February’s edition of CityVoices tackles a long overdue theme – City Health and City Churches. Church-based hospitals and clinics have been present in America’s great cities for a long time. Many of these institutions have grown to be large and important institutions in their communities. In nearly every large city, hospitals are the largest employers. Yet, it seems that poor city residents who need health care the most find little or no access to it. The problem of health care (or lack thereof) has become a national embarrassment.

In the pages ahead, we bring you several helpful articles focusing on various aspects of the health issue, highlighted by an interview with Dr. Jerry Stromberg of the Christian Community Health Fellowship. In the course of reading, you’ll soon become aware of several pioneers in the field and some of the resources they provide. A couple wonderful books in this field can be purchased directly through Amazon.com. Dr. Scott Morris’ “Relief for the Body, Renewal for the Soul” (Paraclete Press, $13.95) is inspiring. It tells the stories of his work with many needy patients through the Church Health Center in Memphis. Other extremely helpful tools are the books written by Dr. David Hilfiger, “Not All of Us Are Saints: A Doctor’s Journey with the Poor,” (Hill and Wang, $19.95) and “Urban Injustice: How Ghettos Happen” (Seven Stories Press, $11.95). Again, order these books directly through Amazon.com.

God’s grace and peace today,
Roger Johnson, Editor – CityVoices

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City Health & City Churches

No, we’re not talking about some “notion” of what makes your city attractive, lively and hot. We’re talking about real people who get sick altogether too often in America’s great urban places. Large numbers of people gather in close quarters in the “urban arena,” bringing with them talents, energies and multiplying health problems. The issues range from the growing numbers of catastrophic accidents happening in city parks, streets and homes to the many chronic and deadly health conditions stemming from poor hygiene and health maintenance practices.

Numerous factors of economics, politics, negligence and neighborhood abandonment are woven into the sometimes-deadly mix of urban community health factors. The result: people in our communities and pews get sick (very sick), live with sickness and sometimes die untimely deaths. A few facts and figures quickly outline the magnitude of the situation that we face as city Christians:

-- Nearly 43 million Americans live without health insurance (15% the entire U.S. population)
-- More than 9 million children under age 19 in the U.S. have no health insurance — and nearly 90 percent of them are in working families
-- Uninsured children are far less likely to have access to the medical and dental care services they need. Children without insurance are 3 times more likely to lack a regular source of health care than children with insurance
-- While 1 in 10 children and teens suffers from an emotional or behavioral problem that would benefit from treatment, fewer than 1 in 5 receives treatment in any one year
-- More than 1 out of 7 Black children living in older housing have elevated blood-lead levels
-- From January through June 2003, 5.1% of the population was unable to obtain needed medical care at some time during the past year due to financial barriers
-- While the number of uninsured persons seeking treatment is increasing: overall, Health Care for the Homeless programs report a 35% increase in the numbers of their patients who are uninsured
-- 38% of children in New York City's shelter system have asthma, 4 times the rate for all New York City children
-- Homeless New York City children suffer from middle ear infections at a rate 50% greater than the national average

So, where’s the urban church in the midst of all these health problems? Right in the very center, providing some of the basic and much-needed care, as well as some of the most sophisticated treatment and surgery known. Do we need to be doing more? Certainly. Take a good look at the following articles, contact churches and clinics that already have some expertise, and then get together with your ministry colleagues to decide what your next step may be.

What we advocate with this month’s edition of CityVoices isn’t urban evangelism, fundraising, maybe not even community development per se. But it is obedient and caring ministry in cities across America and everywhere. As we begin the task of meeting so many unmet health needs, we also discover much about biblical integrity in each of our urban ministries.

Contact: Roger Johnson, CityVoices, 1242 W. Addison Street, Chicago, IL 60613, ph: (773) 477-8163, roger@cityvoices.com

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The State of Urban Health Care: An Interview With Dr. Jerry Stromberg

(Since 1998, Dr. Jerry Stromberg has directed the work of the Christian Community Health Fellowship, based in Chicago. CCHF grew out of the Christian community development movement of the 1970s, and now celebrates its 25th Anniversary with a convention in Atlanta this May.)

Jerry, from your vantage point, how do you see the state of health care for people in our nation’s poorest communities?

The health care system is mostly driven by economic factors, not justice or compassion. Care is very expensive, and major hospitals and community health care providers have reduced access. Many people are now resorting to emergency rooms. We have an increasing number of uninsured people, related to unemployment and jobs without benefits. This is the reality in our cities, but also more broadly for America’s working poor – all over the country. The safety net providers have become more important than ever before. And Christians are doing a lot. But the sheer numbers of needy people are becoming greater.

Many of America’s hospitals that began as faith-based institutions have changed their mission. Some public places, like the City of Washington, D.C., have significantly reduced their community care. Everything has become privatized. The City of Chicago has fewer community health centers than it once had.

In other words, the ability to respond is very minimal, given the economic factors.

People have chosen not to respond, and with what’s happening inside our government, poor people are going to have fewer resources available to support what had been a public system in the past. Medicaid is still a good source of funding for some people. But it is getting pinched with many states paying providers on a longer payment cycle. Some health centers are being funded by the government’s Public Health Section 330 Grant, started back in the 1960s. Over the years it has helped many community health centers that meet certain criteria: comprehensive primary care, sliding scale for payments, a community-oriented board. Quite a few community health centers here in Chicago are operating with significant 330 Grants, providing for care that is not otherwise compensated.

When you think of young Christians who are stepping up, helping to aid in urban medical needs, what examples come to mind that you are proud and even amazed at?

In Buffalo, New York, there’s a Mennonite doctor, Myron Glick, who’s started something called Jericho Road Family Practice. It’s turned out to be a very creative and wonderful practice, especially with refugees in that city. Years back, a group of young physicians started Christ Community Health Services in Memphis. They have grown and become a very effective health center in that city. Included is the work of Dr. Alex Galloway who has creatively met mental health needs in some of Memphis’ African American churches. Paul Lorentzen of the Neighborhood Christian Health Center in Phoenix has also been doing terrific things. The Center tries to provide care for the needy in Phoenix, as well as introduce spirituality in the care they provide. They train volunteers at the clinic who go back and incorporate the same approach in their own practices.

How can Christians do more? What areas of need are on your mind?

There are many opportunities for Christians to be involved in health care, on a volunteer or full-time basis. I feel very strongly about advocacy. To illustrate, there were two guys who got really good at saving people drowning in a river. They were getting awards from the Kiwanis, the Rotary and everyone. Then one day one of the guys looked at the other and said, “You know, we’re doing so well, but don’t you think that we ought to go upstream and find out who is pushing all of these people into the river in the first place?”

Many of the issues are really “upstream,” but we’re almost always dealing with “downstream” stuff. We understand “downstream” things pretty well, but I feel that from a Christian perspective we really need to understand what it means to deal with “upstream” principalities and powers. (Susan Pace Hamill makes this point exceptionally well in her book, “The Least of These: Fair Taxes and the Moral Duty of Chhristians.”)

Why are these kids getting sick? Because when you’re living in a ghetto you get sick. And why the ghetto in the first place?

Right. We address so much to the individual. We have to ask, “How much of this is a system problem, and how much of this is the individual’s sickness?” I heard a well-known preacher maintain that “poverty happens one individual at a time, and that’s how we can address it.” That’s comfortable and encouraging rhetoric, but it’s lousy science and lousy theology. People need to understand that there are also systemic things creating the problems. Christians must be armed with knowledge of how the system really works.

Is there any room for that kind of advocacy in terms of the managed care system as it affects poor people?

When we’re talking goals for “Healthy Nation 2010” we’re talking about blood pressure and items like that. One of the solutions seems to be getting poor people to do blood pressure screening in their church basements. Yes, that’s good; but isn’t there something about this picture that we’re not yet understanding? These are issues of poverty, issues of basic economic and social justice.

Jerry, what do you think city pastors should realize about the health needs of urban communities?

I endorse the notion of a broader community development approach to ministry. Medical care can be a powerful lever. There’s funding for that, and it’s often the case that people want that before they will listen to you about other things. But it has to be plugged into a realization that it’s about jobs, housing and education – things that will make a difference in a community. I encourage pastors to realize some of the options. People do have health care needs. But I don’t think every church has to have its own health center. If they can align themselves and be connected with a good community-based health center, that’s a wonderful thing for their ministry.

I think there could be a role for people from our organization or some of the major urban health centers to conduct a pastors’ seminar, “So Your Church Wants to Start a Health Center.” The Christian Community Health Center on South Halsted here in Chicago is doing a wonderful job working with the city’s African American churches.

Summarize the mission of Christian Community Health Fellowship (CCHF), and how you see that changing or growing over the years.

Some CCHF pioneers were involved with John Perkins’ work in Mississippi, back in 1978. They were trying to start a health center there and asked, “How do we do it?” No good model for doing poverty medicine yet existed. “How do you get health professionals to do it? And how do you get them to stay, once they come?” CCHF began, and is still concerned with challenging, nurturing and supporting Christians who are committed to living out the gospel through health care among the poor. That’s been our mission and I hope it hasn’t changed much over the years.

CCHF produces two journals in one – “Health and Development” and “The Apprentice” – aimed primarily at students. These go out quarterly to our members. To be a CCHF member, all you have to do is send $35 in annual fees ($15 if you are a student) to CCHF at 3555 W. Ogden Avenue, Chicago, IL 60623.

We also have a great annual conference. This May 20-23 we celebrate our 25th Anniversary in Atlanta. We’ll have Dr. David Satcher, former Surgeon General speaking; along with Dr. John Perkins who was with us at the beginning. We have more than 30 workshops. To find out more and to register online, go to www.cchf.org.

Contact: Dr. Jerry Stromberg, Executive Director, Christian Community Health Fellowship, 3555 W. Ogden Avenue, Chicago, IL 60623, ph: (773) 277-2243, jerry@cchf.org.

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Great Hope and Healing for Memphis

(Excerpted from PBS' Religion and Ethics Weekly transcript, February 4, 2000, Bob Abernathy interviewing Dr. G. Scott Morris of the Church Health Center in Memphis)

BOB ABERNETHY: Our cover story today is about hope and healing in Memphis, Tennessee, where people of faith are taking on a major national health-care problem. According to the most recent figures from the Census Bureau, 44 million Americans do not have health insurance. Everyone agrees solving that problem will take more than church volunteers, but take a look at what a devout doctor and Memphis's Church Health Center are doing.

Memphis is famous for music and poverty. It's one of the poorest big cities in the country, and that's why Dr. Scott Morris moved to Memphis to live. Morris's part-time job is being associate pastor of St. John's United Methodist Church. Morris's full-time job is being a medical doctor, the founder of the Church Health Center, located right across the street from St. John's Church.

G. SCOTT MORRIS: The mission of the Church Health Center is to reclaim the church's biblical and historical commitment to care for the poor who are sick. Specifically, we serve the working poor, people who earn enough so they do not qualify for Medicaid, but don't receive and can't afford private health insurance.

ABERNETHY: Morris started the Church Health Center in 1987 by himself with church and foundation backing. He persuaded 150 congregations -- Protestant, Catholic, and Jewish -- to help. He mobilized the medical and philanthropic communities. And today, the Church Health Center has 30,000 patient visits a year, and the price is right - just $10 per visit. Except for the homeless, every patient pays a little. The rest of the budget, more than $4 million a year, comes from churches, synagogues, foundations, and the majority from private donors. Morris takes no money from the government.

MORRIS: It's not about having the government say, "You have to do what you're supposed to do." It is about the people of faith rising up and doing what we are called to do, and that is care for the body and the spirit.

ABERNETHY: The Church Health Center has a small paid staff. Volunteers do all the rest of the work. They sort pills and keep records. Pharmaceutical companies donate medicine, and hospitals give lab work and take patients. Doctors and nurses in private practice work night shifts after their own workdays are over. But Morris wants no volunteer burnout, so he asks doctors to volunteer only once every three months.

However much medical care the center does provide, there are certain services patients cannot get, for instance, prenatal or maternity care, which is available to the poor elsewhere, and there is no reproductive care. All the practitioners at the Church Health Center say they've learned that poverty itself causes sickness of body and soul.

MORRIS: Poverty drives people to lose hope and to lose a sense of who they are. They come 'cause their life is falling apart, and I can't fix that with a 15-minute office visit. And I can't tell you how many people I've seen over the years who came saying, "My back hurts," and in reality, their heart hurts. They have a broken heart.

ABERNETHY: Their experience of treating the poor has turned Morris and his colleagues into crusaders for two fundamental changes: new lifestyles for the poor and a new emphasis on prevention in medicine.

MORRIS: Wouldn't it be better if we had a health-care system where the doctor's role was to, in effect, be a Maytag repairman, to try to keep you healthy rather than wait till your body is broken?

ABERNETHY: So Morris turned a former car dealership into the Hope and Healing Center. Donors gave $7 million for the renovation, creating what looks like a spectacular health club. Anyone can join and get a prescription for health, to lose weight and change diet. There are cooking classes with low-fat recipes, mashed potatoes made with nonfat dry milk. There's also a chapel and a chaplain and regular services of guided meditation.

The question, of course, is: If the Church Health Center works so well here in Memphis, could it be duplicated in every other major city? And if so, how far would that go toward meeting the health-care needs of all the country's working poor? In Washington, Surgeon General David Satcher praises the Memphis approach, but says the needs are greater than volunteers alone can meet.

DAVID SATCHER (MD, United States Surgeon General): I think those kinds of volunteer community programs are great, but I don't think they're an answer to the problem. We need to balance health promotion, disease prevention, early detection, and universal access to health care in this country, and it takes public-private partnerships.

ABERNETHY: Morris agrees his center is not the whole answer. For all it's doing, it's reaching only about a quarter of Memphis's uninsured poor. But that's 30,000 people who were not reached before, and Morris does think his work can be a model.

MORRIS: Every little piece of what we do, we think, can be reproduced. You don't need Scott Morris, who's a physician and a pastor, to do this. What you do need is one person who lives and breathes the idea, who has the commitment and the passion to make it happen.

Contact: Dr. G. Scott Morris, Church Health Center, 1210 Peabody Avenue, Memphis, TN 38104, (901) 272-7170, www.churchhealthcenter.org, info@churchhealthcenter.org

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Total Poverty Awareness

(Adapted from David K. Shipler’s op-ed piece in The New York Times, February 21, 2004.)

Research in the 1990's demonstrated how the paint and pipes of slum housing — major sources of lead — damage the developing brains of children. Youngsters with elevated lead levels have lower I.Q.'s and attention deficits, and — according to a 1990 study published in The New England Journal of Medicine — were seven times more likely to drop out of school.

Take the case of an 8-year-old boy in Boston. He was frequently missing school because of asthma attacks, and his mother was missing work so often for doctors' appointments that she was in danger of losing her low-wage job. It was a case typical of poor neighborhoods, where asthma runs rampant among children who live amid the mold, dust mites, roaches and other triggers of the disease.

Pediatricians at the Boston Medical Center did what they could with inhalers and steroids, and then dispatched a nurse to inspect the family's apartment. She found a leaky pipe and a wall-to-wall carpet where mites could survive the most vigorous vacuuming. The mother asked the landlord to repair the pipe and remove the rug. Nothing happened. The nurse wrote the landlord a letter. Nothing.

So the pediatrics department turned to its staff of five lawyers, hired for just this kind of situation. "After two telephone conversations with our lawyer," said Dr. Barry Zuckerman, the department's chairman, "the landlord took up the carpeting and fixed the leaky pipe." Within weeks, the boy was back in school regularly and his mother was able to keep her job.

This is a model of what needs to be done for low-income families. Unfortunately, it is employed too rarely by private and government agencies, which tend to tackle only the problem the poor present to a particular office. The assistance is often shallow and temporary and, as a result, leaves people vulnerable to the next crisis.

Most doctors, teachers and police officers have no way to reach outside their jurisdictions. That is why Dr. Zuckerman, using donations, has hired lawyers and social workers to help patients press for safe housing, Medicaid and other benefits. He estimates that about 25 clinics around the country are doing the same. "As pediatricians," he says, "we see failed social policies on the faces and bodies of children daily."

Government is especially bad at connecting the dots. Health is over here, housing over there; budgets are separate and are protected by officials with entrenched interests. Practically every program has its own eligibility requirements and forms, and many working people simply can't take time off the clock to trek from waiting room to waiting room. One-third of those eligible don't get food stamps, according to the Census Bureau, and about 30 percent of the poor who are entitled to Medicaid are not enrolled.

One remedy, tried by community action centers created by the War on Poverty, put a variety of specialists under one roof. Their effectiveness unsettled politicians. … Decades later we are still testing this idea, now called "one-stop shopping," as if it were some dubious proposition. Since last July in five California school districts, applications for subsidized lunches have been used as applications for Medicaid as well. What has to be proven for the rest of the state to follow? In Chicago, schools get computerized lists of children who are enrolled in the lunch program but not in Medicaid. Why not in all of America's schools? Job placement is done at a few public housing sites; why not at every one?

What works is an intensive, holistic approach like the one used by the Maya Angelou Charter School in Washington. The school brings its 100 students in for breakfast and keeps them until after dinner. They have small classes, homework sessions with 75 volunteers and counseling from three full-time social workers and a psychologist. Most students arrive in 10th grade reading at sixth- or seventh-grade levels; three years later 70 percent go to college. The cost isn't low — it runs over $25,000 annually per student — but it is a humane investment, one that is helped in part by donations. With more money, the school could become a platform for supporting whole families.

The amalgam of charity and government can be effective, but the full force of the nation's financial power can be mobilized only by the federal government. Only then can we alter the ecology of poverty.

By David K. Shipler, The New York Times, February 21, 2004. Mr. Shipler is the author, most recently, of "The Working Poor: Invisible in America."

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The Vision of Joseph’s House – The Continuing Impact of the Ghetto

The Joseph's House community was first envisioned by Dr. David Hilfiker in the late 1980s as the AIDS epidemic spread into the poorest communities of Washington DC. Homeless, African-American men-many with addictions and/or mental illnesses-were especially affected. Through his work at Christ House, a medical recovery shelter for homeless men in the District of Columbia, Dr. Hilfiker saw the toll that the AIDS epidemic was taking among these men and their need for skilled compassionate care.

Joseph's House was founded in June of 1990. Joseph's House fills a unique role in the care for AIDS patients in the District of Columbia. Joseph's House target population is the poorest of the sickest of the most vulnerable individuals living in the nation's capital. There are few alternatives for men who are very ill and living on the street, in temporary shelters, hospitalized, or incarcerated. These men have virtually no resources and often require 24-hour, 7-day-a-week intensive nursing and personal care during the end stages of their illnesses. At Joseph's House, they experience a loving, accepting community, linkages to other community services, and compassionate attention to their needs.

Since Joseph's House opened, we have welcomed over one hundred and forty men. A continuum of care and support is available to each resident. Joseph's House provides 24-nursing care, personal care services, emotional support, spiritual nourishment, comprehensive case management, addiction recovery support, transitional support for those who regain their health, and end-of-life care for those who progress through the final stages of life.

Dr. Hilfiker’s vision for meeting the needs of Washington, DC’s poor and hopeless has always taken on new dimensions as he has written and alerted America’s to both those immediate needs and to the systems that produce them. In his 2002 publication, “Urban Injustice: How Ghettos Happen,” (Seven Stories Press, New York) Hilfiker argues for a broader systemic viewpoint on poverty, unpacks many of the ghetto’s influences upon human life, and concludes by offering a few beginning solutions. In his introduction he states:

“When I first arrived in Washington (1983), I was already familiar with many of the structural causes of poverty. But like so many of us, I was convinced that if the individual could be strengthened enough, he or she could make it out of the ghetto, and if enough people could be strengthened, the ghetto itself would collapse. I have spent the better part of a professional career trying to strengthen individual poor people. While that may have been a positive endeavor, I no longer believe that individual efforts to improve individual poor people will substantially reduce poverty. … The argument that inner city poverty comes primarily from the personal weaknesses of poor people simply cannot be sustained.”

Contact: Joseph’s House, 2482 Ontario Road NW, Washington, DC 20009, (202) 328-9161, patty@josephshouse.org

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Thanks for Reading CityVoices!

Next month’s CityVoices newsletter focuses on the city church and urban real estate. As churches are being “zoned out” of urban areas, what are the possibilities for growth of God’s kingdom in our nation’s neediest places? What about the toughest issues like taxes and city services for churches?

Remember to contact CityVoices for the very best in resources for city ministry. “Transforming Power” by Robert Linthicum ($14), “The Expanded Mission of City Center Churches” by Ray Bakke ($10) and “The Underclass” ($14) by Ken Auletta can all be purchased by calling CityVoices at (773) 477-8163. Also, look through the Bookstore section of the CityVoices website (www.cityvoices.com) for a complete listing of all available resources.

Thank You!
Roger Johnson – Editor, CityVoices (Chicago)
1242 W. Addison Street
Chicago, IL 60613-3825