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: streetlevelhealth.org

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.

International Boulevard

Since it is Human Trafficking Awareness Month, and I only briefly mentioned the issue in my prior post, I thought I would share about a side of the problem close to home. Zoe Simone Yi and Rebecca Dharmapalan, two teenagers from Oakland School of the Arts, recently won the 2013 Girls Impact the World Film Festival with their 5 minute documentary on child sex trafficking in Oakland. The film in called "International Boulevard," which also happens to be the same street of the clinic / community center where I volunteer once a week.

I had noticed many young women on the street during my 3/4 mile walk from the BART each week, and I wondered if any of them were trafficked youth. Unfortunately, my intuition was likely correct. On any given night, it is estimated that 100 children participate in commercial sex work on International Boulevard alone, with reports siting some as young as 12 years old. In 2009, Oakland was labeled a high-intensity child prostitution area. Furthermore, the Bay Area as a whole, which includes San Francisco and San Jose, is believed to account for as much as 20% - 40% of sex trafficking in the United States. My understanding is that many of the U.S. citizen children that are trafficked within the country are runaways and/or foster youth fleeing from potentially abusive situations to begin with, which has particularly caught my attention as a CASA for foster youth.

A friend and coworker pointed out that the "International Boulevard" film focuses largely on police perspectives of the problem, and that bothered her. I definitely believe it is important for police to be aware of the complicated issues involved in commercial sex work, and I am happy to see that efforts are being made to get help for children trapped in sex trafficking, rather than criminalizing their circumstances. At the same time, prostitution in general is a very stigmatized profession, with an often strained relationship to law enforcement, so it would have been great to hear more from those who are able to talk about their own lived experiences, to give voice to the actual individuals affected. Of course, this may have been difficult to incorporate in this particular short film, given that (1) the producers are themselves youth, (2) victims are minors, and (3) even now-adult former victims may prefer to maintain their privacy. Alternatively, perhaps local community members or advocates from local nonprofits - both those that provide healing services and those that fight to prevent future trafficking - might have added another perspective to the mix. Although the police necessarily have an integral role in ending human trafficking, there are many other groups also working to meet the needs of youth in the context of sex trafficking. Furthermore, many of the best solutions to community problems involve community members expressing the strengths and needs they see, brainstorming interventions and preventive measures, and taking ownership and responsibility for implementing of the best ideas. My main point is that in considering the issue of sex trafficking, we should keep in mind that there are multiple viewpoints on what constitutes trafficking, a wide array of opinions on how it can best be stopped, and a host of varied experiences by the women (and men) who have lived through it.

For those looking for a little more breadth of information from a few other perspectives, I highly recommend "Oakland struggles to protect children from sex trafficking," an article from Aljazeera America.

Regardless of the above critique of the short documentary, I think it is commendable that local youth are getting involved in important problems and raising awareness. And what a testament to their hard work that they won first prize! I hope that their documentary, and all of the press that the Bay Area has received for the child sex trafficking problems here, will lead to better programs and policies to prevent trafficking, as well as an increase in awareness and action among teachers, families, friends, neighbors, law enforcement, community organizations, and activists to end this injustice!