Images of children’s faces greet passersby who drive past the hospital complex in Central West End–faces on banners that happily announce the “coming soon” of this important center. Smiling faces, gleaming buildings, culminating wholeness. These signs, strung across cement blocks, illustrate a vision for a more efficient, as well as elegant, St. Louis health care system. But who are the beneficiaries of these improvements? The depicted faces show no sign of distress or discrimination. Oftentimes, the invisible, underprivileged sectors of the city remain just that: unseen and not targeted enough for initiatives that may improve the quality of life in St. Louis.
Traditionally, the “Gateway to the West” has been regarded as a beacon of accessibility, representative of a doorway to opportunity. However, modern-day St. Louis, as highlighted by both data maps and citizens, appears to be a patchwork of unconnected resources. Rather than an overlapping network of healthcare and education among the 90 municipalities, St. Louis splits by ZIP codes and neighborhoods. Instead of providing the door to opportunity, resources are locked down. A gap exists in St. Louis between resources and people, a fissure that is both physical and figurative in nature.
If we all live in the same city, why are some populations more susceptible to disparities in quality of life? One of the greatest difficulties in ensuring access to resources like proper healthcare lies in targeting the right people. Most often, the unseen populations of St. Louis, such as the growing Hispanic and Latino communities, demonstrate the effects of this multi-faceted divide in the city. Many people from these populations must navigate around this gap in order to maintain the well-being of their families.
Because Midwest Hispanic communities tend to be smaller and more mobile than those around the country, the situation of Hispanic populations within St. Louis remains largely unrecognized because Hispanics and Latinos comprise a mere 3.7 percent of the city population, which is comparable to the rest of Missouri. This community represents one part of invisible population that initiatives fail to reach. Many of the statistics provided by the St. Louis Department of Health focus on comparisons between black and white populations, rarely looking at smaller minorities. As a result, new immigrants and those in the Hispanic and Latino community slip unnoticed through the obvious gaps in the system.
These holes can be found across many cities, not just St. Louis. For instance, many cities with similar issues are beginning to model health initiatives after the projects of Closing the Health gap, an organization based in Cincinnati. Having worked the past summer with Closing the Health Gap, Adriana Ungerleider, a Washington University in St. Louis third-year Global Health student, plans to translate what she learned in Cincinnati to a working in the Hispanic and Latino neighborhood in St. Louis. She reflects on her summer by stating that “specificity is key” in reaching communities that require aid.
For example, organizations that best bridge the separation between ideals and effective change work within communities to address the specific challenges placed on marginalized populations. In the Hispanic and Latino community, one of the greatest issues is lack of health insurance. Immigrants and minorities can easily get lost in the confusing insurance system. According to Ungerleider, registering for insurance is a complicated process, especially for a new citizen speaking a different language. For undocumented residents or those with language barriers, insurance is either difficult or impossible to obtain.
Some private organizations, like Casa de Salud, provide health and mental services like referrals, screenings, and vaccines to the uninsured and underinsured. According to Executive Director Jorge Riopedre, part of Casa’s mission is to “connect people to other sources of care,” working alongside the health care system already in place to bridge the gap between services and the ninety-percent of Hispanics and Latinos who are uninsured.
On the other hand, the city must still concentrate efforts on another aspect of the divide between resources and citizens within St. Louis: the physical divides that show up on all maps of the area. Looking at a demographic map of St. Louis reveals clear blocks for certain income levels, races and services. Just as organizations are working to connect initiatives with actual people, the city must overcome the physical barriers that prevent people from obtaining the means for an improved quality of life.
As seen in the sharp distinction between various neighborhoods, St. Louis has parceled out an uneven amount of resources to various areas. This divide poses problems for those in areas lacking resources. Thinking back to her past experiences as a new student in St. Louis, Ungerleider compares an immigrant or minority possessing a language barrier with a college freshman. Freshmen and immigrants alike must depend on public transportation and a limited number of friends to obtain basic services like healthcare and food markets. However, even for a well-equipped student, Ungerleider said she can recall spending an hour and half on a bus in transit from school to a doctor’s office in West County for a simple appointment. Because the hospitals and clinics tend to cluster in blocks in Central West End and West County, convenient lines of transportation are not always available to a variety of neighborhoods. To many people, it seems “inconceivable that inability plays as much a role as common sense,” Ungerleider said. The question of whether or not to get quality health care can be shortened to a quick decision between keeping a job and spending time in transit to a clinic.
Tying in with this lack of accessibility, food deserts, areas where citizens cannot obtain healthy food stuffs at an affordable cost, play a role in health disparity. Income determines whether or not a family can afford the prices of either full groceries or convenience stores, which affects availability of fresh produce in the pantry. According to a study by Washington University student Madeleine Daepp, though most St. Louis ZIP codes may be located within a mile of a full-service grocery in a neighboring area, the income level is the greatest barrier to healthy grocery shopping. The ZIP codes with the some of the highest concentrations of Hispanic population, 63112 and 63118, have median household incomes ranging from around twenty-five to twenty-nine thousand dollars per year. For many families in these areas, affordable and well-stocked grocery stores are not available. While this is an issue not exclusive to immigrants or Hispanic and Latino populations, varying income levels and access to healthy food plays a large role in the general well-being of wide variety of citizens. In essence, physical discontinuities stop the flow of resources to a spectrum of invisible people like immigrants, minorities, and low-income neighborhoods. (For more information on immigrant populations in St. Louis, visit http://www.iistl.org/).
However, in light of these issues, the city is not idle. St. Louis works alongside private organizations such as Casa de Salud to alleviate the disparities caused by access, income, and racial differences. One section of the 2014-2017 Community Health Improvement Plan provided by the St. Louis Department of Health recognizes how diabetes affects a disproportionate amount of the Hispanic population, with diagnosis being over 66 percent higher in Hispanics and Latinos than whites in the city. According to St. Louis University Hospital, these statistics are largely due to availability of healthy produce as well as predisposition by genetics, tying back to the issue of food deserts.
The St. Louis Department of Health plans to implement the City’s Obesity Plan through the Healthy Eating, Active Living Partnership, which includes an emphasis on active living, healthcare access, and social marketing. Moreover, with the high number of universities in the St. Louis area, much research about health interventions are underway. A constant flow of feedback must insure that measures are implemented effectively within the community. The social marketing objective of the City’s Obesity Plan follows this logic. The goal is to find tried-and-proven ways to “market interventions and change behavior through media/marketing”. Additionally, the city is looking into ways to improve transportation, such as plans for extending metro lines. As of now, the city continually refines its plans for attacking both figurative and physical gaps in St. Louis.
Overall, while the health and quality of life disparities in St. Louis depend on a variety of factors like predisposition and income, much of the issue stems from problems with accessibility and specificity. Specifically targeting the invisible victims of disparities is the only method that will lead to health solutions. St. Louis and private organizations together are making strides in this direction. Riopedre of Casa de Salud emphasizes “collaboration” as the vital goal. The director wants people to know that Casa stands in solidarity with all neighborhoods and “serves a wide range of minorities, anyone who is uninsured.” We want movement and exchange between people. Health issues in St. Louis are not limited to a certain population; rather, as stated earlier, numerous neighborhoods make up the city. Many and all faces of St. Louis should be on the banners proclaiming change.
The patchwork map of St. Louis still has far to go before the contributions of private citizens, researchers, and public officers can knit the city together along a common need for improved access to healthy living. However, with a more intimate look at the people of St. Louis who we claim to be aiding, perhaps we will reach a point where the unseen, those across the gap, will be pictured on banners as the beneficiaries of our ongoing initiatives.