NEW SOLUTIONS, Vol. 23(3) 435-437, 2013
Comment and Controversy CONFERENCE REPORT: COMMUNITY HEALTH CENTERS AND VULNERABLE WORKERS
A one-day conference in Washington brought together leaders of community health centers and worker advocates to discuss collaboration. They agreed that health centers could help protect vulnerable workers. They agreed on use of electronic medical records; access to workers compensation; MedicalLegal Partnerships; better understanding of work settings in their communities; and educating clinicians on work and jobs.
Keywords: work, jobs, community health centers, workers compensation, clinicians
As the United States implements the Affordable Care Act, one key question is how to meet the health-care needs of the millions of newly insured people. Eleven hundred Federally Qualified Health Centers (community health centers) that provide comprehensive primary care to underserved populations will be a key source of care for those gaining insurance coverage. Thus Congress authorized $11 billion over five years for health center expansion. These funds for services in lower-income communities appear to have been largely protected from “sequestration,” this year’s automatic budget cuts. It was in this environment that a new collaboration emerged during a 12 April conference in Washington entitled Community Health Centers and Vulnerable Workers. 435 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/NS.23.3.a http://baywood.com
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With a grant from the Public Welfare Foundation designed to develop new initiatives to protect workers, Celeste Monforton and Liz Borkowski of George Washington University School of Public Health convened leaders from community health centers, from worker centers and advocacy groups, and from the Health Resources and Services Administration’s Bureau of Primary Health Care in the U.S. Department of Health and Human Services. The Bureau funds community health centers. The worker centers help workers achieve fair employment and safe workplaces. Health centers like to say that for their communities, “poverty is the number one diagnosis.” Work provides much-needed income, but it can also harm workers’ health. Workplace exposures and injuries constitute a large fraction of preventable health problems, particularly for low-wage workers. With the exception of health centers receiving funding to serve migrant and seasonal farmworkers, however, few health centers have ever had programs focusing specifically on occupational health and safety. Washington meeting participants discussed steps that both clinicians and non-clinicians at health centers could take to help reduce workplace injuries and disease-causing exposures, and to treat workers suffering from work-related health problems. A former employee of the Massachusetts Department of Public Health described how the department had tried to help health-center clinicians identify and address potentially work-related illnesses—respiratory problems in people employed as cleaners, and elevated lead levels in painters. On the non-clinical side, two administrators from the Spring Branch Community Health Center in Houston, Texas, described their rewarding collaboration with the local workers’ center, which now runs discussion groups about job hazards each month at the health center for health-center clients. Not only do the meetings offer tips for preventing on-the-job injuries, they have attracted new clients to the health center. Dan Hawkins, Vice President of the National Association of Community Health Centers, identified health-center leaders from around the country to provide varied perspectives. Administrators from health centers in Chicago, Houston, and Beaufort, South Carolina, talked of their experiences serving low-wage workers. Representatives from the Migrant Clinicians’ Network, the National Center for Farmworker Health, the National Council for Occupational Safety and Health, and UCLA Labor Occupational Safety and Health highlighted common workplace health problems and strategies for addressing them. How could federal agencies support collaborations to help health centers protect and treat patients who are workers? Could electronic health records help, if they collected occupational information? Three key professionals from the National Institute for Occupational Safety and Health and the Bureau of Primary Health Care joined the discussion. The meeting’s 20 participants seemed to agree on five key points:
• Including occupation in the Electronic Health Record would permit health centers to analyze and target work-related health problems. • Developing health centers’ capacity to manage and treat patients who may be in the workers’ compensation system or qualify for workers’ compensation benefits would help many low-wage workers who use health centers. • Medical-Legal Partnerships might facilitate efforts to ensure that employers follow existing health and safety laws and help injured workers navigate the workers’ compensation system. (The partnerships bring legal services to dozens of health centers to improve the health and well-being of low-income and other vulnerable populations by addressing unmet legal needs and removing legal barriers that impede health.) • Understanding employment and jobs in the communities they serve would help health centers develop programs to counsel workers on how to protect themselves from injuries and exposures on the job, and on their rights to be protected from or receive compensation for injuries and illnesses. • Education about work and jobs would also help clinicians at health centers engage more effectively with their patients. Everyone agreed that the Affordable Care Act and its complex implementation would, in the short run, demand most of health centers’ attention, but there was no doubt that collaboration between health centers and worker advocates can, in the long run, help health centers serve their communities and workers more effectively. No one doubted that in the future collaboration is likely to improve services and links between health centers and the communities they serve. AUTHOR’S BIOGRAPHY ANTHONY ROBBINS is a former Director of the National Institute for Occupational Safety and Health. He directed two state health departments, Vermont and Colorado. In 1983, he served as President of the American Public Health Association. He was the Editor of Public Health Reports and currently co-edits the Journal of Public Health Policy.
Direct reprint requests to: Anthony Robbins, MD, MPA Professor of Public Health Tufts University School of Medicine 130 Appleton Street, Unit 1i Boston, MA 02116 e-mail: [email protected]