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        美國貧困地區的疫情是什么樣子?

        美國貧困地區的疫情是什么樣子?

        DANIEL GREENLEAF 2022-08-03
        我們不能再只關注個人,必須從社會角度看問題。不能只治療病人,而是要治療導致醫療衛生和健康結果嚴重不平等的系統。

        美國人當中有十分之一生活貧困,難以獲得基本商品和服務,疫情凸顯了醫療的嚴重不平等。圖片來源:SPENCER PLATT—GETTY IMAGES

        美國人幾乎每十人就有一人生活在醫療沙漠中,醫療沙漠是指沒有及時急救服務、藥店,有時甚至沒有基層醫生?,F在是業內承認問題存在的時候了,當然如果能著手解決問題更好。

        醫療沙漠很多位于貧困的城市社區。其他則在農村地區,不僅分布廣泛而且很難到達。不管怎樣,現實是雖然美國大多數人理所當然地享受著便捷的醫療服務,每天仍有3000萬美國人面臨就醫困難。

        本公司向身處危險和就醫困難的人派遣司機和家庭護理員。他們經??吹矫绹死锍1缓鲆?,甚至完全無視的一面:需要輪椅和拐杖的殘疾人,關在家里需要外界幫助才能獲得食物和藥品的老人,沒有汽車沒法去遠處疫苗診所的窮人,還有靠氧氣瓶生活的身體虛弱人士。

        當美國其他地區紛紛封鎖,加強力量抵抗疫情時,我們公司派車送30萬人預約接種疫苗,將4萬名感染新冠的患者送往醫院,還跟多個社區組織合作派送200多萬份食物。

        約三分之二美國人是月光族,七分之一美國人生活貧困。我們目睹了疫情如何加劇貧困人群的孤立,加深貧富差距。數量相當大的弱勢群體只能受困原地,連生存必須的產品和服務都無法獲得。

        更糟糕的是,很多人生活在城市沙漠里,社區里幾乎沒有藥店能開處方,超市里幾乎買不到新鮮水果和蔬菜,也沒有醫療工作人員提供持續照顧。飲食情況差導致健康狀況低下,從而導致教育或就業前景黯淡。在健康和醫療方面,郵政編碼可能比基因更重要(意為居住地區比身體素質對健康影響更大——譯注)。

        例如,如果免費醫療影響了做小時工的工作,那就不是免費的。我們發現,很多人選擇新冠疫苗主要根據多少天下午要請假打針,或者能否負擔得起一次、兩次或所有次打針請保姆的費用。

        對低收入和拿最低工資的人來說,疫苗類型是重要考慮因素。我們發現很多人非常愿意選擇強生單針疫苗,因為這對小時工工作安排緊密的人們來說最方便。但單針疫苗在醫學上效果最差,這也是另一種經濟壓力影響個人健康的情況。

        除此之外,疫苗沙漠以及某些社區缺乏新冠檢測中心也很出人意料。結果如何?本就脆弱的人群健康更易感染。美國易感人群當中有三分之一尚未完全接種疫苗,然而催促人們接種疫苗跟創造條件方便人們接種疫苗并不是一回事。

        對于弱勢人群來說,選擇、替代和便利往往是奢侈品。在新冠疫情期間我們一次又一次發現這一點,疫情之前則并不會如此大規模呈現。我們看到了痛苦和默默忍受,對我們提供的服務也有了全新認識。

        我們逐漸意識到,其實所有在醫療領域工作的人都應該意識到的,唯一長期有效的方法是從整體入手。我們必須看到弱勢群體在哪,并前去提供服務。這是找出原因和解決方案的真正辦法。

        展望未來,所有方面都必須作為整體評估。交通、餐飲、醫療衛生、家庭監控、個人移動幫助和遠程監控都要納入生活質量和照顧的方程式。每一項都很重要。真正到臨床或醫學干預之前,其實有很多可能性,這往往是第一步,不是最后一步。

        我們不能再只關注個人,必須從社會角度看問題。不能只治療病人,而是要治療導致醫療衛生和健康結果嚴重不平等的系統。不能再讓這么多人就醫無門。

        支持性照顧社區行業(supportive care community)要宏觀角度看待自身。經歷過兩年新冠疫情的人都不會認為能夠健康生活是運氣。但這是偶然的。對于我們和依賴本公司服務的人來說都是機會。我們可以做得更好,也必須做到更好。(財富中文網)

        丹尼爾·E·格林利夫是位于科羅拉多州的醫療服務公司?Modivcare總裁兼首席執行官。

        譯者:梁宇

        審校:夏林

        美國人幾乎每十人就有一人生活在醫療沙漠中,醫療沙漠是指沒有及時急救服務、藥店,有時甚至沒有基層醫生?,F在是業內承認問題存在的時候了,當然如果能著手解決問題更好。

        醫療沙漠很多位于貧困的城市社區。其他則在農村地區,不僅分布廣泛而且很難到達。不管怎樣,現實是雖然美國大多數人理所當然地享受著便捷的醫療服務,每天仍有3000萬美國人面臨就醫困難。

        本公司向身處危險和就醫困難的人派遣司機和家庭護理員。他們經??吹矫绹死锍1缓鲆?,甚至完全無視的一面:需要輪椅和拐杖的殘疾人,關在家里需要外界幫助才能獲得食物和藥品的老人,沒有汽車沒法去遠處疫苗診所的窮人,還有靠氧氣瓶生活的身體虛弱人士。

        當美國其他地區紛紛封鎖,加強力量抵抗疫情時,我們公司派車送30萬人預約接種疫苗,將4萬名感染新冠的患者送往醫院,還跟多個社區組織合作派送200多萬份食物。

        約三分之二美國人是月光族,七分之一美國人生活貧困。我們目睹了疫情如何加劇貧困人群的孤立,加深貧富差距。數量相當大的弱勢群體只能受困原地,連生存必須的產品和服務都無法獲得。

        更糟糕的是,很多人生活在城市沙漠里,社區里幾乎沒有藥店能開處方,超市里幾乎買不到新鮮水果和蔬菜,也沒有醫療工作人員提供持續照顧。飲食情況差導致健康狀況低下,從而導致教育或就業前景黯淡。在健康和醫療方面,郵政編碼可能比基因更重要(意為居住地區比身體素質對健康影響更大——譯注)。

        例如,如果免費醫療影響了做小時工的工作,那就不是免費的。我們發現,很多人選擇新冠疫苗主要根據多少天下午要請假打針,或者能否負擔得起一次、兩次或所有次打針請保姆的費用。

        對低收入和拿最低工資的人來說,疫苗類型是重要考慮因素。我們發現很多人非常愿意選擇強生單針疫苗,因為這對小時工工作安排緊密的人們來說最方便。但單針疫苗在醫學上效果最差,這也是另一種經濟壓力影響個人健康的情況。

        除此之外,疫苗沙漠以及某些社區缺乏新冠檢測中心也很出人意料。結果如何?本就脆弱的人群健康更易感染。美國易感人群當中有三分之一尚未完全接種疫苗,然而催促人們接種疫苗跟創造條件方便人們接種疫苗并不是一回事。

        對于弱勢人群來說,選擇、替代和便利往往是奢侈品。在新冠疫情期間我們一次又一次發現這一點,疫情之前則并不會如此大規模呈現。我們看到了痛苦和默默忍受,對我們提供的服務也有了全新認識。

        我們逐漸意識到,其實所有在醫療領域工作的人都應該意識到的,唯一長期有效的方法是從整體入手。我們必須看到弱勢群體在哪,并前去提供服務。這是找出原因和解決方案的真正辦法。

        展望未來,所有方面都必須作為整體評估。交通、餐飲、醫療衛生、家庭監控、個人移動幫助和遠程監控都要納入生活質量和照顧的方程式。每一項都很重要。真正到臨床或醫學干預之前,其實有很多可能性,這往往是第一步,不是最后一步。

        我們不能再只關注個人,必須從社會角度看問題。不能只治療病人,而是要治療導致醫療衛生和健康結果嚴重不平等的系統。不能再讓這么多人就醫無門。

        支持性照顧社區行業(supportive care community)要宏觀角度看待自身。經歷過兩年新冠疫情的人都不會認為能夠健康生活是運氣。但這是偶然的。對于我們和依賴本公司服務的人來說都是機會。我們可以做得更好,也必須做到更好。(財富中文網)

        丹尼爾·E·格林利夫是位于科羅拉多州的醫療服務公司?Modivcare總裁兼首席執行官。

        譯者:梁宇

        審校:夏林

        Nearly one of every 10 Americans lives in a medical desert–a place without ready access to emergency care, pharmacies, or sometimes even primary care doctors. It’s time for business to acknowledge the problem, and, better yet, get to work fixing it.

        Many of these medical deserts are in urban neighborhoods filled with poverty. Others are in rural areas that are spread out and hard to reach. Either way, the reality is that 30 million Americans struggle daily to access the medical services that most of the country takes for granted.

        Our company dispatches drivers and home health care aides to at-risk and underserved populations. They bring back dispatches from an America that is often overlooked, if not ignored: people with disabilities who require wheelchairs and crutches, elderly shut-ins who need outside help for food and medicine, the poor without cars who can’t get to far-away vaccine clinics, and the infirm on oxygen bottles.

        While the rest of America was locked down and steeling itself against a pandemic, our company was driving 300,000 people to vaccine appointments, transporting 40,000 patients infected with COVID-19 to doctors and hospitals, and delivering more than two million meals alongside many community organizations.

        Nearly?two-thirds of Americans live paycheck to paycheck–and one in seven?live in poverty. We watched the pandemic exacerbate their isolation, and deepen the disparities between those of us who have and those who do not. So many vulnerable people were, quite simply, stuck where they were, with even less access to the products and services they needed to survive.

        Making matters worse, many live in urban deserts–neighborhoods with few pharmacies to fill prescriptions, few supermarkets with fresh fruits and vegetables, and few medical providers that allow for consistency of care. Poor diet leads to poor health, which leads to poorer prospects for education or employment. Zip code could be more important than genetic code when it comes to health and health care.

        For instance, free care isn’t actually free if it prevents you from earning your hourly wage. We found many people choosing a COVID vaccine based on how many afternoons they’d be required to take off work to get a shot. Or whether they could afford a babysitter once, twice, or at all.

        For lower-income and minimum-wage workers, vaccine type was a huge consideration. We saw a strong preference for the Johnson & Johnson one-and-done shot, which was the most convenient for people with tightly scheduled hourly wage jobs. But that vaccine also was the least effective medically–another case of economic pressures forcing a personal health compromise.

        On top of all that,?vaccine deserts were another, seemingly unanticipated issue, along with a lack of COVID testing centers in certain neighborhoods. The result? Already vulnerable populations were made even more so. In a nation where?one of every three eligible Americans is still not fully vaccinated, urging someone to get a vaccine isn’t the same as making it possible for them to get one.

        Options, alternatives, and easy access are often luxuries for the most vulnerable among us. We saw this firsthand time and again during COVID in a way and on a scale that hadn’t been apparent before the pandemic. We saw suffering and stoicism–and came away with a new sense of what our services should look like.

        We came to realize, as everyone working in the health care realm should, that the only approach that will work long term is a holistic one. We have to see where vulnerable populations are and meet them there. That’s the only real way to figure out the why and what can be done.

        Going forward, everything has to be assessed as part of a whole. Transportation, meals, health care, home monitoring, personal mobility help, and remote monitoring factor into the quality of life and care equation. All of it matters. There are so many possibilities for intervention before a clinical or medical one, which is too often the first step rather than one of last resort.

        We can’t just look at individuals anymore. We have to see this as societal. We can’t just treat patients, we have to treat a system that has led to vast inequities in health care and health outcomes. We must stop leaving so many behind.

        We in the supportive care community need to see ourselves as a part of a whole. No one who lived through the last two years would call this luck. But it is fortuitous. It’s an opportunity both for us and the people who rely on us. We can do better. We must do better.

        Daniel E. Greenleaf is the president and CEO of?Modivcare, a health care services company based in Colorado.

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