Community health centers have long been on the front lines of public health, serving low-income communities that others so often neglect. But COVID-19 has put these systems under significant stress—systems that are absolutely key in the fight against the pandemic and in reopening the economy, as they assist many of the people who are essential workers and who have been hit especially hard by the pandemic.
Fortunately, Joe Biden’s $1.9 trillion coronavirus relief plan promises to increase federal support. Indeed, the Biden administration’s national COVID strategy even calls for a new partnership with community health centers. That call is important. As NPQ noted last December, community health centers are trusted sites for vaccinations; their role will be crucial if the nation’s enormous racial vaccination gap is to be closed.
Community health centers were first established in 1965 as part of President Lyndon Johnson’s war on poverty, which sought to reduce the US poverty rate, then at 19 percent. Dr. H. Jack Geiger, along with other health activists, worked with the newly formed Office of Economic Opportunity to create health centers for people living in poor rural and urban communities who were receiving inadequate medical care.
What began as two “neighborhood health centers” in Massachusetts and Mississippi has evolved over the past 56 years into a system of care that provides local health services for 30 million people (approximately one in 11 Americans) at over 1,400 organizations. Situated at the intersection of economic development and patient-centered, equal access healthcare, this nonprofit model of healthcare uses both federal funds and local resources to meet the physical, mental, and emotional needs of the country’s poorest citizens, many of whom are people of color, and whose limited access to health care derives from longstanding systemic racism and disenfranchisement.
Community health centers provide holistic care regardless of whether patients can pay and have historically received broad political support. These centers treat people of color, people with low incomes, people whose primary language is something other than English, and those who are either uninsured or publicly insured (e.g., insured through Medicaid). These centers provide their patients with not only primary health services but also orthopedic care, cardiac care, dental services, mental health services, nutrition education, translation services, and transportation to appointments. They also prioritize culturally appropriate care in the languages their patients speak.
Peter Shin, Rebecca Morris, Maria Velasquez, Sara Rosenbaum, and Alexander Somodevilla write for Health Affairs that these centers “serve over one in five uninsured people [and] have emerged as a health care backbone for state Medicaid programs. Nationally, nearly one in five Medicaid patients obtains care at a community health center; in 10 states and the District of Columbia, this figure stands at one in four.”
The community health center model focuses on treating the many factors that contribute to human health and wellness, significantly reducing future hospitalization and emergency room visits. They are a notable exception in a US health system largely incentivized by illness (i.e., the system rewards healing the sick rather than keeping people healthy in the first place), in which population health improvement initiatives are underfunded and emergency departments are overwhelmed.
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According to the results of the Commonwealth Fund’s National Survey of Federally Qualified Health Centers, 2013–2018, passage of the Affordable Care Act (ACA) significantly improved the level of care provided by community health centers. Access to care rose six percent from 2013, with patients more able to receive same-day or following-day appointments. This increase also included access to translation services, as health centers employed more bilingual staff and provided 21 percent greater access to telephone-based interpreters. Thirty-seven percent of patients in 2018 received services in a language other than English.
Beyond holistic healthcare, community health centers also act as economic engines for the communities they serve, stimulating local economies. In 2019, health centers created more than $63.4 billion in economic activity in their local communities.
There is longstanding deep skepticism and historical distrust of the health care system by many people from these communities due to infamous and unethical past medical practices engaged in by the scientific and medical community, such as the Tuskegee study and the use of Henrietta Lacks’s tissue for cancer research, but community health centers have become a trusted local resource.
Consequently, health centers could play a vital role in the vaccine rollout. The Current Populations Survey shows that Black workers, as compared to white workers, are about 50 percent more likely to be employed in healthcare and social assistance and 40 percent more likely to work in hospitals, but as reported recently by Jessica Glenza in the Guardian, the Centers for Disease Control and Prevention (CDC) have found that Black Americans comprise only 5.4 percent of vaccine recipients, a number which is significantly lower than the number of Black Americans employed in healthcare or living in long-term care facilities. As Glenza notes, “Black people in the US have died of COVID-19 at a rate 1.5 times higher than white people, and [Latinx] people have died at a rate 1.2 times higher….The dramatic impact of COVID-19 on Black and [Latinx] people in the US reduced life expectancy at birth by two and three years respectively, according to a recent article in the Proceedings of the National Academy of Sciences. By comparison, white people lost 0.68 years of life expectancy at birth.”
Community health centers are crucial in the fight against the pandemic, but like many other nonprofits, they have lately faced financial uncertainty. As of September 2020, these centers experienced $2.9 billion in financial losses. According to the Kaiser Family Foundation, though community health centers have innovated to meet patients’ needs, such as by increasing telehealth access, assisting with food insecurity, and administering hundreds of thousands of COVID-19 tests, the centers also face ongoing shortages of tests and personal protective equipment, and lowered staff morale; their staff, like so many others, must balance “work with obligations at home as schools moved online, and the ramifications of becoming infected with the coronavirus.”
Hopefully, Biden’s relief bill will provide community health centers with the resources they need. In a country whose medical professionals are only belatedly recognizing racism as a threat to public health, ensuring that community health centers have sound financial backing is absolutely essential.—Beth Couch