Cleveland's mayor-elect, Jane Campbell, is in the process of formulating a transition team to fill key positions at City Hall. Ms. Campbell says one of her first priorities will be to set the city's troubled health department in order. Dr. Carla Harwell, M.D. is a physician with University Hospitals Health Care System. Several days per week, you'll find her treating patients at the Otis Moss Jr. Ambulatory Care Center. She sees a range of clients, including people from some of Cleveland's low income neighborhoods. This summer, we asked her where she thought the next mayor's focus should be for public health.
April Baer- What should the top priorities be for the next mayor?
Carla Harwell- I think one of the biggest health priorities for our next mayor of Cleveland is something that's not unique to the city of Cleveland - but I think it's a national problem - and that's something I think I hit on with one of the patients we saw this morning: prescription coverage. It's a battle. It's a fight - getting your priorities straight in terms of what's most important to you: is it important to have a roof over your head and pay bills, or is it a bigger priority to be able to pay for your medicines each money. And I think that's a choice that our elderly patients should not have to make. So I think prescription coverage is something the next mayor needs to look at.
Also in the city of Cleveland there are some disparities in access to health care. Even though there are a lot of medical centers, I think it's still an issue of access to this healthcare are because a lot of patients - for a number of reasons including transportation, lack of medical coverage - still do not have access to preventive primary care medicine, and they're abusing the emergency rooms. With the closing of the area hospitals here, emergency rooms are just overflowing - that's another issue for the next mayor of Cleveland - what do we do about the flooding of the existing ones we're now seeing. So I think the next mayor really needs to look at access to medical care here in the city, the overflowing of our emergency rooms that leads to a problem called diversion-where sometimes ambulances can't even get to hospitals because they're overcrowded. And again, prescription coverage.
AB- Getting back to access, do you have any ideas about what might work? What works to get people to come in and see a primary care physician?
CH- I think when you're looking at how to fix the problem of access to medical care, you have to look at it from two perspectives - one is the educational aspect, actually educating about the importance of having a primary care physician on a regular basis. I get a lot of patients on ER follow-ups that have no idea they should be seeing a doc on a regular basis! And as hard to believe as that is, I hear and see a lot of that. So I think there needs to be some citywide campaign-letting people know that you need to NOT go to the emergency room when you have a urinary tract infection. If you have a primary care physician, that is something that can be handled in the office - if not over the telephone - so I think number one is patient education and the other issue, unfortunately, is coverage. It is one thing to tell a person they need to see a doctor. It is another thing to tell a person how they are going to pay for it. This is more of a national issue not just a city of Cleveland issue. But what could the city of Cleveland do to help? I think that what will come from the next mayor as far as lobbying. What contacts in Washington help bridge the gap to access to medical care? Another issue is welfare reform that took away a lot of health care benefits from individuals and threw them out.
AB- Anything else you'd like to mention?
CH- I think that Mayor White when he formed his task force to look at certain medical issues here in Cleveland - that was a very good thing to do. What I would like to see the next mayor do is to take that a step further and start getting out into the community and somehow not just address that breast cancer is killing African American women seven times faster than Caucasian women. Or the city of Cleveland is one of the fattest cities in the United states and that we have a high prevalence of diabetes but actually get out and take it to the next level and do some sort of intervention. And one of the main interventions that needs to be done is education for the residents of Cleveand to let them know the importance of maintaining preventive health care.