Over the past 20 years, the United States has experienced a profound demographic shift. Throughout the late 1980s and early 1990s, economic instability in Mexico and domestic demand for low-wage agricultural labor fueled the influx of predominantly male Mexican immigrants. By the late 1990s, increasing U.S. labor demands led to dramatic increases in the overall number of Latino immigrants. As demand spread beyond agriculture into industries such as light construction and food service, the ratio of male to female Latino immigrants reached parity. By 2000, census data officially recognized Latinos as the largest minority group in the United States. From 2000 to 2010, Latinos accounted for more than 50 percent of the nation’s population growth.

Today, growth of the Latino community represents a nationwide trend no longer confined to border states, rural America or traditional urban centers. This phenomenon is clearly evidenced in South Philadelphia, where the number of Latino immigrants has risen from 6,220 in 2000 to an estimated 30,000 at present. Of Latino immigrants in South Philadelphia, an overwhelming majority originate from Mexico, few are documented, and most lack English proficiency. Working in low-paying jobs, lacking health care benefits and facing linguistic and cultural barriers, a high percentage of this population exists precariously with respect to health. Despite these obvious challenges, the South Philadelphia Latino community abounds with robust, rapidly growing, and hardworking families.

Save

Save

In 2003, Dr. Jack Ludmir and Dr. Steven Larson organized a series of meetings with local health care stakeholders to discuss the health care needs of South Philadelphia’s Latino community. The convening participants—academic institutions, social service organizations, community leaders and health care institutions—represented a wide range of experience and expertise. During the ensuing nine months, these stakeholders explored a variety of strategies for improving the health of the city’s Latinos. They concluded that a traditional biomedical model of health care delivery would prove ineffective in meeting the complex needs of this immigrant population.

Dr. Matthew O’Brien joined Drs. Ludmir and Larson in 2004. They ultimately decided to design and build a new immigrant health and wellness center to serve the immediate health care needs of the Latino population, while focusing long-term efforts on addressing the social determinants of health. Drs. Ludmir, Larson and O’Brien began with grassroots advocacy efforts, holding a series of town meetings, health fairs, and screenings. These activities provided a forum in which community members could share their ideas about ways to improve the health and wellness of their community. The doctors used the  information gathered from these efforts to establish the foundation of Puentes de Salud: involving practitioners directly in the community and partnering to provide health care and educational programs.

Save

Save

Save

Save

Puentes de Salud operates on a multidisciplinary, community-based collaborative model that promotes health and wellness through low-cost, high-quality health care, innovative educational programs, and community building. Since its founding, Puentes de Salud has prioritized the development of a comprehensive plan for Latino health in South Philadelphia, guided by three objectives:

Save

Save

Save

Save

  • To provide medical services targeting the immediate acute and chronic health needs of the population
  • To design sustainable, long-term strategies for health promotion and disease prevention
  • To create a research partnership between local universities and the community in order to develop best practices for the care of the Latino population, locally and nationally

Social Determinants of Health, Social Justice, and Addressing Structural Violence

Social Determinants of Health

Health is not merely absence of illness, but rather wellness in a holistic sense.  Social factors, such as education, socioeconomic status, and political/legal environment effect health as much, if not more than, biological processes.  However, the social factors that influence health are often neglected by healthcare in general and practitioners in particular.  It is these social factors that are crucial in creating the health inequities that are so prevalent today.  Health disparities can be dangerous to individuals and society as a whole.  Addressing health disparities and social factors that influence health outcomes is crucial to the future of healthcare.

Social Justice

Social justice is defined as “Justice in terms of the distribution of wealth, opportunities, and privileges within a society.”2  Working for social justice in our communities necessitates an understanding of larger power structures that impact community well being, specifically structural violence.  Essentially,“…a commitment to social justice requires that we not limit our sense of justice simply to the more equitable provision of health care to those who are ill, but demands that we examine injustices in the distribution of health and the underlying reasons for unjust burdens of illness.”

Structural Violence

Structural violence refers to societal or institutional factors that preserve inequity, injustice, and human misery—the ways that the unequal distribution of suffering becomes embodied and experienced as violence by the powerless.

Within the concept of structural violence, it is essential to recognize that there may not be any one person who directly harms another; rather, the violence is built into the structure of society and shows up as an unequal distribution of power (resources) and consequently, unequal life chances.

Save

Save

Save

Save

Save

Puentes de Salud embraces a grassroots approach to health and wellness that values the community’s input in identifying health care needs and priorities. Reinforced by a long-term community presence and commitment, Puentes de Salud has earned the trust and respect of the people it serves. This trust has been a key ingredient of Puentes de Salud’s success, strengthening the organization’s ability to fulfill its mission. Early on, local stakeholders such as the Archdiocese of Philadelphia and other service organizations recognized the community-based platform created by Puentes de Salud, giving rise to important partnerships. These ongoing collaborations facilitate the transfer of much-needed resources and services from these stakeholders to the community.

Trained in a traditional biomedical model of health care that favors a hierarchical structure for providers, the organization’s founders experienced the model’s limitations in effectively serving vulnerable communities. Beginning in the early 1990s, Puentes de Salud’s leadership gained firsthand experience with nurse-managed clinics in under-served communities.

Convinced that a team approach is essential to optimize the unique, complementary skills of each individual, Puentes de Salud decentralized the role of the physician, creating a truly interdisciplinary model in which promotoras, nurses, nurse practitioners, students and physicians all collaborate in the care of our community as equal partners.

The centerpiece of Puentes de Salud’s innovative model is the community nurse liaison (CNL), who operates as a health care provider, community advocate, and social worker. The CNL, much like former public health nurses, serves to bridge the community and its needs with health care providers and stakeholders, mobilizing resources to areas of need.

Save

Save

Save

Save

Save

Save