Population Health Blog

Population Health Blog

Why It Matters

Hospital mobile van addresses disparities, but what about causes?

By Dennis Archambault

Norwegian American Hospital in Chicago, one of the awardees in the 2017 American Hospital Association Nova Awards program, was credited with helping reduce health disparities among children on Chicago’s Westside through a mobile clinic. While access to transportation may be one of the social determinants addressed through the project (it wasn’t mentioned in the award narrative), other social determinants such as environmental quality, interior household and school air quality, lead abatement programs, and school health and fitness programs were not addressed.

The first two paragraphs of the narrative are revealing:

“Norwegian American Hospital serves some of Chicago’s neediest zip codes. The average per capita income in its core service neighborhood is $13,391, while the unemployment rate stands at 12 percent.

“Those numbers translate into health problems, such as childhood asthma, elevated blood lead levels and high rates of childhood obesity and teen pregnancy. Because they lack regular medical care, many children in the community can’t meet the vaccine requirements for public school registration.”

Norwegian American Hospital certainly is contribution to the public health infrastructure of Chicago through the mobile clinic, but what if it had approached the health issues addressed in the first two paragraphs – asthma, related to internal and external air quality; elevated blood lead levels related to lead-based paint in old housing stock; and high rates of childhood obesity and teen pregnancy. These are social issues the hospital could partner with public health authorities in its community benefit investment. Depending on your source, household air quality is a major contributor to up to half of asthma cases. (Locally, one community development corporation notes that during the winter, houses with forced air push contaminated dust up into the breathing space of children, increasing their risk to lung ailments.)

The ultimate irony in this case is that the mobile clinic addresses a major social determinant – transportation. Providing a mobile clinic financed through philanthropy – an unsustainable funding model – has limited applications. However, funding an alternative transportation system that provides patients access to primary care medical homes might be more cost efficient.
Speaking of funding, it’s curious that the program is entirely funded through philanthropy: children’s Care Foundation, Northern Trust Co. Charitable Trust, the Col. Stanley McNeil Foundation, and the Illinois Association of Free and Charitable Clinics. There doesn’t appear to be an investment by the hospital itself.

A mobile clinic connected with schools in underserved communities is a good idea and could deliver much primary care than would otherwise be provided to this community. But what if Norwegian American Hospital and its competitors found common purpose in this or other health disparities and decided to improve the social systems that helps create the health disparity? Is that still a radical concept for hospitals?

Dennis Archambault is vice president, Public Affairs, for Authority Health.

‘Fugitive Dust’ ordinance is a good step toward health in all policies

By Peter J. Hammer
In 2013, Detroiters awoke to the shock of finding mountains of pet coke looming over the riverfront. The pet coke incident triggered a growing awareness of the environmental and public health consequences of what is more generally known as “fugitive dust.” The incident also highlighted the absence of effective legal tools to address the problem.This is no longer the case. Detroit City Council is about to consider a comprehensive ordinance to better monitor and control fugitive dust. This ordinance has important symbolic and substantive significance as Detroit chooses what type of future it will embrace.

Detroit is at a crossroads that will determine the type of economy, environment and community that will define its future. Policy makers should work constructively to attract and retain businesses that seek to grow their enterprises in a manner that is good for them, but also respects considerations of public health and the environment. It is equally important that we send a clear message that Detroit will not accept a strategy, particularly in the neighborhoods, that permits business to sacrifice the health and well being of historic Detroiters in the name of economic development.
City Council has been working on an ordinance to control sources of fugitive dust that embodies these principles. Fugitive dust is a serious environmental and public health concern that requires appropriate control. The ordinance also sends a signal that Detroiters have high expectations for how business should be done and the types of future economic development that should be encouraged.

Fugitive dust is an elastic term describing particulate matter suspended in the air by wind and human activity. The dangerous dust emanating from the mountains of pet coke provide a good intuitive illustration of the problem, but fugitive dust can be associated with large piles of other solid bulk material, such as asphalt millings, gravel, sand, and limestone. Depending on location, fugitive dust can create highly-localized hot spots of particulate matter pollution due to wind blowing dust into nearby neighborhoods, schools and homes.

Even short-term increases in particulate matter pollution can negatively affect some of our most vulnerable residents. Scientific studies have linked particulate matter pollution to increased rates of respiratory-related hospital visits and the exacerbation of asthma symptoms among children. This is particularly concerning because the Michigan Department of Health and Human Services labeled Detroit the state’s “epicenter of asthma” based on its findings that the rate of asthma-related hospitalizations in Detroit is three times the state average.

The Fugitive Dust Ordinance outlines common sense control for facilities that have large piles of bulk solid materials, including development of fugitive dust plans subject to the approval of the Building Safety Engineering and Environmental Department(BSEED), maintaining monitors upwind and downwind locations at the facility, and controlling dust being emitted from trucks transporting materials. Additional controls exist for facilities that store any pet coke, coke breeze, met coke, or nut coke. Finally, facilities may apply to BSEED for variances from ordinance requirements where appropriate. These provisions are very similar to fugitive dust controls that exist already in Chicago.

The Fugitive Dust Ordinance is also significant for symbolic reasons. The ordinance establishes an important template for the type of growth we want for Detroit. The “tale of two cities” is increasingly fact, not fiction. While downtown is being built up with new businesses and a shiny new trolley car, the danger is that the neighborhoods will be slated for various forms of exploitative development. The U.S. Ecology proposed expansion in capacity to process 64,000 gallons of toxic waste to nearly 666,000 gallons and the need to brow beat Marathon Oil to invest in basic technology to control air pollutants should be seen as warning shots across the bow. Impoverished neighborhoods have historically been vulnerable to environmental exploitation and the lives of their residents seen as expendable.

The Fugitive Dust Ordinance suggests a brighter and more sustainable path forward. The ordinance gets out ahead of a growing problem. The ordinance adopts national best practices and applies them to Detroit. The ordinance makes clear that while Detroit is open for business, development must respect the environment and the public health of all residents.

As democratic institutions begin to reassert themselves in the wake of bankruptcy and emergency management, this is exactly the type of common sense action we should expect of the City Council.

Peter Hammer is director of the Damon J. Keith Center for Civil Rights at the Wayne State University Law School and member of the Population Health Council