June 28^th, 2012:

It was a busy morning at the Kansas City Free Health Clinic. Not only did we have our typical rush of clients, anxious to see the volunteer doctors who provided their primary care; we were also joined by a news crew and some interested bystanders from Broadway Street, just hoping to catch their 15-minutes of fame.

As a medical assistant and behavior health case manager for KC Free, this was a significant day in my life. More importantly, this was a significant day for the over 47 million Americans who lacked health insurance. Though the Affordable Care Act (ACA) had already passed through the senate and the house and was signed into law by President Obama, this was the day that the Supreme Court was to decide if the Affordable Care Act was constitutional. The ACA was—and still is—a source of great divide in American politics.

At that time, the Kansas City Free Health Clinic only served uninsured adults. To think that this population (18% of the Americans in 2012) could gain access to insurance was energizing to say the least. How much more could the Clinic do to serve our clients if we could bill insurance companies and Medicaid like any other health care provider?

When the Court upheld the ACA, we were ecstatic! Though we were one of the largest free health clinics in the country and offered services ranging from immunizations and EGKs to therapy and needle-exchanges, we were a safety net. As such, we were constantly constrained by financial barriers and the overwhelming needs of the community.

Today:

Almost three years later, I find myself as a Project Coordination Lead for Challenge Detroit’s Health Disparities Challenge. In this role, I am reminded that the universal availability of health care through the ACA does not ensure the universal accessibility of health care and, more importantly, health. Policy aside, an equal opportunity for health simply doesn’t exist in the United States.

In our country, health disparities impact what kind of access individuals have to health care services. Difference in health are often linked to social or economic disadvantages, which stem from characteristics linked to race or ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, or geographic location.

When you begin to pay attention, it’s easy to spot these social determinants of health. Without access to resources such as transportation, affordable healthy food, and a quality education, a person’s ability to maintain a healthy lifestyle decreases. What if this person is also mentally ill? What if their neighborhood is riddled with gang violence? All of these factors interact to negatively impact the overall health of an individual through no fault of their own.

Though health disparities in the U.S. are systemic and complex, it is refreshing to hear of initiatives such as the Health Disparities Coalition right here in Detroit. There is a role for both health care providers and non-health care providers alike. Doctors, nurses and community health workers must sit down with politicians, community organizers, nonprofits and urban planners to identify a myriad of collaborative solutions to these complex issues. As Challenge Detroit fellows, we are privileged to play a small role in the Detroit solution.

To close, I leave you with a quote from the Institute of Medicine in 1999:

“…The determinants of health are beyond the capacity of any one practitioner or discipline to manage. We must collaborate to survive.”

*The Kansas City Free Health Clinic now goes by the name KC Cares Clinic. During my last visit to the Clinic in 2014, I learned that the Clinic now serves the underinsured (along with the uninsured) and charges clients $10/visit for all services (though it will never turn down services to anyone unable to pay the fee).