Central PA Medicine Fall 2020 - 20

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While DoD were first noted in white low-income communities, it has since been established
that the phenomenon of rising middle-age death
rates from specific causes-e.g., drug overdose,
suicide, organ system disease-actually extend
across racial, ethnic, and gender lines, as well
as into cities and suburbs (although a higher
burden remained in the industrial Midwest
and Appalachia where deindustrialization trade
liberalization has been most damaging).
A recent Penn State study has substantiated
that the DoD crisis-as it is reflected in clinical
visits to address drug problems, suicidal ideation,
and struggles with alcohol-expands across
demographic and geographic boundaries. This
emerging finding has caused researchers to revise
their previous lens defining DoD as a crisis of the
" white working class, " and has underscored the
need for a universal and inclusive approach to
address the underlying structural changes in the
country's political-economy that have worsened
life for so many working class Americans.
So too does it suggest that, in our current
protests, we may be seeing rage that extends
beyond the police to a broader societal critique.
Indeed, it is impossible to ignore the fact that
one invisible factor fueling the protests is that
an estimated 30 million Americans are currently
unemployed and tens of millions more living
on the razor's edge of financial collapse and loss
of benefits like healthcare in the face of what is
largely perceived as insufficient federal support.
" Universal " may be a term that seems vague to
some. However, it encompasses the enormity of
the despair-related problems we are witnessing in
our country. For a problem at such a formidable
scale we need equally ambitious solutions. This
involves going to the core of problems that cause
systemic despair and inequality before they
manifest in confrontations with police-things
like housing, education, a living wage, and the
right for everyone to enjoy basic security and
dignity in their respective communities.
Indeed, one important detail about George
Floyd's encounter with police is that it was
precipitated by a store clerk reporting that
George-who had recently lost his job and
was struggling with financial hardship- was
attempting to use counterfeit money. This
demands that we think about more foundational
questions about why Americans are placed in
20 Fall 2020 Central PA Medicine

such precarious economic positions and what
potential policies (e.g., a jobs guarantee, more
robust social welfare benefits, etc.) might help
preempt desperate encounters with the police
and carceral system such as was experienced by
the late Mr. Floyd.

alleviating systemic injustice and disparity is
healthcare and equal access to quality hospital
service. The difference a hospital can make in
a community is profound, as it provides not
only a place of clinical treatment but a source of
economic and health security for a community.
This
specific community pillar has been at the
As part of one of our research projects, we
greatest
risk of failing, even before COVID-19
have attempted to understand what is needed
ravaged
the
hospital landscape. In rural America
in underserved communities suffering from
and
even
urban
centers there is a growing trend
despair. We have held focus groups with Afriof
small
hospital
closures, with the most recent
can-American communities in Harrisburg, and
one
in
Pennsylvania
being UPMC Sunbury
what we've learned is that people perceive a sense
in
Sunbury,
PA
closing
on March 1st. The
of decay in their communities: the loss of culture
primary
reason
hospitals
are
closing is not due
and cohesiveness and a rise in isolation and
to
inadequate
quality,
it
is
due
to their inability
mental health concerns. They see a generation
to
turn
a
profit
based
on
their
population-a
of children adrift, not understanding their own
flaw
unique
to
our
market-based
healthcare
communities or their cultures and customs.
system in the United States.
They see dysfunctional local, state, and
The irony in this case, is that the intention
federal governments that have not responded
of
a small rural or critical access hospital in a
to their needs. Overall, the sentiment of many
non-profit
system is to support the community
communities has become bleak and reflective
around
it,
not
to turn a massive profit. When
of the societal despair first noted by Case and
the
community
that leans on its clinical care is
Deaton. Along with these interviews in rural
financially
struggling
and cannot optimally pay,
and urban areas of Central Pennsylvania, we
there
is
a
high
likelihood
their health has also
have also begun looking at the rash of hospital
taken
a
toll
and,
as
a
result,
the closed hospital
closures, and documenting the overwhelmingly
becomes
another
symbol
of
a system closing a
deleterious impact closures have had in these
door
of
community
prosperity
and ultimately
communities as part of the larger story of despair.
issuing
premature
death
sentences.
This trend of
Hospitals with large amounts of resources in
hospital
closures
has
impacted
African-American
affluent areas tend not to struggle as much as
public access hospitals. This comes from both communities disproportionately as their relative
their client base and the type of services a hospital risk for morbidity increases more in contrast to
offers that can be more lucrative or cash based. other vulnerable populations1. Rural geography
increases the impacts this problem exponentially
Hospitals in this bracket also have greater as well since EMS response times from healthcare
access to investment opportunities and to bring deserts to trauma centers increase and rural
lucrative practices into their network. Critical hospitals are closing quicker than urban locations.
access and rural hospitals lack this opportunity
Altogether, the closure of hospitals is but one
as their purpose for existence is to branch the
element
of a larger narrative of despair in the US.
health gap and give access of care to those who
As
healthcare
providers, we need to keep our eyes
need it most. The strategy of a critical access or
on
the
bigger
picture and stay focused on root
rural hospital is, in essence, the reason hospital
causes.
Both
as
professionals and as a country,
systems have a nonprofit status to help and give
we
need
to
combat
the multifaceted problems
charitable care to those that need it. When these
we
face
first
by
lobbying
and advocating on
hospitals are eliminated it becomes a matter of
immediate risk to those that are directly affected
behalf of our communities to implement polas patients but a long term risk to institutions icy changes. Protections need to be put in place
that exist around that closure.
for hospitals that operate with zero or negative
margins
even with all options exhausted on cost
Alongside the job loss, physician loss, and
saving.
It
is also up to physicians and healthcare
overall draining of community resources the
leaders
to
advocate and develop models to
downstream impact on surrounding hospitals
subsidize
budgeting
to critical access hospitals,
is significant One of the most useful assets in
as their closure further damages the healthcare

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Central PA Medicine Fall 2020

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