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ACP paper finds 'urban health penalty'

From the May 1997 ACP Observer, copyright © 1997 by the American College of Physicians.

By Deborah Gesensway

In an effort to call attention to the "urban health penalty," the College has released a new position paper that argues for attacking inner city health problems as part of a broader policy that addresses the root causes of poverty.

The paper, which was published in the March 15 issue of Annals of Internal Medicine and featured at an Annual Session press conference, renews the College's commitment to solve health care problems in inner cities—where they are most extreme—and its call for universal access to care. The "urban health penalty" refers to the fact that inner city residents suffer the same chronic conditions as people everywhere, but that their situations are made worse by poverty, poor housing conditions, unemployment and other socioeconomic problems.

"Not only is the health status of inner city areas appalling, but the health needs of those areas are much more complicated because of the lack of primary care," said Gerald E. Thomson, MACP, senior associate dean at the College of Physician and Surgeons of Columbia University in New York, speaking at a press conference. "If you don't have a job, if you have poor housing, if you're looking for the next meal, it's very difficult to program your priorities toward preventive measures in health care."

The College is calling on President Clinton to appoint a presidential commission to recommend legislative and community-based solutions. ACP is also asking the medical community to join with business, government and community groups in a joint public-private initiative.

According to the paper, physicians will never be able to improve inner city health care until they look beyond the medical model. The paper also concludes that the poor quality of health in America's urban areas is a disgrace, noting that none of even the most modest efforts at health care reform during the last few years have been targeted at helping underserved people in the inner cities.

Among the specific recommendations offered are monitoring the effect of welfare reform and making changes if poverty increases; requiring Medicaid managed care organizations to provide special services essential in inner-city environments such as transportation, after-hours availability and outreach services; and passing legislation that restricts the availability of firearms and regulates tobacco as a drug.

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