Healthcare outcomes for individuals vary greatly across the United States. Factors such as socioeconomic status and location have a strong impact on the ability to live a healthy life. In South Los Angeles, home to many socioeconomically disadvantaged communities, residents faced alarming health concerns during the COVID-19 pandemic. At the Martin Luther King Jr. Community Hospital, which serves primarily Black and Brown Medicaid populations, 82% of COVID-19 patients had a comorbidity—where another disease is present—and they were typically in the late stages of their illnesses by the time they arrived at the hospital.
This adverse trend is not limited to South LA; it transpires throughout the country. Such reluctance to receive medical treatment before symptoms worsen occurs for multiple reasons. Factors include barriers to obtaining housing near hospitals and lack of access to transportation for medical care. Nationwide, around 5.8 million people in 2017 chose to postpone medical treatment due to a lack of transportation. Even reaching the provider is a substantial hurdle in and of itself.
There is a spatial mismatch between the location of major healthcare providers and low-income and minority homes. When these disadvantaged communities evaluate which amenities have the most value when choosing where to settle—their hedonic analysis—they place less value on access to healthcare compared to other amenities in a desire for cheaper living costs. To overcome the medical-spatial mismatch and alleviate these disparities, the responsibility must shift to urban healthcare providers to initiate community-based preventative care programs in underserved areas at trusted community centers.
The medical-spatial mismatch has grown due to relatively higher housing costs near large hospitals and a lack of suitable employment opportunities where disadvantaged populations reside. Although ZIP codes near smaller hospitals actually have below-average median home prices and rent, this is not the case for large hospitals, which are more common in cities. Since 2001, areas with large hospitals have had approximately $25,000 higher average home prices than areas with no hospitals, and this difference has only widened recently—to around $50,000 in 2017. Similarly, rent prices per month near large hospitals ($1,800) were $250 greater than in areas with no hospitals ($1,550). This contrast can be credited to the workforce from these large hospitals, as their professional staff, like doctors and senior management, have relatively higher earnings and can afford costlier housing.
The widespread issue of medical mistrust among minority communities also contributes to a decreased emphasis on healthcare. Historical events like the unethical Tuskegee Study, where Black men with syphilis were deceived and left untreated by the government for experimental purposes, contribute to the current skepticism. This has led to troubling statistics. When the COVID-19 vaccine was first released, 61% of White adults intended to get vaccinated, but the percentage dipped to 42% for Black adults.
Since disadvantaged communities are located farther away from providers, transportation plays a larger role when they need to receive medical care. However, the ability to use transportation has inequities as well. In Chicago, researchers studied African-American and Hispanic adults with Type 2 diabetes and found that 33.8% of participants had difficulty finding transportation. To mitigate the burden of transportation, a viable solution is to bring medical providers to them before their symptoms worsen.
To address this issue, major medical providers need to first determine which neighborhoods are under-resourced and have higher rates of chronic diseases, such as diabetes and cardiovascular disease. Once these target locations are established, medical providers can deploy their healthcare personnel to disadvantaged areas to conduct preventive care initiatives. By bringing the providers and their preventive care to patients instead of relying on residents to get to the providers on their own, the medical-spatial mismatch in cities begins to erode.
Providers cannot set up their prevention sites anywhere in these underserved areas, however. Medical mistrust is still too prevalent amongst minorities. Therefore, these preventive efforts must not take place in clinical settings, but at trusted community centers such as barbershops. New York University’s Langone Health, a major hospital and healthcare provider in New York City, utilized barbershops to reach out to older Black men and give them colorectal cancer screenings. They found that only 40% of these men had a checkup in the past year. As a result, 17.8% were screened for colorectal cancer within six months. The gaps brought upon by the medical-spatial mismatch in cities can be further bridged by locating these preventive care initiatives in established community centers.
In addition to where community health treatments are located, it is important who is providing the care. There are incentives for having the providers be of the same racial/ethnic background as the target population. In barbershops, where the primary target group is Black men, having Black practitioners and other Black health workers increases medical trust. In Oakland, Black male patients who met with Black male doctors had a higher demand for preventive care services than those who met with non-Black doctors, especially for invasive procedures. With this increased trust and desire toward receiving care, the Black-White male gap in cardiovascular mortality decreased by 19%, while the Black-White male life expectancy gap declined by 8%.
With higher medical trust, disadvantaged residents will begin to value access to healthcare higher when deciding where to live. It will motivate people to reside closer to a provider and seek further treatment when necessary. Moreover, the benefits go beyond simply improving healthcare access. Alleviating the severity of symptoms before they worsen can reduce medical expenses and costs associated with chronic diseases. There has been a 13% increase in the cost per person with diabetes from 2012 to 2017 due to increased emergency room visits and hospitalizations, which could have been mitigated with preventive care.
The medical-spatial mismatch is a nuanced problem that has significant ramifications on the health outcomes of under-resourced communities, with causes ranging from high housing costs near hospitals to mistrust in the healthcare system. A potential solution shifts greater responsibility to the providers. By setting up prevention care sites in community centers, more individuals are able to receive care and increase their trust in healthcare professionals. It is necessary to go beyond solely a healthcare lens to solve this mismatch; other factors such as housing, transportation, and culture are all extremely important. As stated by the late medical anthropologist Paul Farmer, “it is very expensive to give bad medical care to poor people in a rich country.” We need to provide stronger access to care to under-resourced populations in the United States.