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Poverty and poor health.

Reforms appear to be forthcoming, but more is needed than just equal access to health-care system

With the Clintons in the White House, health-care reform appears to be forthcoming. I applaud the concept of universal access. However, in my experience, that seems to be an effort to stretch the current system to include those now excluded. Such an approach might improve access to the system, but much more change is needed if we are to provide everyone, particularly the poor, with equal access to good health.

The emphasis on health technology in the United States has led us into a race to keep up with the latest equipment and procedures while ignoring the education and preventive treatments that could have a great effect on individual and public health. Our insurance policies usually cover large sums for all kinds of acute care but seldom cover smaller costs for routine preventive assessments.

I saw the sad consequences of that while working as a local hospice volunteer. In eastern Kentucky, many people fall through the system's cracks: They're too young for this program, too old for that one, not poor enough for the other. I saw people die of curable illnesses. A spouse or child would say, "Well, he should have seen the doctor when he first noticed it. But we really didn't have the $35, and I guess he waited until it got really bad."

A Kentucky legislative aide said recently: "One argument against a government-sponsored single-payer plan is that usage always seems to go up." I certainly hope so! People might actually seek advice before they are beyond help.

Our free-market attitude sees health as just one more thing we can buy if we have the money, not as a basic right. That attitude also contributes to the high prices of -- and dependency on -- tests, pills and surgery. We are encouraged to buy health from the system, not to accept responsibility for the behavior that could improve our health and limit the need for expensive health care.

Poverty and poor health: The connections are evident across our nation. An unfortunate adjunct of poverty -- lack of education -- contribute greatly to poor health. Health and nutrition education must be a strong component of any health-care reform plan.

I took a young mother of two to the grocery a few months ago. I was appalled by her choices but realized she couldn't have known better. Besides, it's hard to get around the fact that soda pop is cheaper than juice and the salty canned vegetables are cheaper than the fresh ones and much easier to fix. People on food stamps often must settle for what is cheapest.

People with money, on the other hand, can afford more than just better, healthier diets. They also can afford to keep toxic processes and wastes out of their neighborhoods. The poor often can't. It can't be a coincidence that in the last several years, companies have inundated areas like Appalachia and American Indian reservations, seeking sites to dispose of such materials. Citizens groups have done a remarkable job of resisting the companies, but as long as the economy remains depressed, the offers will continue. The promise of a few jobs may be too great if people are desperate.

To those who will forge our national health-care priorities, I say it will not be enough to provide rural areas with new hospitals and shiny equipment. It will not be enough to say we're insured if we still can't afford the costs involved. We need more than |sick care' to provide needed treatment when we become ill. We need real health care: ways to improve and maintain our well-being. This cannot be done simply by looking at services and technology for those who are ill. The complex and related issues of poverty, education, environment and discrimination desperately need to be addressed.

Who knows? Someone may be listening.

Carol Warren has spent the last six years in Harlan County, Kentucky, where she is on staff of St. Stephen's Church in Cumberland.
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Author:Warren, Carol
Publication:National Catholic Reporter
Date:Apr 9, 1993
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