Monday, February 18, 2013

An Inconvenient Crisis

by Sylvester Brown, Jr.
Originally published in the Northsider

CITY HALL — At first listen, the Director of the St. Louis Department of Health, Pam Walker’s PowerPoint presentation on Nov. 13 seemed positive, upbeat even.

Walker, speaking before the city’s aldermanic health committee, described the tireless work of residents, organizations and government officials that has led to a reduction in lead poisoning and rates of mortality, heart disease, cancer, stroke, diabetes, sexually-transmitted diseases and other major health indicators in the city. The city, she said, was heading in the right direction as far as reductions in all these illnesses and diseases.

Yet, when reviewing the actual report, The “Community Health Improvement Plan,” Walker had summarized for the aldermen, a different, alarming assessment appeared, one that many have called a crisis which Walker is not taking seriously enough. When compared to national and state averages, St. Louis ranks much higher in many dangerous health categories, including:
  • The City of St. Louis’ rate for Chlamydia is nearly 3.5 times the U.S. average and 3 times the State of Missouri’s rate
  • The rate of gonorrhea in St. Louis City is 5 times the U.S. rate.
  • HIV infection prevalence is almost double the U.S. rate and nearly 5 times the state rate.
  • The life expectancy rate in the city is a full 2 years lower that the state average and 3 years lower than the national rate.
  • The overall mortality rate in St. Louis City is 26 percent higher than the U.S. rate and 12 percent higher than the Missouri rate.
  • The homicide rate in St. Louis is 32 percent compared to the State average of 8 percent and U.S. rate of 6 percent.
  • St. Louis infant mortality rate remain higher than the U.S. and Missouri rates.
  • Teen birth rates in St. Louis are double the U.S. average.
“It was as if she was talking about a completely different report,” 1st Ward Alderman Charles Quincy Troupe said.

“This information in the Health Assessment and Improvement Plan should place all leaders in every agency, every business and every elected official in alarm, and there should be a massive call for action,” Troupe said. “In order to have impact, this has to be an initiative from the mayor’s office or from the Board of Aldermen, and I am extremely disappointed that no action has occurred. Instead, action has been relegated to the fraught health department.”

Frustrated with the city’s hesitancy to publicly release the health plan or the dire statistics within,
Troupe—a long-time advocate for the city’s low-income residents—has launched his own public information campaign with a series of press releases, titled “St. Louis-Gone to the Dogs.”

Troupe is particularly critical of Mayor Francis Slay’s appointed health director. Walker—a vocal dog advocate who opposes euthanizing animals­—Troupe claims, has paid more attention to dogs than to addressing the high rates of deadly diseases impacting people living in the city’s poorest wards.

“The primary focus of the St. Louis Health Department is dogs and animal control, not protecting the health and well-being of people,” Troupe said. “Under Walker, top level managers are forced to do ‘dog duty’ while clinics are closed and residents complain that they have no idea what the health department is doing.”

Alderman Stephen Conway (8th Ward), who chairs the health committee, said his recommendations on the stray dog issue were mostly ignored, but he believes the city and the health department have been unfairly criticized for its health disparities.

The primary focus of the St. Louis Health Department is dogs and animal control, not protecting the health and well-being of people. -- Ald. Charles Quincy Troupe

“We basically have three problems,” Conway said. “Number one, we’ve always been the worst in the whole country for the past 40 years. Two, our numbers are down in all categories, which is an important feature. And number three, when you look at our region as a whole, part of the problem is that the city is packed into 60 square miles and we have a disproportionate amount of low-to-moderate income people in our area.”

The numbers tend to get “skewed,” Conway says, because, unlike metropolitan areas such as Kansas City with a 400 square mile radius, St. Louis, with limited resources, has to address the needs of a disproportionate number of low-income people suffering health issues who are concentrated within tight “geo-political boundaries.”

“I’m saying, it’s not that bad,” Conway said. “It’s not good but I say look at the size of the city they’re staring at. What I continue to stress is that our numbers continue to get better, especially in the lead poisoning, chlamydia and gonorrhea areas. We might still be the worst, but we’re getting better.”

“Getting better” may not be enough.

The assessment study—funded by a grant from the Missouri Foundation of Health, was necessary to help the city reach national accreditation standards. The city is being ranked alongside other metropolitan areas with similar demographics and disproportionate numbers of low income people.
Conway’s belief that the city is being judged unfairly doesn’t seem to hold water as far as national accreditation goes.

Troupe and other members of the Black Aldermanic Caucus characterize attitudes like Conway’s as a cop-out and part of a long-standing problem with the city’s leaders.

“When we drill down on the zip codes detailed in the assessment plan,” Troupe said, “a more disgusting trend becomes evident. We see disproportionate health disparities in zip codes with high numbers of black and low-income residents and health conditions more like third world countries.”

The MFH-funded study of all St. Louis wards reached the same conclusions as a report on northside wards requested by the Aldermanic Black Caucus and funded by BJC Health systems.

“What we found was that the problems in north St. Louis were the same with blacks, Africans,
Bosnians and poor whites in south St. Louis. In fact, the people on the south side were more critical of the mayor and the health department than the people in north St. Louis,” Troupe explained. “The people in south St. Louis knew who was responsible for the health problems in their communities. They said they have heard nothing from the health department since they closed all their community clinics.”

Troupe also cited a more self-serving reason to explain Walker’s downplaying of the crisis and some aldermen’s lack of enthusiasm about informing the public or dealing with the city’s health woes in low-income zip codes at this particular time.

“They’re not going to release the report because it would create a media flood, and the mayor sees it as affecting his re-election,” Troupe said. “We’ve heard that they wanted to modify the report, but we notified them that we would not look favorable upon that and told them to release it as it stands. Now they’re saying they’ll release it after the election.”

The people conducting the study held extensive focus group sessions across the city. Across-the-board residents voiced distrust and no faith in the health department and “conveyed disappointment with city leaders and elected officials, expressing their beliefs that there is more focus on downtown St. Louis and less on neighborhoods.”

Releasing the results and its negative public comments wouldn’t exactly serve as a ringing endorsement for the city’s top political leader seeking re-election.

To his credit, Troupe said, Jeff Rainford, Mayor Slay’s chief of staff, encouraged Walker to “find the money” to address the health concerns of residents in south and north St. Louis. Upcoming election aside, Troupe said Slay should own up, acknowledge the health challenges highlighted in the study, vow to address them and aggressively move forward.

“Unfortunately, they can’t seem to see past the next election,” Troupe said.

Releasing the results and its negative public comments wouldn’t exactly serve as a ringing endorsement for the city’s top political leader seeking re-election.

Troupe vows to continue his ongoing “St. Louis-Gone to the Dogs” missives until the report is released and this important issue is adequately addressed.

“The health department has cut its staff, and the city is only spending money on dogs,” Troupe said. “Now they’re getting ready to take more money out the health department budget to spend on more on dogs. They’ve done nothing regarding the information that the BJC or the MFH studies have brought out. We need to get the study out there, and get the mayor or whoever is pulling his strings to make the peoples’ health as much of a priority as dogs.

“They aren’t going to do anything until the people start raising hell.”