DETROIT — Southeast Michigan may be known for cold and snowy days, but 70% of Metro Detroit residents are experiencing hotter temperatures due to environmental factors.

Climate Central, a national nonprofit, recently released data on 44 major U.S. cities that have “urban heat islands,” or areas where temperatures are amplified. The data shows census-level tracts across the country that are at least eight degrees warmer than local temperatures.

The nonprofit reported that 41 million people nationwide are within urban heat islands and are at a higher risk of suffering from heat-related illnesses. These areas are warmed by a lack of green spaces, too many tall buildings that block airflow, a heavy population density, and an abundance of surfaces that are more prone to absorb heat, like dark roofs and paved roads.

About 4.8 million people live in the seven counties of southeast Michigan. Many of the cities and towns were built along grids that now amplify heat through distinct rows of homes and buildings. Detroit made history when the historic Woodward Avenue became the first paved road in America. However, the 27-mile-long street is now lined with buildings that draw in heat and warm the metro area.

According to Climate Central, Metro Detroit is one of nine metro areas where over 1 million people are affected by the increased temperatures.

Kaitlyn Trudeau, a senior research associate at Climate Central, said the summer’s extreme temperatures and the amplified heat can create dangerous health situations. The researcher said that development in high-density areas exacerbates climate change and acts as a “multiplier” for increased temperatures. She also said that cities built on grid systems, like those in southeast Michigan, are more likely to “trap in heat” due to lack of airflow.

Trudeau said that increasing access to green spaces and using innovative building materials will prevent temperatures from rising across urban areas.

Health Impacts of Heat

People with chronic conditions, children, older adults, and people who spend prolonged periods of time outdoors are most at risk of a heat-related illness. The three main heat-related illnesses include heat cramps, heat stroke and heat exhaustion.

Just over 8,700 southeast Michigan residents live within the parameters of Community Health and Social Services, or CHASS. Though the health center is located in southwest Detroit, the health center serves residents in areas that include Taylor, Allen Park, Lincoln Park and Ecorse, all of which have urban heat islands.

About 13% of residents within the health center’s coverage area are 65 and older, and 46% of residents are considered low-income.

Dr. Felix Valbuena, CEO of Community Health and Social Services in southwest Detroit, said a mixture of heat and poor air quality is a cause for concern. The already industrial area was blanketed with smoke earlier this summer from wildfires in Canada.

“When we talk about climate issues, we’ve been dealing with the new bridge that they’re building behind (our location), and so there’s been a lot of issues with air quality, and the wildfires in Canada that are coming down,” he said. “So people are having lung issues, chronic obstructive pulmonary disease, and have been ending up in the emergency room, and we’re bringing them in for a follow-up, or they’re calling in and saying, ‘I’m having trouble breathing.’”

Of the patients seen at the center, 264 have been diagnosed with asthma, 157 have chronic lower respiratory diseases, 988 are overweight or considered obese, over 1,300 have diabetes, and over 1,900 have hypertension.

The air and heat are a concern, and Valbuena says that they warn patients to be aware of symptoms of heat-related illnesses like dizziness, fatigue, high blood pressure, and experiences of exhaustion while doing normal activity.

He also cautioned against using alcohol during extreme temperatures and said that alcohol already encourages dehydration. Valbuena shared that those who drink alcohol in the heat are more likely to experience diarrhea and vomiting. Those who take medications to manage chronic conditions should also be mindful since they may be less likely to sweat but are still overheated.

As extreme temperatures soar across the U.S., Direct Relief is focused on supporting health centers across the country, with medical support and with backup power options through its Power for Health program, which aims to install resilient power systems so health center operations can continue during outages.

The post “Urban Heat Islands” Across U.S. Put Certain Neighborhoods At Heightened Risk appeared first on Direct Relief.

J. Ricardo Guzman had spent years, going back to the 1950s, trying to navigate the healthcare system on behalf of his mother, who had lupus and was uninsured. But in those years after the riots, Guzman’s focus shifted to a different kind of access issue.

“We had a little rebellion in 1967, and the after effect was not only the white flight out of the city, but there were a lot of businesses that closed as well as physicians that left,” he said.

Guzman, who grew up in Mexicantown, recalled four community hospitals and clinics that closed or were consolidated in that area in quick succession during the late 1960s and early 1970s, leaving his community in a kind of healthcare desert.

“There weren’t any physicians, any hospitals, any clinics,” he said.

Facing such circumstances, Guzman and other leaders in Detroit’s Mexican-American community began to investigate bringing basic care back to their southwest Detroit neighborhood. They learned about the community health center model, which had recently been enabled by then-President Lyndon B. Johnson’s “War on Poverty” and the associated Economic Opportunity Act of 1964, and decided to implement it.

In what Guzman said was a benefit of “being at the right place at the right time,” he and his partners pitched Michigan’s governor at that time, William Milliken, a Republican, on their idea to provide a new kind of healthcare system to serve their community. Milliken gave them a grant of $150,000 from his discretionary fund, while a local Catholic church, Most Holy Redeemer, gave them heavily discounted rent on a home where patients could be seen. When they found some volunteers, the Community Health and Social Services Center, known as CHASS, was born.

“Why should this person, or anybody, be in a situation where they don’t have insurance because they can’t afford the insurance, don’t qualify for Medicaid, what do people do? That was the hook that pulled me in,” said Guzman, who previously served as the Chairman of the Board for the National Association of Community Health Centers, or NACHC, which represents a network of nonprofit health centers that collectively run over 10,000 clinical sites and care for about 30 million people in the U.S. He retired in 2016 and is now an executive consultant to the CEO at CHASS.

Sitting in the plaza of the health center’s new $17 million facility during their weekly summertime mercado, which features booths with fresh produce grown as close as a few blocks away, made to order food, insurance information, nutritionists, handmade goods from Mexico, and Mexican music, Guzman knew just about all the people who visited — or one of their family members.

“I feel like family here, they treat me really good and I feel comfortable here. And it’s close. I know English really well, but I feel more comfortable, when I have a question, and they respond in Spanish. I recommended people to come here, they help you a lot,” said Yolanda Azofeifa, who had her children at CHASS and has been a patient for about 25 years.

Since it’s inception, CHASS has served as a mainstay in the tight-knit Mexican and Latin American community in Detroit, owing to its continuity, jobs it has provided, culturally-competent providers.

“Se conocen,” said Channing Ferrer, a behavioral health supervisor at CHASS. “Everyone knows everyone, the Latino community herein many ways is a very small community, so when we treat each individual patient and we have a really strong relationship with them, then they tell their friend, who tells their friend. People know what CHASS is about. That people who work here are from this community, and speak the language,” she said.

“From the beginning, people were always able to come to the center, no questions asked,” said Guzman, who added that he believes health care is a basic human right.

He said Direct Relief helped grow their ability to care for people, especially regarding pharmaceuticals.

“For years, I’d go out and beg people [to donate medicines], then about 10 or 15 years ago, we got the linkage to Direct Relief after a conference and Damon [Taugher, vice president of global programs for Direct Relief] said ‘We’ll get you some of the stuff if you need it.’ Our pharmacist hugged him when he visited. There were things he couldn’t get that Direct Relief provided, that patients needed.”

Dr. Felix M. Valbuena, Jr., CEO of CHASS, is carrying on Guzman’s legacy, and stated proudly that nine out of the 11 health providers at the center, all of whom are board certified, speak Spanish.

Recounting his own experiences earlier in his career, Valbuena said he saw firsthand how important culturally-competent care is for patients, beyond just the language.

“I served as an interpreter and that’s a terrible way to get care, to have a third person in there listening to all your business, and the docs were missing cues. They didn’t understand the culture,” he said. While most CHASS patients live in the southwest Detroit, some of their patients come from as far as 50 miles away because they can’t find a nearby provider who understands their culture and language.

As an example, Valbuena referenced an example of diabetic or obese patient in the community, who needs to reassess their diet. Whereas a nutritionist outside the community would be apt to have the patient make drastic changes immediately, so as to follow American Diabetes Association guidelines, culturally-competent care practices would enable a plan to has a higher chance of sticking.

“Our nutritionist understands the language and culture, and she understands what’s realistic for this person’s environment and culture to make a change. That’s the key, to make changes in a way that makes sense,” said Valbuena. CHASS also holds instructional cooking classes and gives patients recipes which include fresh fruits and vegetables.

A key initiative for Valbuena has been to further strengthen the pipeline of healthcare providers at CHASS. The center now brings in University of Michigan medical students and residents, Henry Ford Hospital residents, Wayne State University medical students, as well as nurse practitioner students and undergrads, “to help get them excited about what we do here,” he said. CHASS also started a residency program with WSU.

Valbuena said that he hopes these young people get inspired to provide the next generation of care at community health care centers, which he referred to as “largest primary care network in the nation.”

CHASS operates using a sliding scale for its uninsured patients, which comprise about half of everyone they see. One-third of its budget comes from federal grants, with the remainder coming from a mix of private insurance reimbursements, grants, and federal prospective payment system reimbursements, which are a per-patient amount of money that they use to provide services that insurance will not cover. They also have partnership with Henry Ford Health System, which allows for a referral system, of both insured and uninsured patients, to help treat more serious health conditions. Henry Ford Health also covered $3 million of the new CHASS facility.

Even with this support, other looming challenges face CHASS. As the center looks to expand to more sites in the coming years, it will have to contend with an old issue — that of access to health care. A new bridge to Canada is being built near its facility. The construction plan will result in road closures that will impact walking distance access for many CHASS patients in the community.

“It’s going to hurt us,” said Guzman. “We didn’t have political power. [The bridge] is here because we couldn’t stop them,” said Guzman. How is this going to impact people trying to get to us?”

Though it will be more difficult for some patients to get there, Valbuena pointed out that once they arrive, they will be cared for.

“I believe that FQHCs, or community health centers, are the model of primary health care for the nation. The patients that come to us are the sickest and we’re saving the system billions of dollars, while providing high-quality care,” Valbuena said.

“We serve anybody who comes in the door.”

The post A Health Center Serves as an Oasis in Southwest Detroit appeared first on Direct Relief.

A sweeping new report, published in July in The Lancet Psychiatry, announced that people with depression and anxiety, along with other mental illnesses, are at higher risk for cardiovascular disease, diabetes and obesity.

“The message here is not to dismiss common mental disorders as ‘safe’ for physical health, and to begin addressing physical health in all populations diagnosed with mental illness,” said Joseph Firth, a research fellow at Western Sydney University and lead author of the report.

This isn’t news to health centers.

While a strong link between depression or anxiety and physical health has emerged only relatively recently in academic research, health centers have long experienced the correlation firsthand.

“We’ve been aware of this just by seeing our patients, that chronic illness and mental health go hand in hand,” said Jill Ellingson, mental health director of Community-University Health Care Center in Minneapolis.

Sometimes, explained Felix Valbuena, the CEO of Community Health and Social Services Center in Detroit, a psychological issue can exacerbate a chronic condition – and prevent progress.

“We’ll see a diabetic patient who’s doing everything we ask…and their A1C is through the roof,” he said, referring to a test used to measure blood glucose levels. “More often than not, it’s depression.”

“If you can treat the anxiety or depression, you’re going to have stabilization or improvement of the chronic disease,” said Kim Schwartz, CEO of Roanoke Chowan Community Health Center, which has several locations in North Carolina.

Like many other organizations, these health centers doing something about it, integrating behavioral healthcare into the management of chronic diseases like diabetes.

According to Colleen Diouf, Community-University Health Care Center’s CEO, successful management of a chronic disease often starts, unintuitively, with better mental health.

“People are afraid to get care, they have stigma, they’re not able to manage mental health symptoms,” she said. “Their symptoms are so exacerbated that treating their mental illness is really the first step.”

A Troubling History

Scientists have known about the relationship between mental illness and early death for more than a century. Globally, people with mental illness die 20 years younger on average than the general population, Firth said.

The “why” and “who” has become clearer over time. “In the 21st century, there’s been an exponential increase in the research,” Firth said. With that research has come an increasing awareness that those early deaths are more likely to be because of physical ailments.

While suicide and other “unnatural” causes are of real and grave concern, they account for about 17% of those premature deaths.

Most research focuses on severe mental illnesses, like bipolar disorder and schizophrenia. But the report, which summarizes about 100 reviews of existing research, found a strong link between more common psychological issues– like depression and anxiety – and physical ailments that can shorten lifespan.

There’s also evidence that the disparity in life expectancy is getting worse over time.

Firth said the increase in chronic disease among people with mental illness is due to a combination of lifestyle factors; side effects of medication (which can cause lethargy and increased appetite, and even affect insulin sensitivity in some cases); and social circumstances, such as poverty, that cause reduced access to care.

People with mental illness are more likely than the general population to have poor diets, to be overweight and obese, and to smoke. It works the other way around, too, Firth said: “People with disease are more likely to acquire mental health conditions.”

Forming a Team

Community-University Health Care Center is unusual: Almost as many patients access mental health services as they do primary care. Between 20% and 30% of the health center’s patients have a more severe mental illness, such as major depression, bipolar disorder, or schizophrenia.

They’ve also seen their number of diabetes cases nearly double over the past few years, to around 700-800 cases annually.

For the health center, putting the two together to treat chronic disease felt intuitive. Oftentimes, “we’re coming from the mental health lens rather than the primary care lens,” Diouf said.

Providers at the health center work in “medical teams”: groups of case managers, doctors, medical assistants, psychologists, and interpreters who are all working toward a common goal for each patient, like well-managed diabetes or a higher happiness level.

“It allows us to have really more in-depth, supportive conversations about our patients,” Ellingson said. The health center was awarded for its efforts to integrate mental health care with diabetes medication management in 2017, when it received an Innovations in Care award from BD.  The Community Health and Social Services Center and Roanoke Chowan were also awarded for their innovative approaches to helping patients manage diabetes.

Schwartz explained that the team structure, which Roanoke Chowan Community Health Center also uses, prevents information from falling through the cracks. A patient may mention something to a mental health provider without realizing it’s important for the overseeing physician to know as well.

Teams keep a close watch on all aspects of a patient’s care. A rough patch in a previously well-managed condition isn’t necessarily just about physical health. “Typically when your mental health is not OK, you’re not taking your meds on time, you’re not engaging in other services,” Diouf said.

A Warm handoff

“We’re not just a medical being. There’s a lot more to us than just the medical part,” said Valbuena, of Community Health and Social Services Center.

Although he’s a practicing physician, Valbuena is well aware of a telling statistic: Only about 20% of a patient’s health is determined by medical care; the other 80% is determined by socioeconomic factors and health behaviors.

That means addressing psychological well-being, which plays a major role in health behaviors like diet and exercise, is essential.

At Community Health and Social Services Center, mental health providers are close at hand. “They’re actually on the floor. We can pull them in, give them a warm handoff,” Valbuena said. Using motivational interviewing and cognitive-behavioral therapy, among other techniques, helps patients reach their healthcare goals.

But ultimately, Valbuena said, “I think the vast majority of the time, just having the time to spend with the patient and just listening” makes the biggest difference.

A Mobius Strip

For Schwartz, an essential component of treating a mental health issue is…making it feel like less of a mental health issue.

Patients often come to the health center unaware that there’s something wrong. Schwartz said. And for many of the center’s patients, psychological issues – even more common ones like depression and anxiety – are highly stigmatized.

“We have all kinds of ways to talk about that, so it doesn’t feel like ‘I have a diagnosis of mental illness,’” she said. The trick is to normalize it: to make it feel less like an independent, monumental problem and more like just another component of a patient’s health care.

And that’s really how it works, Schwartz said. Patients who are successfully treated for a mental illness begin to feel better. “Then they take better care because they feel better about feeling better. It’s a Mobius strip.”

Although the connection between mental illness and a shortened lifespan is undeniable, the health centers focus on the positive.

“You always give people hope. The data is just the data,” Schwartz said. It’s important for a patient to understand that “you can be healthier for longer if you can treat these together.”

Diouf feels it’s important for a patient to be aware of the risks that a mental illness can pose, but also to understand that they can change course.

“Just because you have a mental illness doesn’t mean you are going to die sooner,” she said. “It’s about the choices.”

The post Treating a Chronic Disease, Beginning with Mental Health appeared first on Direct Relief.

Working toward controlled diabetes has multiple benefits: healthier people, fewer complications, and lower costs. Complications of uncontrolled diabetes, such as peripheral neuropathy, cardiovascular disease, and kidney issues, are incredibly damaging and resource intensive. The Centers for Disease Control and Prevention estimates that the total medical costs and lost work and wages for those diagnosed with diabetes totals a staggering $245 billion every year.

But despite the severe and life threatening complications, Type 2 diabetes can often be prevented — and managed — through diet and exercise. That’s why self-management and education is so important to treating the disease and improving the quality of life for patients. Health centers across the country and in Michigan are approaching the epidemic in unique ways. CHASS Center, in Michigan, is a great example of what’s working. That’s because at the Community Health and Social Services Center,  known as CHASS, tackling diabetes is a team sport.

Since 2001, CHASS Center has implemented and tested a number of different diabetes interventions.

When a patient is first diagnosed, the care team activates a multi-pronged approach to not only treat the disease, but also to educate the patient on how to manage it. After working with their patients, providers immediately refer them to a community health worker. Community health workers are the frontline defense in the battle against diabetes, especially because physicians may only see a patient two times a year. They help patients create a personalized care plan based on the treatment goal, which includes patient preferences, educational materials, and a schedule for monthly check-ins and home visits, if necessary.

But treatment and support doesn’t stop there. Because diabetes affects all aspects of one’s health, staying healthy means having access to behavioral health specialists who can mitigate stress and encourage healthy lifestyle choices, dentists who can prevent and treat oral health complications, and an onsite pharmacy where it’s easy to pick up medication and stay on track. In addition, these providers work together to identify previously undiagnosed patients with diabetes and connect them with care, providing warm handoffs from one specialty to another. When necessary, they also coordinate care and make referrals to the Henry Ford Health System, which works with CHASS Center to provide vouchers to patients in need.

There are challenges, though.

CHASS Center serves a predominantly Latinx population, which experiences unique cultural and language barriers to accessing care. To make it easier for those patients, 97 percent of CHASS Center’s staff is bilingual, and they provide text and voicemail reminders to their patients in their language of preference. Community health workers who are connected to patients with diabetes address health literacy challenges one-on-one, meeting patients where they are to ensure they understand their condition and their treatment.

Exercising and preparing nutritious foods are also key to managing diabetes, but may be difficult for patients based on their home and financial situation.

At CHASS, there’s an indoor track running through the building. It provides patients and providers alike the opportunity to exercise in a safe environment any time during business hours. They’ve offered yoga and Zumba classes, and they sponsor a 5K road race every year. Patients can learn about cooking nutritious foods through lecture series, workshops, and Cooking Matters demonstration classes, which are facilitated by the Henry Ford Health System Generations with Promise Program. And, to make it easier to find those healthful foods, CHASS Center hosts a Mercado, or farmers market, which provides access to fresh fruits and vegetables every Thursday during the summer. As an added benefit, the Mercado accepts WIC Project FRESH coupons.

All these services are in addition to a number of grant-funded programs that have specifically addressed challenges for the diabetic population. As an example, a grant in 2013 let CHASS launch Fresh Prescription (Rx), which allows providers to “prescribe” food to patients with an A1C greater than or equal to nine. Prescriptions are “filled” in the CHASS Mercado. Fresh Rx just completed its sixth year. CHASS Center also relies on new technologies, such as electronic health records, to automate alerts that prompt providers to screen patients and schedule checkups.

By actively working across specialties, educating patients in a culturally appropriate way, and addressing patients’ social determinants of health, CHASS Center has made tremendous strides in identifying patients with diabetes and helping them manage their condition. In fact, between 2014 and 2016, CHASS Center decreased the number of patients with poorly controlled diabetes by nearly 15 percent, even as the number of patients with diabetes increased by 6.9 percent.

Dr. Felix Valbuena Jr., chief executive officer at CHASS Center, describes it as a work in progress. “While continuing all of our efforts to work as a team to control diabetes and its consequences, our ultimate goal is to increase efficient preventive efforts to decrease the chronic illness burden and improve the overall health and wellbeing of the community we serve,” he said.

– Jen Anderson is the Associate Director of Communications for the Michigan Primary Care Association. This post was originally published on the Michigan Primary Care Association’s website on Nov. 6, 2018. 

The post Managing Diabetes Doesn’t Stop at Diagnosis appeared first on Direct Relief.

We had the opportunity to interview Mark Kirsch, CHASS’ Pharmacist in Charge, about his involvement with CHASS.

Direct Relief: Can you describe for us the work that you do?

Kirsch: My job is not work, it is a pleasure. I am able to use my clinical skills and establish a spectacular formulary along with Dr. Felix Valbuena MD, Chief Medical Director of CHASS Center. Replenishment programs such as Direct Relief allow our patients to receive top of the line medication. My pharmacy staff works as a team to ensure patients have a great experience. Even though we dispense 300 prescriptions daily and filled 62,000 prescriptions in 2011, service is our mission. I have been a pharmacist for over 31 years and this is the best “job” I have ever had.

Direct Relief: What is the biggest challenge your health center faces?

Kirsch: CHASS Pharmacy’s patient population and prescriptions continue to rise. Detroit is suffering with unusually high unemployment and poverty. Even the suburbs, once vibrant, are feeling the economic woes. Detroit has closed down its Health Department Pharmacy and Adult Medicine Clinic. We anticipate an influx of 6,000 patients.

Direct Relief: Why do you work at CHASS?

Kirsch: I enjoy seeing people receive the best medical care in Michigan. Patients are extremely grateful and often say if CHASS didn’t exist, they wouldn’t know what to do. We have social workers, eight medical providers, a full-time dentist and hygienist, two lawyers, an outreach program, WIC, and yes, even a pharmacy. Where else would I work?

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