Wednesday, June 18, 2014

Street Level Health Project's 20 Barriers to Health Care

This past school year, I had the privilege of interning as a Health Navigator once a week at Street Level Health Project in the Fruitvale neighborhood of Oakland. Street Level Health Project is an Oakland-based grassroots organization dedicated to improving the health and wellbeing of underserved urban immigrant communities in the Bay Area. They are working to address health from many different angles, from offering care at their free clinic, to distributing food bags from the food bank, to providing community lunches, to engaging in community organizing and occupational health education through the Oakland Workers' Collective.

As a Health Navigator, I had the opportunity to build relationships with community members and to help them find the right resources to advocate for their own health and wellbeing. Recognizing that health is not just about treating illness, people came to Street Level for legal, food, housing, educational, relational, and other information. For me, the role required practicing active listening (often in Spanish), learning a lot about the resources in the neighborhood, and constantly struggling to find the balance in doing versus supporting. Although my summer internship has pulled me away from working at Street Level, I often find myself thinking of and praying for them as I pass through the Fruitvale BART station on my morning ride to work.

One thing I appreciated about Street Level was that my first week, my supervisor gave me a document explaining some of the barriers to health that many community members face. The list is in many ways common sense, but at the same time, it is easy to be blind to the obstacles that I do not personally experience on a daily basis. I thought I would share a sample of the items in the document, and I would encourage you to read the whole thing here to learn more about some barriers to health care access and to health in general experienced by many immigrants and other local residents.

Image source:

Examples of common barriers for clients at Street Level:

1. No current/valid identification with photo.
2. No proof of income, due to cash payments for work.
3. No proof of address (homeless, squatting, living with friends/relatives, bills and leases are in other people’s names, no contact with primary renter, in recovery/rehab home, etc.)
4. Lack of transportation or funds for transportation.
5. Fear of ending up with a bill for services.
6. Already have a bill and are too embarrassed to go back or think they won’t be seen.
7. In another city working when they finally get a follow-up call for an appointment (seasonal farm workers or other migrant workers).
8. Inability to miss a day of work for medical care.
9. Language barriers, such as limited English, limited literacy, and/or unfamiliarity with the phone tree menu system.
10. Cultural norms about accepting advice from health care providers without asking questions.
11. Different ways of understanding wellness and illness that conflict with Western medicine.
12. Working and supporting the family is valued over self-care.
13. Fear of immigration detention or deportation.
14. The professional, dressed up, or formal atmosphere of clinics and hospitals can be intimidating.
15. Racism and classism encountered in health care settings.
16. Multiple confusing steps (find out if you’re eligible, call to get on a waitlist, make an appointment for program registration, go to registration appointment, make doctor’s appointment, go to separate location for labs and medications, etc.)
17. Difficulty planning ahead for appointments due to the often unscheduled nature of day laborer jobs.
18. Limited communication between multiple different health care providers.
19. Long wait times (all-day waits or long waitlists) for appointments in public clinics and hospitals.
20. Significant documentation or bureaucracy required to maintain coverage for care when circumstances change frequently.

This is not to say that all immigrants or clients experience all or any of these barriers. But many of the people I worked with did experience some of these, and understanding cultural, structural, and other practical barriers to trusting, consistent, and affordable medical care helped me value the perseverance and strength of the people I met and informed the way I responded. Read Street Level’s full list here.