Posts Tagged ‘community clinics’

The Promise of School Based Health

April 16, 2013

By Jim Mangia, President & CEO, St. John’s Well Child and Family Centers

Jim-Mangia-blogAlready this year, St. John’s Well Child and Family Center has opened two school-based health centers, will open another in May and won approval for yet another, with additional facilities to come. These health centers are more than just buildings attached to schools—they are at the heart of the future of healthcare for children and families in South Los Angeles.

While at the grand opening celebration for our new Washington Prep Wellness Center with Supervisor Mark Ridley-Thomas, the Los Angeles Unified School District (LAUSD) and the L.A.’s Trust for Children’s Health this month, a parent of one of the students there introduced herself to me.  She told me that her daughter had asthma and often missed school because of acute asthma attacks.  There were months when their family would be in the emergency room two, three, four times.  She was so grateful that her daughter’s chronic condition could now be managed on campus by a team of physicians and nurses.  She looked at me with hope and expectation.  “Now my daughter will go to college,” she said.

That conversation expressed all the promise and determination of school-based health centers: increased access and improved health outcomes coupled with enhanced educational achievement.  Students without access to quality healthcare must overcome huge obstacles to learning. With each school-based health center opening, we’re tearing those barriers down. It was especially fitting that the doors of Washington Prep opened on April 4, the anniversary of the assassination of Rev. Martin Luther King, Jr. He said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

It made me so proud to realize a dream St. John’s embarked on over a decade ago, when we opened our first school-based health center at Lincoln High School in partnership with LAUSD in 2001.  Since then, we have opened five more in South Los Angeles and Compton, with two more scheduled—a brand new one to replace an older one at Manual Arts, a new one at Compton High School and even more on the drawing board.

The conventional wisdom is that school-based health centers are too small to allow economies of scale and enough “profit” to warrant the investment.  With more than 10,000 public schools in the State of California, there are just over 200 school-based health centers across the state.  And while I agree that sustainability is an important issue to address, we must look at opening school-based health centers as an issue of health and human rights for our communities.  School-based health centers improve the health of the students, their families and the community at large.

Through our work with patients in our school-based health centers, we have our finger on the pulse of student and community health trends and have been able to develop programming to intervene and focus on prevention efforts.  For example, through a joint effort between L.A.’s Promise, which manages Manual Arts High School in partnership with LAUSD, and our California Endowment-funded school health center there, we provide school physicals to every ninth grade student on campus.  We found that more than 40 percent of the student body was obese or at-risk of becoming obese.  With our old health center—and soon with the brand new one opening in May—we are developing education and health programming to directly intervene on the obesity epidemic at Manual Arts High: direct and focused health interventions and primary prevention activities in real time.

This is the promise of school-based health.  As the centers of communities, schools are uniquely positioned to impact the neighborhoods in which they sit and address the “shocking and inhumane” disparities in health care our children and their families face in South Los Angeles and other underserved communities throughout  America.   Much has changed since the Rev. Dr. Martin Luther King, Jr. expressed those words, and unfortunately, much still remains the same.

But what we have learned is that through partnerships between federally qualified health centers like St. John’s, school teachers and administration and the school district—we can and are improving student and community health and impacting inequality.  There is a severe underinvestment in this model for health despite all the evidence urging otherwise.  To honor and celebrate the life and work of Dr. Martin Luther King, Jr., let’s work to increase investment in school-based health centers as an important cornerstone of continuing to realize the dream.

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Obamacare for All

March 18, 2013

Jim-Mangia-blogAmerica’s immigrants have a human right to health

 By Jim Mangia, MPH, President & CEO, St. John’s Well Child and Family Centers

I’m a child of immigrants.  My grandfather emigrated from the slums of Naples to escape Fascism.  He gained his American citizenship by fighting in the first World War.  He worked as a doorman, opening doors for the elite on the upper east side of Manhattan during the week and shined shoes on the weekends to support six children – two of whom died young in the dilapidated tenements of the lower east side.  Despite the hardship, he was proud to be an American citizen and he was forever grateful for the opportunities this country afforded him and his family.  He spoke little English and was proud of his heritage.  Our house was always filled with strangers he had met, more down on their luck than he, who my family would feed and clothe – even though we barely had enough for us.

What he drilled into us every day was the importance of education.  My generation was the first to attend college.  My parents and grandparents did nothing but struggle to make sure we had the opportunities they never did.

Now, almost two generations later, I have the privilege of leading a large network of nonprofit health centers in downtown and South Los Angeles, which provide healthcare to more than 160,000 patient visits each year.  My cousins are doctors, and lawyers and businessmen, with houses in the suburbs and children in the best universities of our country – all as a result of my immigrant grandparents’ backbreaking sacrifices.  The patients who come through our health center doors get care regardless of their ability to pay or their health insurance status.  So many of them are new immigrants, not yet citizens. Fathers from Jalisco, Mexico. Mothers and children from El Salvador. Young men from Guatemala.  Like my grandfather before them, they’re in the United States working to make a better life for themselves and their families and fleeing repression.  They are proud and hardworking and they sacrifice for their children to have the life they never could.

I know who America’s immigrants are.  I sit with them in our health center lobbies every day.  In our waiting rooms I talk to patients like Gustavo, who washes cars for 10 hours a day, on his feet in the baking Los Angeles sun, surrounded by toxic chemical fumes, getting by on barely $10 an hour (if he’s lucky enough to receive enough tips from the car owners).  I see the children of these immigrants whose moldy, roach-infested apartments are making them sick, requiring constant breathing treatments for asthma, or watching our pediatricians pull cockroaches from their children’s infected ears.  Like my grandfather before them, these more recent immigrants are building this country.   They are proud of their heritage and they are grateful to America for the opportunities we provide.  And I believe with every ounce of my being that these patients and indeed everyone in this country have a fundamental right to health.  In fact, isn’t that the very least we can do in exchange for the hard work and dedication immigrants show and have always shown for the American dream?

We have an opportunity as a nation to address the health status and access to care which our immigrant populations are currently denied as politicians in Washington begin the debate over immigration reform including how long it should take for a “pathway for citizenship” for the nation’s 11 million undocumented residents.

My grandfather lived to be an old man because he had health benefits through the Veterans Administration.  My grandmother, ravaged by diabetes, died when I was six.  She didn’t have access to the same benefits, nor could they afford health insurance.  And she died before President Lyndon Johnson began the war on poverty which provided funding to the community health center movement from which the health centers I lead grew.

America’s greatness was built by immigrants, whom we welcomed and rewarded with the honor of citizenship.  Let’s give our immigrant populations the healthcare they deserve so they can fully participate in continuing to build this country – the tradition and promise that was and still is America.  Let’s support them in living their dream.  Without direct access to healthcare services, immigrants often put off accessing care, or they use expensive hospital emergency rooms when they get sick, rather than regularly accessing primary care services at private physician offices and community health centers because they lack health insurance.  This is a huge cost to our society that could be eliminated if newly legalized residents could have access to Medicaid and be allowed to purchase insurance on the state insurance exchanges created by the Affordable Care Act.  But ensuring access to healthcare is more than a cost issue – it is a moral issue.

Immigration reform must include a guarantee of the right to health to every immigrant residing in this country.  Immigrants must be afforded the same right to healthcare that Obamacare provides to all American citizens.  The rallying cry for this effort: “Obamacare for all.” Let’s make sure that our immigrant populations can be healthy and productive members of our society.  Let’s make sure that on day one of the passage of immigration reform, America’s new legal residents will have healthcare access for them and their children.  That’s an America my grandfather would be proud of.


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