Out of the headlines, a wonderful story is happening in Cincinnati. Thousands of low income citizens , minorities, people with disabilities, and aged are learning about healthcare, signing up, and thinking about health and the prevention of disease. For the first time for many people, a real choice for personal and family healthcare has arrived. Since January, 2017, the Cancer Justice Network has met with over 2600 people in churches, community centers, and at health fairs. Very slowly, a trust is being established, a belief that people who have not had health care can get assistance in both receiving screening and treatment. We have focused on cancer but our concern includes all chronic diseases. Now, this positive beginning is being threatened by a president and a Republican congress that wants to wipe away all of these gains. This policy of going backwards must be stopped. Will it?
1. Making sense of the new health bill and the budget: The gigantic slashing of the present health care legislation plus the new budget reorganizing of the government's programs are a clear warning that the enemies of "Make America Great Again" are to be weakened and eliminated. It'd is hard to believe that in the 21st century, an American leader is returning to the principles of authoritarianism or worse. I have to pinch myself each morning to recognize that the nightmare that is looming is happening when the American economy is restoring itself, the stock market is at record highs, and more Americans have health care than ever before. Yet, the resentment of a large part of the country is accurately represented by the president and the Republican congress and the focus of the bitterness is not on the insurance companies that are pulling out of the healthcare market places, or the CEOs that are reaping the rewards of radical tax cuts, or even the the president's outright lies about so many things. The country is on the way to blaming and hurting the poor, the minorities, people with disabilities, the immigrants, those with prior medical conditions, students with loans, veterans seeking mental health support, and anyone who stands up for the most vulnerable citizens in our community.
2. Making sense of the attack on healthcare: The threads of hatred for the poor and minorities have long been expressed in statistics about the radical difference in life expectancy for rich and poor. In our own city, there is a 20 year gap in mortality based upon where you live. Even neighborhoods that adjoin each other, if they are characterized as "rich" or "poor," show dramatic differences in life chances. And, in those communities near our hospitals, the 20 year gaps persists without any programs of education or outreach to alter this reality. America's history of segregation in education, transportation, and housing is finally being exposed with the expected results showing that governments, local, state, and federal, have combined to make life difficult for minorities, immigrants, the aged, and people with disabilities. The lack of fair housing, adequate and affordable transportation, and integrated high quality education has created and sustained a massive imbalance in fostering a good life. Added to these destructive layers of governmental inaction or attack on the poor, is the persistent and "normalized" expectation that the poor, or minorities, or the aged, or those with disabilities can exist with substandard or non-existent healthcare. The new proposed laws that bring back the old prejudices about excluding the poor are nothing new to our community members who have sought some high quality of care that is within their financial means. The major exception was the implementation of Obamacare. Groups, previously excluded were now invited to join health care programs that gave healthcare for previous conditions of ill-health, subsidies for paying for healthcare, education in how to use a primary care provider, and a chance to bring everyone into the healthcare circle of support. A stumbling start of the program followed by suspicions about participation slowed the full acceptance of this program until recently. Now, the current legislation rolls away this provision and 23 million citizens will lose their "place" in healthcare.
3. What about those citizens with chronic health problems, like cancer? Will they be able to continue their treatments if they have started treatments? Thanks to the work of cancer treatment pioneer, Harold Freeman, MD, former president of the American Cancer Society and a surgeon at Columbia University and Harlem Hospital in New York City, a process exists to educate high risk individuals and to offer assistance to involvement with doctors for screening and treatment for cancer. Dr. Freeman has developed a process of "patient navigators," healthcare workers that reach out, educate, and accompany people to their screenings and treatment. Dr. Freeman has been fully aware of the low expectations of high risk individuals for care and sought to overcome resistance to healthcare through identifying people who were trained to listen and act in the best interests of the patient. In five years he was able to alter the survival rate of his patients, improving their chances for life from 30% to 70%, by using navigators. Dr. Freeman was invited to Cincinnati, met with hospital staff, and with the Cancer Justice Network. Based on his work, and the reluctance of all the hospitals to initiate a navigator program that reached out to the community, the Cancer Justice Network launched its program with the support of 25 human service agencies that serve low income people, people with disabilities, minorities, and the aged. This is the only navigation program in Cincinnati. Our volunteer organization has navigators dedicated to following the principles of Dr. Freeman's program. Each week we visit a church, a community center, a school, or a health fair, and share our information, introduce our navigators, and give each person a "road map" to screening and treatment.
People who sign up with us are agreeing to trust that our efforts will bring them into a process that a respects them, offers education about the healthcare process, and accompanies each person through the maze of healthcare options. Now, the political threat to the Medicaid program, the violent attempt to close the Affordable Care Act, and the ambiguity about preconditions, threaten to topple our tiny steps at establishing a compassionate healthcare process. As of today, the continuity of care can exist because the Affordable Care Act still exists. But, the current policy revisions would devastate both access and continuity of care, if approved by the president and congress. We can no longer assure people that if, cancer, or diabetes, or heart disease is found through screening, that they will receive full treatment or any treatment. Hospitals and doctors do not have emergency funds to use to offset projected expenses. The high risk population is just beginning to understand that early testing is the key to life, longer and better life. They want to know: "Will my healthcare be there when I need it?"
4. The long battle for justice in healthcare continues. The Cancer Justice Network will continue to offer programs of education about stopping cancer. We will join protests that indicate that support for quality healthcare is irrelevant to the country's future. We will be in alliance with groups seeking to keep Medicaid, affordable care insurance, support for people with disabilities that assists their living conditions, comprehensive programs for the aged that increase respect, and affirmation of transportation programs that increase mobility. We will also work with doctors and hospitals on their continuing efforts to make healthcare a right. Back in 1971, policy makers and practitioners faced formidable challenges from the medical and hospital associations: "Perhaps the basis of the entire problem, among both doctors and poor people," W. Brooks wrote, "is that they still think of health care as a privilege and not a right. (W. Brooks, "Health Care and Poor People," in Citizen Participation: effecting community change. Praeger. 1971). We have found a group of doctors, nurses, social workers, students, and NAVIGATORS that are passionate about the health rights of high risk people and we see where national health organizations are opposing the new legislation. We are finding a large group of low income citizens that appear to be changing their ideas about working with us to stop chronic disease. Together, in the coming weeks, we will make our voices and votes known.
by Steve Sunderland
Read about the latest progress we are making as a Cancer Justice Network.