In the mid-nineties, Rebecca Onie spent six months in the pediatric unit of Boston Medical Center talking to physicians and low-income families. She heard the story of a child waking up at night with an asthma attack, her bed covered in cockroaches. There was a doctor who repeatedly prescribed antibiotics for a child’s ear infection, even though he knew the real issue was that the family was sleeping in a car. Onie was a college sophomore at the time, and was following up on a hunch that health issues and the more visible symptoms of poverty needed to be addressed in a coordinated and integrated way. “So I asked these doctors, if you had unlimited resources what would you give these patients?” Onie says.
Based on her research, she devised a straightforward solution: Project HEALTH. With the aid of a few student volunteers, Onie set up a Family Health Desk in the hospital to connect patients with critical resources that fall outside the bounds of conventional healthcare, such as housing, food, legal advocacy, and job training. “We just camped out in the waiting room,” says Onie. “It started with a card table, but we stumbled into something powerful.” Doctors made quick assessments of the unmet needs of their patients and wrote “prescriptions” to be filled at the Family Health Desk. Onie had hit upon a big gap in urban healthcare– the fact that doctors aren’t trained to make these connections, and social workers, particularly at huge hospitals, are generally stretched too thin.
From its scrappy beginnings, Onie’s Project HEALTH has grown into a network of 600 volunteers serving thousands of families in Boston, Providence, New York, Baltimore, Washington, D.C., and Chicago. The project is twofold: alleviating the socioeconomic barriers to good health for poor families, and engaging a generation of young people with the tools to fundamentally reshape the healthcare system. Onie has found that the vast majority of Project HEALTH volunteers go on to graduate study or employment related to health and poverty–a pipeline of new leadership for the healthcare sector. The MacArthur Foundation recently awarded Onie a “Genius Grant,” and she hopes to expand her efforts to two additional cities in the next four years.
Onie and Project HEALTH aim to build the capacity of these pediatric clinics while pushing a systems-level change, where basic-needs assessment becomes part of routine vital signs collection. In addition to temperature and blood pressure, say, a doctor would routinely assess whether there is adequate food in the home. “The healthcare system’s purpose is to identify factors that compromise a patients health and find a solution,” says Onie. “These factors are as important as clinical indicators.”
Photo: Courtesy of John D. & Catherine T. MacArthur Foundation
