Public Forum with Rep. Kim Schrier Focuses on Social Determinants of Health

On March 12^th, US Representative Kim Schrier led a virtual public forum about social determinants of health. More than fifty community members tuned in and learned about the socioeconomic challenges that exist in the Upper Valley that can affect an individual’s health and wellness. Also, attendees heard about the work being done to address these challenges.

Schrier moderated the discussion with panelists Diane Blake, CEO at Cascade Medical (CM), Flor Murguia-West, English language learning teacher at Cascade School District (CSD), and Bob Mark, Community Cupboard program manager at Upper Valley MEND.

Murguia-West shared insights about the disparities and issues she’s seen for children of the school district. The district, which supports a population of about 1200 students, is 31% Latinx, and a third of those are English language learners. Forty-four percent of students are eligible for free and reduced meals.

The disparities are stark in terms of housing, which can range from multimillion-dollar homes to agricultural housing. Barriers to healthcare include lack of insurance, language barriers, transportation and scheduling challenges for appointments and lack of access to information.

“Navigating the healthcare system can be cumbersome and difficult,” Murguia-West said. This can lead to hesitancy and distrust. “Some families will wait to receive healthcare services when they’re back in Mexico on a visit.”

Beyond healthcare, Murguia-West pointed out barriers to academic success include language, which makes it harder to tackle the content in a second language. Also, because of the geographic spread of the district, some families are further away from the hub in Leavenworth and thus isolated from extracurricular opportunities. These children often spend more time home alone than their peers who live within the Leavenworth city limits.

Diane Blake shared information about the hospital district, which has an almost identical footprint to that of the school district. She shared key data from a recent Community Health Needs Assessment, which occur every three years. The hospital district has an overall population of 10,000, and the two fastest growing segments are the 65 years old + category and Latinx residents, with projected percentages of the population to be 28% and 12% by 2024, respectively.

Blake echoed some of what Murguia-West said, sharing that close to half of the residents of the district are either in poverty or are the working poor, which means they are employed but living paycheck to paycheck.

CM has started to screen for social determinants of health for all patients, and one barrier that has become apparent is that 7% of patients do not have their own transportation. This is a big deal given that public transportation has limited reach in the district.

Bob Mark has worked for over a decade on issues related to food security and housing and sees them as closely connected to community health. At Upper Valley MEND they’ve worked hard to improve the healthy food options by expanding gleaning efforts. UV MEND coordinates with local farmers to have gleaned produce go to food banks all over the county. He spoke of the fact that a lot of seniors depend on the food bank.

Mark shared how UV MEND’s emergency assistance program often helps individuals who have many intersecting needs, such as rent or utility assistance, transportation assistance and referrals for other needed services.

The discussion also covered the topic of the local “childcare desert.” Blake mentioned the licensed childcare providers could only meet the needs of 10% of the children. This is contrasted with the fact that 78% of families have both or single parents working. This discussion expanded to the attendees, and it was voiced that most preschool teachers do not make a living wage and parents often volunteer to help keep childcare facilities open.

Schrier shared how some of the work in Congress is attempting to address these concerns. For instance, the recently passed American Rescue Plan Act includes a change in child tax credit that will help low income families.

During question and answer, when asked what Cascade Medical is doing on behalf of disparities, Blake mentioned the work toward greater dual language, including a key recent hire of a bilingual financial counselor. “We also want everyone to know that we provide free and sliding scale care,” Blake emphasized.

The services provided by Lake Wenatchee Fire and Rescue in the Plain area were highlighted. Beyond their normal emergency response duties, they visit some residents regularly for paramedicine checkups. They deliver food boxes and help seniors with snow removal in the winter and assist with social service referral.

Schrier asked how Cascade Medical is doing as a small rural hospital. Blake explained that while CM’s charity care is unfunded, the hospital can make margin elsewhere. As a public hospital, CM relies on community taxes. The community has shown support for the hospital continuously through levies.

As for the COVID-19 vaccine, Blake shared that the distribution plan has mostly focused on the mass vaccination sites, such as the one at the Town Toyota Center. She felt it important for critical access hospitals like CM to receive a supply of vaccines for people with transportation issues.

Murguia-West had a final comment, asking to make sure the voices of non-dominant families and individuals are included in future discussions and decision-making processes.

The public forum was a reminder that the work to dismantle barriers to community health is being done by many committed partners. Conversations like these enable better coordination as this collective work continues.