- Originally published in the AScribe Newswire April 4, 2005 Copyright 2005 AScribe Inc.
WEST
LAFAYETTE, Ind., April 4 [AScribe Newswire] -- The number of days
people stay home ill is influenced by neighborhood poverty and whether
they receive subsidized health care, such as Medicaid, says a Purdue
University urban sociologist.
"As state
policy-makers decide whether to cut or invest in their state health
insurance programs, such as Medicaid, they need to better understand
factors, both systemic and individual, that influence whether and how
people seek treatment for illnesses such as diabetes and high blood
pressure," said Sandra Barnes, assistant professor of sociology.
"Limited
health-care options mean that many people in poor urban communities are
less likely to seek preventive care that could help them better manage
their illnesses. In too many instances, this means that residents are
forced to turn to emergency care in the form of expensive hospital
emergency rooms."
Barnes found that
difficulty in obtaining adequate, affordable, accessible health care
undermines the health of many residents in poor urban neighborhoods.
The problem is particularly acute for urbanites who are women and for racial/ethnic minorities.
"Policy
should be shaped to provide more health-care assistance for the working
poor - people who are employed but do not earn enough money to purchase
health care or make too much to qualify for Medicaid," Barnes said. "If
not, we will see higher mortality rates and a decrease in people's
quality of life."
Additional health-care
facilities also should be a priority for impoverished urban areas as
should improving existing services and providing incentives for
physicians to establish practices there, she wrote in Research in the
Sociology of Health Care: Chronic Care, Health Care Systems, and
Services Integration. The journal edition was published in March.
"I
wanted to know whether poor people's health-care decisions are affected
by neighborhood poverty and if they differ among races," Barnes said.
This
study is different than others because it considers the availability,
accessibility and affordability of basic health care for residents in
poor urban areas, including those who are regularly employed but whose
income is below the nation's poverty level, Barnes said.
"Interestingly,
residents in less poor neighborhoods were more likely to stay home ill
from work than those who lived in more impoverished neighborhoods,"
Barnes said. "And people who identified their health as fair or poor
were less likely to seek regular care or spend days home from work or
in the hospital. These results illustrate that, because of economic
hardship, some poor people cannot afford to become sick."
Barnes
attributes this largely to a lack of affordable services and
health-care coverage, especially for some minority groups. Barnes found
that African-Americans in the study relied on
hospital outpatient care at twice the rate - more than 33 percent - of
whites, Puerto Ricans and Mexican-Americans. A greater percentage of
working African-Americans and Mexican-Americans, almost 30 percent and
40 percent, respectively, do not have health insurance coverage, Barnes
said. African-Americans
and Mexican-Americans living in an urban area were the least likely to
remain home or spend time in the hospital when ill, while whites and
Puerto Ricans were more likely to stay home.
"Those
who seek care at urban clinics or don't seek health care at all were
less likely to stay home from work," she said. "People who don't
receive treatment for their illnesses may face more expensive
complications later in life."
"Yes,
individuals decide whether to seek preventive health care, but
policy-makers need to realize there are greater external forces, such
as subsidized health care, that are influencing those decisions."
Barnes' findings are based on data of 2,490 African-American,
Mexican-American, Puerto Rican and white Chicago residents from the
University of Chicago's Urban Poverty and Family Life Survey. For those
surveyed, the average annual household income was less than $15,000,
and more than three-fourths of the respondents were employed. Barnes
analyzed relationships between health care accessibility and the number
of days a person stayed home ill or was hospitalized in 1986.
"Poverty,
which has continued to increase during the past 20 years, remains
central to urban living," said Barnes, whose next book provides an
in-depth look at economic costs incurred and decisions faced by the
working poor in Gary, Ind. The book will be released this summer.
"It
is more difficult for people to focus on their own their illnesses when
they are worried about feeding and clothing their children."
Barnes
also is chronicling the history of black churches. Her work is
supported by Purdue's Department of Sociology and Anthropology and the African American Studies Research Center.