Improving health and wellness in medically underserved communities: insights, innovations, and applications

The American health system is deeply rooted in notions of individual freedom, capitalism, and western Judeo-Christian values. Since its founding, the United States has been a free society built on laws, customs, and culturally engrained beliefs that strongly support individual freedoms for its citizens. These freedoms have also extended to an individual’s health. Benjamin Franklin famously remarked that “health is wealth” and observed that health is something an individual is free to improve, conserve, or waste. Market justice principles propose that healthcare is best distributed in a free economy through market forces. These principles are also the foundation of the capitalist paradigm – where goods and services are efficiently distributed through society, going to those who value them most and who have the ability to purchase them through their own resources – resources obtained through their own efforts. Most goods and services in the U.S. are distributed according to this principle, allowing for efficient product distribution, pricing, quality, and innovation to meet consumer preferences. Thus, there are positive elements associated with the market justice principles embodied within the capitalist paradigm, and it can work well for people who are able to participate in that market through their ability to pay. However, the market justice principle posits “... that giving people something they have not earned would be morally and economically wrong” [1], p. 48. It is this last point that can become problematic when it comes to social goods such as healthcare, and to which we next turn our attention. Healthcare has been described as a particularly valuable social good [2] and the market justice model, which is deeply engrained in the American psyche, does not work as well for social goods like healthcare. The Benjamin West painting Christ Healing the Sick in the Temple is located in Philadelphia’s Pennsylvania Hospital, which is America’s first hospital. The painting is an artifact of American cultural views of health and healthcare that reflects social justice, healing, and compassion. It also implies an emphasis on individual personal health services over population and public health efforts [3]. Social justice principles see healthcare as a social good, not an economic good, and accordingly is at odds with the tenets of market justice and the capitalist paradigm. Social justice views the resources required for health services delivery to be distributed according to one’s needs, not ability to pay. The long American healthcare debate and continuous reform efforts really boil down to the conflict between market justice and social justice principles. Some stakeholders believe more strongly in one than the other. But as the nation ascribes to both market justice (e.g., free capitalism) and social justice (e.g., western Judeo-Christian values) principles, a workable approach to improving health, wellness, and healthcare access at the national and local levels should draw on the best of those principles. Through the innovations described in this supplement of BMC Health Services Research, James K. Elrod and John L. Fortenberry, Jr. show how the Willis-Knighton Health System of Shreveport, Louisiana has been able to make steady progress in improving the health and wellness of underserved communities. The first article, “Advancing indigent healthcare services through adaptive reuse: repurposing abandoned buildings as medical clinics for disadvantaged populations,” describes how the acquisition and repurposing of empty structures can be a cost-effective way for providing needed healthcare services to underserved, indigent communities. Adaptive reuse of historic buildings, for example, is a way to breathe contemporary, purposeful life into old structures while preserving the heritage and character of the communities in which they are located. Such projects, when done carefully, can infuse tired, run down, and vacant areas with a new vitality and attractiveness. The HealthSouth Rehabilitation Hospital of Western Correspondence: [email protected] Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, SHP Building 557, 1720 2nd Avenue South, Birmingham, AL 35294, USA