Quantifying the Effects of Community Health Center Access on Health for Medically-Vulnerable Populations

Abstract

Established in 1965 as a part of President Johnson’s War on Poverty effort, the federal community health center (CHC) program is a primary source of federally-subsidized quality health care services for medically-vulnerable populations in the United States. Despite its current role as a medical safety-net for the nation’s health care system, the CHC program did not begin as a public health program, but rather as a social justice program. Since its formalization, the CHC program has enjoyed relatively consistent Congressional support as a cost-effective means of providing primary healthcare to indigent populations; however, the narrative of the program has shifted overtime from a focus of empowerment and lifting communities out of poverty, to the fortification of the national health care system as a cost-effective provider of quality healthcare care for all. In this manuscript, I argue that this transition from community empowerment and the mitigation of fundamental causes of disease to a more risk-based emphasis on the issue of access, has diminished the urgency around the engagement of the structural effects of poverty on health in favor of a “one size fits all” approach to the provision of basic health care. In an effort to objectively quantify the effects of geographic access on health as a means for evaluating the success of the contemporary program, this research project explores the extent to which proximal access to a CHC is significantly associated with various self-reported indicators of positive health outcomes. My primary research method is multivariable regression utilizing secondary data from the 2012 Southeastern Pennsylvania Household Health Survey, the 2008-2012 5-year American Community Survey Estimate, and the Health Resources and Services Administration Data Warehouse. Using statistical modeling, I test the effect of CHC access on three distinct measures of individual health: (1) self-reported health status, (2) the likelihood of having pain lasting 6 months or more, and (3) the likelihood of having a usual source of health care. Within each model, I also test a series of interaction terms through nested sub-models to uncover any conditional effects of access for selected social groups. This statistical design offers the opportunity to explore whether the main association between access to a CHC and health varies based on the social characteristics and/or social environment of the individual. The findings of my analysis suggest that the effect of CHC access varies for different social groups, with less disadvantaged groups, such as poor non-Hispanic whites with high social capital, and poor individuals living in areas of low disadvantage, receiving the greatest benefit from proximal CHC access. However, individuals at the extremes of social disadvantage benefit least from CHC access alone. I argue that while the provision of CHC access is a noble and necessary tactic for fighting the persistence of health disparities in our medically-vulnerable communities, focusing on access alone is insufficient to solve the problem. The pendulum must switch back to community empowerment and the eradication of structural threats to health to initiate real change for medically-vulnerable populations.