The Health Care Crisis and Faith

Second Quarter 2003

Montana Faith-Health Cooperative

By David M. Young

Despite its huge private and public investment in health care, the United States is burdened with soaring costs for prescription drugs, health insurance, and Medicare and Medicaid. Doctors are leaving their jobs because of the growing cost of malpractice insurance. And perhaps most serious of all about 40 million Americans lack any health care insurance. States and communities across the country, as well as the US Congress, are looking for solutions. The following excerpts have been drawn from "Disparities, Inequities and Injustices in Health Care: The Role of Faith-Based Organizations, " a White Paper released by the Montana Faith-Health Cooperative late last year. One of the paper's drafters, David M. Young, is the cooperative's co-convener and the director of Montana's Office of Rural Health. —Ed.

The US is the only industrialized country in the world that does not guarantee access to medical care to its residents. Each year a total of 18,000 uninsured Americans die prematurely because of lack of access to appropriate health care, including disease prevention and screening technologies, which results in delayed diagnoses and development of lifethreatening complications. This annual loss of human capital is more than six times the number of people who died in the World Trade Center tragedy on September 11, 2001. The US spends more than any other nation on health care, $4,637 per person annually in 2000, yet the World Health Organization (WHO) ranks the US 72nd in health gains and 37th overall in its 2000 Report. Health care costs are devastating many American families. Nationally, health care expenses are the number one cause of family debt and bankruptcy.

The overriding social question is, "How can a country that has the most sophisticated medical technology worldwide, spends more per person on health care than any other nation, and was founded on the principles of equality, human rights and justice for all, allow such injustices, inequities and disparities to occur across its health care spectrum!"

Disparities and Inequities

The American health care system has been plagued for some time by known disparities in health status, health care delivery and health care outcomes among various sub-populations. Those hit the hardest continue to be women, children and minorities. The causes of this continuing trend in widening the "health divide" or "health gap" are very complex and extend beyond rising health care costs and increasing numbers of uninsured. Inequities in the health care system may be an extension of persistent disparities in other sectors of American life such as housing, income, mortgage lending, education, employment, and the criminal justice system. Health equity is not just a medical issue—it is a social, economic, political, legal, moral and biblical imperative.

For this White Paper, "health equity" refers to a concept of fairness in distribution and access such that all individuals have the opportunity to achieve their full health potential through access to the known prerequisites for good health and disease prevention.

A recent nationwide report issued by the Institute of Medicine (IOM) Committee on the Consequences of Uninsurance entitled "Care Without Coverage—Too Little, Too Late," summarizes research evidence contrasting the health of the insured and the uninsured. The significant findings were that working-age Americans without health insurance are most likely to: 1) receive too little medical care and receive it too late; 2) be sicker and die sooner; and 3) receive poorer care when they are in the hospital even for acute care like an automobile accident.

Furthermore, the study showed that without health insurance, people frequently go without appropriate care. For example, the uninsured frequently: 1) go without cancer screening tests; 2) do not receive care recommended for chronic diseases; 3) lack regular access to medications to manage illnesses and other health conditions like hypertension, HIV infection and anti-rejection medication for transplant patients; and 4) receive fewer diagnostic and treatment services after a traumatic injury or heart attack.

Rural America

Montana is top among states with rural health care concerns. Studies have shown that rural areas have a higher proportion of residents who are low income or living in poverty, uninsured or underinsured, who self-report being in poorer health, have chronic illnesses, have higher incidences of substance abuse and domestic abuse, and are disabled, frail and/or elderly. Montana is the least urbanized state in the nation with only three population centers over 50,000 people. Over 80 percent of Montana's 195 communities have populations of less than 3,000 people. The combination of a depressed agriculture economy, budget shortfalls, rising health care costs, deficiency and maldistribution of health care providers, long travel distances to health care facilities, and increasing numbers of uninsured and underinsured have resulted in a crisis situation for the state. Montana's rural residents do not have ready access to emergency services, public transportation, support services, specialty care, disease prevention screening services, or mental and dental health care.

A number of possible solutions have been proposed to address the state's complex problem of escalating health care costs, increasing numbers of uninsured, and inadequate social services for the underserved and most needy populations. It is clear that any solution(s) will require bipartisan support and a state-wide commitment to "health equity."

Health, with its four-fold physical, mental, emotional, and spiritual dimensions, is the outcome of a number of interrelated factors including social, cultural, environmental, genetic, behavioral, economic, geographic, and political factors. Research studies indicate that individual behaviors and environmental factors together are responsible for about 70 percent of all premature deaths in the US. Additional studies show a breakdown of factors that impact health status and health outcomes as 50 percent lifestyle, 20 percent environmental, 20 percent genetic and 10 percent medical service delivery. The bottom line is that we as individuals and communities have a tremendous opportunity to improve health status and health outcomes.

The Faith-Based Opportunity

One promising opportunity is through encouraging and supporting faith-based organizations (FBOs) and community-based organizations (CBOs) to partner with other organizations and interest groups in promoting healthier lifestyles, reducing and eliminating disparities, and reducing the impact of illness, disease and disability. FBOs and CBOs play key roles shaping communities, especially in rural areas. FBOs are assuming a more active role on the health care delivery team through emerging Parish Nurse Programs and Congregational Health Ministry Programs. FBOs and CBOs are also being encouraged to participate in addressing local unmet social needs through federal initiatives such as the Compassion Capital Fund Demonstration Project, an outgrowth of President Bush's Executive Order of January 29, 2001, establishing a White House Office of Faith-Based and Community Initiatives.

Over the past two decades both "health" and "faith" have moved independently to center stage of importance nationally and in Montana. Also, faith and health have become re-unified nationally through the faith-health movement which underwent a resurgence in the 1980s and has been fully endorsed by the current administration. Clearly, individual health is closely linked to community health, and community health is influenced by collective beliefs, attitudes and behavior of all citizens. FBOs shape communities, especially geographically isolated rural communities, and the foundation of rural America is really about relationships and a sense of community. Now is the time for churches and faith-based organizations to step forward, and to be recognized, in order to help meet the health care needs of the people in Montana and across the nation.