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美国贫困地区的疫情是什么样子?

DANIEL GREENLEAF
2022-08-03

我们不能再只关注个人,必须从社会角度看问题。不能只治疗病人,而是要治疗导致医疗卫生和健康结果严重不平等的系统。

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美国人当中有十分之一生活贫困,难以获得基本商品和服务,疫情凸显了医疗的严重不平等。图片来源:SPENCER PLATT—GETTY IMAGES

美国人几乎每十人就有一人生活在医疗沙漠中,医疗沙漠是指没有及时急救服务、药店,有时甚至没有基层医生。现在是业内承认问题存在的时候了,当然如果能着手解决问题更好。

医疗沙漠很多位于贫困的城市社区。其他则在农村地区,不仅分布广泛而且很难到达。不管怎样,现实是虽然美国大多数人理所当然地享受着便捷的医疗服务,每天仍有3000万美国人面临就医困难。

本公司向身处危险和就医困难的人派遣司机和家庭护理员。他们经常看到美国人里常被忽视,甚至完全无视的一面:需要轮椅和拐杖的残疾人,关在家里需要外界帮助才能获得食物和药品的老人,没有汽车没法去远处疫苗诊所的穷人,还有靠氧气瓶生活的身体虚弱人士。

当美国其他地区纷纷封锁,加强力量抵抗疫情时,我们公司派车送30万人预约接种疫苗,将4万名感染新冠的患者送往医院,还跟多个社区组织合作派送200多万份食物。

约三分之二美国人是月光族,七分之一美国人生活贫困。我们目睹了疫情如何加剧贫困人群的孤立,加深贫富差距。数量相当大的弱势群体只能受困原地,连生存必须的产品和服务都无法获得。

更糟糕的是,很多人生活在城市沙漠里,社区里几乎没有药店能开处方,超市里几乎买不到新鲜水果和蔬菜,也没有医疗工作人员提供持续照顾。饮食情况差导致健康状况低下,从而导致教育或就业前景黯淡。在健康和医疗方面,邮政编码可能比基因更重要(意为居住地区比身体素质对健康影响更大——译注)。

例如,如果免费医疗影响了做小时工的工作,那就不是免费的。我们发现,很多人选择新冠疫苗主要根据多少天下午要请假打针,或者能否负担得起一次、两次或所有次打针请保姆的费用。

对低收入和拿最低工资的人来说,疫苗类型是重要考虑因素。我们发现很多人非常愿意选择强生单针疫苗,因为这对小时工工作安排紧密的人们来说最方便。但单针疫苗在医学上效果最差,这也是另一种经济压力影响个人健康的情况。

除此之外,疫苗沙漠以及某些社区缺乏新冠检测中心也很出人意料。结果如何?本就脆弱的人群健康更易感染。美国易感人群当中有三分之一尚未完全接种疫苗,然而催促人们接种疫苗跟创造条件方便人们接种疫苗并不是一回事。

对于弱势人群来说,选择、替代和便利往往是奢侈品。在新冠疫情期间我们一次又一次发现这一点,疫情之前则并不会如此大规模呈现。我们看到了痛苦和默默忍受,对我们提供的服务也有了全新认识。

我们逐渐意识到,其实所有在医疗领域工作的人都应该意识到的,唯一长期有效的方法是从整体入手。我们必须看到弱势群体在哪,并前去提供服务。这是找出原因和解决方案的真正办法。

展望未来,所有方面都必须作为整体评估。交通、餐饮、医疗卫生、家庭监控、个人移动帮助和远程监控都要纳入生活质量和照顾的方程式。每一项都很重要。真正到临床或医学干预之前,其实有很多可能性,这往往是第一步,不是最后一步。

我们不能再只关注个人,必须从社会角度看问题。不能只治疗病人,而是要治疗导致医疗卫生和健康结果严重不平等的系统。不能再让这么多人就医无门。

支持性照顾社区行业(supportive care community)要宏观角度看待自身。经历过两年新冠疫情的人都不会认为能够健康生活是运气。但这是偶然的。对于我们和依赖本公司服务的人来说都是机会。我们可以做得更好,也必须做到更好。(财富中文网)

丹尼尔·E·格林利夫是位于科罗拉多州的医疗服务公司 Modivcare总裁兼首席执行官。

译者:梁宇

审校:夏林

美国人几乎每十人就有一人生活在医疗沙漠中,医疗沙漠是指没有及时急救服务、药店,有时甚至没有基层医生。现在是业内承认问题存在的时候了,当然如果能着手解决问题更好。

医疗沙漠很多位于贫困的城市社区。其他则在农村地区,不仅分布广泛而且很难到达。不管怎样,现实是虽然美国大多数人理所当然地享受着便捷的医疗服务,每天仍有3000万美国人面临就医困难。

本公司向身处危险和就医困难的人派遣司机和家庭护理员。他们经常看到美国人里常被忽视,甚至完全无视的一面:需要轮椅和拐杖的残疾人,关在家里需要外界帮助才能获得食物和药品的老人,没有汽车没法去远处疫苗诊所的穷人,还有靠氧气瓶生活的身体虚弱人士。

当美国其他地区纷纷封锁,加强力量抵抗疫情时,我们公司派车送30万人预约接种疫苗,将4万名感染新冠的患者送往医院,还跟多个社区组织合作派送200多万份食物。

约三分之二美国人是月光族,七分之一美国人生活贫困。我们目睹了疫情如何加剧贫困人群的孤立,加深贫富差距。数量相当大的弱势群体只能受困原地,连生存必须的产品和服务都无法获得。

更糟糕的是,很多人生活在城市沙漠里,社区里几乎没有药店能开处方,超市里几乎买不到新鲜水果和蔬菜,也没有医疗工作人员提供持续照顾。饮食情况差导致健康状况低下,从而导致教育或就业前景黯淡。在健康和医疗方面,邮政编码可能比基因更重要(意为居住地区比身体素质对健康影响更大——译注)。

例如,如果免费医疗影响了做小时工的工作,那就不是免费的。我们发现,很多人选择新冠疫苗主要根据多少天下午要请假打针,或者能否负担得起一次、两次或所有次打针请保姆的费用。

对低收入和拿最低工资的人来说,疫苗类型是重要考虑因素。我们发现很多人非常愿意选择强生单针疫苗,因为这对小时工工作安排紧密的人们来说最方便。但单针疫苗在医学上效果最差,这也是另一种经济压力影响个人健康的情况。

除此之外,疫苗沙漠以及某些社区缺乏新冠检测中心也很出人意料。结果如何?本就脆弱的人群健康更易感染。美国易感人群当中有三分之一尚未完全接种疫苗,然而催促人们接种疫苗跟创造条件方便人们接种疫苗并不是一回事。

对于弱势人群来说,选择、替代和便利往往是奢侈品。在新冠疫情期间我们一次又一次发现这一点,疫情之前则并不会如此大规模呈现。我们看到了痛苦和默默忍受,对我们提供的服务也有了全新认识。

我们逐渐意识到,其实所有在医疗领域工作的人都应该意识到的,唯一长期有效的方法是从整体入手。我们必须看到弱势群体在哪,并前去提供服务。这是找出原因和解决方案的真正办法。

展望未来,所有方面都必须作为整体评估。交通、餐饮、医疗卫生、家庭监控、个人移动帮助和远程监控都要纳入生活质量和照顾的方程式。每一项都很重要。真正到临床或医学干预之前,其实有很多可能性,这往往是第一步,不是最后一步。

我们不能再只关注个人,必须从社会角度看问题。不能只治疗病人,而是要治疗导致医疗卫生和健康结果严重不平等的系统。不能再让这么多人就医无门。

支持性照顾社区行业(supportive care community)要宏观角度看待自身。经历过两年新冠疫情的人都不会认为能够健康生活是运气。但这是偶然的。对于我们和依赖本公司服务的人来说都是机会。我们可以做得更好,也必须做到更好。(财富中文网)

丹尼尔·E·格林利夫是位于科罗拉多州的医疗服务公司 Modivcare总裁兼首席执行官。

译者:梁宇

审校: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.

财富中文网所刊载内容之知识产权为财富媒体知识产权有限公司及/或相关权利人专属所有或持有。未经许可,禁止进行转载、摘编、复制及建立镜像等任何使用。
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