Lehigh Valley suffers from health care inequality

Posted: 6:20 AM EDT Mar 29, 2013   Updated: 6:59 AM EDT Mar 29, 2013
Dr. Bonnie Coyle

Defining the problem was fairly easy. Solving it will not be.

Less than 30 people wrestled with the issue of a lack of health care equality that exists in the Lehigh Valley -- and throughout the United States -- in Bethlehem’s Town Hall Thursday night.

The subject of the program was “Health Care Equity in the Lehigh Valley: Why we don’t have it and what we can do about it.”

Attaining health care equity means providing the highest level of health for all people, explained Dr. Bonnie Coyle, director of community health at St. Luke’s University Health Network.

“Health is precious,” said Coyle, the program’s speaker. “It means so much to everybody. Everybody should have a chance to live healthy and long. Yet here we are in the Valley, where it’s not being experienced evenly and across the board. Are we comfortable with that? Or does it start to make us think ‘this has to be addressed’?”

In Pennsylvania, she said, the average life expectancy for a white middle-class person is 79.4 years. But for a low income minority person, life expectancy is only 72 years.

“Lower income folks are giving up seven years of life,” said Coyle. “That’s a lot of years.”

She added in some other states, the differences are even greater – the wealthiest people live 20 years longer than the least wealthy people.

About 600,000 people live in the Lehigh Valley, according to Coyle, and 60,000 of them –10 percent -- have no health insurance. She said 20 percent of low-income people and 20 percent Hispanics have no medical insurance.

She showed charts illustrating many health problems are dramatically more significant for local residents who are Hispanic or have annual incomes under $25,000.

One survey done by St. Luke’s shows more than 70 percent of non-Hispanics feel the community has a good health care system, but only about 40 percent of Hispanics feel that way.

“The United States has one of the greatest income inequalities of all countries in the world,” said Coyle. “That means our rich people are way more rich than the poor folks.” She added that inequality is growing, so poverty is growing.

Coyle said about $2.5 trillion dollars is spent on health care in the United States, more than twice as much as the next closest country, “yet it’s not buying us health.”

She indicated at least 29 other countries have healthier people. “All these other countries have figured out how to do a better job of keeping people healthy.”
She also said the United States has a two-tiered health system. Those with good insurance have access “to all kinds of amazing technology.”

“But if you have Medicaid or no insurance, it’s a clinic system with long waits. People get different levels of care based on the insurance they come with.”

She said doctors get paid $75 to see patients with private medical insurance but only $15 for low-income patients with Medicaid.

“Almost any doctor will say ‘I’m not racist, I don’t treat my patients any differently when I’m providing care’,” said the doctor. “And yet a ton of research shows there’s a subtle bias that doctors don’t realize. They’re not even conscious of it.”

She said African-American infants still die twice as often as white infants.

Coyle blamed many societal factors for a lack of health care equity: poverty, racism, lack of education, incomes, lack of economic opportunities, unsafe neighborhoods and even environmental factors—people in poor communities often are exposed to more toxins.

She said the Valley’s minority population is growing “and we are seeing more problems with poverty.” She warned if health care disparity is not addressed, it can lead to social instability.

She suggested the solution is to create equitable opportunities, focus on people and where they live and then focus on the health care system.

She indicated the health care system is only a small part of the solution.

“Hospitals and health care systems alone are not going to solve this. The whole community has to come together to solve these problems.”

She added finding a solution it will require a comprehensive and inter-disciplinary approach, including participation by the business community.

“A paradigm shift is required if we’re really going to change this. It’s all about looking at things completely differently.”

She initially was met with silence when she asked her audience: “Where do you think we have to start?”

During the ensuing discussion, there seemed to be a consensus that sending people – especially white, middle-class people – into poor minority neighborhoods to tell residents to stop smoking, eat more fruits and vegetables and get more exercise is not going to end the inequity.

It was mentioned that other countries invest in the wellness of their citizens, just as some U.S. companies do for their own employees.

Some in the audience echoed Coyle’s comment that local businesses need to be brought into the conversation, with one person suggesting she make a presentation to the Lehigh Valley Chamber of Commerce.

One man said a Bethlehem neighbor recently died of a stroke because the person was only taking stroke medicine when he could afford to buy it. He said other elderly people in his neighborhood have lost their health insurance.

There was no discussion about whether the controversial federal laws known as Obamacare might help alleviate health care inequality. Nor was universal health care raised. After the program Coyle said universal health care would contribute to the solution, but is not the only answer.

Thursday’s program was part of a Town Hall Lecture Series presented by the city and Lehigh University’s South Side Initiative. Goal of that initiative is to bring together university faculty, students and staff with Bethlehem residents “to share knowledge, foster democracy and improve the quality of life in the city.”

Most people attending the program already knew each other and Coyle.
She was introduced by Seth Moglen, a Lehigh University English teacher and director of South Side Initiative.