By Francisco Garcia, Management Analyst – Community Engagement Strategist, Integrated Clinical Services, Multnomah County Health Department
As the home to Portland, Oregon’s largest city, Multnomah County has a long, albeit imperfect history of prioritizing public health, dating back even before the founding of Oregon in 1859. Historically, Multnomah County’s early concerns for improved access to doctors or medicine did not extend far past the families of white farmers, loggers, and mill workers living outside of Portland.
As Oregon’s industries expanded into railroads, shipbuilding and agriculture, so did the number of immigrants coming to Portland from Eastern Europe, China and Japan. Unfortunately, these newcomers would face the same discrimination already suffered by generations of displaced Indigenous Oregonians and the descendants of freed slaves, who were also looking for opportunity in Portland’s modernizing economy.
Lamentably, widespread racism and discrimination portrayed Multnomah County’s new settlers as diseased and unclean, resulting in decades of social and economic marginalization. These norms were ultimately codified in the county’s housing, education and health policies. The economic safety net programs of the New Deal, followed by the fight against poverty in the Great Society programs would result in Multnomah County reorienting its outreach and support to the communities that it had previously pushed to the margins.
In the 1960s, funding from the Office of Economic Opportunity allowed Multnomah County to invest in primary care services, build community health centers and hire Neighborhood Health Representatives, transforming how we could serve our patients closer to where they live. In 1977, Multnomah County received its first grant from the Health Resources and Services Administration to establish itself as a Federally Qualified Health Center. This enabled it to provide an even higher level of service with dental clinics, mental health services, and enlist interpreters to help support Oregon’s growing population of newcomers from Vietnam, Laos, and Cambodia.
Almost 35 years later, the Covid-19 pandemic has exposed how Oregon’s legacy of racism and marginalization in health care still impact communities of color in Multnomah County. Our highest risk populations continue to face enormous difficulties when trying to access health care—lack of transportation, language barriers and financial constraints, stigmatization and systemic racism, and competing cultural priorities that influence health care decisions. However, the leadership, care providers and support staff at our community health centers are committed to addressing our history head on and ensuring that our clients do not shoulder the burden alone. That is why Multnomah County has developed its Health Equity Initiative. We are committed to improving and protecting the health of all Multnomah County residents by addressing the ways that societal conditions affect health. Our goal is to incorporate equity into all programs, policies, and practices; develop and implement empowering approaches to address inequities; and increase awareness of the intersections between societal conditions and health outcomes.
Today, Multnomah County Community Health Centers provide clinical services at seven integrated clinics that offer primary care, dental and pharmacy services, one stand-alone dental clinic, a primary care location specialized in serving Spanish speakers, as well as eight student health centers. In addition, we are proud to provide specialized care for individuals living with HIV, and targeted support services to the unsheltered population throughout the county.
At Multnomah County, our mission is to support individuals, families, and communities in achieving health and well being while advancing health equity and eliminating health disparities. Our vision of supporting integrated, compassionate, whole person health is reflected in the array of medical, dental, pharmacy and other services we provide to over 66,000 clients who represent our racially and ethnically diverse community. Of the Health Center’s patient base, 60% of patients identify as people of color, and approximately 46% percent are best served in a language other than English. Nearly 2,000 patients are experiencing houselessness and 95% live below 200 percent of the federal poverty level.
There is almost nothing more important than trust when it comes to building a firm foundation and lasting relationship between a patient and their health care team. We are proud that trust is one of our strongest assets. We commonly hear from patients who will return to see the health care provider team they met years or even decades ago, even if they eventually move many miles away from their original clinic. In fact, one man who visited our vaccine clinic a few weeks ago and navigated the process through an interpreter in Arabic said he moved about a year ago to Milwaukie from Portland but has consistently driven about 10 miles back to outer Southeast Portland to visit his doctor. His words were, “I refuse to change doctors, I like it here.”
On behalf of our governing board, our health care providers, and Multnomah County support staff, we welcome you to National Community Health Center Week. We join you in honoring our shared commitment to uplifting our most vulnerable citizens and celebrate our future of advancing health equity and eliminating health disparities by providing high quality, safe and meaningful care to all.