At annual medical conference, physicians issue warnings about 'urban health crisis'

Describing an inner-city health care crisis that has led to an "urban health penalty," the American College of Physicians released a list of recommendations last week aimed at improving urban health care. At a meeting in Philadelphia of more than 5,000 physicians from around the country, the ACP criticized the current health-care system, which it accused of penalizing minorities and the poor. According to the group's position paper, "the poor health of inner-city residents is largely due to the same chronic conditions suffered by peoples everywhere, but made worse by poverty, poor housing conditions, unemployment and a host of other socioeconomic problems." The end result, according to the ACP, is a system of "injustice" under which poor African Americans receive the lowest level of care of any economic or racial group. According to one study cited by the ACP, a citizen of Bangladesh has a better chance of living past the age of 40 than an African American resident of Harlem. During a press conference with Mayor Ed Rendell, ACP officials proposed several methods for improving urban medical care, ranging from federally-funded universal medical coverage for all Americans to recruiting more physicians for inner-city clinics and private practices. "I believe it is everyone's responsibility to ensure that all people in Philadelphia have equal access to quality medical care," Rendell said in an ACP press release. And the ACP position paper stressed that the problems of inner-city health care are important for the country as a whole -- especially since suburban patients are responsible for much of the burden placed on urban health systems. "The fate of inner cities is? inseparable from the life of the nation," the paper said. But University Health System Chief Medical Officer David Shulkin stressed that there are limits to the care private hospital systems can afford to provide to the uninsured. "The health system cannot solve all of society's problems," Shulkin explained. "If people do not have insurance, that is not something that the health system can help them get." He added, however, that "if we do nothing, these people end up in our? emergency rooms? and of course we take care of them there." The end result of this process, according to Shulkin, is higher costs for all health system users. "It's pretty clear that if you wait until a person gets very, very sick and then they present themselves to a hospital or a doctor, it's more costly than if you prevent that illness from taking place in the first place," he said. In an effort to minimize costly hospitalization, the Health System has emphasized preventive medicine through a large network of primary care physicians. Such an emphasis has allowed the University to implement an ACP recommendation to "address health in the broadest sense and? emphasize prevention and primary care." And Shulkin agreed that "the more that we as the Health System invest in prevention, the less likelihood there is that those patients will end up in the hospital." The ACP also called for universities to increase minority enrollment in their medical schools in hopes that African American and Hispanic doctors would be more likely to work in inner cities --Ea suggestion which many University officials say they have taken to heart. Karen Hamilton, the Medical School's assistant dean of student affairs and director of minority affairs, explained that the University is actively attempting to admit more minority students and has created an "educational pipeline" to get urban middle- and high-school students interested in the medical profession. In addition, the University is participating in the "3000 by 2000" program, which seeks to increase minority representation in medical schools by the turn of the century. The proposal -- spearheaded by the Association of American Medical Colleges -- calls for 20 percent minority representation in medical schools, roughly equaling the national racial proportions. Minorities already constitute 19 percent of Penn's medical school population, according to Hamilton.