In 2005, the Health Care Foundation of Greater Kansas City (HCF) began making grants to Kansas City area organizations committed to eliminating barriers to quality health for the uninsured and underserved. Since then we've awarded more than $200 million to over 400 organizations.
The past decade has been a difficult period for many individuals and organizations served by HCF. Yet it has also been a time of unmatched opportunity. Most notably, the passage of the Patient Protection and Affordable Care Act (ACA) in 2010 represented a landmark event in the evolution of health care reform.
As HCF completes its first decade of grantmaking, we have looked back across the health care landscape to better understand the accomplishments and obstacles surrounding care to the uninsured and underserved in the Kansas City region. Our objective is to learn from, and reflect upon, past experience, in order to better inform the community’s collective efforts going forward.
Behavioral Health
The unforgiving economic climate over the past decade has dramatically altered the profile of those seeking mental health services and greatly increased demand, while program funding at the state and local levels has continued to decline.
Compounding the predicament is an ongoing migration away from institutional care, as well as new mandates to privative services. The end result is a fragile and fragmented mental health system that is increasingly dependent on already hard pressed institutions like shelters, hospitals and law enforcement agencies.
As pervasive as these problems are, they have not stopped the progression of treatment methods and the growing adoption of evidence-based practices. A new emphasis on collaboration has emerged, and this spirit of cooperation is producing a range of creative, pioneering solutions aimed at the development of an integrated, community-based system of care that can respond quickly and appropriately to the full spectrum of mental health needs.
Healthy Eating/Active Living
Although the health challenges set in motion by poor diet, obesity and a lack of physical opportunity are complex and entrenched, the past decade has seen dramatic progress in the Kansas City region.
Over that time, an evolution has occurred in the way good health is perceived and pursued, with the focus shifting from simply educating individuals on healthy habits to embracing a holistic, community-wide approach.
Urban food opportunities have bloomed through partnerships that are bringing healthy food into underserved areas. An abundance of community gardens, urban farms and regional family farms — coupled with innovative distribution systems and purchasing incentives — have increased access to fresh fruits and vegetables. And support for active lifestyle opportunities has produced new attitudes, programs, exercise facilities and pedestrian and bicycle pathways across the area.
Tobacco Prevention
While the number of Americans who indulge in tobacco use has continued to drop, from 42 percent in 1965 to just 17.8 percent today, tobacco products remain the most preventable cause of disease, disability and death in the U.S.
In Missouri and Kansas, tobacco use continues to be an enormous health problem, with the percentage of smokers in both states — 22 percent and 20 percent, respectively — well above the national average. The higher incidence translates into about $3 billion spent annually on tobacco-related health care in Missouri and more than $1 billion spent in Kansas.
Despite the insidious nature of tobacco addiction, major progress has been made on both sides of the state line in reducing this public health risk. Over the past decade, the total number of area smokers has continued to decline, indoor smoking has been greatly reduced and in many cases, eliminated, and educational programs have helped prevent a new generation from picking up the habit.
Physical Health
The transformation underway across the U.S. health system over the past decade has produced dramatic change throughout the Kansas City region. Local clinics, community health centers, safety net hospitals and community organizations all have scrambled to adapt in a fast-changing environment marked by new methods of care delivery, coordination and reimbursement.
Safety net providers have contended with the effects of the Great Recession, an increasingly complex and diverse client population and deep budget cuts at the state level. Yet through it all they've managed not only to sustain safety net care, but strengthen it.
Improved business practices, increased provider capacity, more effective care coordination, expanding use of technology and stronger advocacy efforts all are emerging hallmarks of the area's safety net system. Importantly, many of these improvements have stemmed from better cooperation and collaboration between organizations.
Oral Health
New models of integrated care, improved collaboration among safety net providers and a growing awareness about the relationship between oral and general health all have helped push oral health care closer to the forefront of public health over the past decade.
While oral health safety net capacity in the Kansas City area still falls short of demand, the availability of dental services for the uninsured and underserved nonetheless is significantly greater now than in the early 2000s.
Fortunately, the Patient Protection and Accountable Care Act (ACA) — coupled with a better understanding of the links between poor oral health and a range of diseases — has helped spur the integration of primary care and oral health locally and across the nation. At the same time, well-organized advocacy efforts in Missouri and Kansas have played a central role in key policy successes.
