Attention: Physicians and Hospitals Treating Poor Children

A strong link exists between poverty, poor health outcomes, and high health costs. The poorer patients are , the greater their odds of being uninsured, the more likely they are to delay seeking care, the more advanced their disease is likely to be, and the higher their costs of care will be.

That is why health costs are highest in America’s urban ghettoes, which are fraught with domestic violence, substance abuse, the homeless, the unemployed, the uninsured, and disintegrating or non-existent families, as graphically shown in the movie Precious. These problems often weigh most heavily upon children in the pediatric age group and unwed mothers.

The Social Support Gap

Because of lack of doctors in inner cities, the very young may have nowhere else to turn than to emergency rooms, hospitals, and outpatient clinics. Once these children are discharged, they may have no roof over their head, no family support, no one to help them understand their medications, no food or just fattening food to eat, and no transportation to ferry them back and forth to hospitals, clinics, or doctors. Parents or caregivers may be unemployed or financially destitute. Social workers or visiting nurses assigned to these problems are overwhelmed. Consequently, health outcomes among the pediatric population are poor. Malnutrition, obesity, diabetes, and inadequately treated asthma are rampant.

What is Wrong: The Social Disconnect

What is wrong is the disconnect between health care and community support. This is what critics talk about when they speak of “fragmentation” and” lack of care coordination.” It does little good to prescribe antibiotics if there is no one to assure the child takes them. It does little good if an asthmatic child does not understand how to use a bronchodilating device, or if a diabetic child does not know how to inject insulin or when to take diabetic oral drugs.

Limits of Government, Doctors, Nurses, and Social Workers

As Hillary Clinton wrote “It takes a village to raise a child.” In some of America’s inner cities, there is no village. With his health plan, President Obama, known for his community organizing efforts, is seeking to start to address the problem of children by guaranteeing insurance coverage

That is a good start, but it is insufficient.

There are limits to what government can do. Connecting social services to support the sick child is not a government strength. There are also limits to what doctors can do, in following patients on an outpatient and home basis, providing domestic support, arranging for housing and employment, and connecting social services are some of these limits. And there are limits to what overworked nurses, social workers, and other health professionals can do outside of their jurisdictions.
Good outcomes and improved health often depend more on what happens once patients leave the hospital or doctor than what happens within an institution or medical office.

Help Is On The Way to Correct the Social Disconnect

If you are a family with a sick child, or a doctor working in a pediatric outpatient clinic, a newborn nursery, a clinic for adolescents, an obstetrics practice, a pediatric emergency room, or a community clinic, an overburdened social worker, or a hospital executive wishing to improve the health of your community, help is on the way.

Project Health

The help comes in the form of Project Health, a nonprofit 501 (c) 3 organization. This organization is emblematic of a profound social innovation. Rebecca Onie, JD, a young Harvard-trained lawyer, cofounded it at the Boston Medical Center P in 1996 with Barry Zukcerman, MD, chairman of the Pediatics Department at the time. Project Health serves pediatric patients, their families and caregivers in Boston, Baltimore, Chicago, New York City, Providence, and Washington, D.C., and will expand to two new sites in the next three years.

These urban centers feature two things in common: one, they have large populations of poor inner city kids; and two, they have large populations of idealistic college students who want to make a positive contribution to the health system by volunteering to help sick children

How Project Health Works

Project Health works like this. Its staff trains college student volunteers to connect those in need with community resources – to arrange for housing, food stamps, employment, transportation, and other social services.
Project Health trains students who volunteer for 60 hours on the problems of sick children, the community services and resources available, and how to connect with them. It then sets up a Family Help Desk in the various pediatric settings. Student volunteers sit at the desk and responds to services that doctors “prescribe” for needy patients.

Last year, Project Health's corps of nearly 600 volunteers assistdc over 4,000 families a year in accessing the resources they need to be healthy.
Over a five-month period last year, Family Help Desk clients at Boston Medical Center received the following resources:

• 205 families secured housing, including Section 8 and market rate units and shelters

• 154 clients obtained slots in child care, after school, and Head Start programs.


• 135 clients accessed food stamps, food pantries, dollar-a-bag programs, or farmers' markets,

Across 16 Family Help Desks, an average of 52% of families actually obtained at least one resource they need - i.e., receive food, secure child care, find an apartment - within 90 days of receiving services at the Desk, with the remainder receiving ongoing follow-up until they obtain the resource.

Project Health’s vision is to create the nation's first corps of student volunteers to connect low-income patients with the resources they need to be healthy and, in doing so, create the next generation of leaders committed to tackling this country's greatest health challenges. It seeks to break the link between poverty and poor health outcomes. It is the equivalent of a Domestic Health Peace Corps.