Testimony of Dr. Joycelyn Elders to Congressional Briefing, March 22, 2001

Statement of M. Joycelyn Elders, M. D. March 22, 2001

[Dr. M. Joycelyn Elders is an American physician and government official whose effective advocacy for preventive medicine, especially for children and young adults, led to her appointment as U. S. Surgeon General during the first Clinton administration. She served in that post for 15 months. Previously, Dr. Elders had been director of public health in Arkansas, beginning in 1987.

Dr. Elders is a pediatric endocrinologist, and has written more than 150 articles on hormone-related illnesses and on children's growth patterns. Her autobiography, Joycelyn Elders, M. D., written with David Chanoff, was published in 1996.

From Encyclopedia Britannica]

Thank you, Congressman Conyers, and others for holding this briefing on the crisis of the national public hospital safety net - with D. C. General Hospital as a focus.

D. C. General Hospital is a hospital that has served a community, and an underserved population for a very long time This hospital has served in times when nobody else would. They have many health disparities of concern -- such as teenage pregnancy, AIDS, TB, poverty, health illiteracy, and so forth. No one has gone out there to provide this population with the primary health care to reduce mortalities and morbidities. So why close the only source of care, and promise primary care to an underserved, under-educated population in apparent need?

Everything posed by the close down of this hospital contradicts national health goals, and common sense.

For instance, one of the three major health goals for the year 2010 is to have 100% access and 0% disparity in health care. The other two goals are to have every American have the best possible health that they can. And the third is that every American have access to primary preventive health care.

The idea of these health goals began in a 1979 report of the U. S. Surgeon General. This practice of establishing health objectives in coordination with state, local and national government health professionals continues today.

I urge you to consider the suggestion of closing D. C. General, and then compare it to the health goals for the year 2010.

"Healthy People 2010", established in 2000, included a new objective to "Eliminate Racial and Ethnic Disparities in Health". This initiative came from the simple recognition of the reality of health conditions in the U. S. In a 1998 radio address, President Clinton announced that the nation would eliminate - not narrow - the considerable long-standing racial disparities in health status by the year 2010. For instance, in infant mortality: African American and Native Americans have the highest death rates in the nation. In adult mortality: in 1997, overall mortality was 55% higher for black Americans than for white Americans; life expectancy was still 7.1 years shorter for black males than for white males in 1997; and again, in 1997, the age-adjusted death rates for the black population exceeded those for the white population by 77 percent for stroke, 47 percent for heart disease, 34 percent for cancer, and 655 percent for HIV infection.

Part of the discussion of disparities included access to health care facilities. This access include: provider access, financial access, transportation access, and cultural access. I noted this in a recent address to the Congressional Urban Caucus (June 28, 2000): "... [Our health care system] is not equitable, and certainly not universal. Consider the statistics - 1)We have more than 44 million people who have no health insurance including over 18% of our non-elderly population. 2) 42% of the uninsured population consists of minorities; 3) 80% of the 44 million uninsured people work every day or live in families in which at least one member works every day; 4) 56% of the uninsured earn less than 200% of the poverty rate and many more are underserved by our health care system. Our population is growing older, living longer ... and have more chronic disease and disabilities. Our medical technologies have improved ... however, not all of our citizens are recipients of our progress. Barriers include provider access, financial access, transportation access, and cultural access."

I emphasize the last sentence, because the closing of D. C. General Hospital - a hospital that has long served the inner city urban population of the district; a hospital that serves the uninsured; a hospital that serves a minority community -- is exactly a hospital we would not want to close if we are serious about these national health objectives, and national concerns. Why would we even consider closing this hospital? What would we substitute for the provider access, financial access, transportation access, and cultural access?

The World Health Organization recently released a book comparing the United States to all the industrialized countries. They said we have the best resources, but our system is very unfair - it is number 54 in "fairness".

In this report, WHO carried out the first-ever analysis of the world's health systems. Using five performance indicators: 1) Overall level of population health or disability or "Adjusted Life Expectancy" (DALE); 2) Health disparities within a population; 3) Health system's responsiveness to the needs of the population; 4) Distribution of responsiveness (Rich vs. Poor; Goodness vs. Fairness) and 5) Distribution of financial burden (who pays?) Using these criteria, it was found that the United States stood at # 1 in spending 14% of its gross domestic project; #37 out of 151 countries according to its performance; #72 in its performance on health level (DALE); and #54 in fairness."

Let me repeat: Number 54 in "fairness".

Hospitals are being closed all over America - to make what was once a primarily non-profit vocation a profitable enterprise. But is this fair? By cost cutting analyses, the cheapest care is no care. Or, the most expensive pediatric care is for a child born too little, too soon - a premature child, a possibly deformed child. Would we propose infanticide ... to save money? Is this fair?

We must consider how to avoid cost by providing full access to preventive measures. However, we must not pretend that we will not need full service facilities for the health disasters that do occur. We also cannot close hospitals with the promise of preventive policies as a substitute.

Let us squarely consider this question: Can clinics for preventive care replace the role of a full service hospital?

If the District really did go in and provide good quality prevention for the people who lived in the area -- the people who are served by D. C. General Hospital -- and made sure, then, that the people who had problems that needed more -- that needed tertiary care -- were transported and they knew exactly where they were going, then, that is better. But is the mechanism in place, and proven -- to provide primary care for all the people -- and a system in place to make sure that all the people who were injured could be transported immediately, and know where they were going, and know they were going to be seen immediately when they got there? If this is to be a believeable alternative, then I think this system must be fully in place before one would consider getting rid of the hospital.

It is true that the most expensive medical care is emergency room care. For many people, that is all they have, and the only place that they can be seen. However, we must fully solve that problem before we consider depriving people of that solution.

D. C. General is a hospital that serves more than the poor. It is a major trauma center. And hospitals in other areas of the country -- serving wealthy and poor -- are overburdened and shut down by the American health and economic crisis. We must solve this problem nationally. I call on Congress to consider what must be done to provide quality health care to all Americans. The immediate step, and the focus of this briefing, is to support D. C. General Hospital as a full service, expanded hospital. The second step and immediate step is to move quickly to save the American health care system as a whole.