How to bring preventive care to women in low income areas
The health of a community depends on many things, like race, income and access to care. Because of that, there continue to be barriers to health care in particular communities. But there is one model that works in central New York that has impacted a hard to reach urban community.
One area where there is a big racial disparity in health care is among women diagnosed with breast cancer. Overall, white women are slightly more likely to develop the disease, but African-American women are more likely to die from it, by a substantial margin.
Linda Veit, assistant vice president for community relations for Upstate Medical University in Syracuse works with lower income populations. She said the higher death rate can be traced to a lack of regular mammograms, which identify cancers early and can lead to successful treatment. She said at this point, a lack of health insurance isn’t a barrier.
"We used to have people who didn’t have health insurance, but that’s not so much the case now," said Veit. "Most people have health insurance. I think it’s an awareness and an education factor that’s stopping them from getting the health care and, specifically, the cancer screenings they need."
Another barrier, according to Viet, is that living in poverty leaves little time to make appointments for health screenings.
"Taking care of their health is probably not top of their mind," she said. "They need to be able to put food on the table. They need to figure out safe housing situations. They need to be able to educate children. So being screened for cancer is probably not in their top ten priorities."
To get past these barriers, Upstate has started a program called She Matters, which encourages women in public housing to get mammograms. The difference is that the people doing the encouraging also live in the housing. These resident health advocates, like Rita Lawrence, are trained to get the message out.
"It’s going to reach residents and people in the community that don’t really think or know there are resources they can access."
Lawrence meets residents where they live, in community rooms for lunch and learns, manning tables in lobbies, and at community events. And because she is a neighbor, residents are more likely to listen.
"We can sympathize and emphathize with them because we are from the same area, same community," said Lawrence.
And so far, Viet said it’s working. The number of mammograms is up in the five years since the program started, and some cancers have been detected early. And more than that, Viet said these women are taking responsibility for their own health.
"In the last five years in housing, we are changing behavior. We have women who are not relying on us telling them 'You are due for your annual mammogram.' They are actually going, scheduling themselves. We have seen a significant behavior change having been there five years. I think the tide is changing. They’re being more educated and understanding how they have to take care of themselves."
The next step is making inroads on other health issues that have a bigger impact on communities in public housing. And trying to make that happen is Connie Gregory, an engagement specialist for Healthy Neighbors Partnership, a collaboration between Upstate and the Syracuse Housing Authority.
"A lot of our programs are around chronic disease prevention, such as diabetes and high blood pressure," said Gregory.
So that means the Resident Health Advocates are in the community talking up simple ways to stay healthy, by promoting better nutrition and exercise. Gregory said some simple things are getting through.
"We put a lot of emphasis on drinking water versus sodas and sweet drinks. I’ve noticed a difference on that. We put a lot of emphasis on reducing sugar intake, I know the resident health advocates have really latched on to that," Gregory said.
But there issues related to poverty that make some of these concepts harder to push through. For example, in an area where there are several public housing sites clustered on Syracuse’s south side, there isn’t easy access to a grocery store that sells fresh fruits or vegetables.
"And the corner stores that are in the neighborhood aren’t providing enough healthy foods at a reasonable price, that’s a big deterrent," said Gregory. "If the only food that’s in there is fried foods, and if you’re in a hurry, that’s what you are going to get. So if anything, support for better markets in the neighborhood and better marketing in the neighborhood about healthy eating would be helpful."
Gregory said that goes for exercise as well. Often sidewalks are in bad shape and there is poor lighting, so it’s hard to get people to just go out for a walk for exercise.
And according to Viet, while breast cancer may be an easy item to promote, other health screenings may not be. For example, lung cancer.
"We would love to be able to do more education and screening as far as early stages of lung cancer, trying to diagnose that early," said Veit. "We’re making some inroads, but it’s a harder program and I think it's harder because you have the stigma associated with smoking."
Veit also said mental health services are almost non-existent in these communities, and there needs to be more access there.
In the meantime, Upstate is moving ahead on another front to get more preventive medical care into this hard to reach community. Viet said mobile mammograms will become available in 2019, with mobile lung cancer tests possibly following. And as long as the message about the success of early detection gets out, then some of these barriers can fall.
"I think people are realizing that cancer isn’t a death sentence anymore. You can treat it and live as a survivor and a thriver for a long time."