Reaching the Poor with Health Promotion through Community Free Clinics

Much has been written about the health problems and needs of poor, uninsured, and homeless citizens in urban areas. 1-4 As a result, low health status among the urban poor has been variously described as a condition intrinsic to their lives or as a result of barriers to adequate medical care, education, and other social goods. Increased responsibility has been placed upon local communities concerned with the social and medical needs of indigent populations. 5 Although many public officials have called for increased attention by the federal government to the needs of indigent persons for primary and clinical preventive services, 6 the U.S. system of health care has been more responsive to entitled groups while committing fewer resources to the health care needs of millions of low income and working poor individuals and families. Sadovsky7 and others have argued that a substantial number of acute and chronic illnesses are the result of living environments, personal habits, and access to resources. In support of this view, Steinbach 8 has pointed out that people with low income are often less healthy than the rest of the population because they lack access to preventive health care, health education, and health maintenance goods and services. There is a strong association between poverty and health problems. For example, as compared to middle and upper income groups, individuals with low incomes are 60% more likely to die from preventable or treatable diseases such as pneumonia, diabetes, and tuberculosis. 8 The poor also have the highest incidence of dental disease 9 and limiting disabilities. 1° For people between the ages of 45 and 64, the prevalence of such chronic condi-