Another finding in the recently released statistics from the 2009 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) regards poverty in this country. People living in the poorest communities in the U.S. have a 19% higher per capita rate of inpatient hospitalization than those in all other communities, or 1,420 per 10,000 in the local population versus 1,189 per 10,000. There is undoubtedly a direct connection between hospitalization and living without basic needs being covered adequately. And while poverty in the U.S. may be considered a relative concept rather than an absolute condition, it remains our responsibility to the nation as a whole to supply those basic needs while implementing ways to lift those living in poverty permanently out of such a set of circumstances.
Nations do not necessarily need wealth to gain health. This is being demonstrated by the results of in-depth research offering proof that the implementation of disease control priorities in developing countries can significantly reduce the burden of disease and improve the quality of life for all people. Although food and shelter can be handled by food stamps, direct payments in the form of welfare, and public housing availability and subsidies, providing health care is far more complex. That's because knowing you need food or shelter is among Maslow's early, lowest level responses to human survival instincts. But in the case of health care, a baseline level of health literacy is necessary to help build the awareness of one's needs before actually making it available and teaching individuals how to access care.
A cornerstone of prenatal care includes nutrition classes to safeguard the full-term, healthy development of the baby throughout pregnancy, but shouldn't instruction be included as well on how, including weight management, the young mother maintains her pelvic floor support to minimize the risk of incontinence and pelvic organ prolapse? And who is going to provide such instruction if there is already a scarcity of primary care providers in such communities, not to mention an absence of specialists?
The same case can be made regarding continence care for impoverished elders, so their skin is protected against dermatitis, infection, and pressure ulcers by the provision of absorbent products that meet minimum quality performance standards. In health care specifically, the supply of basic needs is often restricted by constraints on government budgets. Such is the case with cuts and ceilings on Medicaid coverage, with state budgets in the red and reeling from sustained, high unemployment rates contributing to the growth in numbers qualifying for Medicaid. But another more subtle problem relates to access itself, exacerbated by the brain drain of health care and educational professionals especially from poor, rural communities.
As poverty in America is tackled, let us not forget the complexities of health-seeking behavior and the role of public health education that integrates continence care messages.
Nancy Muller, PhD, MBA