Last Saturday morning I was thinking about health disparities as I prepared to give a keynote speech at the Whittier Street Clinic’s Men’s Health Summit and Grand Opening Ceremony. I have recently joined their Health and Wellness Foundation Board and the CEO, Frederica Williams, has wasted no time putting me to work. For those of you who do not know the Whittier Street Clinic, it is a historic neighborhood practice in the Roxbury neighborhood of Boston that was founded in 1933 as a free neighborhood clinic for obstetrical care. It is now a Federally Qualified Health Center (FQHC) and Level 3 Patient-Centered Medical Home (PCMH), and is licensed by the Massachusetts Department of Public Health.
The mission of Whittier Street Health Center is to provide high quality, reliable and accessible primary care and support services to promote wellness and eliminate health and social disparities.
Whittier serves 27,000 patients and community residents, providing them with primary care, behavioral health, dental care, vision care, and social services. Whittier’s coordinated care delivery model uses multidisciplinary teams staffed by physicians, nurses, and medical assistants. The teams are supported by clinical pharmacists, nutritionists, and case managers. Aligned with their mission, the practice provides free programs to improve the health and wellness of the surrounding neighborhoods, which are Boston’s most challenged in the struggle with poverty, violence, and the other social determinants of health.
One specific example of how Whittier Street is trying to make a difference is a support program targeted for young men (18-34) who face enormous challenges as they seek opportunities in a world where unemployment of their demographic is greater than 25% according to a report from the Gallup organization in April 2015. It is a sad reality that the problem is getting worse despite the efforts of organizations like Whittier Street directing efforts at helping young men prepare for job interviews. The program even goes so far as to focus on the language and dress modifications that the men need to make to have a better chance of finding an excellent job. Whittier has also been supportive of the efforts to bring better nutrition to the neighborhood and they have applauded the opening of an excellent supermarket, Tropical Foods, around the corner on Melnea Cass Boulevard. Unemployment and poor nutrition are two of the greatest threats to the health of all ages, but especially to the health of the youth of the community.
Whittier has a new home that offers the residents of its community one of the most beautiful and well appointed ambulatory facilities that exists anywhere. The building has a palpable focus on the dignity that every patient deserves when getting care. Opened in January 2012, this Silver LEED-certified, 78,900-square foot health facility gives them the capacity to provide up to 220,000 visits annually which should allow substantial expansion to adequately care for up to 80,000 patients.
Whittier recognizes that the men of their community represent a very challenged population and part of the event at which I spoke was the opening of a fabulous new exercise facility. This new exercise area is available to anyone, but the needs of men who are harder to reach was a central consideration and motivation for its construction. The new exercise facility is an extension of the holistic philosophy of the practice that provides, in addition to primary care and improved handicap access, an array of services in one location, such as a Community Resource Room for community events, an Urgent Care Clinic, expanded Dental Services, a 340B pharmacy, and specialized clinics for chronic illnesses prevalent among the patients of the community.
In that I have just recently become a part of the Whittier Street family, I had been quite surprised by the invitation to speak at the opening of the Men’s Health Summit and the opening of the fitness center. I shared the platform with the mayor of Boston, the Honorable Marty Walsh who was there to recognize the continuing service of Whittier Street Health Center to Boston’s most diverse and challenged citizens. The program also included the presentation of several awards that were given to professional staff, to board members and to members from the community whose efforts have made a difference in the Whittier Street programs to improve the care for men.
As I was contemplating what I might say to this very diverse gathering of dignitaries, employees and community members, I kept coming back in my mind to the speech that Dr. Robert Ebert gave on October 19, 1967 at Simmons College which is just a few blocks away in the Fenway neighborhood. Whittier Street’s new location on Tremont is also less than a mile from the Harvard Medical School and the Brigham where the bulk of my medical education occurred. Four things impress me when I read Dr. Ebert’s speech for the first time in 2008. First, he had accurately analyzed the state of healthcare in 1967. Second, things have not changed much over the past 48 years. Third, Dr. Ebert was on a mission to create a change in the way we train doctors and how we deliver care because he thought that doing so would be a major step in the direction of improving the health of individuals and of the community. This was a Triple Aim speech delivered 40 years before we had the Triple Aim. Finally, I suddenly realized just how much Dr. Ebert’s intent and wisdom had impacted who I am today.
Considering the cutting edge thinking of our time, what did Dr. Ebert left out? He describes with great clarity the social issues that determine health and that are still so hard to manage today. He envisions teams with new “standard work” for physicians and nurses and suggests how we should make sure that professional responsibilities are assigned for efficiency, effectiveness and as an exercise cognizant of the growing scarcity of clinicians. His answer to the professional shortages that are most significantly felt in the inner city and rural environment is for everyone to be working at “the top of their licenses”, doing only what only they can do and allowing other members of the team to share the work. He anticipates the need for innovation to solve problems and he basically describes the Wagner approach to the management of chronic disease decades before it appears in the literature. He is empathetic of the need for dignity and stresses that charity or municipal hospitals usually provide good care on an incidental and not in a coordinated fashion, and this care may be demeaning to the recipients of care who deserve more. He recognizes that better care for the diverse populations of the urban core is not a “copy and paste” reproduction of what works in the suburbs. He understands and is concerned about the plight of the underserved, recognizing their need to be participants in articulating the solutions that will affect their care.
The room was full of members of the Whittier Street Health Center’s community. They had come out to celebrate what had been created with them and for them. They responded with affirmation to Dr. Ebert’s words from across time as if I was reading to them from Holy Scripture. The Mayor sitting on the front row responded with affirming nods. When he rose to deliver his words following my presentation he echoed many of the same sentiments and then produced the most startling piece of evidence for the cruelty of health care discrepancies that I have ever heard. The life expectancy of a resident of the Roxbury community is 58.9 years. The life expectancy of a resident of Back Bay is 91.9 years. Hopefully those numbers will improve and that 33 year discrepancy will narrow substantially as we get further into healthcare reform in the aftermath of Chapter 58 in Massachusetts and the ACA in all of America.
