September 24, 2018
By Rich Lord and Kate Giammarise I Pittsburgh Post-Gazette
Talk of dozens of efforts to help disadvantaged kids had gone on for an hour Thursday when a soft, Scottish-accented voice piped up.
"Why don't you just go ahead and create a strategic plan for Pittsburgh's kids?" asked John O'Dowd, a doctor with the United Kingdom's National Health Service who works on improving overall health around Glasgow, Scotland. "Just do it."
That brought a swell of laughs and chatter from the few score people gathered at the Alloy 26 conference space in Allegheny Center. Put that way, it sounded so simple. Then Michelle Figlar, vice president oflearning at The Heinz Endowments, took a stab at answering.
"I'm trying to reflect on why we haven't done it, and I don't think there's anything stopping us, nothing at all," she said. "I'm going to challenge us to do that."
That moment happened around halfway through a four-day visit by four Scottish health officials, part of a Robert Wood Johnson Foundation-funded project in which Pittsburgh and Glasgow are trading notes on health and child welfare. The cities share a loss of industry, huge health care networks and persistent poverty in some neighborhoods. Over the course of days of meetings, though, some big differences bubbled forth.
Glasgow depends on one big institution - the National Health Service - to contend with many aspects of poverty and inequality, which is viewed in Scotland as the root of most health problems. Pittsburgh has hundreds of small nonprofits with a variety of funding sources and specialties ranging from mental health to healthy food to the provision of free diapers.
Pittsburgh's network is entrepreneurial and energetic, noted Sonya Scott, a physician who leads the push to shore up child welfare in Glasgow.
"We, I think collectively, have been astounded by the community initiatives that are happening," she said.
But it all "seems like plugging [holes in] the dam, and not dealing with the water behind the dam," she said on Friday, at Carl's Cafe in Rankin, a borough in which more than half of the children live in poverty. "It's just not good enough."
No money, poor health
In Scotland, there's no longer much argument about the connection between poverty -especially in childhood - and lifelong health problems, Dr. Scott said.
"Take any priority you have right now for improving child health," she said, rattling off problems ranging from stillbirth and low birth weight to maltreatment, neglect, behavioral difficulties, cognitive delays and tooth decay. "Take anything at all and you'll see an association with poverty and, importantly, with income inequalities."
That's what the data shows in Glasgow, where virtually all health care is handled - and carefully studied - by the government. Dr. Scott said the data has convinced her that when a child grows up deprived of food, nurturing and education, we're all poorer.
"That child whose cognitive development is limited by being locked in and trapped in poverty is a loss to all of us, because that could be the child that discovers the cure for cancer or the child that discovers the cure for dementia," she told the advocates gathered at Alloy 26.
Pittsburgh's health system knows that, but doesn't always act on it, said Elizabeth Miller, chief of the Division of Adolescent and Young Adult Medicine at UPMC Children's Hospital of Pittsburgh.
"We're still in the state where we're going to screen for [economic] problems and we're going to refer" patients to social service agencies, she said, but doctors are "not holding ourselves accountable" for the results. A pediatrician, she said, might diagnose asthma and refer the parent to an agency that tests the home and finds mold, compelling the landlord to kick the family out. "And suddenly you have a family that's no longer housed."
Scotland hasn't solved all childhood health problems, Dr. Scott noted, but its parliament has vowed to slash child poverty by 2030, and has a 15-point plan to do so. There's no comparable pledge or plan here, though a few states (Utah, for instance) have made child poverty an official priority.
In Pittsburgh, "We try to build a social welfare system for each individual, out of nothing," said Kenneth Thompson, a psychiatrist with the Squirrel Hill Health Center who launched the Pittsburgh-Glasgow partnership.
One of the hosts of the Alloy 26 event, Patrick Dowd, who directs Allies for Children, offered Pittsburgh a starting point: his organization's pitch for a 0.25-mill property tax increase, throughout Allegheny County, which would cover early learning, after-school programs and nutritious meals for kids. That proposal will be on the Nov. 6 ballot.
"Here in this region, this is exactly the moment to start making these kinds of shifts," Mr. Dowd said shortly after Dr. O'Dowd called for a plan. "The value of investment in kids and ultimately in people is economic development."
That proposed tax is not meant to replace any strand of the net of governmental and nonprofit organizations that now work on child welfare issues, Mr. Dowd was quick to note. It's just meant as a start.
He said the Pittsburgh area "is resource-rich, but it's also highly fragmented . ... Are there some places, when we're thinking about kids, where we can have a more centralized view?"
Just add a plan
Dr. Scott suggested another starting point- an attitudinal shift. There's a tendency, on both sides of the Atlantic, to blame the poor for their woes, she said, especially because poverty and addiction are so often connected.
"People aren't poor because they drink and they smoke," she said. "They drink and they smoke because they're poor."
Similarly, she said research and observation tells her that poverty isn't caused by bad parents, but rather by a lack of sufficient money.
"Parenting is really difficult in the best of circumstances," she said. "It's bloody near impossible if you're worried about keeping a roof over your head."
Cyclical effects result, the Scots acknowledged, when poverty, addiction, abuse and neglect reinforce each other. And it's important to address the symptoms of deprivation - but not to the exclusion of attacking the root cause.
Pittsburgh, they concluded, has the will to become a better and fairer place for children - but perhaps not the plan or the coordination necessary to do it on a large scale.
"What we [in Scotland] have is universal health care," Dr. O'Dowd said. "What you have that we need is all of that enthusiasm and social entrepreneurialism and the ability to be ingenious and to find great networking and to engage with people."
Pittsburgh is "almost there," he said, missing, perhaps, a plan and unity behind a goal. "You don't need permission to do this."
© 2018 Pittsburgh Post-Gazette
Rich Lord: email@example.com or 412-263-1542. Kate Giammarise:
firstname.lastname@example.org or 412-263-3909.
Mr. Wertz has worked over 40 years in the field from Community BH Services, Director of large and small Acute Psychiatric Inpatient Units, and County MH/IDS Administrator. In addition, he served over 12 years as Administrator in a large Assisted Living Program while advocating for and supporting the rights of the Consumer in the Community setting. He holds both Bachelors and Masters Degrees in Psychology with a focus on clinical work. In his current position, Mr. Wertz advocates for the inclusion of the Family and other Significant Persons in the provision of service, along with other advocacy for the improved treatment of publicly funded Seriously Mentally Ill Consumers in our Commonwealth.