Meeting the Health Care Needs of Underserved Children

147 Presentation MEETING THE HEALTH CARE NEEDS OF UNDERSERVED CHILDREN XYLINA BEAN, M.D. Assistant Professor of Pediatrics Associate Director of Neonatology King/Drew Medical Center 12021 South Wilmington Avenue Los Angeles, California 90059 When I was asked to talk about meeting the needs of medically underserved children, I realized that this entire conference would concentrate on that topic. Having spent hours trying to figure out what else there is to say, I feel very much like the lady from Mississippi [Dr. Dorsey] yesterday. I have an overwhelming urge to say, "You already know exactly how to help these children, so go out and do it." So I thought I would discuss some of the approaches to meeting the needs of underserved children that we are using in Los Angeles, and hope that presenting some of those models may suggest ideas for maximizing resources in other communities. Programs designed to help underserved children must be built on an understanding of some basic facts. First of all, these chUdren are biologically vulnerable. Compared to other children, they are more likely to be born dead. They are more likely to be premature. They will be sick. And they continue to have these biological risks throughout childhood and adolescence. In addition, the children are environmentally vulnerable. These children are, by definition, the products of poverty, and by definition, poverty creates high-risk environments. We have single-parent homes. We have unemployment . We have homelessness. We have prenatal and postnatal drug and alcohol abuse, aU of which should be components of any programs that deal with underserved children. Taking these environmental factors into account, we must also examine the health characteristics of the population at large. In general, at-risk communities have more health care problems. They have problems of greater severity. Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 148 Meeting Health Care Needs Many of their problems stem from their increased biological susceptibility. Another part of this susceptibility is financial and part is social, because at-risk persons also tend to use existing health care facilities less than other persons. Given this model of the population, the question becomes how, then, to provide services in the context within which most of us have to work. A portrait of South Central Los Angeles South Central Los Angeles is the area of the city with the lowest income and the highestpercentageof minorities. Ithas the highestpercentageof blacks in the county. It has the worst profile of all major health care parameters. Dr. Satcher, who was dean at King/Drew Medical Center before he left for Morehouse and subsequently became Meharry's president, is well aware of the problems of this community. The King/Drew Medical Center emerged from the 1965 Watts riots and was one of the major positive aspects—some would say the only positive aspect—of this urban rebellion. Many of the infants we see at King/Drew are medically fragile. They were born premature and / or with low birthweight. They are children with AIDS and the infants of substance abuséis—children unique in their very severe medical problems. A recent Robert Wood Johnson Foundation multicenter study1 found that if an infant is given intensive support, their immediate medical outcome and long-term developmental outcome improve markedly. But much of the population in the Robert Wood Johnson study was middle-class. The services needed to provide this care to a poor population such as the one we serve are very different, because the needs of the families are different. Our population needs such basic services as food, shelter, and housing, all of which must be addressed in order for a given medical intervention to be successful. Ecoprimary care In my opinion, California is not a progressive state. But interestingly enough, we have been able to do a number of progressive things to address the problems of at-risk children. We believe that models that attempt to address the health care problems of children must take into account the complex interaction between health status, environment, and health delivery I described above. Dr. Lewis King, the dean at King/Drew Medical Center, asked employees in the entire...