The Urban Collaborative Project is leading the charge to make sure that southeastern San Diegans get access to after-hours health care.
Currently, many residents in the region lack sufficient access to care because they often have to travel outside of their communities to get medical attention after normal business hours or on weekends, when urgent-care centers in the area are closed, according to the collaborative.
The collaborative is an outreach program that uses volunteers to address disparities within the community, and its health-action team is working to do just that with the goal of expanding urgent-care services to include wraparound services and after-hours care right in their community.
Barry Pollard, CEO of the collaborative, experienced this gap in health services one Saturday morning while in search of an urgent-care center for his asthmatic daughter. Finding none, he hopped in his car and drove to a neighboring community — a luxury he says many others don’t have.
“Most of the people in our community use mass transit, so when you’ve got four kids and one needs to go to an urgent care center, that’s a three-hour bus ride or a $50 Uber ride,” Pollard said.
“A lot of our people work two or three jobs, so they may not be able to go until Saturday morning … or late at night when they get home,” said Dr. Suzanne Afflalo, a community health advocate and leader on the collaborative’s health action team. “So, instead, they just deal with it.”
County health data shows that more than 43 percent of residents in the area of Encanto, Emerald Hills, Valencia Park and Skyline visited hospitals outside of the 92114 zip code for emergency services in 2019, according to the San Diego County Health and Human Services Agency.
More than 80 percent of the 56,700 people living in 92114 are minorities, according to 2019 data from the San Diego Association of Governments.
Besides the inconvenience, Afflalo said, the lack of services often results in these patients having more severe health problems, as many choose to put off doctor visits.
County health data show staggering health disparities in the central region as a whole, which includes an estimated 513,871 residents, representing 15.5 percent of San Diego County’s population. It is comprised of southeastern San Diego, downtown San Diego and other outlying urban communities, including North Park, College Area, Encanto, Paradise Hills, Barrio Logan, Hillcrest, Mission Hills and University Heights, according to the HHSA.
That data shows that central-region residents are least likely of any other HHSA region in the county to have a usual place to go when sick or needing health advice, according to the UCLA Center for Health Policy Research. Southeastern San Diego specifically has the second-highest proportion of residents with no health insurance — 12.2 percent — in the central region.
The central region also had the highest proportion of residents reporting fair or poor health — 15 percent — in 2019. Southeastern San Diego has the highest proportion of residents with disabilities — 11.3 percent — in the central region.
Studies have shown that chronic diseases are more prevalent in disadvantaged communities due to the lack of access to health care services.
In the central region, seven out of the top 10 leading causes of death were chronic diseases in 2019 — led by heart disease, cancer and stroke — and chronic diseases account for 51 percent of all deaths in the region, with southeastern San Diego reporting the highest rate of chronic diseases in the region.
Southeastern San Diego also has twice as many hospital discharges for asthma and hypertensive disease as any other central subregion — and double the countywide figure.
Afflalo has been providing free health fairs to the community through the pandemic. But she said there needs to be a more permanent — and accessible — solution.
Clinicians prepare to provide free health care services at a community health fair held at the Jackie Robinson Family YMCA.
(Courtesy of Dr. Suzanne Afflalo)
Moreover, Afflalo says the lack of appropriate levels of care in the community results in these patients being forced to visit emergency rooms for non-emergent situations.
“There’s a lot of diagnoses that are seen there that really have no right to be there, and it’s costing four times as much to be seen for something like bronchitis in the ER versus … in a clinical setting,” she said. “We want to provide appropriate care for the appropriate diagnosis in the community.”
Urgent-care centers fill a vital gap when someone becomes sick or injured, but their regular doctor is not available or they can’t wait for an appointment. These centers are equipped to handle minor procedures such as X-rays and stitches and common diagnoses such as the flu or strep throat.
“It’s going to be convenient, accessible, and will really decrease some of those barriers to our health care, which is going to help improve some of these health disparities,” Afflalo said.
While the collaborative’s idea for the project came to fruition about four or five years ago, it was only after the pandemic shed light on many of these regional health barriers that it truly picked up momentum.
“This is a glaring access issue,” Pollard said. “In the current model of providing health services and resources, one size does not fit all … The systems aren’t working. We need another system.”
Now, Pollard and Afflalo are working to develop greater collaboration across sectors, bringing together health-care providers, experts, local government and residents to find a solution that works for the community.
The collaborative hopes to partner with existing urgent-care facilities and have health-care providers bring in after-hours clinicians to serve the community in the evenings and on weekends at existing facilities, with a long-term goal to create a dedicated space in the community that can provide wraparound services.
These clinics would be accessible to anyone who walks in, no matter their health-plan coverage or lack thereof, Afflalo said.
“If it’s convenient to them in the community, we want them to be able to be seen at that clinic instead of having to go outside of the community,” she added.
The collaborative hopes this can also help to get those in the community more comfortable with seeking medical attention and, more importantly, help them know when to do so.
“The goal is to really try to do as much prevention, not allowing them to stay (away from the doctor) that long and get that sick,” Afflalo said.
To get involved, email Barry Pollard at the Urban Collaborative Project at [email protected].