Ask a resident of North St. Louis what is available in their community for a person with mental health problems or crack addiction, and the response you would probably get is “jail.”
That startling perception points to a disturbing lack of access to health care for many thousands of North Side families, who live only a few miles from renowned institutions of health care that unfortunately feel like a world away from them.
Lack of mental health services was one of several issues cited in results released last week from a six-month study of North St. Louis health care access. A task force for the study included representatives from federally qualified public health centers, Barnes-Jewish Hospital, other health care providers and members of the St. Louis Board of Aldermen.
Dr. Will Ross, associate dean of diversity for Washington University School of Medicine, and 18th Ward Alderman Terry Kennedy co-chaired the task force.
The study, conducted by Research and Evaluation Solutions, Inc. (REESSI) and paid for by BJC, examined existing data and combined it with qualitative data obtained from focus groups of North St. Louis residents and task force members.
The report includes 18 recommendations to help eliminate disparities in the access to health care in North St. Louis. They included strategic planning; patient and staff education; community outreach; networking, collaboration and partnerships; funds to improve infrastructure, facilities and health care access; a health information clearinghouse; expanded offerings of medical, behavioral and dental services; and community policing.
“There was strong advocacy for community policing to increase the residents’ comfort in accessing health services after hours,” Ross said. “People want to see visible evidence of community-based policing, where police themselves do not appear apprehensive about walking around the neighborhood.”
Most of the recommendations addressed lack of services.
“The report emphasized the need for improved access to non-emergency care and expanded primary and specialty care in the North side,” Ross said.
Lack of primary care doctors in North St. Louis and low Medicaid and Medicare reimbursement for doctors are issues for health providers.
No insurance and no money to pay a doctor, along with a feeling of being unwelcome and disrespected, are issues for patients. Parents who cannot afford to take off work need alternate hours for health care. Long wait times that can require multiple visits also keep residents from seeking care.
The result: People just keep getting sick until they wind up in emergency rooms or in slow-moving waiting rooms in public clinics.
Ward 1 resident Antionette Bullay attended the recommendations meeting. She said St. Louis clinics are doing a wonderful job. However, with the closings of four North St. Louis-area hospitals over the years (Homer G. Phillips Hospital in 1979, City Hospital #1 in 1985, Normandy in 1993 and 2000, Regional in 1997), they are overwhelmed with patients.
“They are overcrowded. The doctors are overworked. People are sitting in the clinics like pack rats,” Bullay said.
“When they go to the hospital, they only have Forest Park, they can’t afford to go to Barnes. And the clinics can only do so much.”
New North Side hospital?
Bullay hopes the study will result in a new hospital in the heart of North St. Louis. However, there is no consensus among task force members.
“With a comprehensive approach to health care and with increased education about primary and preventive health care, we may find out the health of the community can improve without the need for a new hospital in North St. Louis,” Ross said.
“What is needed more urgently is increased funding for capital improvements, increased allied health providers and greater networking of existing community health centers.”
What the task force agrees upon is a recommended comprehensive health care “beacon.” Black aldermen want that beacon to represent good health, jobs and community cohesiveness in North St. Louis.
“One thing that Homer Phillips provided for our community is this example, this model that could inspire others to go into medicine, health care and related fields,” Kennedy said.
“There is nothing like that now and we are looking to hopefully engender that, to inspire that to happen and to get the funds to make it happen.”
Although there was no such thing as stimulus money when the task force convened, the report lists it as a possible funding source.
Kennedy said another facility could take the form of an urgent care facility or expansion of existing health center facilities that could reduce the burden on health centers and emergency rooms.
Both Ross and Kennedy said the study was the first of several presentations to get health access task force recommendations before the full Board of Aldermen, additional stakeholders and community members.
Kennedy said African-American aldermen pushed for a study to assess the health care needs of St. Louis residents when BJC sought to extend its lease on public land that is part of Forest Park.
Kennedy said the next step is to continue discussions with public health centers and with BJC.
“They are supposed to be linking some expertise and resources towards the various recommendations and then seeking other types of resources, both funding and expertise from other places to be able to implement it,” Kennedy said.
Melba Moore, commissioner of health for the St. Louis Department of Health and task force member, applauded Kennedy and others for leadership in calling for the study.
“It says for one, you are a value to us, we want to know what you think,” Moore said.
“This can only be resolved by us collectively working together to come up with a solution.”
Ross said he is also pleased with the cohesion and vision of the African American Aldermanic Caucus as its members embrace the need for a comprehensive approach to improving the health of the North Side.
“Our community needs real healing, and that sort of healing occurs when we address all the social factors that impact our health,” Ross said.
Moore said the message is getting through that preventive health is the way to improve the incidence of heart disease, diabetes and other health problems in St. Louis.
“The community is ready,” Moore said.
“When people say, ‘We want to know what we can do to prevent it,’ isn’t that the message that public health talks about?”
