National Health Policy versus State Policy Implementation Case Study

National Health Policy versus State Policy Implementation

National health policy sets the tone for the nation on how to implement, strategize, and achieve specific health goals. However, states often times have the option to not fully implement certain health policies based on their state needs. Thus, health policy varies in every state and can lead to varying health outcomes. This week, you will learn the national- and state-level impact of a healthcare policy.

Read the following case study from your textbook:

Then, visit the Kaiser Family Foundation Web site at

Kaiser Family Foundation -Health Policy Research, Analysis, Polling, Facts, Data and Journalism

and research health policy at the national and state levels. Narrow down your focus to the geographic region or location you identified in W1: Assignment 3 (ATTACHED). This would be the same area which you plan to work on for your Course Project.

Then, respond to the following:

CASE 15 The Diethylstilbestrol Story An Investigation into the Evolving Public Health Policy for
Pharmaceutical Products MARGARET ANN MILLER, EMILY BLECKER, AND MEGHAL PATELi
Regulatory agencies such as the United States Food and Drug Administration (FDA) play an
important role in promoting and protecting public health by preventing or limiting exposure to
unsafe products. Unfortunately, laws and regulations that protect public health are rarely proactive.
Most current laws, regulations, and policies governing the manufacture and sale of pharmaceutical
drug products (drugs) were enacted following a public health disaster. Understanding how public
health disasters have impacted the development of health laws and regulations is critical for
understanding current public health policy in the United States and for developing a proactive,
rather than reactive public health framework. This case study describes the tragic story of the
prescription drug, diethylstilbestrol (DES). It involves numerous players in the public health arena
including research scientists, regulators, pharmaceutical companies, physicians, lawyers,
advocates, and of course, patients. INTRODUCTION In 1971, several physicians noted an alarming
increase in the development of clear cell adenocarcinoma in teenage girls and young women. This
rare and potentially deadly form of vaginal and cervical cancer had previously occurred mainly in
women over 50 years of age. The only treatment was major invasive surgery to remove the uterus
(hysterectomy) or vagina (vaginectomy). This surgery was not only emotionally and physically
painful but sometimes not a cure. A few physicians began to search for the cause of this rare form
of cancer, and one physician, Arthur Herbst, described a common link: all of the women developing
clear cell adenocarcinoma were exposed to DES in utero.1 The implications of this finding were
terrifying for the American public—millions of children might develop cancer or some other
reproductive problem after an unknown length of time because their mothers took this prescription
medication during pregnancy. Today there is still no test for detecting DES exposure and it is
impossible to know how many people were, or will be, affected by the medication. DES remains one
of the most significant public health disasters of the 20th century. THE BEGINNING Starting in the
mid-1920s, scientists understood the action of natural estrogens and their potential utility for
treating numerous conditions from cancer to wrinkles. The natural estrogens identified at that time
were not water soluble and showed no activity when given orally. Several research scientists (many
of whom were supported by pharmaceutical companies) began their search for an orally active
form of estrogen. In 1938, British physician and chemist Charles Dodds and his team of scientists
published a paper describing the synthesis of DES, a compound that showed estrogenic activity
when consumed orally in tablet or pill form. The synthesis of DES was relatively simple and
inexpensive, and by publishing the formula, Dodds relinquished his patent rights. Although Dodds
promoted the use of DES for the treatment of menopausal symptoms and encouraged the
marketing of DES by pharmaceutical companies, he also voiced concerns about the potentially
harmful effects of the medication.2 THE APPROVAL PROCESS Prior to 1938, there was no federal
law to prevent the marketing of pharmaceutical drugs—whether safe or hazardous, effective or
useless.ii Any drug product could be marketed provided it was synthesized according to the
standard compendia and properly labeled. At the time, drug companies were small manufacturers
producing patent medicinesiii that were sold over the counter at pharmacies, while most physicians
prescribed pills and potions formulated from their own recipes. Beginning in the early 1930s,
Congress considered strengthening the 1906 Pure Food and Drug Act, but support for legislation
was inadequate until 1937, when a drug company introduced an untested formulation of
sulfanilamide with a solvent that caused the death of over 100 people, many of them children.3
Starting in 1938, drug companies had to submit evidence of a drug’s safety for its intended use to
the FDA before it could go on the market. The FDA had 2 months to approve, reject, or request
additional data from the firm, and failure to act on the application would lead to automatic approval
of the drug. This mandate for premarket evidence of a drug’s safety represented the birth of the
new drug application (NDA).iv,3 Despite the lack of product exclusivity that would have been
provided by a patent, several drug companies, including Eli Lilly & Company, took an interest in
producing and marketing DES. In 1940, 13 drug companies filed NDAs for DES. In anticipation of
this event, a number of scientists published studies showing that estrogens induced cancer in
animals, and wrote editorials urging a thorough review of DES by the FDA. FDA informed the drug
companies that it did not believe the current data supported a determination of safety for DES and
that it would turn down the applications. The companies withdrew their applications but committed
to work together to develop the clinical safety information needed for DES to obtain FDA approval.
The following year, the drug companies again filed NDAs for DES. This regulatory submission
focused on the safety of DES in human clinical studies—evidence that discounted the disturbing
findings from several animal studies. In 1941, DES was officially approved by the FDA for four
indications: treatment of gonorrheal vaginitis, menopausal symptoms, senile vaginitis, and
prevention of lactation in women who had given birth. The product label listed a number of side
effects for estrogen treatment v as well as precautions and contraindications of use:
“Diethylstilbestrol is contraindicated in patients with personal or familial history of breast or genital
cancer (except in the treatment of cancer). Prolonged, continuous administration can lead to
endometrial hyperplasia and to ‘breakthrough’ bleeding…”4(para 3),vi In 1943, two Harvard Medical
School physicians, George and Olive Smith, began evaluating the use of DES to prevent and treat
complications of pregnancy. Animal research suggested DES could stimulate the production of
progesterone, and the Smiths hypothesized that increasing progesterone production would prevent
many complications of pregnancy. In their study of approximately 600 pregnancies, DES was
effective in preventing miscarriage, late pregnancy toxemia, intrauterine death, and premature
delivery.5 The Smiths advocated for the prophylactic use of DES in all pregnant women to prevent
complications of pregnancy (also termed accident of pregnancy) associated with progesterone
deficiency. In 1947, DES was approved by the FDA for use in preventing accidents of pregnancy.6
THE MAGIC BULLET The FDA does not regulate the practice of medicine. Once DES was approved,
physicians were legally allowed to use it for any purpose. The scientific and medical communities
viewed orally active estrogen as a magic bullet that could be used to treat many medical conditions
and improve the quality of life. In addition to the FDA-approved indications, DES was used by
physicians for the treatment of acne, osteoporosis, heavy menstrual bleeding, female infertility, and
prostate cancer, as an oral contraceptive, and as a morning-after pill. DES was given to teenage
girls who were too tall in an attempt to stunt their growth and to male transsexuals to help prepare
them for a sex change. DES was eventually used to treat over 100 conditions and was prescribed
across the United States and throughout the world. DES was even given to livestock to promote
rapid weight gain.2 Following World War II, Americans experienced a period of great social
optimism. New suburban complexes were being developed, science and technology seemed to
have no limits, and physicians were viewed as kings. As soldiers returned home from war, they
were eager to get married and start families. The era known as the baby boom began.vii Despite a
surge in pregnancies during this era, many women desperate to have children were struggling with
miscarriages. These women were eager for suggestions from their physicians about any
medications that would help them prevent miscarriages. FDA’s approval of DES for accidents of
pregnancy in 1947 led to a surge in DES use among pregnant women. Herbst et al. estimated that
between 1946 and 1951, DES was prescribed for about 1 out of every 20 high-risk, pregnant
patients at Boston’s Lying-In Hospital.7 Physicians were encouraged by the drug company sales
representatives to use DES not only in high-risk pregnancies but also as a “vitamin” for all pregnant
women. Drug company sales representatives offered incentives for physicians and pharmacists to
prescribe their company’s product—including free samples, medical booklets, and an assortment of
gifts for their personal and professional use. Pharmacists were offered incentive plans for buying
DES products, including discounts on larger purchases. At that time, Eli Lilly & Company was one of
the largest pharmaceutical companies in the world; it is estimated that Lilly produced 50 to 75% of
all the DES products sold in the United States.2 However, because several drug companies
manufactured DES and because it was widely used, it is difficult to determine exactly how many
people, including pregnant women and their offspring, were exposed to DES during this time.viii
FROM MAGIC BULLET TO TIME BOMB Although doctors widely prescribed DES for pregnant
women, some early clinical studies failed to show an increase in progesterone levels in pregnant
women treated with DES. In the early 1950s, Dieckmann et al. noted that the Smiths’ studies lacked
an adequate control group and the benefits reported for DES could simply be due to improved
medical care given to the study participants. Dieckmann’s research group conducted a randomized,
double-blind clinical trial (a study design that is still considered the gold standard by the FDA) to
assess pregnancy outcomes in women who were assigned to receive either DES or a placebo. The
study definitively showed that DES did not work to prevent miscarriages or any of the other
indications proposed by the Smiths. In fact, although not statistically significant, there was a clear
trend for the women taking DES to have more miscarriages, more premature deliveries, and lower
birth weight babies than women who took the placebo.8 The Smiths provided comment on the
study stating their belief that the negative findings were due to the heterogeneous sample of
pregnant women, which masked the effect of DES.9 Despite the lack of efficacy in the double-blind,
placebo-controlled clinical study and the increasing evidence that DES caused reproductive tumors
in animal models, DES continued to be widely prescribed to pregnant women throughout the 1950s
and 1960s. Beginning in the 1950s, some public health professionals suggested that drug product
safety needed to be considered in light of product effectiveness. A congressional investigation and
subsequent hearing launched by Senator Estes Kefauver in the late 1950s raised questions about
drugs, including drug effectiveness. However, once again, Congress was not able to garner support
for a stronger drug law until another tragedy occurred. This time it was thalidomide.3 Thalidomide
was developed by a German pharmaceutical company, and was approved and widely used in
Europe between 1957 and 1961 to treat morning sickness in pregnant women. In the late 1950s
and early 1960s, more than 10,000 children in 46 countries were born with limb deformities. In
1961, a German pediatrician demonstrated a link between these birth defects and the use of
thalidomide during the first trimester of pregnancy. Later that same year, thalidomide was removed
from the market in Europe.10 In the United States, the impact of thalidomide was minimized
because the FDA insisted that additional studies were needed to demonstrate safety as mandated
in the 1938 legislation and refused to approve the drug application. Although thalidomide was
never approved for sale in the United States, millions of tablets were distributed to physicians as
part of the investigational clinical testing program.3 In 1962, following on the heels of the
thalidomide tragedy, the United States Congress amended the drug law to require, among many
other items, that: (1) manufacturers establish the effectiveness of drugs through adequate and
well-controlled clinical trials prior to marketing; (2) the FDA exert greater control over
investigational studies; and (3) manufacturers test for safety during pregnancy before a drug
received approval for sale in the United States.3 For products such as DES that were approved prior
to these amendments, the FDA engaged the National Academy of Sciences/National Research
Council to convene panels of experts to review the published literature to determine if the results
supported product efficacy for a particular indication. The results of the panel reviews were
submitted to the FDA, which evaluated the findings and published its approval decisions in the
Federal Register. If FDA determined that a drug was ineffective for a particular indication, the
agency had to follow the legal administrative hearing process to withdraw the NDA.11 Following
the passage of the 1962 amendments to the drug law, drug companies needed to provide the
National Academy of Sciences/National Research Council review panel with published clinical
studies to support the clinical efficacy of DES for each of its approved indications. The National
Academy of Sciences/National Research Council panel concluded DES was effective in the
treatment of menopause, senile vaginitis, postpartum breast engorgement, functional uterine
bleeding, and controlling carcinoma of the breast and prostate. With regards to the accidents of
pregnancy claim, the panel stated that accidents of pregnancy is a very vague term and probably
includes a whole group of indications, and that the company should be asked to clarify exactly
what indications it covered. The panel also stated that it “feels that this drug is not harmful in such
conditions as threatened abortion, but that its effectiveness cannot be documented by literature or
its own experience.”12(p 2) In 1970, Herbst and Scully published a paper describing
adenocarcinoma of the vagina in seven adolescent females. This finding was especially concerning
because these cancers were usually seen in women over 50 years of age.1 Interestingly, two of the
mothers suspected their DES use during pregnancy had caused the cancer in their daughters.7 In
early 1971, Herbst et al. published a study in The New England Journal of Medicine titled,
“Adenocarcinoma of the Vagina: Association of Maternal Stilbestrol Therapy with Tumor
Appearance in Young Women.” This study described the association between clear cell
adenocarcinoma of the vagina seen in seven women ages 15 to 22 and in utero exposure to DES.13
Herbst next obtained the patient records from the Smiths to allow for the study of other mothers
exposed to DES. In these studies, Herbst determined that the development of vaginal adenosis was
dose dependent and related to the gestational age of exposure, with exposure prior to 18 weeks
causing cancer. In addition, Herbst established a patient registry to study the clinical,
epidemiologic, and pathologic aspects of clear cell adenocarcinoma in young women with and
without DES exposure. From the registry data, it was determined that adenocarcinomas occurred
with a cumulative incidence of approximately 1 in 1000 exposures to DES. DES became the first
example of a chemical known to cause cancer in offspring following in utero exposure.
Noncancerous alterations of the reproductive tract were an even more common finding, affecting
75% of the female offspring exposed to DES, which contributed to the overall concern regarding the
use of any medication during pregnancy.7 The young women facing the health problems as a result
of DES exposure in utero became known as “DES daughters.” Shortly after the publication of the
first paper by Herbst in 1971, the FDA sent a bulletin to all U.S. physicians advising them against
the use of DES in pregnant women. In November, 1971, the FDA published a Federal Register notice
stating that based on the findings of the National Academy of Sciences/National Research Council
Drug Efficacy study, it would approve DES for the treatment of osteoporosis, disturbances of the
menstrual cycle, suppression of lactation, and to lessen blood loss at surgery. However, based on
concerns about the association between DES use in pregnant women and adenocarcinomas in the
offspring, the FDA concluded that for pregnant women, the risk of treatment did not outweigh the
benefits and thus DES was contraindicated for use during pregnancy.14 Following a contentious
comment period, the FDA withdrew the approval of DES for use in pregnant women in 1975.15 It
has been estimated that between 5 and 10 million pregnant women and their offspring were
exposed to DES worldwide from 1938 to 1971. It has now been proven that the DES daughters face
a statistically small, but nevertheless significant, risk of developing clear cell adenocarcinoma.
Additionally, they face an even greater risk of having a premature birth or other difficulties
becoming pregnant due to DES exposure.7 While most of the initial attention given to DES was
placed on the affected daughters, in the 1980s, attention was broadened to include the problems
faced by DES sons. Assessing the biological impact of DES exposure on males was more difficult
than it was for females. Many men rarely go to the urologist, and often they do not admit to having
genital or reproductive problems. However, many DES-exposed sons experienced reproductive
problems such as pain during sexual intercourse, a low sperm count, and a smaller than average
penis. THE EMOTIONAL AND SOCIAL IMPACT Epidemiologic incidence numbers do not begin to
capture the emotional and social impact of DES exposure. Many DES mothers felt guilty about
taking a medicine while pregnant, resulting in harm to their children, while others objected to
having their daughters examined. Cancer and surgical removal of the vagina and uterus had a very
traumatic effect on the teenagers and young women who developed clear cell adenocarcinoma.
After these surgeries, numerous young women felt angry about what had happened to them and
struggled with their body image. Many young women and young men who faced problems due to
DES exposure developed a fear of sexual relations and social rejection. Some couples were willing
to discuss their experiences and difficulties in trying to get pregnant but still did not discuss the
tension that occurred between them. Women often had trouble seeking support from their
husbands whom they felt could not understand or respond to the emotional distress they were
feeling. Infertility and other medical problems related to DES put a strain on many marriages and
sometimes led to divorce.2 DES ADVOCACY Many DES advocacy groups were formed to seek
compensation from the drug companies responsible for manufacturing DES and to help the victims
of DES exposure handle the physical and emotional consequences of their health problems. In
1977, Fran Fishbane became the first president of DES Action, National. The goal of DES Action,
National was to identify all DES-exposed individuals, to provide referral and follow-up care, to
develop networks of information, and to offer a newsletter on legal and other information pertaining
to DES. Fran Fishbane later became the head of the Ralph Nader–funded Public Citizen’s Health
Research Group. The advocacy community pressured the drug companies and public health
community to assume responsibility for the problems associated with DES exposure. This led to
the development of a patient registry of women exposed to DES. Patient registries are
observational studies designed to determine the safety of a drug in the real world by tracking the
health of patients who have taken the medication. Patient registries, also referred to as phase IV
studies, remain the best way to identify safety signals for marketed drug products and are now a
common requirement for the approval of drugs used by pregnant women. LEGAL ACTION In civil
law, an individual or an organization (plaintiff) sues another individual or group (defendant),
claiming the defendant committed some wrong. Sometimes the plaintiff will join with other
individuals or organizations that are making the same accusation. A specific branch of civil law is
the product-liability field. When people claim to be injured by a product, they may sue the
manufacturer of that product for damages. Thus, numerous lawsuits were filed against
manufacturers of DES. However, one major problem in many of the lawsuits surrounding DES was
that DES was never patented, and many different manufacturers produced the drug. Furthermore,
many women did not know which company synthesized the pill that they or their mother took. In
one famous DES case, a lawyer named Jason Brent filed a lawsuit in 1976 on behalf of Judith
Sindell against Abbott Laboratories, E.R. Squibb, and Eli Lilly & Company. The defendants were all
leading drug companies and known manufacturers of DES. Since it was not known which company
made the DES Sindell’s mother had taken, the court decided that each defendant would be held
responsible for a percentage of the total compensation based upon their portion of the total DES
market. This decision, upheld by the California Supreme Court in 1980, changed the course of legal
history because the plaintiffs were now able to sue the manufacturers even if they didn’t know
which company manufactured the exact drug product they were given.2 CONCLUSION DES
products are no longer on the market in the United States and regulatory standards for FDA
approval of medicine are now much more stringent than those used when DES was approved.
However, the fact that so many scientists, physicians, and regulators failed to recognize the
problem with DES until it was too late begs the question: could a public health disaster similar to
DES happen again? Understanding laws and regulations and process of drug approval and
postmarketing surveillance will help public health professionals engage proactively in ensuring the
safety of pharmaceutical products. About the Authors Margaret Ann Miller, PhD, received her PhD
in endocrinology-reproductive physiology from the University of Wisconsin-Madison in 1981 and
was a postdoctoral fellow at the University of Illinois, Champaign-Urbana. In 1985, Dr. Miller
accepted a posit ion at Monsanto Agricultural Company working on the approval of recombinant
products. In 1989, Dr. Miller joined the United States Food and Drug Administration (FDA) in the
Center for Veterinary Medicine. She held several positions within the Center for Veterinary Medicine,
including deputy director for human food safety. In 1999, Dr. Miller joined the FDA’s Office of
Women’s Health as the manager of science programs. In this position, she initiated several
successful research initiatives that promoted the health of women. In 2005, she accepted a 2-year
detail to the World Health Organization, where she worked on food safety. Dr. Miller is currently the
associate director of regulatory activities in the Washington office of the National Center for
Toxicological Research and a professorial lecturer at The George Washington School of Public
Health and Health Services. Emily Blecker is majoring in sociology with a concentration in health
and medicine at the University of Pennsylvania. She is interested in having a career in public health
after she graduates. In 2010, Ms. Blecker received a summer internship from Oak Ridge Research
Institute and worked at the National Center for Toxicological Research at the Food and Drug
Administration. Meghal Patel, MPH, is a graduate of Indiana University, where she received a
bachelor of science degree in biology and a bachelor of arts degree in psychology. In 2010, she
received her master of public health from The George Washington University School of Public
Health and Health Services, concentrating in global health. She participated in writing this case
while working at the National Center for Toxicological Research at the Food and Drug
Administration under Dr. Margaret Ann Miller. ADDITIONAL RESOURCES Centers for Disease
Control and Prevention. DES update home. http://www.cdc.gov/des/ National Cancer Institute. DES
questions and answers. http://www.cancer.gov/cancertopics/factsheet/Risk/DES REFERENCES
1. Herbst AL, Scully RE. Adenocarcinoma of the vagina in adolescence: a report of 7 cases including
6 clear-cell carcinomas (so-called mesonephromas). Cancer. 1970;25(4):745–757. 2. Meyers R.
D.E.S.: The Bitter Pill. New York, NY: Seaview/Putnam; 1983. 3. United States of America. The Food
and Drug Administration. About FDA: summary of NDA approvals & receipts, 1938 to the
present.http://www.fda.gov/AboutFDA/WhatWeDo/History/ProductRegulation/SummaryofNDAApprovalsReceipts1938tothepresent/ucm2006085.htm. Updated February 16, 2011. Accessed
July 9, 2010. 4. United States of America. The Food and Drug Administration. New Drug Application:
Diethylstilbestrol Tablets, U.S.P. September 16, 1947. 5. Smith OW. Diethylstilbestrol in the
prevention and treatment of complications of pregnancy. Am J Obstet Gynecol. 1948;56(5):821–
833. 6. D.E.S. timeline.http://www.douglasandlondon.com/docs/DES-Timeline.pdf. Accessed July
15, 2010. 7. Herbst AL. Diethylstilbestrol and adenocarcinoma of the vagina. Am J Obstet Gynecol.
1999;181(4):1576–1578. 8. Dieckmann WJ, Davis ME, Rynkiewicz LM, Pottinger RE. Does the
administration of diethylstilbestrol during pregnancy have therapeutic value? Am J Obstet Gynecol.
1953;66(5):1062–1081. 9. Smith, GvS. as quoted Dieckmann WJ, Davis ME, Rynkiewicz LM,
Pottinger RE. Does the administration of diethylstilbestrol during pregnancy have therapeutic
value? Am J Obstet Gynecol. 1953;66(5):1075–1076. 10. Miller MT, Stomland K. Teratogen update:
thalidomide; a review, with a focus on ocular findings and new potential uses. Teratology.
1999;60:306–321. 11. Karst KR. Marketed unapproved drugs—past, present and future. RA Focus.
February 2007:37–42. 12. National Academy of Science/National Research Council. Drug efficacy
studies for diethylstilbestrol. Available at www.pharmapendium.com. Published 1969. Accessed
July 20, 2010. 13. Herbst AL. Adenocarcinoma of the vagina: association of maternal stilbestrol
therapy with tumor appearance in young women. N Engl J Med. 1971;282(16):878–881. 14. Food
and Drug Administration. Certain estrogens for oral or parenteral use: drugs for human use; drug
efficacy study implementation. Fed Regist. 1971;36(217):21537–21538. 15. Food and Drug
Administration. Certain estrogens for oral use: notice of withdrawal of approval of new drug
application. Fed Regist. 1975;40(25):5384. i The views expressed in this publication are those of the
authors and do not necessarily represent of those of the United States Food and Drug
Administration. ii In 1906, Congress passed the Pure Food and Drug Act, which prohibited the sale
of misbranded or adulterated food, drinks, and drugs. iii Patent medicines are medicines, usually of
low potency, protected by patent and available without a prescription. iv To administer a n
unapproved new drug to humans, the manufacturer requested an investigational new drug
application exemption from the FDA. v Side effects include nausea, vomiting, fullness and
congestion of the breasts, edema, uterine bleeding (either during or upon cessation of
administration), and, rarely, various forms of abdominal distress or pain, anorexia, diarrhea,
lassitude, vertigo, headache, anxiety, insomnia, thirst, scotomata, cutaneous rashes, purpura, and
jaundice. Gynecomastia and loss of libido may occur in men. vi Product labels are available online
at www.pharmapendium.com. vii The U.S. Census Bureau defined the increased births between
1946 and 1964 as the baby boom. viii Major manufacturers of approved DES products include:
Abbott Laboratories, Ayerst, McKenna & Company, George A. Breon & Company, Charles E. Frost &
Company, Eli Lilly & Company, Merck, Inc., William S. Merrell Company, Sharp & Dohme Inc., E.R.
Squibb & Sons, Inc., The Upjohn Company, Winthrop Chemical, and Wyeth Laboratories.
COMMUNITY HEALTH CENTERS
Community Health Centers
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COMMUNITY HEALTH CENTERS
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Community Health Centers: Wayne County, Michigan
Wayne County Demographics
Wayne County, Michigan, as of 2018, had a total population of 1.75 million people with a
median age of 38 and an average household income of $46,390. The population grew by around
0.01% from the previous year, with the average household income increasing by 2.78%. The
population consists of 6.5% persons under the age of 5, 23.6% under the age of 18, 15.4% of the
population consists of persons who are 65 years old or over, and 51.8% females, with the rest being
male. 54.6% of the population consist of whites only, Black or African Americans alone are 38.8%,
Native Americans alone 0.5%, and Asians alone 3.5%. People who belong to two or more races
are represented by 2.6% of the population, while Hispanics or Latinos are represented by 6.1% of
the entire population (United States Census Bureau, 2018).
Of the 1.75 million people living in the community, 85.9% are high school graduates or
higher, with 23.3% of the population having a Bachelor’s degree or higher. 12.1% of the population
under the age of 65 years live with disabilities, while the persons under the age of 65 years without
healthcare insurance represented by 6.8% of the population. The median household income is
$45,321, with per capita income in the last 12 months being $25,976. 21.7% of the population in
Wayne County live in poverty (United States Census Bureau, 2018). These demographics,
therefore, reveal that community health centers in Wayne County are greatly needed by the
population because a significant percentage of the community is not financially well off. Since the
services offered by community health centers are less expensive compared to care provided by
hospitals and outpatient clinics, they come in handy by offering the community affordable care
and more extensive programs that are greatly needed by the patients.
COMMUNITY HEALTH CENTERS
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Health-Related Services Delivered
Community health centers in Wayne County provide a wide range of health-related
services. The services they provide go beyond what other healthcare providers like out-patient
clinics and hospitals offer to patients. Community health centers in Wayne county provide not only
primary healthcare services, but also specialty care, including cardiac, orthopedic and podiatric
care, mental health and dental services, care coordination, transportation to and from healthcare
facilities, and outreach activities which are driven towards finding patients in need of the services
mentioned. Community health centers also deliver care that is culturally appropriate since they are
offered in languages that the members of the community understand and in ways that respect their
cultures and values (Schumann, 2019).
The services that are offered in Community Health Centers in Wayne County are tailored
towards meeting the needs of the members of the community in this specific area. This is evidenced
by the 91 percent of health centers that offer translational/interpretation services, 80 percent that
provide programs of weight reduction, case management services in 89 percent of the health
centers, and 90 percent of them offer on-site services to assist patients in identifying additional
programs which can be beneficial to them. The extent of care that community health centers offer
the members of the Wayne County community improve overall patient outcomes.
Patients who receive care in these community health centers develop better relationships
with their health care providers, such as nurses and other physicians. The care provided in these
centers is less expensive compared to patient care provided in other healthcare facilities such as
hospitals and outpatient clinics (Schumann, 2019). This is mainly because care providers in these
health centers are more centered on the provision of additional services and comprehensive
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primary care. The provision of health care in community health centers saves the County
government a significant amount of money on an annual basis by eliminating unnecessary visits
to the emergency department and other healthcare facilities like clinics and hospitals.
Available Social Services
Some of the social services available for the people of Wayne County that are aimed at
improving their overall health include behavioral health and community services, senior/volunteer
services, and child welfare services. The behavioral health and community services category focus
on substance use programs and Worthy, Able and Ready (WAR) programs which are aimed at
counselling, supporting and managing people with substance abuse issues, and enable people who
have been incarcerated to transition into the community. Others, such as child welfare services and
senior volunteer services, ensure that the health of children and seniors are considered a priority
for the betterment of the overall community or population (“Community Social Services of Wayne
County,” 2020).
Barriers to Access to Healthcare
There are several barriers to access to healthcare within the Wayne County community,
with the main one being poverty or low income. The high cost of healthcare coverage, another
slightly different barrier that is closely related to poverty or low incomes, does not resolve the
conundrum that this community faces. Economic troubles in the Michigan state have significantly
raised the rates of unemployment forcing several members of the community to lose their health
coverage through their employers (Rigg, 2018). These employers cannot afford to cover the health
insurance of their employees, especially due to the rising costs of healthcare. Of all the counties in
Michigan, Wayne County has the worst health ranking. This is partly due to another barrier to
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healthcare access, which is the education levels of the community. Moreover, the lack of adequate
community resources in the entire Michigan state is another barrier that hinders members of the
community from gaining access to quality healthcare, which may result in poor quality or
unsatisfactory patient outcomes.
How Healthcare Providers Can Improve Access to Quality Care
Healthcare providers in Wayne County or the entire Michigan state can improve access to
quality care within the community through the use of several strategies. First, they should reduce
or work towards eliminating the barriers to healthcare access that affect low income, uninsured,
and underinsured members of the community. Healthcare providers can also support safety net
capacity in the service area to enhance the population’s access to primary care. They should also
increase people’s awareness of available health resources. The community health centers in Wayne
County will be imperative in ensuring that the community receives all the types of primary health
care that a significant percentage of the population needs (Martinez, King, & Cauchi, 2016).
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References
Community Social Services of Wayne County. (2020). Retrieved from
http://www.csswayne.org/
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