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Wealth should not make health. Period.


In America, there is an incontrovertible truth: the richer you are, the healthier you are likely to be.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


In America, there is an incontrovertible truth: the richer you are, the healthier you are likely to be.


Further reading: Senate bill to repeal Obamacare cuts Medicaid, subsidies for the poor


Chances are, if you’re poor or a member of certain racial, ethnic or socioeconomic groups, you’re much more likely to die younger. You’re also more likely to experience worse health outcomes and suffer more from heart disease, cancer, diabetes and a host of other serious conditions. Poverty and low income are also associated with higher rates of infant mortality and higher death rates for all 14 leading causes of death.

Between the healthiest and the sickest people in the United States, there’s a persistent health equality gap-and the gap is widening.

Health disparities among the poor (14.5% of the U.S. population fell below the poverty line in 2013) or among those who lack decent educational, lifestyle or job opportunities, “serve as a barrier to health equity across a wide range of diseases and health behaviors,” the American Academy of Family Physicians (AAFP) notes.

For example:

·      The incident rate of cancer among African Americans is 10% higher than among whites.

·      African Americans and Latinos are about twice as likely to develop diabetes as white people.

·      Among African Americans, the incident rate of asthma is 28% higher than among whites.

·      Non-Hispanic blacks are at least 50% more likely to die of heart disease or stroke before age 75 than non-Hispanic whites.

A big part of the problem is the disparity of care, including access to clinics, doctors’ offices and medication, and a shortage of primary care specialists to treat illness and disease.


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Today, 65 million Americans live in a “primary-care desert,” lacking access to the primary care physicians who account for more than half of all visits to doctors. The problem is particularly acute in minority, low-income and rural communities.

A study of U.S. Census and American Medical Association data from 2000 to 2006, found that about 25% of blacks and Hispanics lived in ZIP codes with few or no primary care physicians, compared to 9.6% of Asians and 13.2% of whites.

Next: This isn't just a 'theory'


People in poor households are particularly disadvantaged. According to the federal Agency for Healthcare Research and Quality, a household with income lower than the 2013 federal poverty level ($23,550 for a family of four) had worse access to care than people in high-income households ($94,200 or higher) based on 21 access measures. The report also found that compared to whites, Hispanics had worse access to care for 14 of 20 measures and blacks for 12 of 22 access measures. 


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While there may be no quick fix to the problem, increased access to primary care specialists would go a long way toward reducing health disparities, largely because family doctors treat more diverse populations than any other medical specialty. To improve individual and population health outcomes, it’s imperative that we strengthen primary care-the “first line of defense” in the nation’s health care system.

As the World Organization of National Colleges and Academies of Family Medicine said in a 2013 report, the evidence has “repeatedly shown that the strength of a country´s primary health care system and its primary care attributes significantly improves populations´ health and reduces inequity.”

It’s not just theory. Better access to primary care is producing meaningful results in communities across the country.

In Annapolis, Maryland, the Anne Arundel Medical Center opened two primary care clinics as part of a strategy to more effectively reach and treat minority patients and to reduce hospitalizations and emergency department visits.

The strategy quickly paid off.

A year after the Medical Center opened its first clinic in a public housing unit for seniors, it tracked significant decreases in medical 911 calls, emergency department visits and admissions and readmissions among residents served by the clinic. That, says Patricia Czapp, MD, a family physician who spearheaded the venture, “can only happen if people get high-quality, affordable care before they need to dial 911.”


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Family doctors are committed to doing their part to accomplish the three main goals set by the federal government’s Healthy People 2020 initiative: achieve health equity, eliminate disparities and improve the health of all groups.

As Czapp says: “Health holds the key to prosperity. When individuals prosper, we as a society prosper and enjoy greater quality of life.”


Glen R. Stream, MD, MBI, is a family physician in La Quinta, California, and president of Family Medicine for America’s Health, which sponsors Health is Primary.

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