Creating access for unhoused people in the Bronx

Modern Healthcare sought to map the parts of the U.S. with the poorest access to healthcare and highest levels of social vulnerability. With support from the University of Southern California Annenberg School for Communication and Journalism, Modern Healthcare used the Centers for Disease Control and Prevention social vulnerability index, along with Health Resources and Services Administration access scores, to identify areas with common problems but unique circumstances, including Evangeline Parish, Louisiana, the Bronx, New York, and Navajo County, Arizona.

During his State of the City address in January, New York Mayor Eric Adams (D) committed to providing “free, comprehensive” healthcare to homeless residents who stay in shelters for longer than seven days. That would redirect them from emergency departments to primary care providers, benefiting their health and the city’s budget, he said.

But in the city’s Bronx borough, healthcare providers are backlogged and appointments can be hard to come by. Residents of wealthy neighborhoods have concierge doctors on demand, while the poor can go decades without a check-up.

“It's a very different reality in terms of the demand for services and the supply of services,” said Paulette Spencer, community engagement specialist and policy analyst for Bronx Community Health Network, a federally qualified health center.

There’s also a complex housing crisis. The Bronx has faced one of the highest rates of eviction in the country since the COVID-19 pandemic began and housing is very expensive. Low-income Bronxites are subject to myriad other social vulnerabilities that contribute to uncontrolled chronic illnesses and the spread of diseases, said Earle Chambers, director of family and social medicine research at Albert Einstein College of Medicine.

Even in a metropolis flush with resources and assistance programs, neighborhoods that need the most support get left behind. Social service agencies operate in silos, often have long wait times, can be challenging to navigate and leave residents with unmet needs, all of which discourages some from even seeking assistance. Lack of trust in the healthcare system steers people away from receiving care. So does cost.

“We need to make sure that when our families do have emergencies, they're not overwhelmed with crippling debt afterwards,” said City Council member Marjorie Velázquez (D), who represents a large swath of the Bronx.

Offering to pay for care is just one part of creating access. Healthcare organizations can better serve patients by screening them for social needs and deploying community health workers into the neighborhoods that need the most help.

Barriers such as housing insecurity, limited access to fresh food and scant economic opportunities affect patients' health and need to be folded into the care model, said Dr. Ted Long, senior vice president for ambulatory care and population health at the city-run NYC Health + Hospitals.

“I'm not going to be able to optimize one of my patient's asthma if they live in a house where there's mold,” said Dr. Kevin Fiori, associate professor of pediatrics and family and social medicine at Albert Einstein College of Medicine. “That is going to exacerbate [the problem] and they're going to end up in the emergency department and they're going to have poor care as a result."