded access to health care in poorer communities. Some other OEO programs, including Community Action and Head Start, also incorporated health services into their offerings over time.
While all of these services continue to exist today, the issues that Sargent Shriver describes persist and are exacerbated by our health insurance system. Even with the gains made in coverage after the passing of the Affordable Care Act (ACA), otherwise known as Obamacare, millions of Americans continue to have no access to health insurance. According to a CDC report published earlier this year, as of 2020, it is estimated that 31.6 million people remained uninsured – that’s 9.7% of the US population. Inflation has made it even more difficult for the poor, particularly in Black, Indigenous, and LatinX communities, to access health care. And our institutions often make it difficult to make health care more affordable. Just this past weekend, for example, 43 Republican senators blocked a proposal to cap the cost of insulin, a diabetes treatment on which 7 million of the nation’s 37 million diabetics rely, at $35 dollars per month. The cost of insulin has tripled in the past 10 years, and a monthly supply can cost up to $1,000 in some states. The exorbitant cost of insulin has led some people suffering economic hardship to ration the drug, which has caused other serious health issues (loss of vision, kidney disease) and put lives in danger.
Inside the health care crisis, however, there lie opportunities to implement creative solutions that will bring equity to economically disadvantaged neighborhoods. For example, to accelerate the pace of COVID-19 vaccinations in every community in the US, the vaccination program was expanded in March 2021 to include more than 950 Community Health Centers around the country. Many communities have also joined the mobile vaccination unit program, bringing vaccines to underserved areas. These developments are wonderful examples, but much more must be done to ensure that, from infancy to old age, all people living in the world's wealthiest nation can have easy access to the services they need to maintain good health, not just during a pandemic, but each and every day.
The COVID-19 crisis has shown us the many ways in which Sargent Shriver's words still remain true today. Any local map of COVID-19 cases and deaths by zip code shows that poorer neighborhoods have consistently had higher case numbers and mortality rates from the virus, and that communities of color have been disproportionately affected.
With the COVID crisis and in general, many conservative voices argue that we cannot afford to care for everyone. But looking at the human cost of the approach to health care in this country, we should really be asking: how can we afford not to care for the health needs of every member of our population?