There may be no substitute for a healthy income when it comes to managing chronic health conditions in children, says a new study – even when they have access to free health care.
Canada has a system of free universal access to health care, meaning the cost of care wasn't a barrier for these children. But their families' income may have been: Researchers found that the lower their families' income, the less likely it was that their diabetes was under control.
Dr. Johnny Deladoëy, a pediatric endocrinologist at the University of Montreal's hospital, led the study and said it's "really not a medical issue" – it's a social one.
"The point is that it's not a failure of the universal health care system," he said. "The problem here is that even with free access to health care, there's a cost."
He used the study's examination of type 1 diabetes among low-income children as an example: Parents who have to be largely absent from the home in order to work multiple jobs to make ends meet often aren't able to closely monitor their children's insulin regimens, said Deladoëy. In that situation, it doesn't matter whether the insulin is free – it's the need for more money that's acting as a barrier to children's health. Families in situations like that need more support, he said, and not in the medical sense.
"What we can do is try to help these families by giving them help [with, for example, the] supervision of their children," he suggested.
In South Los Angeles, incomes are low. According to data from the Los Angeles Times' Mapping L.A. project, nearly 70 percent of households in the region make $40,000 or less annually, and more than 86,500 of those homes make $20,000 or less.
Nina Vaccaro is the executive director of the Southside Coalition of Community Health Centers, whose eight member clinics provide free or low-cost care to communities throughout South L.A., where a lack of access to health care is widespread. In South L.A.'s patient population, said Vaccaro, it's important to remember that "there's only so much free health care can offer."
"The rest is on the patients when they leave the four walls of the clinic," she said.
Vaccaro used to run a free L.A.-based clinic that also served an underserved patient population. She recalled one diabetic patient who was receiving the "best care possible," and couldn't understand why she was consistently coming into the clinic with dangerously high blood sugar levels. So Vaccaro visited the patient at home.
"She didn't actually have a refrigerator she could use to store items – she just couldn't afford it," she said. "She was a single mom with several children and she couldn't afford to buy the things she needed." Those things included food with a semblance of nutritional value – and the refrigerator needed to keep those foods fresh.
The same sort of challenges can arise with exercise, too. When low-income patients are told to get more exercise, Vaccaro said doing that outside may not be an option, because they don't feel safe in the areas where they live.
"They can't afford the gym memberships and there aren't places for them to go out and exercise," she said. Or they don't have time because they're working multiple jobs.
"I think that's the big challenge for health care providers when you're serving a low-income community," said Vaccaro. "Not being able to do anything more."
But, she noted, clinics have started attempting to chip away at that, with programs focusing on health education, group exercise and nutrition counseling, for example.