Every year, 30,000 uninsured St. Louisans living in poverty get access to health care through the Gateway to Better Health program.
Of those carrying “Gateway cards,” 50 percent have diabetes or hypertension – or both.
“We are doing a good job of getting them into our medical centers when they’re sick,” said Rob Fruend, CEO of the St. Louis Regional Health Commission, which organizes and monitors the program. “But we started thinking – what if they didn’t show up so sick in the first place? And what’s driving that?”
The commission found that the root cause of these conditions is often toxic stress and trauma.
“And we realized just how under-reported this is,” Fruend said.
Addressing toxic stress and trauma is the next movement in public heath, Fruend said.
“It’s almost like when they discovered germ theory at the turn of the century or when we figured out that smoking kills,” he said. “It’s that revolutionary. Toxic stress and trauma is the new smoking in terms of how we are just figuring out how bad it is on your body and how poorly resourced we are in communities to address it.”
Just before Ferguson erupted, the commission launched a campaign called Alive and Well STL to raise awareness about stress and trauma. Fruend said the commission had heard from community members that residents were so stressed they knew “something is going to pop.”
“The relationship between trauma and stress to impacting physical health is clear based on research,” said Peter Sortino, chairman of the commission and assistant vice chancellor of Washington University in St. Louis. “We felt strongly that St. Louis needs to keep up with these findings.”
On April 29, the St. Louis Regional Health Commission will receive the Health Advocacy Organization of the Year award at the St. Louis American Foundation’s Salute to Excellence in Health Care luncheon at the Frontenac Hilton. It is being awarded for its important contributions to providing greater access to health care for the uninsured.
The commission was founded in 2001, following the closure of the last remaining public hospital in St. Louis, when the region faced a fiscal crisis jeopardizing its “healthcare safety net,” Fruend said.
Civic Progress, an organization comprised of the leading corporate executives in St. Louis, formed a task force to address the crisis. The participants recommended the formation of a Regional Health Commission, a consortium of government representatives, providers of care, and members of the community charged with developing and implementing a long-range plan to improve health care access and delivery to the uninsured and underinsured.
Sortino said one of the commission’s proudest achievements has been integrating primary care with behavior health services throughout the past six years.
Another is the Gateway to Better Health program, which provides up to $30 million annually in funding for primary and specialty care, as well as other outpatient services.
“Missouri unfortunately has yet to expand Medicaid,” Fruend said, “and until that day we need a program in St. Louis because we have so many people in poverty that are uninsured. We need something to take care of them.”
About 80 percent of Gateway card carriers are African-American. So when the commission decided to roll out a campaign on dealing with stress and trauma, they started with the community they serve.
“We find just being black in St. Louis is stressful because of the extra layer of racism that they have to deal with on both macro and micro levels,” Fruend said. “That adds a layer of stress and sometimes even trauma to their lives, so this is a particular population that deserves focus.”
As part of the campaign, the commission went straight to media partners that would reach the black community, including The American and Radio One Hot 104.1.
Alive and Well STL has supported training to encourage organizations to adopt trauma-informed practices. They have even worked with the St. Louis Cardinals, who host summer sports camps for children. They are currently talking with coaches about how to limit yelling and “toughening up” techniques for children living in high-stress situations or have experienced trauma in their lives.
Rosetta Keeton, a patient access consultant, said when she has given talks about toxic stress and trauma to community groups and patients, it’s always well received.
“I help people to know when they are going through their toxic stress and trauma,” she said. “People seem relieved that there is a name to what is happening to them.”
Fruend said the commission has been focused on making sure the uninsured have access to health care for 15 years.
“But we are never going to reduce health disparities,” he said, “unless we go back and address this piece of the puzzle as well.”
Tickets for the 16th Annual Salute to Excellence in Health Care Awards Luncheon on Friday, April 29 at the Frontenac Hilton are $750 per table for VIP/Corporate seating and $50 each/$500 table for Individual seating. To order tickets, call 314-533-8000 or visit www.stlamerican.com.
