PROVIDENCE – Kudos, with some strong caveats, to G. Wayne Miller on his front page story, “The wellness gap,” in the Sunday, Oct. 7 edition of The Providence Journal, which detailed how disparities in health care have social justice overtones, with medical outcomes affected by race, income, health insurance, education and place of residence.

My problem with the article, which detailed the impact of lead poisoning on a child and his mother, after the child ingested lead from paint chips and dust when he was a child, leaving the child with substantial brain damage, was what was entirely left out of the story: the work to establish health equity zones in nine Rhode Island communities during the last four years. [There was a one small paragraph added to the end of the print version of the story, which did not appear in the original digital story.]

In his story, Miller spoke extensively with Dr. Michael Fine, the former director of the R.I. Director of Health, who left in 2015, and who is the author of a new book, Health Care Revolt. Fine is certainly well versed to talk about health inequities.

But Miller failed to speak with either Dr. Nicole Alexander-Scott, the current director of the R.I. Department of Health, or with Ana Novais, the executive director of Health at the agency, who have been most responsible for shepherding the work on health equity zones in Rhode Island. Was this an error of omission or commission?

Given that The Providence Journal failed to cover the 2018 Health Equity Summit, held on Thursday, Sept. 20, at the Providence Convention Center, which drew more than 750 participants, and instead chose to cover another event happening a scant 50 yards away, the evidence seems to point toward an error of commission.

Miller’s story used the R.I. Department of Health’s 2015 Minority Health Facts report as its launch point, but failed to discuss what has occurred since that report was written more than three years ago in developing solutions to the burdens of health inequalities.

What was also missing from the story was the context behind the work to develop health equity zones – that 80 percent of health outcomes occur outside of what happens in a doctor’s or nurse’s office.

“Unless you work in the community, addressing the conditions that are creating that burden of disease, you are always going to be rescuing people,” said Novais, executive director of Health at the R.I. Department of Health. “And, there is no money, not enough money, to rescue people indefinitely. If you start to diminish the conditions that led to the poor outcomes, then you are going to be more successful.”

Myopic vision
Then there was the myopic sidebar describing how health providers are working to lesson disparities, with the focus on what health systems such as Lifespan, CharterCARE and Care New England are doing – as if the major health systems define the universe of health care in Rhode Island. [Yes, there was a mention of Blackstone Valley Community Health Care, but left out of the reporting was the fact that a new Neighborhood Health Station will be opening up this fall in Central Falls, the first of its kind in the nation, built by Blackstone Valley.]

Equally problematic, there was also no mention in Miller’s reporting in the sidebar about the work being done by Care New England as one of the 32 Accountable Health Communities in the nation, as part of a five-year program underwritten by the Centers for Medicare and Medicaid Services focused on population health, creating collaborative strategies to address health equity and the social determinants of health. The sidebar appeared to be heavily weighted toward Lifespan.

Left out of the conversation
The discussion of childhood lead poisoning as an example of health disparities was equally problematic, once again because of what got left out of the story. Why was there no mention of the Childhood Lead Action Project, which since 1992 has been the primary advocacy group in the state seeking to eliminate lead poisoning through education, parent support and advocacy? Why was there no interview with Laura Brion, the executive director of the community agency? Or, why not talk with Dr. Peter Simon, who coordinated the lead poisoning prevention efforts at the R.I. Department of Health for more than two decades?

Simon told ConvergenceRI that the picture painted by Miller’s article was way off the mark. “Lead screening rates were already above 80 percent for children in the middle of their second year of life by the mid-1990s, while most of the country was barely breaking 30 percent,” he said.

Further, Simon said: “Disparities in health by race and income exist for many reasons, none of which were discussed in this ProJo article.”

Simon posed the questions that he believed went totally unaddressed in the Miller’s story when it came to talking about disparities: Why does Rhode Island not invest in affordable housing? Why do urban schools receive state funds through a formula that systematically ignores the poverty and disadvantage in the lives of public school students? Why do suburban communities continue to resist the development of affordable multifamily rental properties?

Further, Simon said that because of the extraordinary advocacy for health insurance, children and mothers were covered under Medicaid whenever an eligibility expansion had been offered.

“Our rates of uninsured are an outcome of people working together to provide access to medical care,” he said. “Unfortunately, we all now recognize that medicine does not produce more than 25 percent of the ingredients for a healthy community. This has been known for 25 years and continues to be ignored in Rhode Island by our thought leaders.”

If we want to see healthy communities, Simon concluded, “We need to look for our lost keys somewhere else than under the street lamp.”

To G. Wayne Miller, here is a public invitation for a cup of coffee at Olga’s, that hub of innovation, for a discussion about health care in Rhode Island.