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Implementing a Human Right to Health:   a Qualitative Case Study  Lewis & Clark County, Montana Purvi Pinakin Patel Candidate for JD/MPH Preceptor:  Anja Rudiger, Ph.D National Economic & Social Rights Initiative (NESRI) New York, NY
Lewis & Clark County, Montana County Seat:  Helena  Year Organized:  1864 Square Miles:  3,461 Lincoln HELENA Augusta Canyon  Creek
County Health Profile ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
December 2008 Resolution:  Health Care as a Human Right
Needs Assessment Partners ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Using a Human Rights Framework ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methodology ,[object Object],[object Object],[object Object],[object Object],[object Object]
Participants Group Date # Participants Helena - Task Force 8/17/09 3 Helena - YWCA 8/17/09 7 Canyon Creek 8/19/09 2 Lincoln 1 8/20/09 2 Augusta 8/25/09 13 Helena - FoodShare 10/13/09 10 Lincoln 2 10/14/09 3 Helena 4 11/5/09 7 TOTAL 47   AGES # percentage 18-24 years 2 5% 25-34 years 5 12% 35-44 years 0 0% 45-54 years 11 26% 55-64 years 13 31% 65+ years 11 26%
Participant Demographics ,[object Object],[object Object],  Education Level number percentage no HS Diploma 2 5% HS/GED 14 34% Associate's  4 10% Bachelor's  13 32% Graduate 8 20%   Income number percentage < $20,000 16 41% $20,000 - $49,999 11 28% $50,000 - $100,000 9 23% $100K+ 3 8%   Health Insurance Status  number percentage Uninsured 11 24% Employer-based 17 37% Gov-sponsored 14 30% Individual 6 13% Other (e.g. VA, parents) 5 11%
Health as a Human Right ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key Findings :  Access:   Cost & Financing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],“ We’re Medicare, and it’s wonderful. It’s wonderful. I mean I wish everybody in the country had it.”    --  2 nd  Lincoln Focus Group
Key Findings :  Availability   of Health Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key Findings :  Quality of Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Key Findings :  Acceptability & Dignity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Is Health/Healthcare a Human Right? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],“ I consider it to be out ethical responsibility to supply it to everybody, but I don’t see it as a human right.”  (Helena 4)
Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Limitations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],“ The group we did last week… it’s not a reflection of the entire community, but it’s a reflection of some parts of the community …”    -- Researcher, about the Lincoln group
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acknowledgements

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Qualitative Research on Health as a Human Right in Lewis & Clark County, Montana.

  • 1. Implementing a Human Right to Health: a Qualitative Case Study Lewis & Clark County, Montana Purvi Pinakin Patel Candidate for JD/MPH Preceptor: Anja Rudiger, Ph.D National Economic & Social Rights Initiative (NESRI) New York, NY
  • 2. Lewis & Clark County, Montana County Seat: Helena Year Organized: 1864 Square Miles: 3,461 Lincoln HELENA Augusta Canyon Creek
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  • 4. December 2008 Resolution: Health Care as a Human Right
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  • 8. Participants Group Date # Participants Helena - Task Force 8/17/09 3 Helena - YWCA 8/17/09 7 Canyon Creek 8/19/09 2 Lincoln 1 8/20/09 2 Augusta 8/25/09 13 Helena - FoodShare 10/13/09 10 Lincoln 2 10/14/09 3 Helena 4 11/5/09 7 TOTAL 47   AGES # percentage 18-24 years 2 5% 25-34 years 5 12% 35-44 years 0 0% 45-54 years 11 26% 55-64 years 13 31% 65+ years 11 26%
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Editor's Notes

  1. Good Afternoon, my name is Purvi Patel, and I - like Allison - am a JD/MPH candidate. For my ALE I worked with the National Economic and Social Rights Initiative, whom Allison mentioned earlier. Specifically, I worked with Anja Rudiger, the Human right to Healht Program director, to analyze qualitative focus group data collected in Lewis &amp; Clark County, Montana as part of a county health needs assessment.
  2. Some background on Lewis &amp; Clark County: it is located roughly in central-western Montana and is home to Helena, the state capital. The towns you see depicted here were the locations for the focus groups that I helped analyze. Note that Augusta is located north of the mountains. The northern part of the county is fairly isolated from the southern half, which played into some o the healthcare concerns -- the closest town within-county health services to Augusta is Lincoln, on the other side of a mountain pass. Most norhtern residents consequently tend to go out of county for care and services.
  3. This data was drawn from previously-compiled county statistics, and are the same type of stats used by the county health board in making decisions. [state stats] This last point - there is a community health center located in Helena that will take low-income patients on sliding-scale fees. What we heard a lot from low-inome residents is that the center was often booked up and unable to take on new patients. They offer both primary care and dental services. [state last stat]
  4. So based on the type of stats seen in the last slide, and in light of the recent debates on national health care reform, the county health board passed a resolution in December 2008 declaring health care to eb a human right to all county residents. [read laguage from first point]. To implement the new mandate, the county created a Task Force on local Access to Universal Healthcare to begin a multi-phase implementation. Phase I was to conduct a health needs assessment. My ALE was involved with the QUALITATIVE data analysis for this health assessment, although there has also been another QUANTITATIVE component to the Task Force’s work that had nothing to do with my ALE, but which will be a part of my final report to the county.
  5. To help with the county-wide needs assessment, the Task Force tapped the NESRI and the Montana Human Rights Network. [read slid data] NESRI’s job was to provide research guidance and technical assistance to the partners on the groundin Montana, as well as to analyze the qualitative data gathered by partners in Montana.
  6. Poor availability of family doctors Available doctors may not accept Medicare/Medicaid, or may restrict their number of publicly-insured patients Praise for satellite clinic available in Lincoln