Geography Reference
In-Depth Information
13.6.7
Other Targeting Measures
The type of comprehensive, multi-agency approach described above is only one of
the ways in which attempts are being made to improve the health of disadvantaged
people. Another is the targeting of poor people by giving income supplements on
condition the children attend school and keep their vaccinations up to date, an ap-
proach pioneered by the Brazilian Bolsa Familia programme which has reduced
the poverty level of over 44 million people. More specific health care access for the
poorest in American cities can be seen by the addition of new community clinics,
either free standing or mobile. They provide health care in disadvantaged areas,
where there are few local physicians or pharmacies, creating centres that provide
a range of services, such as physicians, dentists, as well as counselling and health
promotion units. In impoverished parts of American cities, school health education
and provision is an increasing trend, which often includes the addition of clinics, es-
pecially aimed at targeting adolescents and their problems (Fitzpatrick and LaGory
2011 ). A National Assembly of School-Based Health Care acts as a co-ordinating
and advice centre for these school-based clinics which have grown from 20 in 1980
to currently over 2000 in 44 states. Research has shown that schools with clinics
have fewer disciplinary problems, course failures, and school absentee rates, as well
as better health (Smith 2013 ).
There is also a long history of the work of particular individuals acting as the
catalysts for change in particular deprived areas. For example, a Venezuelan physi-
cian, America Bracho, was influential in establishing Latino Access, a non-profit
organization in the poor, mainly Spanish speaking area of Santa Ana, an area of a
third of a million people in Los Angeles, one of the toughest, crime-ridden, deprived
and unhealthy areas in the country (LHA 2009 ). Also churches have long had a
role in trying to cater for the poor and the disabled. In recent years more active ap-
proaches have developed, such as the Communities of Shalom (CS) set up by the
United Methodist Churches. Initiated by the Rev Joseph Sprague it has now cre-
ated hundreds of shalom zones in impoverished areas from its beginning in 1992,
training local residents to promote health information and social capital. In many
American cities some churches have partnered with public health departments in lo-
cal universities to create facilities and programmes to improve the health of people
in poor neighbourhoods, using trained local volunteers and specialists, such as the
Congregations for Public Health in Birmingham, Alabama (CPH). All these exam-
ples represent the contemporary equivalents of the settlement houses of nineteenth
century cities, designed improve the educational, health and economic prospects of
people in impoverished areas, although these were mainly secular, as seen in work
of Hull House in Chicago and many other cities (Adams 1910 ). Another policy has
tried to improve to areas of high disadvantage and ill-health by seeking to reduce
concentrations of poor families, such as by scattering, instead of creating, public
housing clustering, and by removing families to other locations where there are bet-
ter facilities and more social mixture (Rubinovitz and Rosenbaum 2000 ; Comey et
al. 2008 ). Although there have been some successful resettlement schemes the scale
of the areas of impoverishment means that it cannot be a solution for all areas.
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